Development And Validation in a Clinical Population Assignment

Discussion Eight
This case study examines the assessment, planning, and interventions for an eighty-year-old female patient presenting with complaints of anxiety, panic attacks, and insomnia. Her medical history is significant for CAD, HTN, HLD, DM, and COPD.
Assessment
The assessment of this patient requires a comprehensive history, physical examination, and other appropriate evaluations. First, a detailed patient history should be obtained, including information about the onset, duration, severity of symptoms, and any triggering factors. The patient’s past medical history is significant for CAD (coronary artery disease), HTN (hypertension), HLD (hyperlipidemia), DM (diabetes mellitus), and COPD (chronic obstructive pulmonary disease), which should be considered in the assessment. A physical examination should be conducted to assess the patient’s overall health, including vital signs, cardiovascular and respiratory function, and neurological examination. It is essential to evaluate the patient’s mental health using validated assessment tools such as the Generalized Anxiety Disorder 7 (GAD-7) questionnaire, Panic Disorder Severity Scale (PDSS), and Insomnia Severity Index (ISI). These tools will help assess the severity and impact of symptoms on the patient’s daily functioning (Kraepelien et al., 2021). Development And Validation in a Clinical Population Assignment

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Psychosocial factors should also be considered during the assessment. This includes exploring recent life stressors, social support, coping mechanisms, and any history of trauma or significant life events that may contribute to the patient’s anxiety, panic attacks, and insomnia. In addition, laboratory and diagnostic tests such as a complete blood count, metabolic panel, lipid profile, HbA1c, thyroid function tests, and cortisol levels may be ordered to assess overall health and identify any specific abnormalities or imbalances.
Endocrine Considerations
In this case, there are several endocrine considerations to keep in mind. According to Elder et al. (2023), abnormalities in thyroid function can contribute to anxiety and insomnia. Therefore, evaluating thyroid hormone levels would be essential to determine the cause of these symptoms. Additionally, assessing cortisol levels can help rule out adrenal insufficiency or Cushing’s syndrome, which can impact mental health and sleep patterns.
Goals for Therapy
The primary goals for therapy in this geriatric client include significantly reducing anxiety symptoms and the frequency and severity of panic attacks. This will improve the patient’s overall well-being, functional ability, and quality of life. It also aims to improve sleep quality. Enhancing the patient’s ability to fall asleep, maintain sleep, and achieve restorative sleep is essential as it will alleviate distress and improve daytime functioning. Development And Validation in a Clinical Population Assignment
Planning and Interventions
A collaborative approach involving a multidisciplinary team is crucial to develop an effective treatment plan for the patient. This team may consist of a primary care physician, psychiatrist, and other specialists as needed. The treatment plan should incorporate non-pharmacological and pharmacological interventions tailored to the patient’s needs. Non-pharmacological interventions are vital in managing anxiety, panic attacks, and insomnia. Cognitive-behavioral therapy (CBT) or other evidence-based psychotherapeutic approaches can help address the underlying causes of anxiety and improve coping mechanisms (Nakao et al., 2021). Implementing good sleep hygiene practices, such as maintaining a regular sleep schedule, creating a comfortable sleep environment, avoiding stimulants close to bedtime, and practicing relaxation techniques, can also aid in improving sleep quality.
Pharmacological interventions may be considered based on the patient’s symptoms and overall health. Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are often used as first-line treatment options for anxiety disorders (Edinoff et al., 2021). However, benzodiazepines should be used cautiously in older adults due to the increased risk of adverse effects. Considering the patient’s comorbidities and potential side effects, low-dose sedative-hypnotics such as zolpidem or ramelteon may be prescribed for insomnia.
Medication interactions that may cause serotonin syndrome in this patient include combining selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) with monoamine oxidase inhibitors (MAOIs) or other medications that increase serotonin levels (Scotton et al., 2019). In addition, concurrently using medications like triptans (used for migraines) or tramadol (an opioid with serotonergic effects) can also lead to serotonin syndrome. This can be assessed by monitoring for symptoms such as agitation, confusion, rapid heart rate, dilated pupils, increased blood pressure, tremors, and muscle rigidity. It is essential to review the patient’s medication list and educate her about the signs and symptoms of serotonin syndrome, emphasizing the need for prompt medical attention if they occur. Development And Validation in a Clinical Population Assignment

References
Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., Viswanath, O., Urits, I., Boyer, A. G., Cornett, E. M., & Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: A narrative review. Neurology International, 13(3), 387–401. https://doi.org/10.3390/neurolint13030038
Elder, G. J., Altena, E., Palagini, L., & Ellis, J. (2023). Stress and the hypothalamic–pituitary–adrenal axis: How can the covid ‐19 pandemic inform our understanding and treatment of acute insomnia? https://doi.org/10.1111/jsr.13842
Kraepelien, M., Kerstin, B., Forsell, E., Hentati Isacsson, N., Bjurner, P., Morin, C. M., Jernelöv, S., & Kaldo, V. (2021). A very brief self-report scale for measuring insomnia severity using two items from the Insomnia Severity Index – development and validation in a clinical population. Sleep Medicine. https://doi.org/10.1016/j.sleep.2021.03.003
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1). https://doi.org/10.1186/s13030-021-00219-w
Scotton, W. J., Hill, L. J., Williams, A. C., & Barnes, N. M. (2019). Serotonin syndrome: Pathophysiology, clinical features, management, and potential future directions. International Journal of Tryptophan Research, 12(12), 117864691987392. https://doi.org/10.1177/1178646919873925 Development And Validation in a Clinical Population Assignment

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An eighty years old female patient presents with complaint of anxiety, panic attacks, and insomina. Past medical history is significant for CAD, HTN, HLD, DM and COPD. Describe the assessment, planning, and interventions that are appropriate in this situation. Are there any endocrine considerations? What goals will you sent for therapy in this geriatric client? WHat medication interactions may cause serotonin syndrome? How will you assess? Development And Validation in a Clinical Population Assignment