- Jessica is a 14-year-old client who recently graduated from a small 8thgrade class of 22 students. She started 9thgrade at a large high school two days ago and after staying at the school for 15 minutes, had to go to the nurse because of stomach pains, nausea, and severe anxiety. She was referred to you for a psychiatric evaluation. During the evaluation, you discover that she had separation anxiety disorder when she started kindergarten years ago. This was helped by providing a transitional object, meeting her very supportive teacher prior to starting school, having a tour of the school and classroom, and having the teacher introduce her to another student prior to starting and having a few play dates with this new friend as well as allowing the parents to walk her into the class. Now, 8 years later, the same diagnosis has resurfaced. Jessica refuses to go to school because she is fearful that the symptoms will return and she will be embarrassed and ostracized by the other students. You institute psychotherapy but decide to prescribe medication as well because the therapy may take several weeks to allow her to return to school and you know school refusal is a psychiatric emergency. What would you prescribe and why?
5. Jason is a 27-year-old client who has an executive position at a large company. He was just promoted which means he will have to fly out of town several times a month. He is terrified of flying. You start systematic desensitization but he decides that he will need an antianxiety medication. He has been in recovery for alcohol dependency for 2 years. What will you prescribe?
6. Owen is another client of yours of similar age to Jason. He also has a fear of flying. He is flying to Fort Lauderdale in two weeks and is terrified. He needs to fly every 5 years or so. He does not want to do any type of therapy, but wants some medication, just to get through this trip to Florida. What medication would you prescribe and why?
7. Jamie is 12 years old. She has difficulty falling asleep because of anxiety. You begin psychotherapy. Her mother asks if there is something she can take until the therapy begins to work. What might you suggest?
8. Carolyn is 42 years old. You just diagnosed her with generalized anxiety disorder and prescribe escitalopram 10 mg. She has early morning awakening around 3 am and even with sleep hygiene methods, cannot fall back asleep. It is interfering with her functioning at work. You tell her the medication will take 2-4 weeks to begin to work. She asks for another medication to help until the SSRI begins to work. What might you prescribe and why?
9. Cynthia is a 75-year-old patient diagnosed with bipolar disorder. She has been stabilized on carbamazepine for many years and does very well on this medication. Recently she has been going to a senior citizen day program and has a great deal of generalized anxiety that seems to be increasing. Her PMHNP prescribed Buspirone 5 mg BID. Is this a good choice? Why or why not?
10. You prescribe Zolpidem 5 mg for Sally, a 50-year-old client who is having difficulty sleeping ever since her partner died a few weeks ago. Sally tells you that years ago her PCP prescribed clonazepam for sleep. She read that both work on the benzodiazepine receptor site and wonders why you didn't prescribe clonazepam - for that worked very well. She is very bright and needs a sophisticated and comprehensive answer. What would you tell her?
11. You are referred from a PCP a 38-year-old client diagnosed with insomnia. The PCP had prescribed the client Quetiapine 25 mg for sleep. The medication works, but the client read that this medication is an antipsychotic medication with a lot of side effects and feels that she does not want to take this medication. What are some reasons that the PCP may have prescribed this medication and what would you do?
12. Jordan, a new patient, comes to your office for high levels of anxiety. You do a Beck Anxiety Inventory and the total score is 29. What level of anxiety does this patient have? It is your job to determine if there is a specific, categoricalanxiety disorder diagnosis. For each of the 9 major categories of anxiety disorders, write two questions for each as to what you will ask the client in order to determine what anxiety disorder(s) he might have, thus you should have 18 questions in total.
13. What is systematic desensitization and how can it be useful in treating a patient who had a fear of flying in airplanes? Develop a hierarchical protocol to use for a patient with fear of flying and explain how you will implement the protocol with behavioral techniques.