Clinical Case Studies in Long-Term Care Psychiatry Navigating Common Mental Health Challenges in Geriatric Care
Book contents
- Clinical Case Studies in Long-Term Care Psychiatry
- Clinical Case Studies in Long-Term Care Psychiatry
- Copyright page
- Contents
- Preface
- Section 1 Neurocognitive Disorders
- Case 2 “I Think I Hit My Head”
- Case 3 “It’s like She’s a Different Person”
- Case 4 “I Am Tired All the Time”
- Case 5 “I Am Okay”
- Case 6 “Leave Me Alone”
- Case 7 “I Am Fine”
- Case 8 “Those Children Are Cute”
- Case 9 “Those Terrible Men Have Left”
- Case 10 “I Saw the Heavenly Gates”
- Case 11 “Leave Me Alone”
- Section 2 Mood Disorders
- Case 13 “My Mom Looks Like a Zombie!”
- Case 14 “My Soul Is in England”
- Case 15 “I Feel Terrible”
- Case 16 “I Don’t Care”
- Case 17 “I Feel Very Lonely”
- Case 18 “I Don’t Feel Right”
- Case 19 “I Am Feeling Great”
- Case 20 “I Am Staying Here Illegally”
- Section 3 Psychotic Disorders
- Case 22 “He Just Won’t Get Up”
- Case 23 “My Body Is Being Taken over by a Fungus!”
- Case 24 “This Is Humiliating”
- Case 25 “I Want to Go Home”
- Case 26 “I Am a Worrier”
- Case 27 “Get out of My House”
- Section 4 Anxiety and Related Disorders
- Case 29 “My Vision Has Been Worsening in the Last Two Weeks”
- Case 30 “I Am Not Addicted to Valium”
- Case 31 “Of Course, I Worry about Him”
- Case 32 “Bombs Are Falling! Run, Run!”
- Section 5 Substance Abuse Disorders
- Section 6 Personality Disorders
- Case 35 “I Cannot Wait to Get out of This Miserable Place”
- Section 7 Miscellaneous Neuropsychiatric Disorders Affecting Patients in Long-Term Care
- Case 37 “Everyone Is Just So Good to Me!”
- Case 38 “Why Do They Say I Have Dementia?”
- Case 39 “I Hate That Guy … I Can’t Get Any Sleep!”
- Case 40 “Just One Kiss”
- Case 41 “I Don’t Feel Well”
- Case 42 “I Like Food”
- Case 43 “I Like the Way She Laughs”
- Case 44 “This Is So Hard”
- Index
- References
Case 29 - “My Vision Has Been Worsening in the Last Two Weeks”
Generalized Anxiety Disorder
Published online by Cambridge University Press: 31 October 2024
Book contents
- Clinical Case Studies in Long-Term Care Psychiatry
- Clinical Case Studies in Long-Term Care Psychiatry
- Copyright page
- Contents
- Preface
- Section 1 Neurocognitive Disorders
- Case 2 “I Think I Hit My Head”
- Case 3 “It’s like She’s a Different Person”
- Case 4 “I Am Tired All the Time”
- Case 5 “I Am Okay”
- Case 6 “Leave Me Alone”
- Case 7 “I Am Fine”
- Case 8 “Those Children Are Cute”
- Case 9 “Those Terrible Men Have Left”
- Case 10 “I Saw the Heavenly Gates”
- Case 11 “Leave Me Alone”
- Section 2 Mood Disorders
- Case 13 “My Mom Looks Like a Zombie!”
- Case 14 “My Soul Is in England”
- Case 15 “I Feel Terrible”
- Case 16 “I Don’t Care”
- Case 17 “I Feel Very Lonely”
- Case 18 “I Don’t Feel Right”
- Case 19 “I Am Feeling Great”
- Case 20 “I Am Staying Here Illegally”
- Section 3 Psychotic Disorders
- Case 22 “He Just Won’t Get Up”
- Case 23 “My Body Is Being Taken over by a Fungus!”
- Case 24 “This Is Humiliating”
- Case 25 “I Want to Go Home”
- Case 26 “I Am a Worrier”
- Case 27 “Get out of My House”
- Section 4 Anxiety and Related Disorders
- Case 29 “My Vision Has Been Worsening in the Last Two Weeks”
- Case 30 “I Am Not Addicted to Valium”
- Case 31 “Of Course, I Worry about Him”
- Case 32 “Bombs Are Falling! Run, Run!”
- Section 5 Substance Abuse Disorders
- Section 6 Personality Disorders
- Case 35 “I Cannot Wait to Get out of This Miserable Place”
- Section 7 Miscellaneous Neuropsychiatric Disorders Affecting Patients in Long-Term Care
- Case 37 “Everyone Is Just So Good to Me!”
- Case 38 “Why Do They Say I Have Dementia?”
- Case 39 “I Hate That Guy … I Can’t Get Any Sleep!”
- Case 40 “Just One Kiss”
- Case 41 “I Don’t Feel Well”
- Case 42 “I Like Food”
- Case 43 “I Like the Way She Laughs”
- Case 44 “This Is So Hard”
- Index
- References
Summary
It is not uncommon for a resident to try multiple medications to manage anxiety disorder before finding a tolerated and effective psychotropic. An SSRI or SNRI are usually the first-line agent for pharmacotherapy. Concern for anxiety is often brought up by caregivers when patients demonstrate disruptive behaviors related to anxiety such as yelling out, resisting care, becoming frightened with personal care, and repetitive behaviors such as pushing a call light many times a day, pacing, or restlessness. First-line agents in the treatment of anxiety disorders in long-term care include SSRIs and SNRIs. Second-line agents or supporting agents may incude buspirone, mirtazapine, propranolol, and trazodone. Avoid benzodiazepines and anticholinergics. Strategies to address difficult to manage anxiety include reconsidering the first-line agent for appropriate dose and duration, adding an augmenting agent, switching from an SSRI to and SNRI, and considering the possibility of low-grade psychosis and a potential contributing factor to anxiety.
- Type
- Chapter
- Information
- Clinical Case Studies in Long-Term Care PsychiatryNavigating Common Mental Health Challenges in Geriatric Care, pp. 140 - 145Publisher: Cambridge University PressPrint publication year: 2024
References
Further Reading
Chen, J. T., Wuthrich, V. M., Rapee, R. M., Draper, B., Brodaty, H., Cutler, H., Low, L. F., Georgiou, A., Johnco, C., Jones, M., Meuldijk, D., & Partington, A. (2022). Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomized controlled trial. PLoS ONE, 17 (6), e0269981. https://doi.org/10.1371/journal.pone.0269981CrossRefGoogle Scholar
Choi, N. G., Zhou, Y., Marti, C. N., & Kunik, M. E. (2022). Associations between changes in depression/anxiety symptoms and fall worry among community-dwelling older adults. Journal of Applied Gerontology: the official journal of the Southern Gerontological Society, 41 (12), 2520–2531. https://doi.org/10.1177/07334648221119464CrossRefGoogle ScholarPubMed
Hill, N. L., Mogle, J., Bell, T. R., Bhargava, S., Wion, R. K., & Bhang, I. (2019). Predicting current and future anxiety symptoms in cognitively intact older adults with memory complaints. International Journal of Geriatric Psychiatry, 34 (12), 1874–1882. doi: 10.1002/gps.5204. Epub 2019 Sep 3. PMID: 31468598; PMCID: PMC6854282.CrossRefGoogle ScholarPubMed
Lamoureux-Lamarche, C., Berbiche, D., & Vasiliadis, M. (2020). Treatment adequacy and remission of depression and anxiety disorders and quality of life in primary care older adults. Health and Quality of Life Outcomes, 19. www.ncbi.nlm.nih.gov/pmc/articles/PMC8444434/Google Scholar
Landreville, P., Gosselin, P., Grenier, S., & Carmichael, P. H. (2021). Self-help guided by trained lay providers for generalized anxiety disorder in older adults: Study protocol for a randomized controlled trial. BMC Geriatrics, 21 (1), 324. doi: 10.1186/s12877-021-02221-x. PMID: 34022795; PMCID: PMC8140311.CrossRefGoogle ScholarPubMed
Nair, P., Walters, K., Aw, S., Gould, R., Kharicha, K., Buszewicz, M. C., & Frost, R. (2021). Self-management of depression and anxiety amongst frail older adults in the United Kingdom: A qualitative study. PLoS ONE, 17 (12). https://doi.org/10.1371/journal.pone.0264603Google Scholar
Penninx, B. W., Pine, D. S., Holmes, E. A., & Reif, A. (2021). Anxiety disorders. Lancet (London, England), 397 (10277), 914–927. www.ncbi.nlm.nih.gov/pmc/articles/PMC9248771/CrossRefGoogle ScholarPubMed
Stavestrand, S. H., Sirevåg, K., Nordhus, I. H., Sjøbø, T., Endal, T. B., Nordahl, H. M., Specht, K., Hammar, Å., Halmøy, A., Martinsen, E. W., Andersson, E., Hjelmervik, H., Mohlman, J., Thayer, J. F., & Hovland, A. (2018). Physical exercise augmented cognitive behavior therapy for older adults with generalized anxiety disorder (PEXACOG): Study protocol for a randomized controlled trial. Trials, 20. https://bpsmedicine.biomedcentral.com/articles/10.1186/s13030-023-00280-7Google Scholar
Welzel, F. D., Luppa, M., Pabst, A., Pentzek, M., Fuchs, A., Weeg, D., Bickel, H., Weyerer, S., Werle, J., Wiese, B., Oey, A., Brettschneider, C., König, H., Heser, K., Eisele, M., Maier, W., Scherer, M., Wagner, M., & Riedel-Heller, S. G. (2021). Incidence of anxiety in latest life and risk factors. Results of the AgeCoDe/AgeQualiDe Study. International Journal of Environmental Research and Public Health, 18 (23). https://doi.org/10.3390/ijerph182312786CrossRefGoogle ScholarPubMed