Case Study #3 – Henry

Case Study #3 – Henry

Henry is a 53-year-old domiciled, married, and self-employed man with no formal past medical history who has never seen a psychiatrist. He was brought into the psychiatric emergency room by his wife after telling her he was so overwhelmed by insomnia and constant sky-high anxiety that he needed help.

The patient states that he has always been a worrier. He states that he has had long-standing concerns about his overall state of health (although he sees doctors regularly and has no chronic medical conditions) and about his financial future. However, although he has always been a worrier, these fears have never stopped him from being productive, enjoying his life, or having meaningful relationships with others. He immigrated to the United States at age 21, pursued a graduate degree in engineering, and is self-employed in real estate development.

He reports 2 years of financial stress. Since that time, he has been consumed with constant excessive worry about his health, about his wifes health, about their finances, and about accomplishing his daily tasks. He feels restless constantly and feels that the restlessness and constant anxiety make him unable to focus at work, which worsens his anxiety further. He states he is unable to stop himself from constantly focusing on these fears and is not relieved when others reassure him. He states that worst of all, despite being extremely fatigued at the end of the day, he is unable to fall asleep due to anxious ruminations. He states it takes him about 3-4 hours to fall asleep and then he wakes up after just 6 hours of sleep.

Approximately 12 months ago the patient saw his primary care doctor for insomnia. His doctor prescribed alprazolam, initially at 0.5 mg at the hour of sleep, but because of continued anxiety, the dose was slowly increased and the patient is now taking more than recommended by his doctor. He is currently taking 4 mg of alprazolam at bedtime as well as, 1-2 mg as needed during the day.

Henry also admits that, while he has not told his primary care doctor, he has found over time that increasing the amount he drinks with dinner helps him fall asleep. He states he has been drinking three shots of vodka at night as well as having 1-2 beers during the day for the past 6 months. He states that while this regimen helps him fall asleep, he awakens every night around 3 a.m. with intensely high anxiety and palpitations, which prevent him from falling back asleep. He states he feels guilty about his drinking but has been unable to cut down because of cravings, desire to immediately relieve anxiety, and insomnia. While the patient denies spontaneous suicide thoughts and denies active plans to end his life, he states that he would not want to live if told his anxiety would never go away. He denies anhedonia, use of other substances, hallucinations or violent thoughts. He begs multiple times, Doctor please, just give me something for sleep, something stronger that Xanax!

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1. What diagnoses would you consider for this client? Explain your rationale with scholarly sources and describe information that supports these findings based on assessment information.

2. What are medical concerns that you have for this client?

3. What modes/levels of treatment would you recommend for this client? Be sure to list them in the priority in which they need to be addressed.
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There are no right answers, but I expect you to use scholarly sources to develop well-reasoned responses to the questions. Be sure to cite your responses in APA style. Answers need to be a minimum of 250 words.

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