Case of the Week

CC: Muscle tension HPI: Patient is a 28 YOF who presents with severe and constant muscle tension associated with excessive worrying since the birth of her first child seven months ago. She says she worries about everything all the time: US relations with other countries, saving for her child’s college fund, her husband’s health, etc. PFSH is unremarkable. ROS is positive for palpitations and insomnia, but negative for anhedonia. EXAM: BP 130/80, Pulse 101, T 98.6°F. Logical thought processes. Normal abstract reasoning. No hallucinations or delusions, but pre-occupied with constant worrying. Affect is anxious and worried. IMPRESSION: 28 YOF who describes herself as a “constant worrier” presents with muscle tension and worsening generalized, compulsive worrying for seven months. She is not depressed, but endorses insomnia, occasional palpitations and decreased ability to concentrate. Most likely etiology is generalized anxiety disorder, but will rule out organic causes. PLAN: - Check TFTs, chem 7, EKG. - Will start Paroxetine 20 mg daily. - Worked with the patient to identify and challenge negative beliefs. - Also discussed relaxation techniques. - RTC in six weeks for re-evaluation. 16 minutes spent in psychotherapy as described above in addition to the E/M service provided.