Anxiety, Stress and Substance Abuse - Case Study Example

CASE STUDY  (HEALTH AND SOCIAL CARE) 22nd September, 2008 This case discusses Linda who is a 28 year old woman and presents to emergency department with deep lacerations to both of her wrists. Linda states she has accidentally cut herself because of her overwhelming tiredness and fatigue caused by the fact that she is unable to fall and stay asleep unless she uses medication and or alcohol to help her fall asleep. Linda has suffered a remarkable loss of appetite over the last 3 months and admits to having lost interest in socializing because she feels tense and nervous whenever she goes anywhere. She states that she finds it hard to concentrate. She lacks motivation and is unproductive at work as a clerical officer for the Roads and Traffic Authority. Linda describes the level of level of tension and nervousness as long as she can remember, but that this has been exacerbated with the death of her sister 13 months ago. Although Linda has an extensive family network in New Zealand, she has no significant extended family present in her life locally. She has no record of mental health history. Linda is vague and non-specific about her current use of prescribed or non-prescribed medications and is unable to remember how much alcohol she has drunk in the last week. Linda states that she has rang lifeline on many occasions but did not follow up on the advice until now. She appears well dressed, thin, and pale has dark circles under her eyes and continually wrings her bandaged hands in her lap. Components of a nursing assessment for Linda Dysfunctional or maladaptive response to stress Clearly Linda is suffering from a dysfunctional or maladaptive response to stress, which are partly driven by her own set of beliefs. Dysfunctional beliefs can cause a person like Linda to interpret things in a maladaptive way, and greatly increase the chance that she experiences with stress and mood problems. Many people will have bought into literally thousands of such beliefs. Generally, maladaptive behaviors in response to stress or anxiety might include: excessive worrying, sleeplessness, nervousness, changes in eating habits, fatigue, tension, head and body aches, lowered immune response,, a racing mind, lack of concentration, forgetfulness, etc. Anxiety is a severe state of stress and its symptoms that last for 6 or more months that may or may not be triggered by specific stimuli and may or may not be permanently affecting of life style. In Linda’s case stress acts a specific response to all her nonspecific demands. This process being complex, her stress response or "stress reactivity" is triggered by various stressors, ranging from live events to daily hassles and including chronic stressors. These stressors, as Linda has many surrounding her, bog her down. Her stress response is not univocal: it has physiological, cognitive and behavioral components. (Légeron P, 1993) Linda’s history reveals her anxiety state. Anxiety disorders are common psychiatric disorders. Since Linda is suffering from anxiety state, she experiences physical symptoms related to anxiety. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) classifies the anxiety disorders into the following categories: 1. Anxiety due to a general medical condition 2. Substance-induced anxiety disorder 3. Generalized anxiety 4. Panic disorder 5. Acute stress disorder 6. Posttraumatic stress disorder (PTSD) 7. Adjustment disorder with anxious features 8. Social phobia 9. Obsessive-compulsive disorder (OCD) 10. Specific phobias If we analyse the above ten points, we can clearly see that Linda’s condition coincides with a number of them. (Robins, LN, Regier, DA. 1990) In Linda's case stress response is adaptive because of the homoeostasis factor. It has proved maladaptive since it has an intensity or endurance beyond that required to overcome the stress stimulation on account of the stressor being chronic. Substance abuse (SUD) Comorbid posttraumatic stress disorder/substance-use disorder is a frequent diagnosis in clinical populations that severely affects course and outcome. In clinical populations (focusing on either disorder), about 25-50% have a lifetime dual diagnosis of posttraumatic stress disorder and substance-use disorder. Patients with both disorders have a more severe clinical profile than those with either disorder alone, lower functioning, poorer well being, and worse outcomes across a variety of measures. Epidemiological research has established high rates of comorbid PTSD and SUD. Among people with lifetime PTSD, lifetime SUD is estimated at 21-43%, compared with 8-25% in those without PTSD. Even higher rates are found in clinical populations. For example, up to 75% of combat veterans with lifetime PTSD also met criteria for lifetime alcohol abuse or dependence. In clinical SUD samples, the prevalence of lifetime PTSD ranges from 26 to 52%, and for current PTSD the range is 15-41%. (Clark HW, 2001; Jaycox LH et al,2004; Langeland W et al,2004) Role of the nurse in assisting Linda to adapt to stress Nurses routinely encounter stress and anxiety patients whom they find difficult to intervene. Some of these anxiety patients are characterized as difficult because they frequently evoke strong negative feelings in nurses and medical practitioners alike, stemming mostly from an inability to establish and maintain an effective physician-patient relationship. Other patients, however, frustrate nurses on account of their complicated medical problems; typical case of symptoms overlapping on one another and most of them idiopathic. Consequently, nurses find caring for some complex patients, as Linda is, both challenging and rewarding. Nurses have observed that traditional biomedical training has emphasized detecting physical disease in a manner similar to puzzling out a murder mystery. Nurses often derive intellectual satisfaction from caring of so-called occult diseases/ condition/ symptoms. This can be accomplished by taking into account patient’s history, his or her interaction with the environment and positive side of socializing. Recent studies have shown that no organic cause can be found for more than three quarters of such physical complaints as fatigue, chest pain, or dizziness.( Kroenke K, Mangelsdorff AD, 1989). In the search to rule out physical disease, many patients receive extensive workups for their illness complaints, while psychosocial evaluations are frequently deferred or incompletely accomplished. When psychosocial evaluations are accomplished, the most common findings include complicated mixes of current stressful life events, chronic social stressors, psychiatric disorders, childhood and adult sexual and physical victimization, chronic somatization, high health care utilization, and comorbid medical disease. These studies have also shown that patients and physicians differ markedly in their perception of how medically ill and disabled the patient is. Patients not only are likely to perceive themselves as considerably more ill and disabled than their physicians do, but they often perceive a lack of empathy and understanding on the part of their physicians. Factors related to self harm and suicide risk for Linda Research has suggested that anxiety states and even mood disorders are linked to suicidal behaviour, and the conditions are a 'state-dependent' phenomenon. Recently, growing evidence has come forward and is well accepted that clinically explorable suicide risk factors comorbid anxiety, substance use, and mixed state of depression could also be an important precursor of suicidal behaviour. In the majority of patients, which exhibit conditions as Linda, suicidal behaviour is predictable and preventable, with a good chance of betterment. A proper exploration of suicide risk factors in patients as Linda go a long way in helping patients overcome their problems. A successful, acute and long-term treatment of these patients substantially reduces the further risk of deterioration, even in this high-risk population. However, since there is always a flip side to the coin, even Linda can draw from her internal strength many attributes that will help her provide herself a way to healing. She can channelize her internal strength into: Develop good relationships Learning how to create healthy relationships Be part of a safe, supportive and non-judgemental group environment. Learn techniques to boost self-esteem and a sense of competence. Go for a moderate walk, and do meditation and offer prayers, and so on REFERENCES 1. Légeron P, Behavioral and cognitive strategies in stress management, Information from Industry, Encephale. 1993; 19 Spec No 1:193-202. 2. Robins, LN, Regier, DA. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. The Free Press; 1990. 3. Clark HW, Masson CL, Delucchi KL, et al. Violent traumatic events and drug abuse severity. J Subst Abuse Treat 2001; 20:121-127. 4. Jaycox LH, Ebener P, Damesek L, Becker K. Trauma exposure and retention in adolescent substance abuse treatment. J Trauma Stress 2004; 17:113-121. 5. Langeland W, Draijer N, van den Brink W. Psychiatric comorbidity in treatment-seeking alcoholics: the role of childhood trauma and perceived parental dysfunction. Alcohol Clin Exp Res 2004; 28:441-447. 6. Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med 1989;86:262-6. Read More