NRNP 6635 Case History Report – Week 4: Anxiety Disorders, PTSD, and OCD Training Title 40: Ms. Connie Weidre
Training Title 40
Name: Ms. Connie Weidre
Gender: female
Age: 53 years old
T- 99.0 P- 102 R 24 156/86 Ht 5’4 Wt 1lbs73
Background: Lives with her husband in Memphis, TN, has one daughter age 25. She has never
worked. Raised by mother, she never knew her father. Mother with hx of generalized anxiety and
was verbally abusive, abused benzodiazepines; no substance hx for patient. No previous
psychiatric treatment. Has one glass red wine with dinner. Sleeps 12-13 hrs.; appetite decreased.
Has overactive bladder, untreated. Allergic to Zofran; complains of headaches, takes prn
Tylenol, has diarrhea 2-3 times weekly, takes OTC Imodium.
Symptom Media. (Producer). (2016). Training title 40 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-40
1. Introduction
Patient: Ms. Connie Weidre, 53‑year‑old female.
Context: Case study from Symptom Media video (2016).
Clinical Focus: Anxiety disorders in middle‑aged adults, diagnostic reasoning, treatment planning.
Importance: Demonstrates how family history, psychosocial stressors, and untreated medical issues can contribute to anxiety presentations.
2. Demographics and Background
Age: 53 years old.
Gender: Female.
Vitals: T 99.0, P 102 (tachycardia), R 24 (tachypnea), BP 156/86 (hypertensive).
Height/Weight: 5’4”, 173 lbs (BMI ~29.7 → overweight).
Family: Lives with husband in Memphis, TN; one daughter age 25.
Childhood: Raised by mother, never knew father.
Family Psychiatric History: Mother with generalized anxiety disorder, verbally abusive, benzodiazepine misuse.
Education/Occupation: Never worked outside the home.
Medical History: Overactive bladder (untreated), headaches, diarrhea 2–3 times weekly.
Allergies: Zofran.
Substance Use: One glass of red wine with dinner; no other substance use.
Psychiatric History: No prior psychiatric treatment.
Lifestyle: Sleeps 12–13 hours/day, decreased appetite.
3. Psychosocial Stressors
Family Dynamics: Raised by verbally abusive mother with anxiety and substance misuse.
Occupational Identity: Never worked, possible lack of external social support or self‑efficacy.
Medical Concerns: Overactive bladder, headaches, diarrhea.
Social Isolation: Limited role outside family, may contribute to anxiety.
Generational Transmission: Family history of anxiety and maladaptive coping.
4. Clinical Presentation (Anxiety Features)
Reported Symptoms:
Tachycardia (P 102).
Tachypnea (R 24).
Hypertension (BP 156/86).
Excessive sleep (12–13 hours/day).
Decreased appetite.
Somatic complaints: headaches, diarrhea, bladder issues.
Behavioral Indicators:
Possible avoidance of stressors.
Somatic focus (headaches, GI upset).
Sleep disturbance (hypersomnia).
Risk Factors:
Family history of anxiety.
Psychosocial stressors (abusive mother, lack of occupational role).
Untreated medical conditions.
5. Mental Status Examination (MSE)
Appearance: Appropriate grooming, overweight.
Behavior: Cooperative, anxious demeanor.
Speech: Normal rate/volume, may be slowed due to fatigue.
Mood: Reports anxiety, worry.
Affect: Constricted, tense.
Thought Process: Logical, coherent.
Thought Content: Preoccupation with somatic symptoms.
Cognition: Alert, oriented ×3.
Insight/Judgment: Fair, recognizes symptoms but limited coping strategies.
6. Differential Diagnosis
Generalized Anxiety Disorder (GAD): Excessive worry, somatic symptoms, family history.
Somatic Symptom Disorder: Preoccupation with physical complaints.
Depression: Hypersomnia, decreased appetite, fatigue.
Adjustment Disorder with Anxiety: Symptoms linked to psychosocial stressors.
PTSD: No trauma exposure reported, less likely.
OCD: No obsessions or compulsions reported.
7. Diagnostic Considerations (DSM‑5)
GAD Criteria: Persistent worry ≥6 months, difficult to control, associated with restlessness, fatigue, irritability, muscle tension, sleep disturbance.
Somatic Symptom Disorder: Excessive thoughts, feelings, or behaviors related to somatic symptoms.
Depression: ≥5 symptoms for ≥2 weeks, including depressed mood or anhedonia.
Connie’s Case:
Prominent somatic complaints and family history support GAD or somatic symptom disorder.
Hypersomnia and decreased appetite suggest comorbid depression.
8. Assessment Tools
GAD‑7: Screens for generalized anxiety.
HAM‑A: Hamilton Anxiety Rating Scale.
PHQ‑9: Screens for depression.
PHQ‑15: Screens for somatic symptom severity.
C‑SSRS: Suicide risk assessment (though no self‑harm reported).
Medical Labs: Thyroid function, metabolic panel, urinalysis for bladder issues.
9. Treatment Plan
Pharmacological:
SSRIs (sertraline, escitalopram) → first‑line for anxiety/depression.
SNRIs (duloxetine, venlafaxine) for anxiety and somatic symptoms.
Buspirone for chronic anxiety.
Address medical issues (overactive bladder, GI symptoms).
Psychotherapy:
Cognitive Behavioral Therapy (CBT).
Stress management techniques.
Psychoeducation about anxiety and coping.
Supportive therapy for family dynamics.
Lifestyle Interventions:
Exercise, relaxation techniques.
Sleep hygiene (reduce hypersomnia).
Nutrition counseling.
Supportive Measures:
Family involvement.
Community support groups.
Coordination with primary care for medical issues.
10. Monitoring and Follow‑Up
Weekly therapy sessions initially.
Medication monitoring every 2–4 weeks.
Suicide risk reassessment.
Collaboration with primary care for medical comorbidities.
11. Challenges
Medication Adherence: Must balance psychiatric and medical treatments.
Family Stress: History of abusive mother.
Medical Comorbidity: Overactive bladder, headaches, diarrhea.
Stigma: Mental health stigma in middle‑aged women.
12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.
Consent: Informed consent for treatment.
Safety: Suicide risk management.
Cultural Sensitivity: Address stigma and family dynamics.
13. Case Summary
Ms. Connie Weidre: 53‑year‑old female presenting with anxiety symptoms, somatic complaints, and family history of anxiety.
Likely Diagnosis: Generalized Anxiety Disorder with possible comorbid depression and somatic symptom disorder.
Treatment: Combination of psychotherapy, pharmacological interventions, lifestyle changes, and medical management.
Outcome Goal: Symptom reduction, improved functioning, resilience building, prevention of relapse.
📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.
What is Connie’s age? a) 50 b) 53 c) 55 d) 57
Where does Connie live? a) Nashville, TN b) Memphis, TN c) Dallas, TX d) Atlanta, GA
What family history is relevant? a) Mother with generalized anxiety and benzodiazepine misuse b) Father with diabetes c) Sister with depression d) Uncle with hypertension
What medical condition does Connie have? a) Overactive bladder b) Asthma c) Diabetes d) Thyroid disease
Which vital signs indicate anxiety? a) P 102, R 24, BP 156/86 b) T 99.0, BP 120/80 c) P 70, R 18 d) T 97.0, BP 116/68
Which diagnosis involves excessive worry ≥6 months? a) GAD b) Adjustment Disorder c) Panic Disorder d) PTSD
Which diagnosis involves preoccupation with physical complaints? a) Somatic Symptom Disorder b) OCD c) PTSD d) GAD
Which tool screens for generalized anxiety? a) GAD‑7 b) PHQ‑9 c) PHQ‑15 d) CAPS‑5
Which therapy targets negative thought patterns? a) CBT b) DBT c) IPT d) Psychoanalysis
Which medication class is first‑line for anxiety? a) SSRIs b) TCAs c) MAOIs d) Benzodiazepines
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