Social workers take particular care when diagnosing anxiety due to its similarity to other conditions. In this Discussion, you carefully assess a client with anxiety disorder using the steps of differ

CASE OF HYUNH

Intake Date: May 1, 2019

IDENTIFYING/DEMOGRAPHIC DATA:

Hyunh is a 39-year-old female of Vietnamese ancestry who has been married for 21 years. She lives with her husband and her 15-year-old son. Hyunh owns a nail salon.

CHIEF COMPLAINT/PRESENTING PROBLEM:

Hyunh presents for treatment complaining of an increased sense of hopelessness and a persistent feeling of being a failure. She relates that she has no motivation and nothing seems to bring her pleasure. Hyunh reports feeling very sad and has difficulties getting out of bed in the morning, having irregular sleep patterns, frequently awakening throughout the night and staring at the clock, unable to fall back to sleep. Hyunh reports intense periods of anxiety affecting her sleep and occurring upon awakening and she especially worries about her son, her business, and things going on in her neighborhood, and wondering if everything will work out in her family members’ lives. She states that her anxiety becomes so severe that it makes her teeth chatter uncontrollably. Hyunh reports that she experiences periods of tearfulness and crying during the day especially when things are particularly stressful at her business. She is always tired and fatigued and has difficulty making even simple business decisions.

HISTORY OF PRESENT ILLNESS:

Hyunh states that she has always worried about being successful and that the recent business ownership has increased these feelings. She states that feelings of impending disaster plague her in the morning and that these anxious feelings have been going on since June 2018 when she took possession of the nail salon. Client states that she feels as if her “anxiety regulator” has broken.

Client stated her husband is supportive and helps her with the nail salon. She wants this to work out and it frightens her that it may not. Client states her husband has complained a bit because Hyunh’s schedule left little time for him and that Hyunh was very involved with her parents and other family members. Hyunh believes she would fall apart if her husband stopped supporting her. Hyunh states this anxiety of hers has led to an intense period of frequent and severe “attacks” which included chest pains, shortness of breath and dizziness. When this happens, she just wants to throw up. Client states that since she bought the nail salon she has bizarre dreams, suffers from night sweats and chills, and wakes up with a feeling that she is going crazy. Since June, Hyunh has lost 35 lbs. and has difficulty concentrating on running her business. Her attacks would come on suddenly; they did not last very long, but it seemed like hours.

She states that she cannot shake feelings of anxiety, especially when she is unable to reach her husband. She has spent the last several months worrying about the attacks happening when she cannot reach him. Hyunh states she also began worrying about dying. She reports a previous period of depression that began in 2015 after she left her previous job. She identified feelings of hopelessness and sleep disturbances as well as persistent thoughts of suicide. Client states she began psychotherapy and was put on Prozac for about one year. She worked through the loss of her job and felt generally happy for two years, but after going into business for herself, things became harder.

Client reports years of worrying about her life, her son, and all of her family members. Even though it makes her irritable, she doesn’t even try to stop it anymore. Being an owner of a business has increased things for her to worry about. She expresses concern about her business although there is no indication that there is any trouble.

CURRENT FAMILY ISSUES AND DYNAMICS:

Hyunh was married in 2001. Hyunh has worked all her adult life, mostly as a manicurist. She comes from a family of business owners. Client has one child.

MENTAL STATUS EXAM:

Hyunh presents as friendly and cooperative and is dressed neatly in appropriate attire. Hyunh’s mood is depressed. She is oriented to time, place, and person. She demonstrates general knowledge consistent with education. Hyunh demonstrates proper judgment, insight, and normal memory, both recent and remote. Additionally, Hyunh presents with normal perceptions and normal stream of thought. Hyunh’s speech is spontaneous. She initially presents with an appropriate affect although she demonstrates a moderate lability to her mood. Her expression of mood ranged from intense laughter to periods of uncontrollable sobbing. Mood was congruent with expression. Hyunh appeared anxious when discussing monetary matters. She denies active suicidal/homicidal ideation but states that her family would be better off if she were dead so that they could collect on the insurance.