Case Study
Case presentation
A 34-year-old female patient presented with symptoms of anxiety.
The patient had a 10-month history of anxiety symptoms.
Medical history
- Persistent feelings of restlessness, trouble concentrating, sleep disturbance, fatigue, nausea, muscle cramps and a sensation of having lumps in the throat.
- Persistent concerns that her husband could become ill or might have an accident during his commute to work.
- History of neither substance use or alcohol intake.
Family psychiatric history :
No history of any psychiatric disorders.
Physical examination
| Blood pressure | 120/75 Hg |
| Oxygen saturation | 98% |
| Pulse rate | 95 beats/minute |
| Respiratory rate | 18 breaths/minute |
Investigations
Blood work-up
| Complete blood count | All components in normal range |
| Random glucose level | 125 mg/dL |
| Arterial blood gas analysis | All components in normal range |
| Thyroid function tests | All components in normal range |
| Renal function tests | All components in normal range |
Imaging analysis
| Electrocardiogram | Normal |
| Chest X-ray | Normal |
| Peak flowmetry | 475 L/min |
Mental Assessment
Questionnaire Score:
Generalised anxiety disorder-7 (GAD-7) is 13
Confirmed diagnosis: Generalised anxiety disorder.
Treatment: Combined SSRI and BZD tablets for 5 weeks
Follow-up after 5 weeks: Symptoms of GAD resolved almost completely after 5 weeks.
Combining BZD and SSRI offers benefits such as:
- Faster anxiety relief.
- Reduced SSRI-related anxiety during initial treatment.
- Improved management of situational anxiety.
Therefore, a BZD and SSRI combination can be administered to patients with anxiety.
References:
SSRI: Selective-serotonin reuptake inhibitor
BZD: Benzodiazepine
- Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017;19(2):93-107.
- Espiridion ED, Fuchs A, Oladunjoye AO. Illness anxiety disorder: A case report and brief review of the literature. Cureus. 2021;13(1).
- Raju NN, Kumar KS, Nihal G. Clinical Practice Guidelines for Assessment and Management of Anxiety and Panic Disorders in Emergency Setting. Indian Journal of Psychiatry. 2023;65(2):181.
- Garner AR, Stuart GL. Integrating mindfulness and acceptance into traditional cognitive behavioral therapy during the covid-19 pandemic: A case study of an adult man with generalized anxiety disorder. Clinical Case Studies. 2023;22(2):120-37.
- Dunlop BW, Davis PG. Combination treatment with benzodiazepines and SSRIs for comorbid anxiety and depression: a review. Prim Care Companion J Clin Psychiatry. 2008;10(3):222-8.
- Bushnell GA, Rynn MA, Crystal S, et al. Simultaneous benzodiazepine and SSRI initiation in young people with anxiety disorders. The Journal of Clinical Psychiatry. 2021;82(6):37519..
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