Lesson 1: Clinical Disorders - Part A
PART A
Organic Anxiety Disorder - Case Study 4
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Description A 78 year-old retired president of a lumber company presented During the assessment of his symptoms, the patient denied that he had laboured breathing, heart palpitations, nausea, and choking sensations, but admitted that he did have trembling, sweating, light-headedness, and a fear that he would die if he did not get outside. The patient reported that he had a need to be “active.” Upon further investigation by the doctor, the man remembered a similar series of episodes almost thirty years earlier following eye surgery. The patient was confined to his bed for days with eye patches and an apparatus to prevent head movement. Once the confinement was over, the patient experienced the recurring symptoms for more than a year. The retired lumberman said that he was sleeping and eating well and had not gained or lost weight. He told the doctor that he did not have crying spells, urinary incontinence (loss of bladder control), or a decrease in energy. He did state that he had been taking Valium each day (5 to 10 mg) for the last two months to help decrease feelings of nervousness and tension. He also noted mild memory problems, some difficulty with balance, and pain in his right arm. His difficulty with balance prevented him from summer gardening as did his difficulty with the co-ordination of brisk walking and other movement. He was also found to have a “beefy” red tongue which gave him considerable discomfort. A medical examination discovered a form of anemia (macrocytic) and a vitamin B12 deficiency. The patient was given a B12 replacement that effectively stopped his panic attacks. |
Diagnosis The patient described symptoms typical of panic disorder; however, laboratory findings showed a vitamin B12 deficiency. Consequently, a diagnosis of organic anxiety disorder was made because the B12 replacement therapy effectively stopped the episodes. Regarding the episodes of panic earlier in his life (in the absence of a known organic cause), it is assumed that he then had panic disorder. The current organic anxiety disorder may be a manifestation of an underlying vulnerability to panic attacks. See below for a DSM summary. Axis I: Organic Anxiety Disorder Axis II: No diagnosis or condition Axis III: Vitamin B12 deficiency Axis IV: Severity: 1 – none Axis V: Current GAF: 0 |
himself for treatment following a series of episodes in which he felt apprehensive and restless. To decrease his feelings of discomfort, he insisted upon being outdoors. He described his most recent episode as occurring at 3:00 a.m., a week prior to seeing the doctor. He awoke from his sleep with a feeling that the walls were coming in on him. He claimed he was fully awake; he got up, dressed himself, and went outside. He felt much better once outdoors, but he claimed it took an entire day to feel “normal” again.