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Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety

BACKGROUND INFORMATION
The client is a 46-year-old white male who works as a welder at a local steel fabrication

factory. He presents today after being referred by his PCP after a trip to the emergency

room in which he felt he was having a heart attack. He stated that he felt chest tightness,

shortness of breath, and feeling of impending doom. He does have some mild

hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He

had his tonsils removed when he was 8 years old, but his medical history since that time

has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was

normal. Remainder of physical exam was WNL.

He admits that he still has problems with tightness in the chest and episodes of

shortness of breath- he now terms these “anxiety attacks.” He will also report occasional

feelings of impending doom, and the need to “run” or “escape” from wherever he is at.

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In your o�ce, he confesses to occasional use of ETOH to combat worries about work. He

admits to consuming about 3-4 beers/night. Although he is single, he is attempting to

care for aging parents in his home. He reports that the management at his place of

employment is harsh, and he fears for his job. You administer the HAM-A, which yields a

score of 26.

Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed.

Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he

does endorse feeling “nervous”. A�ect is somewhat blunted, but does brighten several

times throughout the clinical interview. A�ect broad. Client denies visual or auditory

hallucinations, no overt delusional or paranoid thought processes readily apparent.

Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorder

RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Decision Point One
Select what you should do:

Begin Paxil 10 mg po daily

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Begin Imipramine 25 mg po BID

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Begin Buspirone 10 mg po BID

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