Risk for late-onset of generalized anxiety disorder

You are seeing Rita, a 67-year-old female, in your office. Rita\'s daughter is with her at this visit for a follow-up on her hypertension but mentions to you she thinks her mother looks \"thin.\" You look in the chart and see that, since her last visit three months ago, Rita has lost 15 pounds. You ask Rita if she has been trying to lose weight, and she tells you that she hasn\'t.
Please respond with four appropriate differential diagnoses and rationales. Pick one as the main diagnosis and create a plan of care for that patient.
Here is an example of what I want below:
Differential Diagnosis:
Risk for late-onset of generalized anxiety disorder- GAD is a chronic illness. The onset is typically adolescence and early adulthood (Strawn et al., 2018). This patient started experiencing her symptoms after the death of her husband. Most patients present with a comorbid mental health disorder. This diagnosis should be considered due to patient exhibiting characteristics of anxiety. Patient has voiced feeling irritable, worry, anxiety and experiencing sleep disturbance but not for more than six months. Patient also denies any comorbid psychiatric disorders which usually present with GAD.
Unipolar major depression- Depression is one of the most common psychiatric disorders followed in primary care. Having had one major depressive episode, not caused by another comorbidity is part of the criteria for this diagnosis (UpToDate, 2021). Patient is experiencing depressed mood, sleep disturbance, decreased appetite, irritation, poor concentration, and feelings of emptiness. This diagnosis should be ruled in as her main diagnosis.
Bipolar Disorder- Bipolar disorder is a multicomponent illness, involving frequent and severe disruption in mood, cognitive changes, and sleep disturbance. This diagnosis should be considered but ruled out because patient does not meet the diagnosing criteria that includes four or more episodes in a 12-month period (Rowland et al., 2018).
Post-traumatic stress disorder (PTSD)- Bereavement is the response to the loss of a loved one. It can trigger post-traumatic stress disorder (UpToDate, 2021). The risk for developing PSTD is high during the first year of loss and bereavement period. This patient presents with the recent loss of her husband three months ago. Patient cared for her husband during his chronic illness before his passing and this type of loss causes more burdensome on the (UpToDate, 2021). This diagnosis should be considered but may be ruled out due to her recent loss of her husband and considering the natural response of grief the patient is experiencing at this time.
Final Diagnosis: Unipolar major depression (UpToDate, 2020)
Plan (UpToDate, 2020):
Initiate Screenings (UpToDate, 2020)
Complete history and physical (UpToDate, 2020)
Complete ROS (UpToDate, 2020)
Diagnostics/ Screenings (UpToDate, 2020):
GAD 7 (UpToDate, 2020)
PHQ 2(UpToDate, 2020)
PHQ 9 (UpToDate, 2020)
CBC (UpToDate, 2020)
BMP (UpToDate, 2020)
TSH (UpToDate, 2020)
Non-pharmacological (UpToDate, 2020):
Exercise (UpToDate, 2020)
Psychotherapy (UpToDate, 2020)
Pharmacological (UpToDate, 2020):
Start sertraline (zoloft) 25 mg tablet one tablet by mouth daily (with gradual titration based on response)(UpToDate, 2020)
Consult/Referral (Gautam et al., 2020):
Psych consultation for cognitive and behavioral therapy (Gautam et al., 2020)
Patient education:
Eat a healthy and balanced diet (UpToDate, 2020)
Many people with depression that is not too severe can get better by participating in counseling (Gautam et al., 2020)
Do not take medication that is prescribed for someone else without consulting your provider (UpToDate, 2020)
It is important to have a daily exercise routine, exercise releases hormones that may help lower depression and feelings of anxiety (Strawn et al., 2018)
Start aerobic exercises at least 3 days a week as much as you can tolerate for 10 weeks (Strawn et al., 2018)
Cognitive behavioral therapy will help you develop better behavior patterns and skills of coping (Gautam et al., 2020)
You may take sertraline with or without food (UpToDate, 2020)
It may take 4-6 weeks before sertraline starts working (UpToDate, 2020)
Avoid drinking alcohol while taking this medication (UpToDate, 2020)
Your sleep and appetite may improve after starting this medication (UpToDate, 2020)
If you miss a dose, take it as soon as you remember (UpToDate, 2020)
Do not take two doses at the same time (UpToDate, 2020)
Side effects that you may experience the first week while on this medication are (UpToDate, 2021):
Nausea (UpToDate, 2020)
Vomiting (UpToDate, 2020)
Diarrhea (UpToDate, 2020)
Agitation (UpToDate, 2020)
Insomnia (UpToDate, 2020)
You must be willing to remain on this medication for at least six months (UpToDate, 2020)
Do not suddenly stop taking this medication to avoid flu like symptoms, call provider first (UpToDate, 2020)
It may take 8-10 weeks of therapy before you achieve the highest benefit (UpToDate, 2020)
Do not take medication that is prescribed for someone else (Rowland et al., 2018)
Follow up (UpToDate, 2020):
Call office for any questions or concerns including questions concerning medication side effects (UpToDate, 2020)
Return in 4 weeks for medication response, follow up and to evaluate response to therapy (Gautam et al., 2020)
Call your provider or 911 if you feel like you want to hurt or kill yourself (UpToDate, 2020)