Signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments

Full Answer Section

Signs and Symptoms:

Body-Focused Repetitive Behavior Disorder (Specifically Finger-Biting):

• Behavioral:
  • Recurrent and repetitive finger-biting.
  • Biting may occur consciously or automatically.
  • May bite cuticles, skin around the nails, or the fingers themselves.
  • Visible physical damage to fingers, such as redness, swelling, cuts, open wounds, infections (if not properly cared for), and scarring.
  • Repeated attempts to stop or reduce the behavior, often unsuccessful.
• Emotional/Cognitive:
  • Urge or compulsion to bite fingers, often preceded by feelings of tension, anxiety, or boredom.
  • Sense of relief or gratification immediately following the biting behavior.
  • Feelings of shame, guilt, embarrassment, and self-consciousness related to the finger appearance.
  • Distress or impairment in social, occupational (e.g., playing in the orchestra), or other important areas of functioning due to the behavior and its consequences.

Generalized Anxiety Disorder:

• Emotional/Cognitive:
  • Excessive worry and anxiety about a number of events or activities (e.g., academic performance).
  • Feeling restless, wound-up, or on-edge.
  • Difficulty concentrating or mind going blank.
  • Irritability.
• Physical:
  • Muscle tension (though not explicitly reported, it's a common symptom).
  • Fatigue.
  • Sleep disturbance (difficulty falling or staying asleep).

Pharmacological Treatments (Considered in Conjunction with Therapy):

Given the patient's lack of prior psychiatric medication and the likely role of stress, pharmacological interventions would be considered cautiously and typically after or alongside non-pharmacological approaches. If anxiety or the finger-biting significantly impairs functioning and doesn't respond adequately to therapy, the following might be considered in consultation with a medical doctor or psychiatrist:

• Selective Serotonin Reuptake Inhibitors (SSRIs):
  • Examples: Fluoxetine, sertraline, escitalopram. These are often first-line treatments for anxiety disorders and OCD-related disorders. They can help reduce overall anxiety levels and may indirectly decrease the urge to engage in body-focused repetitive behaviors.
  • Considerations in Kisumu: Availability and cost of these medications would need to be assessed. Potential side effects and the need for regular follow-up with a prescriber are important.
• N-Acetylcysteine (NAC):
  • Mechanism: An over-the-counter supplement that may help reduce body-focused repetitive behaviors by modulating glutamate levels in the brain.
  • Considerations in Kisumu: Relatively accessible and may have fewer side effects than prescription medications. Dosage and potential interactions with other medications (like birth control pills) would need to be discussed with a healthcare provider.
• Buspirone:
  • Mechanism: A non-benzodiazepine anxiolytic that can be helpful for generalized anxiety.
  • Considerations in Kisumu: May be an option if SSRIs are not tolerated or effective for anxiety. Requires consistent daily use.

Important Note: Prescribing medication is outside the scope of a community nurse's practice. Any consideration of pharmacological treatment would necessitate referral to a medical doctor or psychiatrist for proper evaluation and prescription. As a community nurse, my role would be to educate the patient about potential options and facilitate access to these services.

Non-Pharmacological Treatments:

These would be the initial and primary focus of intervention:

• Cognitive Behavioral Therapy (CBT):
  • Focus: Identifying and changing negative thought patterns and maladaptive behaviors associated with anxiety and finger-biting.
  • Techniques:
    • Exposure and Response Prevention (ERP): Gradually exposing the patient to situations that trigger the urge to bite her fingers and helping her resist the urge.
    • Cognitive Restructuring: Identifying and challenging anxious thoughts related to academic performance and social self-consciousness.
    • Habit Reversal Training (HRT): A specific CBT technique for body-focused repetitive behaviors involving:
      • Awareness Training: Helping the patient become more aware of when, where, and why she bites her fingers.
      • Competing Response Training: Teaching her to engage in a behavior that is physically incompatible with finger-biting when she feels the urge (e.g., clenching fists, holding an object, applying lotion to her hands).
      • Motivation and Social Support: Enhancing motivation to change and enlisting support from her boyfriend or family.
  • Considerations in Kisumu: Access to therapists trained in CBT and HRT might be limited. Telehealth options or training local counselors could be explored. Cultural adaptations of CBT techniques might be necessary.
• Stress Management Techniques:
  • Mindfulness and Meditation: Practicing techniques to increase awareness of the present moment and reduce anxiety.
  • Relaxation Techniques: Deep breathing exercises, progressive muscle relaxation.
  • Time Management and Organization Skills: Helping the patient manage her academic workload and reduce feelings of being overwhelmed.
  • Healthy Lifestyle Promotion: Encouraging regular physical activity, a balanced diet, and sufficient sleep, which can all impact mood and anxiety levels.
  • Engaging in Enjoyable Activities: Encouraging participation in hobbies and activities outside of academics that bring pleasure and reduce stress (e.g., orchestra practice for enjoyment, social activities).
• Support Groups:
  • Connecting the patient with support groups for anxiety or body-focused repetitive behaviors, if available in the region or online. Sharing experiences with others can reduce feelings of isolation and provide coping strategies.
  • Considerations in Kisumu: Availability of specific support groups needs to be assessed. Creating a local peer support network could be a longer-term goal.
• Psychoeducation:
  • Providing the patient with information about anxiety disorders and body-focused repetitive behaviors to normalize her experience and reduce stigma.
  • Educating her about the connection between stress and her symptoms.
• Environmental Modifications:
  • Identifying triggers for finger-biting (e.g., specific situations, times of day) and exploring ways to modify these environments or routines.
  • Using physical barriers (e.g., bandages on fingers as a reminder).

Appropriate Community Resources and Referrals in Kisumu:

• Local Health Clinics and Health Centers:
  • For initial assessment of anxiety and mood symptoms.
  • For physical health check-ups to rule out any underlying medical conditions contributing to fatigue or anxiety (e.g., anemia, thyroid issues).
  • Potentially for basic counseling services if available.
• Mental Health Professionals (Psychologists, Counselors, Psychiatrists):
  • Referral: If specialized psychological therapy (CBT, HRT) or pharmacological management is indicated. Identifying local mental health professionals in Kisumu or exploring telehealth options would be crucial.
  • Considerations: Accessibility, affordability, and cultural sensitivity of these services.
• Community Health Workers (CHWs):
  • Role: CHWs can provide basic health education, support, and follow-up within the community. They can help reinforce healthy lifestyle messages and connect the patient with formal healthcare services.

Sample Answer

Working Diagnoses:

• Body-Focused Repetitive Behavior Disorder, Other Specified (F42.8 [DSM-5-TR], F98.8 [ICD-10]) - Manifesting primarily as chronic and distressing finger-biting leading to physical harm (scars) and impaired control.
• Provisional Generalized Anxiety Disorder (F41.1 [DSM-5-TR], F41.1 [ICD-10]) - Characterized by reported feelings of anxiety, being overwhelmed by academic demands, difficulty concentrating, and sleep disturbance, potentially triggered or exacerbated by the stress of starting graduate school.