21 y/o female presents to psychiatric ER c/o agitation and restlessness. She is accompanied by her mother and sister and states she is having heart palpitations. Medicine ER has ruled out acute cardiac involvement. The patients states that she has a lot of anxiety and is feeling quite anxious with school a new job, parents recently divorced and now she has been told she needs to care for a pet while her mother travels. She also complains of occasional fatigue, heart palpitations, generalized sweating and occasional headaches. Pt continues to state that there is no pattern to the symptoms but they come and go. She has self tx headache with ibuprofen with minimal relief. Onset of symptoms correlate with starting college back in September and sxs have progressively gotten worse.

PMH: None pertinent to chief complain

Surgical hx: none

Meds: Orthotricyclin low qd

All: PCN (rash) Reglan (agitation)

Occupation: new job at beauty shop (Sephora adding to her stress)

College undergrad student B student: liberal arts

Patients recently divorced 3 months ago.

Family hx: Mother has hx of GAD recent dx depression (divorce related?)

Denies TOB use and occasionally drinks at college parties. Denies other drugs.

States she sleeps fine. Denies issues falling asleep, staying asleep or waking up.

Denies SI/HI, AH/VH or paranoia.

1. O)

Vitals: stable slightly tachy

Exam: WNWD female in mild distress and is pacing throughout the room and when she does sit down shes restless.

Cardiac: RRR without gallops skips or murmurs

Lungs: CTA

Neuro: CN II-XII grossly intact.

DTRs intact

Romberg negative

Cerebellar function intact

Labs: urine tox            WNL

CBC                WNL

BMP                WNL

LFTs               WNL

TSH                WNL (talked about)

EKG unremarkable

A/P

21 y/o female presents to urgent care c/o anxiety, restlessness and palpitations off and on for 10 months progressively getting worse and is suspected to have General Anxiety disorder.

Rule out: Acute adjustment disorder

Rx: hydralazine 25mg PO. STAT.

D/C home with appointment made with psychiatrist and PCM for further evaluation and management. RTC ER if sxs worse of thoughts of self harm or HI occur.

Suicide hotline number issued.

Reassurance.

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Psych Pharm Cards