The University of Texas System

CPAN Case of the Month – August 2023

Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a PCP during this consultation.

Patient: adolescent female

Reason for CPAN consultation: assessing potential anxiety diagnosis and treatment

Explanation of the case and outcome of the call:

We received a call a few months ago from a repeat CPAN caller requesting assistance with diagnostic clarity and a treatment plan for a school-aged patient struggling greatly with anxiety. The patient was experiencing symptoms of worry and difficulty controlling worries primarily around being away from her parents and getting “bad” grades, although academically she was doing quite well. She was also experiencing symptoms of nausea, occasional vomiting, poor appetite, low energy, difficulty concentrating, and difficulty falling asleep. Additionally, during school drop-off, she was crying and often refusing to get out of the car, leading to many missed school days and significant parental distress. Of note, basic lab work, given GI symptoms and low energy was normal. Fortunately, this patient had responded positively, although only partially, to a fluoxetine dose of 20mg daily.

Although overall, this may seem like a fairly straightforward case of anxiety, we scheduled this patient for a one-time consult. The direct consult was able to offer additional clarity regarding diagnoses of both generalized anxiety disorder (GAD) and separation anxiety disorder, as well as a recommendation to increase her dose of fluoxetine as needed, which the PCP felt more confident in doing after the consult. Recommendations were also made for psychotherapy. This type of consultation was also able to offer an opportunity to discuss separation anxiety at length with the parents and strongly, yet gently, reinforce the need to resist giving in to school avoidance, which typically only reinforces the avoidant behavior. This can be a very difficult conversation to have with families, for both PCPs and Child and Adolescent Psychiatrists, and this offered an excellent opportunity to support the PCP in this situation and reassure the family about this approach. Fortunately, both parents were actively engaged and supportive of the treatment plan. The consult resulted in the family and PCP feeling more confident with this treatment plan and allowed clear communication between all parties involved for consistency and clarity.

This is a great example of how our direct consult program can support the family, PCP, and improve patient outcomes.