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THE CASE OF JASON - A YOUNG MAN STRUGGLING TO KEEP UP

Published Monday 22 of December, 2014


Jason is a 25 year old college graduate who works at a fast-paced technology company. During his first few months at the company, he had some difficulties meeting demands, which he assumed was a normal part of adjusting. As the months passed, he struggled to keep up. He had been a good ‘multi-tasker’ but now wasn’t completing assignments. As his concerns about productivity grew, he was distracted at work, worrying about his performance. In his second year on the job, he wondered if something deeper was wrong. He made an appointment at the nearest primary care clinic to see if he had attention deficit disorder.


Collaborative Care Introduced


Fortunately, Jason’s primary care clinic offers integrated behavioral health care using the Collaborative Care model, with the primary care physician (PCP), 2 full-time care managers, supported by a consulting psychiatrist who is on-site for a half-day per week, making up the care team. The exposure to evidence-based behavioral health care has helped the PCPs become more adept at identifying behavioral health needs in their patients. Jason’s new PCP noticed that he appeared very nervous and administered a standardized screening tool for anxiety. After explaining that Jason scored in the moderately-severe range, the PCP offered for Jason to meet with the Collaborative Care team. Jason had never previously considered seeking mental health care, but after the PCP reassured Jason that he would maintain primary responsibility for overseeing Jason’s care, he agreed. The PCP introduced the care manager who gave Jason a handout about anxiety and scheduled him for a full assessment a few days later.


At Jason’s initial meeting, the care manager learned that Jason’s struggles were taking a toll in many aspects of his life. Jason compensated for inefficiency at work by working from home at night, but over time this wasn’t enough. Whenever he was not at work, he was thinking about his incomplete tasks, thoughts that woke him several times each night. He was exhausted and felt “burned out.” He had given up exercising, which was an important stress reliever. Jason also admitted that he would ‘beat himself up’ about not meeting his expectations. In addition to Jason’s significant generalized anxiety, he also had panic attacks, becoming short of breath and sweaty as his thoughts spun out of control. Despite his difficulties, he enjoyed his work and the stimulating environment. He believed that stress helped him achieve in his life and was reluctant to let it go.

The care manager reviewed Jason’s developmental history and learned that Jason had been a high-performing student who excelled academically and socially from a young age. He had no difficulty in the less structured college environment and was an honors student.


Empowerment Through Education


A week later, Jason reported he was more aware of his anxiety. He noticed his worrying consumed about half of his workdays. He had returned to the gym for several intense workouts to relieve stress.

Over several sessions, the care manager helped Jason learn how the body’s stress response systems operate, how his anxiety would manifest in his body and affect his thoughts and behavior, and how he could manage better. Jason felt empowered knowing what steps to take and how to monitor his symptoms to know if he was on the right track.


Jason made important improvements in his lifestyle, with more regular habits for sleep, meals, and physical activity and started an antidepressant medication (used as a first-line medication for generalized anxiety and panic). Jason learned to notice his automatic thoughts and was less distressed by them. His anxiety abated and he stopped having panic attacks. As he gained confidence in his ability to manage his stress, his work performance picked up. He knew it would still be challenging to meet the demands of his career, however he felt more competent to do so.


Conclusion


Jason is a talented young man whose increasingly serious symptoms of generalized anxiety and panic caused distress and impairment at work. Jason had longstanding perfectionistic traits. Perhaps due to stigma, he had never considered that he could have an anxiety disorder. Through team-based care, Jason received the correct diagnosis and effective treatments in his primary care clinic. Although J delayed getting help, the high quality care he received prevented more serious problems from emerging had he remained untreated.


This is the kind of integrated physical-behavioral care we should all be receiving in primary care. If you are not, TELL YOUR PCP you would like to see him/her begin collaborative care as soon as possible. To make integrated care a reality, doctors need to hear from their patients.


**Source: University of Washington’s AIMS Center; 2014.


Florence C. Fee, J.D., M.A.

Executive Director

NHMH