Create a different scenario for a 60 year old female. "CC: Anxiety medication management and cognitive behavioral therapy (CBT) follow-up.

HPI: Patient is a 58-year-old female with a history of generalized anxiety disorder, presenting today via telehealth for anxiety management and evaluation of CBT effectiveness. The patient reports feeling more relaxed when using breathing exercises learned in therapy.

PMH:

Medical History: Hypertension, controlled with medication.

Psychiatric History:

F419 Generalized anxiety disorder

F432 Adjustment disorder with mixed anxiety and depressed mood

Medications:

Sertraline 50 mg daily

Lisinopril 20 mg daily

Allergies/Intolerance: Shellfish (Itchy throat)

Family History: Mother had anxiety.

Social History: Non-smoker; drinks alcohol socially (1-2 glasses of wine per week). Exercises regularly by walking her dog and attending yoga classes twice a week. Maintains a balanced diet and has strong social support from family and friends.

Assessment:

Patient is alert and oriented to person, place, and time. Presents with an appropriate affect and mood. Dressed appropriately for the season and cooperative throughout the session. Reports a decreased frequency of anxiety episodes, though still experiencing occasional nervousness in social situations.

Treatment/Plan:

Continue current medication regimen (Refilled)

Continue weekly CBT sessions to work on social anxiety triggers.

Education: To maintain her exercise routine and relaxation techniques.

Follow up in 6 weeks to evaluate progress and consider medication adjustment if necessary."