A primary care provider is discussing school performance with an adolescent patient. The patient

A primary care provider is discussing school performance with an adolescent patient. The patient states that their grades are doing well, but they have been struggling with significant anxiety and GI upset prior to giving presentations in class. The provider should: refer the patient to a therapist for cognitive behavioral therapy. prescribe lorazepam 2 mg orally as needed. prescribe sertraline 25 mg orally daily. assure the patient that their stress is normal.

In this scenario, the adolescent patient is experiencing significant anxiety and gastrointestinal upset specifically related to giving presentations in class, even though their grades are good. Given the context of the situation, the most appropriate response from the primary care provider would be to refer the patient to a therapist for cognitive behavioral therapy (CBT).

Rationale:
Cognitive Behavioral Therapy (CBT):

CBT is a well-established and effective treatment for anxiety disorders, particularly in adolescents. It helps patients identify and change negative thought patterns and behaviors that contribute to their anxiety. This approach can equip the patient with coping strategies and tools to manage their anxiety related to public speaking and presentations.
Prescribing Lorazepam:

Lorazepam is a benzodiazepine that can be used for short-term management of anxiety; however, it is generally not the first-line treatment for anxiety disorders in adolescents. Long-term use of benzodiazepines can lead to dependence and does not address the underlying issues contributing to anxiety.
Prescribing Sertraline:

While sertraline, a selective serotonin reuptake inhibitor (SSRI), can be effective for anxiety and depression, starting medication without first exploring psychotherapy may not be the best approach. Additionally, starting at a low dose (25 mg) may not be sufficient for therapeutic effects. Psychotherapy, particularly CBT, is often recommended before or alongside medication.
Assuring Normalcy of Stress:

While it is important for the provider to validate the patient’s feelings and acknowledge that some level of stress is normal, simply assuring the patient that their stress is typical without offering concrete help or strategies is insufficient. It may minimize the patient’s struggles and not provide the support they need.
Conclusion:
The best course of action for the primary care provider is to refer the patient to a therapist for cognitive behavioral therapy. This intervention is appropriate for addressing the patient’s specific anxiety symptoms and can lead to more effective management of their anxiety surrounding school presentations. Once the patient has had the opportunity to engage in therapy, the provider can then reassess the need for medication if necessary.