Assessing and Treating Patients With Anxiety Disorders Assignment

Assessing and Treating Patients With Anxiety Disorders Assignment

Anxiety is a familiar feeling in times of danger, and it is believed to be a component of the adaptive fight-or-flight survival response (Stahl, 2013). Anxiety disorders are marked by extreme worry or fear as opposed to typical uneasiness or nervousness. Intense worry, apprehension, dread, and concern are symptoms of this set of disorders, which are classified as mental health conditions. Clinical issues like nausea and hypertension may appear, impacting everyday activities substantially.

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Anxiety disorders are the greatest prevalent mental illnesses, afflicting approximately one-third of all people at a certain time in their life (Murray and Jitender, 2015). With appropriate treatment and diagnosis, sufficient control of apparent stresses can be restored, as well as restrictions placed on possible stressors, allowing the growth of anxious feelings to be kept within normal bounds (Stahl, 2013) Assessing and Treating Patients With Anxiety Disorders Assignment.

Following an intense bout of tightness in the chest, difficulty breathing, and a sense of imminent dread, the client, a 46-year-old Caucasian man, visits the facility as a referral from his doctor. During the clinic visit, he describes his panic attacks as acute moments of dread or thoughts of impending doom that cause significant physical responses such as shortness of breath and chest tightness. He shares worries about work instability combined with pressures from home and admits to using alcohol to deal with them sometimes. The Hamilton Anxiety Scale (HAM-A) revealed severe to moderate anxiety symptoms that required psychiatry consultation. This paper seeks to distinguish between different treatment methods in order to provide effective therapy. The selected choices will be accompanied by justifications and the intended outcomes. Evidence will be collected and analyzed in order to substantiate justifications and, if necessary, suggestions for improvement.

 Decision # 1: Begin Zoloft 50mg PO BID

I selected Zoloft as my treatment option since SSRIs have advantages that outweigh the risks, are tolerable, have high effectiveness, are the preferred treatment for generalized anxiety disorder, and are rapidly metabolized when consumed with meals (Strawn et al., 2018). Zoloft has been shown to reduce symptoms of anxiety in as little as eight weeks with minimal adverse effects (Strawn et al., 2018). To prevent aggravating the present symptoms, I would have to enlighten the client on the need of abstaining from drinking when using this medication Assessing and Treating Patients With Anxiety Disorders Assignment.

Buspirone 10 mg was not an option for me since it has low compatibility to serotonin 5HT2 receptors, triggering distress and requiring meal consumption to reduce uptake (Wilson and Tripp, 2020). Because the client has a tight chest and moderately high blood pressure, buspirone side effects such as blurred vision, exhaustion, tremors, sore throat, CNS depression, akathisia, diaphoresis, and chest discomfort may worsen the client’s condition (Wilson and Tripp, 2020). Furthermore, I chose not to administer imipramine 25 mg as a therapeutic approach since TCAs have more complicated side effects than SSRIs, such as dry mouth, increased appetite, blurred vision, glaucoma, urinary retention, orthostatic hypotension, tachycardia, constipation, weight gain, confusion, diaphoresis, arrhythmia, and delirium (Fayez & Gupta, 2020). Individuals with extreme anxiety symptoms should avoid imipramine since it has been found to increase suicide ideation during first therapy (Fayez & Gupta, 2020). In patients who experience shortness of breath, moderate hypertension, and chest tightness, imipramine’s side effects may aggravate the situation (Laureate Education, 2016b) Assessing and Treating Patients With Anxiety Disorders Assignment.

I was hoping that by using an SSRI for therapy; the client will feel better and experience fewer adverse effects by his subsequent visit. I also plan to contact the client every week to monitor any adverse effects or issues from the Zoloft medicine, as well as provide information on how to manage anxiety at home.

In this scenario, obtaining informed consent from the patient prior to giving psychiatric medicines is an ethical consideration. Providing informed consent is only possible if the patient is knowledgeable about the medicine’s therapeutic effects.

Decision #2: Increase Zoloft to 75gm Orally Daily

Since the client had reported no adverse effects, I decided to raise the Zoloft dosage. Within four weeks, his symptoms began to diminish, and his HAMA score of 18 indicated mild anxiety (Laureate Education, 2016b). To avoid the short-term restlessness that these medicines may cause, SSRIs for anxiety disorders should be begun at lower dosages (Murray and Jitender, 2015). If the patient shows a partial response, there is certainly a possibility that he may react after another 4-6 weeks of treatment at higher doses (Stahl, 2013). This provided confidence that the drug might be maintained with just slight dosage adjustments eliciting positive outcomes Assessing and Treating Patients With Anxiety Disorders Assignment.

Given that the 50 mg dose has already alleviated the symptoms, increasing the dosage to 100 mg would be overwhelming. Zoloft may cause diarrhea, sleeplessness, nausea, reduced sex drive, and delayed ejaculation when used in high dosages. SSRIs may also cause weight gain if used in high dosages for an extended length of time. Since the patient got a partial response, I did not choose to keep the Zoloft dosage constant. As a result, keeping the dosage the same would have no therapeutic impact on the patient. There was no additional improvement in the patient’s anxiety symptoms. The client may thus eventually become non-compliant, as the medication is not beneficial.

My goal is that patients’ symptoms will decrease and be able to return to usual life and function without worry. Furthermore, I want to assist the client in quitting drinking and smoking in order to prevent medication interactions since alcohol may enhance medicine lethality.

In regards to ethical considerations, patients have the right to expect full confidentiality from healthcare professionals. As a result, it is both unethical unlawful and to disclose information about the client without his express agreement.

Decision # 3: Maintain Current Dose

It was only sensible to maintain the medication at the same dosage since the patient had shown a complete response. Reduced doses have a lower therapeutic impact, whereas increased doses have a higher risk of side effects Assessing and Treating Patients With Anxiety Disorders Assignment.

Due to the highly negative impacts of Zoloft at high dosages, I did not want to raise the present Zoloft dose to 100 mg orally daily. While increasing the dosage of Zoloft to 100 milligrams might reduce the negative impacts, even more, it would be unwise to do so. By suppressing platelet coagulation, large dosages of Zoloft are linked to a higher risk of hemorrhage. In addition, Zoloft, like citalopram, can cause a dose-dependent lengthening of the QT interval (Ojero-Senard et al., 2017). Moreover, I did not introduce an augmentation drug like BuSpar since there was no evidence that it was necessary. It was not essential to supplement Zoloft since it was successful in controlling the condition. Buspirone is a second-line drug for the treatment of anxiety disorders, particularly in geriatric individuals. BuSpar, in contrast to other anxiolytics like benzodiazepines, is minimally sedating and possesses a reduced likelihood of becoming dependent. Introducing an agent like BuSpar, nevertheless, might raise the chance of side effects, including nausea, sleepiness, blurred vision, headaches, and vertigo.

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I anticipated the patient’s symptoms to keep improving when I made this choice. Furthermore, I anticipated that the client would not be affected by the medication’s side effects.

When it comes to ethical considerations, the principle of beneficence must be considered, and the healthcare professional’s primary goal should always be to support the patient’s best interests. In accordance with the principle of nonmaleficence, a clinician should refrain from instituting treatments that have not been shown to be successful by scientific evidence Assessing and Treating Patients With Anxiety Disorders Assignment.

Conclusion

To summarize, anxiety disorders are very common in today’s society, and as a result, healthcare professionals ought to be knowledgeable on how to assess and treat them. Zoloft, Buspirone, and Imipramine are examples of pharmacological treatments that are utilized in the management of generalized anxiety disorders. Typically, Zoloft and other selective serotonin reuptake inhibitors (SSRIs) are used as the first line of treatment. In the event that a client does not get a complete response after using Zoloft, the practitioner may decide to raise the dosage on an individual basis Assessing and Treating Patients With Anxiety Disorders Assignment

References

Fayez, R., & Gupta, V. (2021). Imipramine. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK557656/

Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author. https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/05/mm/generalized_anxiety_disorder/1.html

Munir, S., & Takov, V. (2017). Generalized anxiety disorder. https://europepmc.org/article/nbk/nbk441870

Murray, B., Jitender, S. (2015). Generalized anxiety disorder. The New England Journal of Medicine, 373, 2059-2068. https://doi.org/10.1056/NEJMcp1502514

Ojero-Senard, A., Benevent, J., Bondon-Guitton, E., Durrieu, G., Chebane, L., Araujo, M., Montastruc, F., & Montastruc, J. (2017). A comparative study of QT prolongation with serotonin reuptake inhibitors. Psychopharmacology, 234(20), 3075-3081. https://doi.org/10.1007/s00213-017-4685-7

Stahl, S. M. (2013). Stahl’s essential pharmacology: Neuroscientific basis and practical applications (4th ed). New York, NY: Cambridge University Press.

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966

Wilson, T. K., & Tripp, J. (2020). Buspirone. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK531477/ Assessing and Treating Patients With Anxiety Disorders Assignment