Assessing and Treating Patients with Anxiety Disorders Paper

Assessing and Treating Patients with Anxiety Disorders Paper

The client, a 46-year-old Caucasian man, presents to the emergency department with complaints of breathing difficulties, tightness of the chest, and a sense of impending doom. The client was referred to me by his primary care physician, who said that he had moderately high blood pressure and is on a low-sodium regimen. A generalized anxiety disorder is the underlying medical condition after examining the client. The HAM-A (Hamilton Anxiety Rating Scale) score of 26 for this client indicates that he is on the cusp of being classified as either moderately anxious or severely anxious. His weight is around 15 pounds more than it should be. His Electrocardiogram was normal, and it was determined that he did not have a myocardial infarction while in the Emergency Department. There were no abnormalities in the results of his physical examination. Assessing and Treating Patients with Anxiety Disorders Paper

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Generalized anxiety disorder is a diagnosis that the client’s social background lends itself to. He worries about his employment because of the tough management at his workplace. The patient is a single man who is striving to care for his elderly parents in the comfort of his own home. The client consumes three to four bottles of beer at night in order to alleviate his anxiety about his job. Taking care of his parents while also juggling the demands of his job makes it difficult for him to maintain a healthy balance between work and life. The patient’s symptoms have worsened, and he has expressed a feeling of dread as a result. On the other hand, he claims that he has never used any kind of psychiatric medicine in his whole life. The patient appears alert, well-oriented and adequately dressed for the occasion. His speech is lucid, logical, and focused on achieving a certain purpose. During the interview process, the patient’s emotions are muted, although they do light up at certain points. No abnormalities were found in his HEENT evaluation. Assessing and Treating Patients with Anxiety Disorders Paper

Decision #1: Begin Zoloft 50 mg orally daily

My choice was based on the patient’s Hamilton Anxiety Rating Scale score of 26. A lower score would have necessitated a reduction in dose to 25 mg orally daily. Another finding was that the client had a very mild case of high blood pressure. While this may be the case, he has decided to treat the problem with a low-salt regimen. To avoid exacerbating the client’s high blood pressure, it’s critical to examine the medications’ negative effects while prescribing medication for this individual. Zoloft belongs to a family of antidepressants known as selective serotonin inhibitors (SSIs). When using Zoloft, some of the most common adverse effects encompass nausea and vertigo, as well as dry mouth and insomnia (Garakani et al., 2020). These adverse effects, on the other hand, are unique to every patient. Due to the medication’s advantages outweighing the dangers, I have decided to prescribe it.

Due to the potential adverse effects, I opted out of the other two alternatives. For example, Tofranil 25 mg orally BID is linked with adverse symptoms such as vision impairment, constipation, vomiting, nausea, and an increase in weight. On the other hand, Buspirone might induce chest discomfort, dizziness, and breathing difficulty, among other adverse effects (Wilson & Tripp, 2018)Assessing and Treating Patients with Anxiety Disorders Paper. These drugs might also make patients jittery or anxious, which can affect their sleep and overall well-being.

The chosen treatment’s ultimate objective was to alleviate the symptoms that the client was suffering from. A mild anxiety level could be expected after taking Zoloft every day. Breathing difficulty, a sense of approaching disaster, and chest tightness are all expected to diminish within four weeks of treatment.

When it comes to ethics, the client’s social history is the most important factor. He is presently living with his elderly parents and admits to sometimes drinking. Consuming alcohol while taking Zoloft is discouraged by the FDA since both the alcohol and medication impact the brain (Strawn et al., 2018). Zoloft’s adverse effects might be exacerbated if individuals drink more alcohol while taking the medication. Suicidal ideation, despair, headaches, sleepiness, and nervousness are all possible adverse effects. Assessing and Treating Patients with Anxiety Disorders Paper

Decision #2: Increase Dose to 75 mg Orally Daily

My choice was based on the fact that the patient’s anxiety about work has diminished during the last few days with the prior dose. There are no more breathlessness or chest tightening sensations. The Hamilton Anxiety Rating Scale score has also decreased significantly to 18, which is a remarkable improvement. Patients who show a decrease in symptoms and a partial response to therapy are considered to be responding. He hasn’t had any adverse reactions to the medication. No serious side effects or adverse medication responses have been mentioned, which means the medication chosen for him was a good match for his medical needs.

The Patient will require a greater dose of the medicine to have a better chance of success with his therapy. Because mild anxiety is defined as a rating of 17 on the Anxiety Scale, the dose was increased from 50 mg orally daily to 75 mg. It is important to observe that the client is tolerating his medicine and that adherence has been attained to a high degree.

Raising the dose to 100 mg orally daily would become an overdose because the client has shown just a 50% symptomatic reduction (Strawn et al., 2018). It is also possible that sticking to the same Dose might lead to a decrease in the patient’s improvement in their symptoms, which could lead them to discontinue taking the medication.

Ethical issues at this point entail the potential for obesity. Weight gain is a possible negative effect of long-term usage of Zoloft 75 mg. In order to sustain a reasonable weight while using Zoloft, the client should include weight-loss plans into his daily scheduleAssessing and Treating Patients with Anxiety Disorders Paper.

Decision #3: Maintain Current Dose

In making this decision, the fact that the client has demonstrated a satisfactory response to the drug, with over a 50% decrease in symptoms, has been taken into consideration. This might be linked to adherence to treatment, the absence of drug interactions or sensitivities, and excellent food-drug combinations. Allowing the patient to use the medicine for a longer period of time is critical to getting a comprehensive picture of its impact (Ströhle et al., 2018). Continued use of Zoloft 75 mg orally daily for additional 12 weeks would give the practitioner enough time to assess both the medication’s impact and any potential adverse reactions Assessing and Treating Patients with Anxiety Disorders Paper.

If the dose is increased to 100 mg daily, the manifestations of the condition will be alleviated even more, including his anxiety dropping below 10, his sense of impending doom disappearing, and his fear of losing his employment diminishing even more. It may, however, enhance the likelihood of experiencing negative effects from the medicine. Furthermore, nothing about the scenario of the patient suggests that the introduction of an augmentation agent is required. BuSpar is not required since the patient has responded to the medication before and is doing well without it.

Keeping the client’s symptoms steady and minimizing any unwanted side effects are the main goals I was hoping to achieve during this phase of the therapy process.

The implications of psychotropic medications, which include drug interactions, greater costs of treatment, and worse health effects, represent an ethical concern at this point.

Conclusion

The client goes to the emergency room because he thinks he’s suffering from a heart attack and wants to be checked out. The Electrocardiogram and physical examination performed by his Physician, however, rule out a heart attack. Chest tightness, difficulty breathing, and a sense of impending doom are among the symptoms experienced by the client. He also has a history of high blood pressure and is somewhat overweight. The client claims that he has not used any kind of psychiatric medicine. Thus, a daily dose of Zoloft 50 mg would be adequate to assist alleviate the aforementioned symptoms. According to the HAM-A scale, the patient’s anxiety level is moderately severe, as indicated by a score of 26. It is safe to say that the patient’s symptoms have greatly decreased following four weeks of taking the medicine, showing excellent drug adherence. Because the client’s response to the medicine was good when the dose was raised to 75 mg daily during the first evaluation, keeping the same dose for additional 12 weeks would be necessary Assessing and Treating Patients with Anxiety Disorders Paper.

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It is possible that ethical considerations might influence clinical judgments based on the patient’s socioeconomic background and the usage of multiple medications. When a patient is undergoing therapy, he must engage his family members in the practice to guarantee that they are supportive of him. This client should be closely monitored for weight gain as one of the possible negative effects of this medication. Due to his history of high blood pressure, which puts him at risk for heart attacks, the patient needs to notify the practitioner immediately he observes even the smallest change in his body weight Assessing and Treating Patients with Anxiety Disorders Paper.

References

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in psychiatry, 1412. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.595584/full?crsi=662497080&cicada_org_src=healthwebmagazine.com&cicada_org_mdm=direct

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

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Ärzteblatt international. https://doi.org/10.3238/arztebl.2018.0611

Wilson, T. K., & Tripp, J. (2018). Buspirone. https://europepmc.org/books/nbk531477

The Assignment: 5 pages

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL. Assessing and Treating Patients with Anxiety Disorders Paper

He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.

In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.

Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorder

RESOURCES

• Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0 Assessing and Treating Patients with Anxiety Disorders Paper

 

Decision Point One

                                                Select what you should do:

 

                                              Begin Paxil 10 mg po daily

                                         Begin Imipramine 25 mg po BID

                                            Begin Buspirone 10 mg po BID

 

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

 

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples Assessing and Treating Patients with Anxiety Disorders Paper.

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Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. Assessing and Treating Patients with Anxiety Disorders Paper

Your decision tree assignment will consider the treatment of a caucasian male with anxiety disorder. BACKGROUND INFORMATION The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL. He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at. In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26. Client has never been on any type of psychotropic medication. MENTAL STATUS EXAM The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation. You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26. Diagnosis: Generalized anxiety disorder RESOURCES § Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0 Decision Point One Select what you should do: Begin Paxil 10 mg po daily Begin Imipramine 25 mg po BID Begin Buspirone 10 mg po BID Decision #1 (1 page) • Which decision did you select? • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Conclusion (1 page) • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.