Case Study – Anxiety Disorders Discussion
The most common mental disorders, impacting approximately 40 million individuals in the United States today, include anxiety disorders (Bystritsky, et al., 2013). Anxiety symptoms can be almost as crippling, but they are less debilitating than most mental health disorders such as bipolar disorder, depression, and schizophrenia. A split within the mental health and psychological culture on how to categorize anxiety disorders existed before the launch of the 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Within the large category of anxiety disorders, the American Psychiatric Association (APA) identifies the following: panic disorder, social anxiety disorder (SAD), and generalized anxiety disorder (GAD) (Bandelow et al., 2017). This paper seeks to address Suit the local, a 23-year-old Hispanic woman who is raising concerns about feelings of being on the edge, restlessness, and increased exhaustion. Details would be discussed regarding L.P.’s diagnosis, pharmacotherapeutic objectives, monitoring parameters, adverse effects, and long-term prognosis. Case Study – Anxiety Disorders Discussion
Diagnosis
Generalized anxiety disorder (GAD) is possibly the condition that L.P is suffering from. Generalized anxiety disorder is a continuous anxiety condition with worries over multiple activities or feelings that are broadly understood as inappropriate and abnormal by the patient (Stein & Sareen, 2015). The patient’s fear can be debilitating and cause functional loss and distress. GAD can impact many realms and put at risk the health, career, and finances of the patient (Stein & Sareen, 2015). Gastrointestinal problems, body aches, headaches, restlessness, fatigue, and insomnia are physical symptoms commonly linked to GAD. There are many scales used to measure the seriousness of GAD, and the most widely used is GAD-7. The higher the GAD-7 rating, the greater the patient’s physical disability.
Numerous factors, such as endocrine conditions, neurohormone functions, genetic abnormalities, and abnormal reactions to traumatic circumstances, are believed to cause GAD. It is important to rule out health problems that can trigger related manifestations like pheochromocytoma, hyperthyroidism, or hyperparathyroidism when assessing a patient for possible anxiety disorders (Stein & Sareen, 2015). GAD is regarded as an exemption diagnosis, meaning that before establishing an anxiety diagnosis, medical conditions ought to be eliminated (Bandelow et al., 2017).
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Pharmacotherapy Goals
The primary purpose is to alleviate the nervousness and anxiety that L.P experiences. In addition, another aim is to enhance L.P’s quality of life and enable her to get her daily routine back. The aim of administering medicine is to give the patient a relaxed state. The CNP should administer the drug that would not make the L.P feel dizzy during the day because she is a working individual.
Lab Testing
For a patient getting treated for GAD, proper laboratory testing is essential. Most medicines are taken up in the kidneys or liver. In order to determine normal hepatic and renal function, the patient ought to have a comprehensive complete metabolic panel taken. There can also be a drug screening, thyroid function tests, urine tests, and complete blood count (CBC). L.P should be encouraged to arrange regular appointments to see her healthcare provider. L.P would require to be checked regularly in the early stages and should be set for weekly visits. If symptom relief takes effect, visits should be shifted to weekly, then quarterly if SSRI’s are administered to L.P. She should be informed that for six weeks, she may not achieve the improvement of the symptoms. Even if she feels stronger, particularly if given SSRIs, she should also be told about the necessity of not withdrawing from her drugs. Severe adverse effects may arise including a severe regression in symptom control if SSRIs are suddenly halted without being tapered gradually. L.P should also undergo blood glucose screening and heart function tests in addition to the tests specified above (Bandelow et al., 2017). Other monitoring involves evaluating the patient for severe fatigue, syncopal incidents, and bradycardia if SSRIs are administered. Case Study – Anxiety Disorders Discussion
Drug Therapy
When the symptoms are moderate, intermittent, without any accompanying disability in occupational and social functionality, not all patients suffering from GAD need medication (Locket al., 2015). First-line treatment involves antidepressant medication where pharmacotherapy is needed which includes either a selective serotonin noradrenaline reuptake inhibitor (SNRI) like duloxetine or venlafaxine or a selective serotonin reuptake inhibitor (SSRI) like duloxetine, paroxetine, or sertraline (Locke et al., 2015). SSRIs tend to raise serotonin levels, thereby generating feelings of calmness, joy, and relaxation (Bandelow et al., 2017).
Benzodiazepines are also widely used to treat GAD and work on the GABA-benzodiazepine receptor, leading to anterograde amnesia, problems with concentration, and sedation (Gillatio, 2010). Benzodiazepines do not alleviate anxiety by itself, but by lowering worry and getting rid of physical symptoms such as muscle pain, they help to reduce anxiety (Gomez et al., 2018). Because of elevated levels of dependency that can lead to prolonged usage, care should be ensured when using benzodiazepines. The primary treatment goal for GAD should involve symptom relief, whereas symptom remission, which involves both functional dysfunction and symptom resolution, is the long-term focus.
Success of Therapy
The patient receiving significantly substantial relief or removal of generally related symptoms like worry, panic, and anxiety determines the success of GAD treatment. L.P should be empowered to have insight into how she thinks her present treatment plan is fairing on. In order for the medical practitioner to make medication adjustments if needed, the patient should also be empowered to mention any adverse reactions she may experience. It may entail modifications in L.P’s drugs attributable to often experienced side effects while seeking to accomplish effective symptom relief.
In GAD care and management, the use of combined therapy with behavioral therapy and pharmacotherapy has been found to be the most efficient (Locke et al., 2015). Behavioral therapy offers mechanisms of calming, problem-solving, cognitive restructuring, all of which have demonstrated to be effective. L.P can try to handle her reaction to stimuli through behavioral therapy to regain self-control. Endorphins are known to be produced by physical exercise, and can cause feelings of happiness and enjoyment, which eventually results in an effective treatment strategy for the patient.
Monitoring for Medication Therapy
The patient should be observed for compliance with medication when using SSRI’s. The majority of persons report minimal side effects if there are any. Blurred vision, dizziness, reduced sex drive, difficulty in achieving an orgasm are typical side effects to watch for in women. The patient will have to be examined every two weeks after the drug is first administered to assess whether or not the medication is effective.
Adverse Reactions
There are adverse effects that can arise after taking Benzodiazepine, including anterograde amnesia, difficulty focusing, and sedation. There are some outcomes that one does not experience, and the CNP should be notified if any of these problems arise, and the drug should be discontinued and another medication will be administered. If L.P begins to experience suicidal feelings, panic attacks, or severe anxiety, the CNP should be promptly told so that a different treatment can be initiated.
Klonopin Therapy
Klonopin is a kind of benzodiazepine-classified anti-anxiety drug. Because of its tranquilizing, relaxing, and sedating nature, it is sometimes called a tranquilizer or sedative. Loss of balance, dizziness, lightheadedness, and drowsiness, are typical side effects associated with this medication (Frye, 2016). The related addictive properties are, like most benzodiazepines, extremely taken into account when administering for prolonged usage. If L.P demonstrates a reliance on Klonopin, it may become impossible to discontinue the drug treatment because withdrawal effects could arise (Frye, 2016). Usual indications of withdrawal comprise irritability, vomiting, tremors, convulsions, and anxiety. All benzodiazepines, like Klonopin, decelerate the central nervous system, therefore if using Klonopin, L.P should be informed against drinking alcohol and using substances. The use of Klonopin can be avoided if L.P will accomplish symptom control by using other non-addictive medications. Case Study – Anxiety Disorders Discussion
Health Promotion
L.P notes that she is always healthy and cares about herself. To maintain this way of living, she should be motivated to regain it. It is necessary to encourage a healthy balanced diet and fitness regime. The use of psychotherapy as therapy can also be promoted as it will enable her symptoms to be managed and she will maintain a happier and fulfilling life. L.P should be advised to take medicine as required and, as indicated, and continue to maintain follow-up visits.
Long-Term Prognosis
The prognosis for individuals with generalized anxiety disorder can be better if they can obey their treatment strategy and follow all drugs as directed. There are usually bad effects in patients that are not treated, which may include suicidal thoughts and severe depression (Stein & Sareen, 2015). L.P.’s long-term prognosis is good with constant supervision from her health practitioner. Behavioral therapy should be continued and strategies to relieve stress should be applied.
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Conclusion
Generalized anxiety disorders are highly underdiagnosed and undertreated. it is a mental health condition that, with adequate care and treatment, can be successfully controlled. Patient involvement in their treatment plan and encouraging them to take an involved part in their decisions of treatment greatly increase their performance and results in a better opportunity to lead a happy and fulfilling life.
References
Bandelow, B., Michaelis, S., & Wedekind, D. (2017, June). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93-107
Bystritsky, A., Khalsa, S., Cameron, M., & Schiffman, J. (2013, January). Current diagnosis and treatment of Anxiety Disorders. Managed Care and Hospital Formulary Management, 38(1), 41-44, 57.
Frye, K. (2016). Taking Klonopin for panic disorders. Retrieved from www.webmd.com
Gomez, A. F., Barthel, A. L., & Hofmann, S. G. (2018). Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review. Expert opinion on pharmacotherapy, 19(8), 883-894.
Locke, A., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. American Family Physician, 91(9), 617-624.
Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059-2068. Case Study – Anxiety Disorders Discussion