Assessing and Treating Clients with Anxiety Disorders
Walden University Assessing and Treating Clients with Anxiety Disorders-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University Assessing and Treating Clients with Anxiety Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for Assessing and Treating Clients with Anxiety Disorders
Whether one passes or fails an academic assignment such as the Walden University Assessing and Treating Clients with Anxiety Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for Assessing and Treating Clients with Anxiety Disorders
The introduction for the Walden University Assessing and Treating Clients with Anxiety Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for Assessing and Treating Clients with Anxiety Disorders
After the introduction, move into the main part of the Assessing and Treating Clients with Anxiety Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for Assessing and Treating Clients with Anxiety Disorders
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for Assessing and Treating Clients with Anxiety Disorders
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
Stuck? Let Us Help You
Completing assignments can sometimes be overwhelming, especially with the multitude of academic and personal responsibilities you may have. If you find yourself stuck or unsure at any point in the process, don’t hesitate to reach out for professional assistance. Our assignment writing services are designed to help you achieve your academic goals with ease.
Our team of experienced writers is well-versed in academic writing and familiar with the specific requirements of the Assessing and Treating Clients with Anxiety Disorders assignment. We can provide you with personalized support, ensuring your assignment is well-researched, properly formatted, and thoroughly edited. Get a feel of the quality we guarantee – ORDER NOW.
Anxiety disorders refer to a series of mental disorders, which are characterized by excessive episodes of fear. These conditions usually result from worry about an anticipated future event (Lissek et al., 2014). The symptoms of anxiety disorder are quite similar to heart attack making the diagnosis challenging. However, with a proper review of symptoms, nurses can come up with an effective care plan for the patient. For instance, in the case provided, the 46-year-old white male reported to the emergency unit thinking that he was suffering from a heart attack. The patient reported symptoms of chest tightness, shortness of breath and sensations of impending doom. He has a history of mild hypertension, which was managed with a low sodium diet. Even though he is 15lbs overweight, his EKG is normal, and hence myocardial infarction was ruled out in the emergency room. He claimed that he has been using ETOH for the management of work-related stress, while at the same time taking about 3-4 beers every night. A rating using the HAM-A scale yielded 26, which indicates that the patient is suffering from Generalised Anxiety. Therefore, the primary aim of this paper is to review the patient’s case scenario and come up with medications that can be applied in the successful management of the generalised disorder why considering factors affecting the pharmacodynamics and pharmacokinetics of the elected drug regimen. Moreover, psychiatric practice nurses have to take into account the ethical aspect of prescription while formulatin
g a pharmacotherapy for any mental health patient.
Decision Point One
Selected Decision
Initiate patient on Zoloft 50 mg PO daily
Reason for Selection
In the management of generalized anxiety disorder, the first decision is normally to administer Zoloft 50mg orally twice a day. Zoloft is a selective serotonin reuptake inhibitor (SSRI) used in the management of several mental disorders, including anxiety and depression and is also associated with minimal severe side effects. Consequently, the patient has not been using any other psychotropic drugs before, and it is advisable to start such patients on less active psychotropic agents such as Zoloft, which can clear the patient’s symptoms quite faster (Rothschild, 2014). This drug takes 26 hours to be eliminated from the system hence implying that its OD administration makes it safe. Further, the fact that it achieves its steady state a week into its administration makes it an effective medication for the present condition.
Tricyclic antidepressants such as Imipramine, while more effective than SSRIs, have a longer duration of action, and hence can potentiate their adverse effects for an extended time. Imipramine has also been associated with several side effects such as increased heart rate, changes in EKG and low blood pressure (Stahl, 2013). These side effects disqualify the use of the drug given the patient history of heart problems. Buspar is classified as a drug for the management of generalized anxiety disorder by the FDA (Rothschild, 2014). Ideally, it is not a GABA receptor analog and will thus elicit lower withdrawal symptoms. The drug is however metabolized slowly, and hence a twice a day dose might be of higher concentration, hence high toxicity. This leaves as with Zoloft 50mg twice a day as the best choice of drug in managing the patient’s generalized anxiety disorder.
Expected Results
With Zoloft, the expected results at the prescribed dosage of 50 mg twice a day was an overall reduction in the symptoms of generalized anxiety disorder within 2 to 4 weeks. The client was expected to return with at least a 50% remission rating on the HAM-A scale. By the end of week four, the patient is expected to report a reduction of fears concerning works and nervousness (O’Hara et al., 2019). The symptoms of anxiety such as constriction in the chest and breathlessness should improve by the end of week four.
Differences between Expected Results and Actual Results
The patient returned to the clinic after four weeks reporting that the feeling of shortness in breath and chest constriction had improved. Consequently, he reported that he had a reduced amount of concerns and worry about his work. However, a check on the HAM-A scale indicated a reading of 18 from the previous 26, which is less than the expected 50%. The results are modest but do not meet the expectation of the treatment.
Decision Point Two
Selected Decision
Increase the Zoloft dose to 75 mg PO twice a day
Reason for Selection
Given that the drug was active in its action, it is recommendable that the dosage is increased to 75mg orally daily. The rationale behind this decision is that at a lower dose, Zoloft had reduced the symptoms of chest tightness and shortness of breath by some degree but not entirely (Nojoumi, Ghaeli, Salimi, Sharifi, & Raisi, 2016). It thus follows that a higher concentration would diminish the symptoms even further. Previous studies show that Zoloft among other SSRIs can be administered progressively until a maximum level that deliberates for maximum benefit to the patient. Increasing the dose to 100mg is not recommended, as the dosage for psychotropic medications is often to be increased progressively while observing physiological reactions to avoid undesired effects (Cuijpers et al., 2014). Also, maintaining the dose at 50mg PO twice daily will have no improvement. Thus, the correct decision is to increase the dosage to 75 mg.
Expected Results
The expected outcome of the increased dosage to 75mg was complete elimination of symptoms of chest tightness, shortness of breath and feelings of fear within 2 to 4 weeks (Bernik et al., 2018). Other symptoms that are associated with a generalized anxiety disorder are also expected to be resolved entirely within this time.
Differences between Expected Results and Actual Results
The client, however, came back to the clinic after four weeks with an overall symptom reduction of 61% according to the HAM-A scale. This is particularly below the anticipated outcome, but still a significant improvement in the patient’s condition. However, the drug was effective in managing the patient’s condition, and it is believed that with time, it would be expected that the body will be able to fully adapt to the concentrations of the drug and a complete remission the symptoms will be achieved.
Decision Point Three
Selected Decision
Continue Zoloft dose to 75 mg PO twice a day
Reason for Selection
Psychotropic agents can have increased effects within a maintained optimum dosage. A dosage that can clear up to 50% of the associated symptoms of a condition with no associated side effects can be maintained as an optimal therapeutic dose and will be able to clear the symptoms fully with time (Rothschild, 2014). This way, it is suggested that the dose of Zoloft be maintained at 75mg PO daily. It is also recommended that the client include non-pharmacological measures such as watching his diet and weight patterns as the drugs may have reduced effectiveness in people who are overweight. It is not advisable to increase the dosage to 100mg PO daily, as the previous dosage was already effective, and an increase in dose may elicit undesired side effects.
Expected Results
It is anticipated that the ongoing dosage will continue being effective in managing the patient’s condition. After 2 to 4 weeks, the patient is expected to come back to the clinic with full remission of symptoms of chest tightness and shortness of breath (O’Hara et al., 2016). It is also expected that he will no longer be nervous about work.
Differences between Expected Results and Actual Results
After four weeks, the client came back to the hospital, with fully resolved symptoms. He no longer complained of shortness of breath, or chest tightness or fear. This outcome perfectly matched the expectation of the maintained dosage to clear the symptoms relating to generalized anxiety disorder entirely.
Effect of Moral Contemplations on the Therapy Proposal
In managing anxiety, there are often several ethical concerns that relate to both the patient and the drugs that will be offered in the management of the mental condition. For instance, there is no single drug designated for anxiety in its numerous levels and forms, and the management procedures have to be proved through trials and ‘experimentation’ on how the patient will react to the intervention (Baldwin et al., 2014). Dosage modifications may also have the patients nervous and raise concerns that the patients will frequently need to be counseled on the reasons for various medical adjustments. Patient education on their disorder is yet another aspect that needs to be considered. Once a patient is fully aware of their mental condition, it might ideally be easier for them to admit and manage it in the available numerous medically viable ways. Their ability to decide on the situation should also be assessed and considered in the treatment process.
Conclusion
From the provided case study on general anxiety disorder, many indicators are evident. Some of the main indications are the same as heart attack among other medical problems. Anxiolytic treatment is multifaceted and comprises several thoughts relating to ethical hitches in health care. SSRIs are a group of drugs vital and operative in the treatment of anxiety disorders. The importance of learning about first-line agents in the treatment of anxiety disorders before the initiation of the second-line agents, in addition to observing other interventional options is perfectly noted.
References
Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., … & Malizia, A. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder, and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 28(5), 403-439.
Bernik, M., Corregiari, F., Savoia, M. G., Barros Neto, T. P. de, Pinheiro, C., & Neto, F. L. (2018). Concomitant treatment with sertraline and social skills training improves social skills acquisition in social anxiety disorder: A double-blind, randomized controlled trial. PLoS ONE, 13(10), 1–18. https://doi.org/10.1371/journal.pone.0205809
Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical psychology review, 34(2), 130-140.
Lissek, S., Kaczkurkin, A. N., Rabin, S., Geraci, M., Pine, D. S., & Grillon, C. (2014). Generalized anxiety disorder is associated with overgeneralization of classically conditioned fear. Biological Psychiatry, 75(11), 909-915.
Nojoumi, M., Ghaeli, P., Salimi, S., Sharifi, A., & Raisi, F. (2016). Effects of Passion Flower Extract, as an Add-On Treatment to Sertraline, on Reaction Time in Patients with Generalized Anxiety Disorder: A Double-Blind Placebo-Controlled Study. Iranian Journal of Psychiatry, 11(3), 191–197. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=117911534&site=ehost-live
O’Hara, M. W., Pearlstein, T., Stuart, S., Long, J. D., Mills, J. A., & Zlotnick, C. (2019). A placebo controlled treatment trial of sertraline and interpersonal psychotherapy for postpartum depression. Journal of Affective Disorders, 245, 524–532. https://doi.org/10.1016/j.jad.2018.10.361
Rothschild, A. J. (2014). The evidence-based guide to antipsychotic medications. Washington, DC: American Psychiatric Pub.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Anxiety disorders refer to a group of mental disorders that affect a significant proportion of the world’s population. Individuals suffering from these disorders experience significantly elevated levels of fear. They also experience elevated worry concerning future or expected occurrences. Often, healthcare providers might face a challenge in differentiation between anxiety disorders and heart attack due to the closely related symptoms in these conditions (Timulak & McElvaney, 2017). Therefore, a careful review of the symptoms should be undertaken to determine the exact cause of the patient’s problem. The provided case for this assignment is an adult patient who came to the emergency department thinking that he had a heart attack. This could be seen from the symptoms he presented with such as dyspnea, tightness of the chest, and feelings of impending doom. A careful examination of the patient revealed that the EKG was normal with HAM-A scale of 26, which implies that he is suffering from anxiety disorder rather than heart attack. Consequently, this research paper explores the decision pathways that can be adopted to manage the patient’s anxiety disorder.
Decision Point One
Selected Decision
The selected decision for point one would be starting the patient on Zoloft 50 mg PO BD daily
Reason for Selection
The first decision in managing the client’s health problem is the administration of PO Zoloft 50 mg BD for 2/7. This decision was reached due to the existing evidence that demonstrates the effectiveness of Zoloft in the management of general anxiety disorder. According to McKay, Abramowitz and Storch (2017), Zoloft belongs to a group of drugs called selective serotonin reuptake inhibitors. It works by blocking the reuptake of serotonin at the receptor sites. The selectivity of Zoloft has made it an effective agent against conditions that include depression and anxiety disorders. The decision to consider it was also informed by the fact that its use is associated with minimal adverse effects to the patient. It can be seen from the case that the patient does not have any history of use of psychotic medication. As a result, it would be advisable to start him with Zoloft since it can result in faster resolution of the symptoms that the patient is experiencing.
The use of Imipramine can be considered for managing the condition of the patient. This drug belongs to the class of Tricyclic antidepressants, which have been shown to be more effective than selective serotonin reuptake inhibitors. However, Imipramine is not an alternative medicine to use in this patient due to its prolonged duration of action, which might increase the patient’s vulnerability to adverse effects of the drug. The drug can also potentiate the risk of adverse outcomes such as tachycardia and abnormal EKG findings. Therefore, Imipramine is not an effective alternative drug for this patient. Buspar has also been shown to be effective in the management of general anxiety disorders. However, its use is not recommended in this patient due to its slow metabolism, which can raise toxicity associated with it (McKay et al., 2017). Consequently, Zoloft remains the best alternative drug to prescribe to this patient, as it has enhanced safety and efficacy when compared to the rest.
Expected Results
The use of Zoloft is expected to result in a reduction in the symptoms that the patient presented with to the emergency unit. It is estimated that the use of the drug will result in a 50% decline in the symptoms with a significant reduction in fears by the end of four weeks. Therefore, the client’s quality of life is anticipated to improve by this time.
Differences between Expected Results and Actual Results
The client was booked for a follow-up clinic visit at four weeks. He reported that there was a significant reduction in dyspnea, chest tighteness, and fear. He was now able to focus on his work. There was also a reduction of HAM-A scale to 16 from 26. Therefore, the outcome revealed moderate effectiveness of the intervention, hence, making it a desirable approach to treating generalized anxiety.
Decision Point Two
Selected Decision
The second decision point I would consider is increasing the dosage of Zoloft to 75 mg BD twice a day.
Reason for Selection
The above analysis revealed that Zoloft is effective in treating the symptoms of the patient. It would therefore be necessary to raise the dosage of the drug to 75 mg PO BD for two days. The consideration for this decision is informed by the fact that the initial dosage resulted in the reduction of symptoms of chest tigheness and dyspnea. However, the symptoms have not resolved completely. As a result, raising the dosage will imply a further reduction in the prevalence of these symptoms. Evidence has demonstrated that drugs in the group of selective serotonin reuptake inhibitors can be raised in dosage to maximum to enhance the recovery process. However, raising the dosage to 100 mg is not desirable since it might result in adverse reactions that might affect the health and wellbeing of the patient (MacKillop et al., 2017). Therefore, maintaining the dosage to 50 mg PO BD might not lead to any improvement in the symptoms.
Expected Results
The main aim of raising the dosage of medication to 75 mg was to cause a complete resolution of symptoms the patient was experiencing. It is anticipated that there will be complete resolution after a period of two to four weeks. Similarly, other symptoms such as fear and others associated with the disorder are expected to have resolved by this time.
Differences between Expected Results and Actual Results
The client was scheduled for a follow-up visit after 4 weeks. The client reported a significant reduction in symptoms of chest tightness and shortness of breath. However, there was an improvement of the HAM-A scale to 63%. This was below the expected level as per the treatment guidelines. However, the symptoms are expected to resolve further as the client adapts to the high dosage of the medication.
Decision Point Three
Selected Decision
The selected decision in point three is to continue the use of Zoloft 75 mg PO BD.
Reason for Selection
The effects of Zoloft increases with sustained optimum dose in managing the generalized anxiety disorder. This is seen in the use of psychotropic drugs where the therapeutic effect of the medication rose with sustained optimum dosage. Therefore, the dosage of the Zoloft should be maintained with the anticipation of continued therapeutic effect of the drug. It is however important at this stage that the client incorporates the use of non-pharmacological interventions in managing the symptoms of the disorder. This is important in preventing relapse of the symptoms (Watson & Greenberg, 2017). The dosage should not be raised to 100 mg PO OD since it increases the risk of adverse effects with the drug.
Expected Results
It is expected that the prescribed regimen will result in complete resolution of the symptoms of the disease. Therefore, the client will report no symptoms of the disorder within the next 2-4 weeks.
Differences between Expected Results and Actual Results
The client came back to the clinic after four weeks. He reported complete recovery from the symptoms. As a result, maintance of optimum dosage of Zoloft was found to be effective in promoting effective management of general anxiety disorder in medium and long-term.
Effect of Moral Contemplations on the Therapy Proposal
The management of anxiety is associated with significant ethical concerns. This can be seen from the lack of adequate evidence on a drug that can be used to treat anxiety effectively. There is also conflict in management where combined therapies have been shown to be effectiove in managing the disorder. However, it raises the risk of drug toxicity and adverse effects. The constant need for modifying dosage of the drugs also raises concerns among the patients on their response to treatment. In this case, healthcare providers have to provide regular health education on the need for the modifications and potential health effects of the adopted decisions (MacKillop et al., 2017). Therefore, optimum outcomes can be achieved with a consideration of patient adherence to treatment as well as maximization of treatment methods with few side effects to the patient.
Conclusion
In summary, the management of general anxiety disorder can be a challenging process for the patient and healthcare providers. This can be seen from the increased risk of misdiagnosis due to resemblance in symptoms of the disorder with those of heart failure. However, the case study has revealed that the use of Zoloft is effective in treating general anxiety disorder. The dosage should maintained at a maximum to result in sustained therapeutic effect in the long-term. Therefore, healthcare providers should prioritize the use of first line drugs in managing the disease followed by second and third line medications.
References
MacKillop, J., Kenna, G. A., Leggio, L., & Ray, L. A. (Eds.). (2017). Integrating Psychological and Pharmacological Treatments for Addictive Disorders: An Evidence-based Guide. Taylor & Francis. McKay, D., Abramowitz, J. S., & Storch, E. A. (Eds.). (2017). Treatments for Psychological Problems and Syndromes. John Wiley & Sons.
Timulak, L., & McElvaney, J. (2017). Transforming generalized anxiety: An emotion-focused approach. Routledge.
Watson, J. C., & Greenberg, L. S. (2017). Emotion-focused therapy for generalized anxiety. American Psychological Association.