Assessing and Treating Clients with Anxiety Disorders
Assessing and Treating Clients with Anxiety Disorders
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
Assessing and Treating Clients with Anxiety Disorders
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
Assessing and Treating Clients with Anxiety Disorders
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
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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.