Assignment: Assessing and Treating Patients With Anxiety Disorders

Assignment: Assessing and Treating Patients With Anxiety Disorders

Walden University Assignment: Assessing and Treating Patients With Anxiety Disorders-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University  Assignment: Assessing and Treating Patients 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  Assignment: Assessing and Treating Patients With Anxiety Disorders

Whether one passes or fails an academic assignment such as the Walden University   Assignment: Assessing and Treating Patients 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  Assignment: Assessing and Treating Patients With Anxiety Disorders

The introduction for the Walden University   Assignment: Assessing and Treating Patients 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  Assignment: Assessing and Treating Patients With Anxiety Disorders 

After the introduction, move into the main part of the  Assignment: Assessing and Treating Patients 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  Assignment: Assessing and Treating Patients 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  Assignment: Assessing and Treating Patients 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.

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Sample Answer for Assignment: Assessing and Treating Patients With Anxiety Disorders

One of the most prevalent mental diseases among adults is an anxiety disorder, which is defined by a pervasive fear and worries that negatively affects the patient’s general well-being. Over 15% of Americans over the age of 18 had mild, moderate, or severe anxiety symptoms in 2018 according to the CDC (Garakani et al., 2020). Many treatment options, including both pharmacological and psychological therapy, have been created to help support the psychological health and well-being of those who have been diagnosed with the disease due to the increasing incidence of the mental disorder.

The case study that was provided describes a 46-year-old White man who claimed to be having a heart attack when he arrived at the emergency room. He spoke of feeling out of breath, his chest tightening, and a feeling of imminent doom. Also, he had a tonsillectomy when he was eight years old and has a history of mild hypertension. The client confesses to drinking. He received a score of 26 on the HAM-A scale. A generalized anxiety disorder may also be diagnosed based on the results of the mental state examination.

The majority of this patient’s care will be provided by medication, with the inclusion of other psychiatric therapies as necessary. However, several pharmacokinetic and pharmacodynamic factors will affect the medication selected for this patient. The patient had a number of these traits, including advanced age, being white, being obese, drinking alcohol, having a history of mild hyp

ertension, and having a HAM-A score of 26, which indicated GAD. The purpose of this paper is to describe how to make decisions that are successful in light of the patient’s characteristics as listed above, the outcome of the care, and any necessary adjustments to the treatment plan.

Decision #1

Selected Decision and Rationale

From the available treatment options, starting 10mg of Paxil orally once per day is the best course of action. Due to Paxil’s excellent effectiveness and desirable safety profile, which have been shown through evidence-based practice, the FDA has approved it for the management of anxiety-related conditions in adults. Paxil is a member of the SSRI family of drugs (Williams et al., 2020).

Past studies have demonstrated that paroxetine has a good effect on the management of anxiety-related conditions even at lower doses. It also has a strong tolerability profile, no associated risks of dependency, and is relatively safe even when used in excess (Carl et al., 2019). Due to the variant allele CYP2D6*4, the main polymorphism that results in decreased drug liver metabolism and thus improved systemic circulation, the medication is also suitable at modest dosages for Caucasians (Chen et al., 2019).

Imipramine should not be used to treat anxiety problems since studies have shown that it is ineffective and unsafe when compared to other options, especially given the patient’s advanced age (Garakani et al., 2020). Moreover, the medication has been related to weight gain, making it more difficult for the individual to control his weight gain. Contrarily, buspirone has a poor safety record in middle-aged and older people and should only be used in cases when there are no other, safer alternatives. Due to the patient’s concurrent alcoholism, utilizing this medication will only result in dependency (Slee et al., 2019).

Expected Outcome

For the next four weeks, the patient is expected to have at least a 50% reduction in symptoms, with self-limiting adverse reactions including headache and vertigo (Chen et al., 2019). The HAM-A score of the patient needs to be below 10.

Ethical Consideration

Legally, the PMHNP must safeguard the patient’s well-being and prevent harm. As a result, in addition to preserving the patient’s autonomy, it is important to adhere to ethical principles like beneficence and nonmaleficence when choosing the most successful treatment option (Slee et al., 2019).

Decision #2

Selected Decision and Rationale

The most advised approach at the moment was to increase the paroxetine dose to 20 mg orally once a day based on the individual’s reaction. According to clinical guidelines, the paroxetine dose should be increased at 10-mg intervals according to patient response, but not more than 50mg per day (Chen et al., 2019).

The initial intervention has reduced the individual’s anxiety symptoms during the last four to five days. She now has a HAM-A score of 18, as well. This confirms the drug’s great effectiveness and tolerability (Carl et al., 2019). No adverse effects were noticed, demonstrating an excellent safety profile. According to prior studies, the majority of people need up to 8–12 weeks to get the recommended dosage for the most effective management of GAD manifestations (Garakani et al., 2020). For best effectiveness, this medication had to be kept up and its dosage increased.

The clinical guidelines conflict with increasing the dosage to 40 mg, thus doing so is not appropriate. As a result, boosting the dosage with a large amount jeopardizes the patient’s ability to tolerate the medication (Williams et al., 2020). It is likewise wrong to keep taking the same medication at the same dose since the patient was unhappy with the results. Patient compliance with the medication will thus deteriorate since no additional effect on the treatment of anxiety symptoms is anticipated (Carl et al., 2019).

Expected Outcome

An increase in dose is anticipated to have even greater control over the patient’s anxiety symptoms because his chest pain and shortness of breath have already been treated (Chen et al., 2019). In light of this, it is expected that the HAM-A score will be lower than 10.

Ethical Consideration

The PMHNP now has to effectively inform the patient of the results and the following steps to involve him in health-related choices (Carl et al., 2019). Even if the nurse’s decision is best for the patient’s health, they must concur on the course of action to preserve the patient’s autonomy, which is essential for promoting positive outcomes.

Decision #3

Selected Decision and Rationale

The ultimate choice was to keep the patient’s paroxetine dosage same while keeping an eye on him or her for signs that they could require more anxiety-related medicine. The patient’s anxiety symptoms decreased by 61%, demonstrating excellent compliance with and tolerance for the medicine (Carl et al., 2019). Despite the fact that paroxetine is intended to treat all signs and symptoms of anxiety, research suggest that patients have reached the appropriate dosage upon reaching more than 50% of their symptoms resolved (Slee et al., 2019). In order to maintain the therapeutic effects and reduce the risk of long-term usage adverse effects, they should continue taking the drug at the same dosage and schedule (Hofmann & Hay, 2018).

At this point, there was no need to increase the dosage to 30 mg since the individual had already shown more than 50% symptom alleviation. A larger intake than the recommended amount is linked to more toxicity and negative effects (Williams et al., 2020). Only if the patient had shown just a minor effect even after receiving the full dose—which was not the case—would a different therapy have been considered. Because buspirone is associated with a high risk of tolerance, as was previously noted, it is not advised for this individual (Carl et al., 2019).

Expected Outcome

With continued paroxetine use at the same dosage, the patient is anticipated to have significantly more controlled anxiety symptoms, as shown by the astounding efficacy of the stated outcome (Chen et al., 2019). His HAM-A score ought to be around 7, which denotes little to no worry.

Ethical Consideration

The patient was satisfied with how the medication controlled her anxiety symptoms, based on the reported result (Williams et al., 2020). To enhance care outcomes, the caregiver must honor the patient’s liberty while also emphasizing the need of following to the treatment plan.

Conclusion

Anxiety disorders are among the most prevalent mental diseases that affect middle-aged and older people. Many signs of this mental illness put the patient’s health and well-being in danger. Nonetheless, several therapeutic approaches have been put forth in light of prior research showing their superior effectiveness in the treatment of this mental condition (Garakani et al., 2020). There are several considerations when selecting a medicine for a particular patient. In the offered case study, the patient’s initial treatment consisted of giving them paroxetine 10 mg once a day (Williams et al., 2020). The other two options weren’t viable because of their poor safety profiles and increased dependence issues (Slee et al., 2019). The patient was able to regulate his or her anxiousness with this strategy without experiencing any breathing difficulties or tightness in the chest. The dose was increased as a consequence to 20 mg once a day, as recommended by the majority of professional practice guidelines (Chen et al., 2019).

After taking 20 mg of paroxetine once a day for four weeks, the patient had more than 61% of their symptoms disappearing. Studies show that a patient has received the right amount of medication when their anxiety symptoms have decreased by more than 50%. (Carl et al., 2019). Because there were no side effects reported, the medication has an excellent safety profile. The patient was therefore instructed to keep taking the medication at the same dose to get even greater alleviation from anxious symptoms. For each choice chosen, the PMHNP made sure the patient was appropriately informed about all of the options, including both their positive and negative effects (Hofmann & Hay, 2018). The fact that the patient was involved in deciding which medicine to take into consideration also preserved his autonomy.

References

Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., Van Ameringen, M., Smits, J. A. J., & Powers, M. B. (2019). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 49(1), 1–21. https://doi.org/10.1080/16506073.2018.1560358

Chen, T.-R., Huang, H.-C., Hsu, J.-H., Ouyang, W.-C., & Lin, K.-C. (2019). Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis. Journal of Psychiatric Research, 118, 73–83. https://doi.org/10.1016/j.jpsychires.2019.08.014

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, 11(595584). https://doi.org/10.3389/fpsyt.2020.595584

Hofmann, S. G., & Hay, A. C. (2018). Rethinking avoidance: Toward a balanced approach to avoidance in treating anxiety disorders. Journal of Anxiety Disorders, 55, 14–21. https://doi.org/10.1016/j.janxdis.2018.03.004

Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Freemantle, N. (2019). Pharmacological treatments for a generalized anxiety disorder: a systematic review and network meta-analysis. The Lancet, 393(10173), 768–777. https://doi.org/10.1016/s0140-6736(18)31793-8

Williams, T., McCaul, M., Schwarzer, G., Cipriani, A., Stein, D., & Ipser, J. (2020). Pharmacological treatments for social anxiety disorder in adults: A systematic review and network meta-analysis. Acta Neuropsychiatrica, 32(4), 169-176. doi:10.1017/neu.2020.6‌

Sample Answer 2 for Assignment: Assessing and Treating Patients With Anxiety Disorders

Anxiety disorders are characterized by pathologically elevated levels of anxiety. One of the common anxiety disorders is generalized anxiety disorder (GAD). It is characterized by anxiety, tension, worry, and fears about various day-to-day events and problems. Patients with GAD experience difficulties controlling excessive worries (DeMartini et al., 2019). GAD’s excessive anxiety and worry cannot be accounted for by a medical condition or substance use. The purpose of this paper is to discuss the case scenario of a patient with an anxiety disorder and describe the treatment and ethical considerations that may impact treatment.

Case Overview

The case scenario portrays a 46-year-old white male referred by his PCP after visiting the ER due to the fear of having a heart attack. The client mentions that he experienced chest tightness, dyspnea, and a feeling of impending doom. He has a history of mild hypertension and is overweight by roughly 15 lbs, but the rest of his medical history is unremarkable. His EKG and physical exam findings were normal, and myocardial infarction was ruled out. The client reports that he still experiences chest tightness and episodes of dyspnea, which he calls anxiety attacks. He also has infrequent feelings of impending doom and a need to escape. He scores 26 on the Hamilton Anxiety Rating Scale and is diagnosed with GAD.

The patient factors that may influence medication prescribing include age, the severity of the patient’s GAD, treatment preferences, current medical condition and medications, and previous medication trials (DeMartini et al., 2019). The clinician needs to consider the patient’s current hypertension and overweight and prescribe a drug that will not aggravate the conditions.

Decision #1

Start Zoloft 50 mg orally daily.

Why I Selected This Decision

Sertraline, a selective serotonin reuptake inhibitor (SSRI), was chosen because it is the most cost-effective SSRI. It is also indicated in the first-line treatment of GAD in adults. Strawn et al. (2018) found that the potential side effects of Zoloft are relatively well-tolerated, which leads to a higher compliance rate and better patient outcomes.

Why I Did Not Select the Other Options

Imipramine was not an ideal choice because it is a 2^nd line therapy used when SSRIs are unsuccessful in alleviating GAD symptoms. Besides, Imipramine is associated with anticholinergic unpleasant side effects such as dry mouth, sedation, and constipation (Strawn et al., 2018). The side effects may contribute to a low compliance rate, which delays achieving the desired treatment effects. In addition, Buspirone was not ideal since it has no antipanic activity. Thus, it would not adequately alleviate the anxiety attacks in the client. Furthermore, Buspirone has a prolonged onset of action and is not recommended as monotherapy in treating GAD (Strawn et al., 2018).

What I Was Hoping To Achieve

I hoped that Zoloft would improve the GAD symptoms by at least 50% by the fourth week, and the HAM-A score would improve to 12. According to Garakani et al. (2020), SSRIs such as Zoloft have been established to be efficacious in treating anxiety disorders.

How Ethical Considerations May Impact the Treatment Plan

Ethical principles that may affect the treatment plan include beneficence (duty to do good) and nonmaleficence (duty to cause no harm) (Bipeta, 2019). The PMHNP upheld beneficence and nonmaleficence by prescribing Zoloft, which is associated with the best treatment outcomes and least side effects. The other drugs were not prescribed due to their associated treatment outcomes and side effects.

Decision #2

Increase Zoloft to 75 mg daily.

Why I Selected This Decision

The Zoloft dose was increased because the patient’s anxiety symptoms had not fully abated. Although he reported that the chest tightness and dyspnea had abated, he still experienced some degree of worry, and the HAM-A sore showed a partial response. Increasing the dose was thus an ideal choice to promote full remission of GAD symptoms (Strawn et al., 2018). Besides, the dose increase was gradual since it allows the PMHNP to monitor the drug’s side effects adequately.

Why I Did Not Select the Other Options

Increasing Zoloft to 100 mg was inappropriate since it is a high dose increase. Thus, it does not allow the clinician to effectively monitor the drug’s effect on the patient and its side effects. It is recommended that the dose is gradually increased to promote successful therapy. In addition, changing the dose was not ideal because the patient exhibited a partial treatment response to the initial dose. Treatment guidelines recommend that the drug be changed only when there is no positive response to therapy after eight weeks or adverse effects (Garakani et al., 2020).

What I Was Hoping To Achieve

I hoped that gradually increasing the dose would help to fully alleviate the depressive symptoms while at the same time monitoring the drug’s associated side effects. The initial dose of Zoloft is 25 to 75 mg daily, while the usual dose range is 50-200 mg daily (Garakani et al., 2020). Thus, 75 mg is an acceptable dose for this patient.

How Ethical Considerations May Impact the Treatment Plan

Nonmaleficence was upheld in this decision by gradually increasing the dose, which would allow the PMHNP to monitor the drug’s effect, thus preventing harm to the patient (Bipeta, 2019). Besides, beneficence was upheld by increasing the dose to promote complete remission of symptoms and better patient outcomes.

Decision #3

Maintain the current dose.

Why I Selected This Decision

The current dose was maintained at 75 mg because the patient demonstrated an adequate positive response to the dose. The patient reported a further decrease in the depressive symptoms with a 61% reduction in symptoms, and the HAM-A score improved to 10. Besides, there were no reported side effects, and thus, maintaining the dose was ideal to avoid adverse effects if the dose was increased (He et al., 2019).

Why I Did Not Select the Other Options

Increasing Zoloft to 100 mg was not an appropriate choice because the patient had an adequate positive response to the current 75 mg dose. Increasing to 100 mg may alleviate the symptoms further but poses the risk of side effects which may affect the drug compliance rate (He et al., 2019). Besides, an augmenting agent was not added to the plan because the patient had an adequate response with Zoloft monotherapy. Besides, monotherapy is highly recommended to prevent polypharmacy.

What I Was Hoping To Achieve

I was hoping that maintaining the dose would promote a progressive remission of the GAD symptoms and further improve the HAM-A score while at the same time causing no harm to the patient through side effects. Strawn et al. (2018) found that Zoloft continues to improve GAD symptoms over time regardless of a fixed dose.

How Ethical Considerations May Impact the Treatment Plan

The ethical principle of autonomy may impact the treatment plan if the patient does not consent to the medications or requests a change in treatment due to side effects. The PMHNP must obtain informed consent and explain the benefit of the prescribed medication and potential side effects (Bipeta, 2019).

Conclusion

The specific patient factors that may influence decisions on medication in the above patient include age, the severity of GAD, patient’s treatment preferences, current medical condition and medications, and previous medication trials. The patient was initiated with Zoloft 50 mg daily. The drug was selected because it is indicated as a first-line treatment in GAD and is associated with effective treatment outcomes (Strawn et al., 2018). Besides, it is associated with minimal side effects compared to Imipramine. Buspirone was not selected due to the lack of antipanic activity, which is crucial in managing the patient’s anxiety attacks. The initial dose led to a partial decrease in GAD symptoms, which led to increasing Zoloft to 75 mg daily (Strawn et al., 2018). The aim of this decision was to alleviate the GAD symptoms further. The dose was not increased to 100 mg daily to allow monitoring of side effects. Besides, the drug was not changed because the patient demonstrated a positive response to the initial drug, and no side effects were reported.

The patient’s symptoms decreased with Zoloft 75 mg with a 61% remission in symptoms. The dose was then maintained at 75 mg to allow for a progressive decrease in symptoms and monitoring of side effects. Augmentation was not recommended to avoid polypharmacy (Garakani et al., 2020). Ethical principles of beneficence and nonmaleficence influenced the treatment plan. The clinician selected medication known to have the best treatment outcomes and the least adverse effects to promote better health outcomes (Bipeta, 2019). Autonomy should also be respected by considering the client’s decisions when developing the treatment plan.

References

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals of internal medicine, 170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020

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://doi.org/10.1176/appi.focus.19203

He, H., Xiang, Y., Gao, F., Bai, L., Gao, F., Fan, Y., … & Ma, X. (2019). Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: a network meta-analysis. Journal of psychiatric research, 118, 21-30. https://doi.org/10.1016/j.jpsychires.2019.08.009

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

Sample Answer 3 for Assignment: Assessing and Treating Patients With Anxiety Disorders

Anxiety disorder is a serious mental disorder affecting the quality of life of most individuals globally. About 40 million adults in the United States over the age of 18 years are diagnosed with anxiety disorder each year. Most patients normally ignore the symptoms of anxiety disorder early in life, which ends up complicating their quality of life later. However, studies show that with early diagnosis, the symptoms can be adequately managed, promoting the patient’s well-being (Curtiss et al., 2017). Through evidence-based practice, several treatment options have been approved by the FDA for the management of patients diagnosed with anxiety disorder. In this paper, a middle-aged white male patient diagnosed with an anxiety disorder is managed with adequate reasoning behind the selection of individual treatment options. Both pharmacodynamic and pharmacokinetic factors affecting the choice of the psychotropic agents to utilize with the patient have also been elaborated.

The patient in the provided case scenario is a 46 years old white male who reported to the clinic complaining of anxiety symptoms. The current visit was as a result of a referral from an emergency room where he reported claiming to have a heart attack. Some of the symptoms displayed by the patient include chest tightness, shortness of breath, and the feeling of impending doom. The patient is overweight. He is also suffering from mild hypertension, which he manages appropriately with a low sodium diet. He has a history of surgery as his tonsils were removed at the age of 8 years. He confirms taking alcohol, about 3 to 4 beers a night to manage his stress. When Hamilton Anxiety Rating Scale (HAM-A) was administered, the patient displayed a score of 26. He however denies auditory or visual hallucinations or suicidal thoughts. His current primary diagnosis is generalized anxiety disorder (GAD).

 Decision Point One

Begin Zoloft 50 mg orally daily

Reason for Decision One

According to the FDA, the first-line treatment for GAD is selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (Sertraline). Zoloft is absorbed from the gastrointestinal tract very slowly with a peak serum level after between 6 to 8 hours. The metabolism of the drug is affected by genetic factors such as CYP2B6 and CYP2C19 with a half-life of 26 to 32 hours among white patients, just like the one in the provided case study (Strawn, Poweleit, & Ramsey, 2019). Among children, this half-life is reduced, increasing the frequency of administering the drug. However, the once-daily dose among adults promotes compliance among patients with proven effectiveness in remission of the patient’s symptoms within 8 to 12 weeks.

Imipramine could not be considered given that it is a tricyclic antidepressant mainly utilized among patients with depression (Curtiss et al., 2017). The psychotropic agent is also associated with elevated systolic blood pressure. Such BP makes it very dangerous for this patient as he is already suffering from mild hypertension.

Buspirone on the other hand is associated with cardiovascular side effects such as palpitations, chest pain, and increase heart rate, and hence could compromise the patient’s health status even further (Curtiss et al., 2017). The drug can also lead to weight gain, which is not necessary at the moment given that the patient is overweight.

Expected Outcome

Within four weeks, the patient is expected to report back to the clinic with more than 50% remission of symptoms such as shortness of breath and chest tightness. Consequently, he should have more hope in life with a reduced feeling of impending doom (Strawn et al., 2018). His HAM-A score will also reduce by more than 50%.

Ethical Considerations

Based on nursing legal and ethical considerations, PMHNP needs to consider the patient when making choices of which drug to use given that the patient is an adult (Strawn et al., 2018). He should be informed of all the expected outcomes for each option, both positive and negative.

Decision Point Two

Increase Zoloft dose from 50mg to 75mg PO daily

Reason Behind Decision 2

The first intervention displayed positive results with improved patient symptoms. His HAM-A score has also been reduced to 18. This outcome displays great tolerance and adherence to the treatment regimen, with a desirable safety profile given that no side effects were reported. Studies show that Zoloft can take up to 8 to 12 weeks to fully alleviate the patient’s symptoms. However, it is necessary to increase the dose at intervals of 25mg per week to promote its effectiveness, with a maximum dose of 200mg (Chen et al., 2019). Close monitoring of the patient will however be necessary to ensure that the drug does not cause adverse effects.

Increasing the Zoloft dose to 100mg was not necessary as evidence-based guidelines recommend increment at intervals of 25mg per week while monitoring the patient’s progress to avoid adverse effects (Williams et al., 2020). As a result, in case the 75 mg dose fails to elicit the desired effect with no symptoms, then this decision might be considered during the next visit.

With the great tolerance and adherence displayed by the patient, it is not necessary to replace Zoloft with another psychotropic agent (Williams et al., 2020). This will only lead to new symptoms which will compromise the patient’s life and affects his compliance with the treatment plan.

Expected Outcome

The patient is expected to report back to the clinic after 4 weeks with complete remission of the anxiety symptoms (Curtiss et al., 2017). His HAM-A score should also display normal to mile results of less than 8. He should restore his normal life just like before the diagnosis, with increased energy levels and interest in daily activities.

Ethical Considerations

PMHNP are encouraged to adopt patient-centered care to promote the adherence of the patient which promotes positive outcomes (Strawn et al., 2018). Given that the patient is quite impressed with the treatment outcome, the clinician must continue with the same regiment with an appropriately increased dose to promote healing and prevent harm for the patient.

Decision #3

Selected Decision

Maintain Zoloft 75mg PO daily and continue to monitor progress

Reason Behind Decision 3

Based on the treatment outcome of the last intervention, the patient seems to greatly tolerate the drug with a 61% reduction in anxiety symptoms. His HAM-A score also reduced to 10 which shows mild anxiety. Despite the expectation of 100% remission of symptoms, studies show that psychotropic agents which display more than 50% remission of symptoms with no side effects must be continued for an extended time to promote the quality of life and well-being of the patient. Consequently, EBP recommends the use of Zoloft for about 8 to 12 weeks for the complete remission of symptoms (Williams et al., 2020). As such, it is necessary to maintain the 75mg dose for another four weeks while monitoring the patient to promote health and reduce harm.

Increasing the dose to 100 mg is not necessary as this will only result in side effects that will compromise the patient’s health (Williams et al., 2020). High doses of Zoloft have been associated with several side effects such as fatigue, skin rash, dizziness, and insomnia.

Just as mentioned earlier, buspirone is not necessary whether as an adjunct therapy or replacing Zoloft, as this will lead to additional side effects as a result of a high risk of cardiovascular complications (Curtiss et al., 2017). This approach could only be considered when the patient displayed ineffectiveness to Zoloft as monotherapy.

Expected Outcome

The patient is expected to display complete remission of symptoms with no side effects in the next week as a result of previously displayed tolerance to the psychotropic agent. He should be able to report to work as normal, with no fear for his boss (Williams et al., 2020). His HAM-A score should also display results less than 8. He should enjoy his normal life with restored interest and energy.

Ethical Considerations

When managing patients with a mental disorder, the clinician needs to earn the trust of the patient to improve compliance (Williams et al., 2020). Satisfaction of the patient with a positive treatment outcome, just like in the case discussed above boosts the patient’s trust in the clinician, leading to an even further desirable outcome.

Conclusion

Anxiety disorder is a serious mental disorder ignored by most people in its early stages until when the patient’s quality of life is affected. However, studies show that with early treatment, the patient’s mental health can be restored. Several treatment options have however been provided with different outcomes in different patients. As such, several pharmacodynamic and pharmacokinetic factors are normally taken into account when deciding on what psychotropic agent to use with which patient (Strawn, Poweleit, & Ramsey, 2019). The first choice in managing the assigned patient is initiating Zoloft 50mg which is FDA approved as the first line for management of GAD. Factors such as the patient’s race, hypertension, and overweight were considered before making this choice. Consequently, the other two options could compromise the patient’s health (Chen et al., 2019). The patient displayed a positive outcome with great tolerance, which contributed to the second decision being increment of the dose to 75mg per day. This decision led to a 61% reduction of the patient’s symptoms within four weeks. The patient reported no side effects and was happy with the progress. As such, the last decision was to maintain the dose for another week for further remission of the patient’s symptoms (Curtiss et al., 2017). Studies show that it takes up to 8 to 12 weeks to display the complete effectiveness of Zoloft in managing anxiety disorders.

Several ethical considerations come across during the treatment of the patient’s condition. The patient being an adult gives him the right of making decisions concerning his health (Williams et al., 2020). Hence the PMHNP must ensure that the patient is well educated about the treatment options and their positive and negative outcome for him to be able to make contributions towards decisions concerning his health. Consequently, the patient must be educated on the need for psychotherapy to promote treatment outcomes.

References

Chen, T. R., Huang, H. C., Hsu, J. H., Ouyang, W. C., & Lin, K. C. (2019). Pharmacological and psychological interventions for generalized anxiety disorder in adults: A network meta-analysis. Journal of psychiatric research, 118, 73-83. DOI: 10.1016/j.jpsychires.2019.08.014

Curtiss, J., Andrews, L., Davis, M., Smits, J., & Hofmann, S. G. (2017). A meta-analysis of pharmacotherapy for social anxiety disorder: an examination of efficacy, moderators, and mediators. Expert opinion on pharmacotherapy, 18(3), 243-251. DOI: 10.1080/14656566.2017.1285907

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. DOI: 10.1080/14656566.2018.1491966.

Strawn, J. R., Poweleit, E. A., & Ramsey, L. B. (2019). CYP2C19-guided escitalopram and sertraline dosing in pediatric patients: a pharmacokinetic modeling study. Journal of child and adolescent psychopharmacology, 29(5), 340-347. DOI: 10.1089/cap.2018.0160

Williams, T., McCaul, M., Schwarzer, G., Cipriani, A., Stein, D. J., & Ipser, J. (2020). Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis. Acta neuropsychiatric, 32(4), 169-176. DOI: 10.1017/neu.2020.6