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