Managing patients with generalized anxiety disorder essay paper
Managing patients with generalized anxiety disorder essay paper
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is a common psychiatric presenting with excessive worry and anxiety over several events or activities, restlessness, irritability, fatigue, loss of concentration, insomnia, and muscle tension (DeMartini, et al, 2019). Its prevalence is about 30% in the United States of America. The onset of generalized anxiety disorder is between the age of 11years to 20years. Generalized anxiety disorder has a high rate of comorbidity with a depressive mood disorder, alcoholism, and substance abuse. Managing patients with generalized anxiety disorder essay paper
This patient presents with chest tightness, hypertension, episodes of shortness of breath, and a feeling of impending doom. He also complained of feeling anxiety attacks, taking alcohol to combat worries about work, and fears for his job. The patient initially presented with symptoms of a panic attack. A panic attack is a psychiatric condition that presents with spontaneous onset of fear. However, his mental state examination is suggestive of generalized anxiety disorder due to his “blah” mood, he endorses the feeling of nervousness, his affect is blunted, and brightens several times during the interview. His score of 26 on the Hamilton Anxiety Rating Scale suggests severe anxiety disorder.
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Pharmacotherapeutic agents effective in treating generalized anxiety disorders are selective serotonin agents and tricyclic antidepressants (DeMartini, et al, 2019). The three pharmacological decisions for this patient help restore the psychological function of the patient. The decisions made will include the reason for the decision selected, the reason for omitting the other two decisions, the expected outcome of the decision made, and the ethical consideration that impact the treatment plan.
Decision one
Begin paxil 10mg PO daily
Reason For Selecting This Decision
Paxil is a selective serotonin inhibitor FDA approved for generalized anxiety disorder, panic attack, obsessive-compulsive disorder, and post-traumatic stress disorder (Yang, et al, 2018). Paxil is taken orally at a dose of 10mg once a day. Its dosage can be titrated upwards to achieve the desired therapeutic effect, depending on the patient’s ability to tolerate the drug. It increases the synaptic serotonin concentration by blocking the serotonin reuptake. The drug also has a high affinity for muscarinic and dopaminergic receptors that contribute to its antidepressant side effects. Common side effects are emotional flattening, extrapyramidal symptoms, weight gain, and tachycardia. Paxil is the best choice for this patient because it has an immediate-release formulation that is effective for generalized anxiety disorder. Managing patients with generalized anxiety disorder essay paper
Why I Did Not Select The Other Two Options
The other two options are imipramine 25mg BID and Buspirone 10mg PO BID. Imipramine is a tricyclic antidepressant FDA approved for the treatment of depression. It blocks the reuptake of serotonin and norepinephrine, has a greater affinity for serotonin thus producing more anticholinergic side effects (Cheong, et al, 2018). It is not the appropriate drug for this patient because it was initiated at a high dose of 25mg. imipramine is initiated at a lower dose of 10mg then titrated up gradually to higher doses to prevent adverse effects such as blurred vision, delirium, constipation, tachycardia, and dry mouth. Buspirone is an anxiolytic and antipsychotic drug used in the treatment of acute psychosis and anxiety disorder (Thom, et al, 2020). However, it is not the drug of choice for this patient because it achieves its therapeutic effect after four weeks of drug administration.
The Expected Outcome
The desired effects of Paxil are reduction of fear and worry, reduction of the HAMA-A score, decrease of symptoms such as chest tightness and shortness of breath.
Ethical Considerations That Impact Treatment Plan And Communication With The Patient
Ethical considerations during the treatment of patients with mental health illnesses include privacy and confidentiality, beneficence, and non-maleficence. The patient’s information should be confidential unless the patient consents to the disclosure. Patients with mental health disorders at the acute phase cannot make medical-related decisions. Therefore, the PNP should protect them from harm and give the best treatment.
Decision Two
Increase the dose to 20mg PO daily
Reason For Selecting This Decision
Paxil is the drug of choice for this patient because the patient reports to the clinic relieved symptoms and a decrease in the HAMA-A score from 26 to 18. This is an indication of its effectiveness in acute generalized anxiety disorder. Increasing the dosage to 20mg PO daily helps improve the symptoms such as excessive fear or worry and anxiety (Yang, et al, 2018). In addition to that HAMA-A anxiety score moves from moderate anxiety to mild anxiety. Upward titration of the drug dosage by 10mg weekly helps avoid undesirable side effects. Therefore, this makes the appropriate choice of the drug.
Why I Did Not Select The Other Two Options
The other two options are increasing the dose to 40mg PO daily and no change in drug/dose at this time. Increasing the drug dose to 40mg daily is not the choice because the abrupt increase of drug dosage worsens the side effects of the drug. In addition to that, the drug dose increase should be gradual by 10mg every week. Not changing the drug/dose at this point will not improve the patient’s symptoms. In addition to that, the patient will present with moderate anxiety disorder despite taking the medication. Managing patients with generalized anxiety disorder essay paper
The Expected Outcome
Previously, the patient reports positive outcomes such as a decrease of the symptom and reduction of severe anxiety to moderate anxiety. Increasing the drug dosage to 20mg will help improve the symptoms. The patient will also score less than 18 in the HAMA-A anxiety score.
Ethical Considerations That Impact Treatment
At this point, the patient’s symptoms have increased and their cognitive function is intact. Therefore, the patient can consent and make decisions regarding their treatment. the ethical considerations with a positive impact on his treatment are the ability to make medical associated decisions and consent to the treatment given to him.
Decision three
Maintain the current dose
Reason For Selecting This Decision
Maintaining the current dose is the best option because the symptoms have improved beyond 50%. He reports a further reduction of the symptoms since the previous visit. The HAM-A score has been reduced to 10. Paxil 20mg will meet the desired therapeutic effects without the patient complaining of side effects. However, the dosage can be gradually titrated upward from 10mg weekly to a maximum of 60mg per day depending on tolerance to the patient (Yang, et al, 2018).
Why I Did Not Select The Other Two Options
The other two options are to increase to 30mg PO daily and add augmentation agents such as Buspirone. Paxil 30mg is not a good choice for the patient because the drug achieved its maximum therapeutic effects. In addition, the patient has been on treatment for over eight weeks with no complaints of adverse effects. Increasing the dose might put the patient at risk of side effects. Adding augmentation options such as Buspirone is not a good option for this patient because he responded positively to Paxil the first and the second dose. Buspirone treats generalized anxiety disorder. However, it becomes effective four weeks after treatment initiation (Thom, et al, 2020). Therefore, I will not add significant value to the current treatment. Managing patients with generalized anxiety disorder essay paper
The Expected Outcome
The expected outcome is to suppress the symptoms. In addition, decrease the HAM-A score to less than ten without any drug adverse effects.
Ethical Considerations
At this point, the patient has fully recovered from an acute generalized anxiety disorder. Ethical principles in this point are respect of autonomy, justice and fairness, beneficence, and non-maleficence. The patient can make decisions by himself with the guidance of a PNP.
Conclusion
Generalized anxiety disorder is a common psychiatric condition presenting with restlessness, irritability, fatigue, loss of concentration, insomnia, and muscle tension. Drugs used in generalized anxiety disorder are selective serotonin inhibitors (SSRI) and tricyclic antidepressants (TCA’s). However, SSRI is the most preferred because they have few side effects. Paxil is the drug of choice because it has desirable effects throughout the treatment.
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| A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Conclusion (1 page) Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature. Managing patients with generalized anxiety disorder essay paper |
References
Cheong, P. K., Ford, A. C., Cheung, C. K., Ching, J. Y., Chan, Y., Sung, J. J., … & Wu, J. C. (2018). Low-dose imipramine for refractory functional dyspepsia: a randomised, double-blind, placebo-controlled trial. The Lancet Gastroenterology & Hepatology, 3(12), 837-844.
DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized anxiety disorder. Annals of internal medicine, 170(7), ITC49-ITC64.
Thom, R. P., Keary, C. J., Waxler, J. L., Pober, B. R., & McDougle, C. J. (2020). Buspirone for the treatment of generalized anxiety disorder in Williams syndrome: a case series. Journal of autism and developmental disorders, 50(2), 676-682.
Yang, Y., Huang, Z., Zhang, X., Li, J., Huang, Y., Chen, W., … & Wu, C. (2018). Development of Paroxetine Hydrochloride Single Layer Controlled-Release Tablets Based on 32 Factorial Design. Pharmaceutics, 10(4), 243. Managing patients with generalized anxiety disorder essay paper
