Therapy for patients with anxiety disorders and PTSD treatment essay
Therapy for patients with anxiety disorders and PTSD treatment essay
Anxiety Disorders
Anxiety disorders are the most common psychiatric issues in the United States of America. The prevalence rate is at 50% of the population above 20years old have anxiety disorders posing a risk for depression. Causes of anxiety disorders may include injury, illness, interpersonal conflicts or loss, stimulants like caffeine, and substance use like cannabis. Anxiety disorders can be social anxiety, panic disorder, specific phobia, and agoraphobia. However, before concluding a diagnosis, the PNP should rule out the patient’s sleeping patterns, substance and stimulants abuse, and concurrent depressive symptoms. The American psychiatric association states that patients with anxiety disorder present with; palpitations, chest pain, fear of losing control, de-realization, shortness of breath, feeling of choking, paresthesia, and the need to escape (Thibaut, F. 2017). These symptoms may recur or persist for up to one month. Therapy for patients with anxiety disorders and PTSD treatment essay
The diagnostic test that helps rule out other diseases is a complete blood count, thyroid function test, urinalysis, and urine drug screen. The recommended treatment methods are antidepressants and psychotherapy (Bandelow, et al, 2017). Psychotherapy has proven to be effective for all patients through controlled cognitive-based therapy. The patient has anxiety disorder because he presents with a feeling of having a heart attack, chest tightness, shortness of breath, impending doom, and the need to escape. Upon mental state examination, he is well-kempt, alert, and oriented. He is nervous and poses to have a blunted and alternating broad affect. He is scoring 26 (moderate to severe anxiety disorder) on the HAM-A anxiety rating scale. In this paper, I will discuss three decisions made in treating patients with anxiety disorder and the impact of ethical considerations in treatment. Therapy for patients with anxiety disorders and PTSD treatment essay
BUY NOW A PLAGIARISM-FREE PAPER HERE
Decision #1
Which decision did you select?
Begin paxil 10mg PO daily
Why did you select this decision?
Paxil is a selective serotonin reuptake inhibitor (SSRI) FDA approved for anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, and depressive mood. SSRIs are the first-line agents recommended for the long-term treatment of anxiety disorder. Paxil has a weak affinity for norepinephrine and dopamine that induces the downregulation of the up-regulated receptors in anxiety disorder (Munir, et al, 2017). Paxil is administered orally and its dosage titration depends on the patient’s drug tolerance. Its peak time is within 5 hours and has a 21hours plasma half-life. Its side effects are drowsiness, dry mouth, loss of appetite, and sweating. I chose this drug because it is effective in anxiety disorders and is well tolerated compared to other antidepressants.
Why did you not select the other two options provided in the exercise?
Imipramine is a tricyclic antidepressant FDA approved for depression and anxiety. It is a second-line drug for treating anxiety due to undesirable effects and toxicity. It works by blocking the norepinephrine and serotonin. Additionally, it has a greater affinity for serotonin which regulates attention, behavior, and mood. However, its greater affinity to serotonin increases the risk for central and autonomic effects (Simões, et al, 2019). I did not select imipramine because of its undesirable effects on the patients. These side effects are delirium, confusion, convulsions, weight gain, and dizziness. Moreover, the drug may worsen the patient’s symptoms like tachycardia, hypotension, and arrhythmias. Therapy for patients with anxiety disorders and PTSD treatment essay
Buspirone is an antianxiety drug FDA approved for short-term relief of anxiety symptoms. It has a high affinity for serotonin and dopamine (Tamdemir, et al, 2021). The recommended dose for anxiety disorders is 15mg daily and the dose may be titrated upwards by 5mg to a maximum of 60mg per day. However, I did not select this drug because it induces nervousness, dizziness, ataxia, and confusion. In addition, it may worsen chest pains.
What were you hoping to achieve by making this decision?
The expected outcome is to reduce chest pain, shortness of breath, chest tightness, the feeling of heart attack, and reduce the HAM-A score. These are achievable because serotonin has a high a weak affinity for serotonin and muscarinic agents that regulates mood, anxiety, and behavior. A high affinity for muscarinic agents helps in reducing symptoms like chest tightness and tachycardia.
How ethical considerations impact the treatment plan and communication with patients
Ethical principles are the values that regulate nursing practice and impact the patient’s treatment and communication. Examples of ethical principles are beneficence, non-maleficence, confidentiality, consent, and autonomy. For example, during the interview, I will assure the patient of confidentiality by not disclosing their shared information. The principle of confidentiality enables the clinician to create rapport and trust with the patient. This creates a good communication forum for the patient and eventually improves the outcome.
Decision #2
Which decision did you select?
Increase the dose of Paxil to 20mg per day
Why did you select this decision?
Paxil is the first-line treatment in patients with anxiety disorders whose control is achieved gradually within two to four weeks. The recommended adult dose is 20mg per day. However, the drug requires a slow-up ward titration to monitor its efficiency and side effects. Moreover, the patient’s symptoms are gradually reduced from the first visit. Therefore, I made this choice because Paxil 20mg is recommended adult dose and the drug is effective for the patient with no side effects.
Why did you not select the other two options provided in the exercise?
Increasing Paxil to 40mg PO daily is not a good option because it increases the risk for adverse effects. The FDA recommends slower upward titration with lower doses while monitoring for effectiveness and adverse reactions. Not changing the drug will not reduce the patient’s symptoms because Paxil 20mg is the effective adult dosage, Therapy for patients with anxiety disorders and PTSD treatment essay
What were you hoping to achieve by making this decision?
The expected outcome after increasing Paxil to 20mg is to improve the HAM-A scale and reduce chest pain, nervousness, and shortness of breath. The previous dose proved to have a slight improvement in the patient’s symptoms without adverse reactions.
How ethical considerations affect the treatment plan and communication with patients
Ethical principles that would affect treatment in this visit are beneficence and non-maleficence. Beneficence is the act of doing good to a patient. I will prescribe the best drug for the patient to improve his symptoms. I chose to increase the patient’s dosage to achieve the therapeutic goal. Non-maleficence is protecting the patient from medical harm. I will apply this by prescribing the correct drug without adverse effects on the patient. Beneficence and non-maleficence impact the patient’s treatment outcome.
Decision #3
Which decision did you select?
Maintain current dose
Why did you select this decision?
I will maintain Paxil 20mg PO daily because this is the best adult dose for a patient with anxiety disorder. The patient’s symptoms improve by 61% from the previous visit. Additionally, the maximum effect of this drug is achievable between three to four weeks after administration.
Why did you not select the other two options provided in the exercise?
Increasing to 30mg is not a good option because the patient is tolerating the drug well. It may predispose the patient to undesirable effects like drowsiness and weight gain. Augmenting the patient with buspirone is not recommendable because of its adverse effects like nervousness, dizziness, ataxia, chest pain, and confusion. Moreover, the patient is responding well to Paxil.
What were you hoping to achieve by making this decision?
The expected outcome is to stabilize the patient’s symptoms because the patient is already responding well to this treatment. Therapy for patients with anxiety disorders and PTSD treatment essay
How ethical considerations affect the treatment plan and communication with patients
The patient’s symptoms are stable at this point. I would recommend them to continue with treatment and start psychotherapy sessions. I will apply the principles of autonomy and consent. Autonomy is the ability of a patient to make informed medical decisions. Consent is asking for permission before initiating treatment. I will explain the illness, the causes, treatment methods, drug side effects, and the prognosis. I will advise the patient to continue with treatment despite symptom recovery. I will allow the patient to decide on psychotherapy sessions for full recovery of the cognitive functions.
Conclusion
Palpitations, chest pain, and fear of losing control, de-realization, and shortness of breath, feeling of choking, paresthesia, and the need to escape characterize anxiety disorders. Examples of anxiety disorders are social anxiety, panic disorder, specific phobia, and agoraphobia. The treatment modalities are antidepressants and psychotherapy. Antidepressants help in symptom recovery while psychotherapy helps restore cognitive functions. Selective serotonin reuptake inhibitors are the recommended agents for the long-term treatment of anxiety disorders. Ethical principles enable good communication skills and proper treatment thus improving the patient outcome.
References
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93.
Munir, S., Gondal, Z., & Takov, V. (2017). Generalized anxiety disorder (GAD).
Simões, L. R., Netto, S., Generoso, J. S., Ceretta, R. A., Valim, R. F., Dominguini, D., … & Barichello, T. (2019). Imipramine treatment reverses depressive-and anxiety-like behaviors, normalize adrenocorticotropic hormone, and reduces interleukin-1β in the brain of rats subjected to experimental periapical lesion. Pharmacological Reports, 71(1), 24-31.
Tamdemir, S. E., Aksu, B. G. M. H., & Hocaoglu, C. (2021). Buspiron, SSRI/SNRI kaynaklı bruksizm için bir çözüm olabilir mi?. Klinik Psikiyatri Dergisi, 24(2), 246-256.
Thibaut, F. (2017). Anxiety disorders: a review of current literature. Dialogues in clinical neuroscience, 19(2), 87.
Assignment instructions
Topic- Therapy for Patients With Anxiety Disorders and PTSD Treatment
The Assignment: 5 pages
Examine Case Study: An Asian American Woman. Diagnosis-Bipolar Disorder. Therapy for patients with anxiety disorders and PTSD treatment essay
Link to case study- https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html
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. Therapy for patients with anxiety disorders and PTSD treatment essay
- 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.
BUY NOW A PLAGIARISM-FREE PAPER HERE
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. Therapy for patients with anxiety disorders and PTSD treatment essay
