Week 5 Assignment
Assignment: Assessing and Treating Clients With Anxiety Disorders
Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 9, “Anxiety Disorder and Anxiolytics”
Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD. New York, NY: Cambridge University Press.
To access the following chapters, click on the Illustrated Guides tab and then the Anxiety, Stress, and PTSD tab.
Chapter 4, “First-Line Medications for PTSD”
Chapter 5, “Second-Line, Adjunct, and Investigational Medications for PTSD”
Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety, 29(4), 328–-339. doi:10.1002/da.21913
Note: Retrieved from Walden Library databases.
Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Note: Retrieved from Walden Library databases.
Required Media
Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources
Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., & … Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. doi:10.1155/2014/537306
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.
The Assignment
Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Walden NURS 6630 Week 5 Sample Paper
(Assessing and Treating Clients With Anxiety Disorders)
Anxiety Disorders
Student’s Name:
Institutional Affiliation:
Anxiety Disorders
Anxiety disorders refer to a group of mental disorders that are usually characterized by feelings of fear and anxiety. Several factors can cause anxiety disorder, which includes other mental disorders, stress buildup, trauma, drugs, or alcohol. These disorders can prevent one from carrying on with their daily lives. Symptoms of anxiety disorder include dizziness, nausea, breath shortness, sleep difficulties, inability to stay still and calm, panic, and fear. This paper discusses the decisions of the pharmacologic interventions that are the most effective in the treatment of a 46-year old white male who has been diagnosed with generalized anxiety disorder.
Decision One
The first decision that I selected was, to begin with, Zoloft 50 mg PO daily. The reason for choosing this decision is because Zoloft is used to treat mental illnesses like obsessive-compulsive disorder, depression, social anxiety disorder, and post-traumatic stress disorder. Zoloft 25-50 mg daily is the standard dosage that is usually prescribed to adults. Starting at a dose that is too high can cause vomiting and nausea. The Food and Drug Administration has approved Zoloft for the treatment of social anxiety disorder (ER, 2015). Zoloft belongs to the selective serotonin reuptake inhibitors class of medications. These medications increase the amount of serotonin in the brain. They prevent the uptake or reabsorption of serotonin in the brain, which helps in increasing the amount of the chemical in the nerve synapse. Serotonin is a neurotransmitter chemical that helps in the transfer of signals between brain cells, which helps in regulating anxiety and mood (Driot et al.,2017). Another reason as to why I selected this decision is because Zoloft is usually associated with positive emotions. Another reason for choosing this decision is because Zoloft 50 mg can be taken with or without food and is taken once daily. This reduces the occurrence of medical errors (Clifford, Duncan, Heinrich, K., & Shaw, 2015). Although there were other options, it was not appropriate to use those decisions. The reason as to why I did not select Imipramine 25 mg PO BID is because this medicine takes time before its full effects are experienced. It can take weeks or months. The symptoms of a patient can also relapse after tapering from the drug, which is not the case when Zoloft is used. Another reason for not selecting Imipramine is that one of its side effects is that it causes an increase in anxiety, which is not appropriate in this case, considering that the patient has a generalized anxiety disorder. The reason for not selecting Begin Buspirone 10 mg PO BID is that it also takes time before its full effects are experienced. The medicine can take four to six weeks for one to experience its full clinical effects (Reinhold, & Rickels, 2015).
By making this decision, I was hoping to reduce the unwanted thoughts that the patient was having. Decrease unwanted fears. For example, the patient fears for his job. I was also hoping to reduce the patient’s level of anxiety.
There was no difference between what was expected to be achieved by making the decision and the actual results since the patient reported that the problems with tightness in the chest and episodes of breath shortness had reduced significantly. The patient also reported that worries about work had also reduced, which was also an indication that the goals for administering the medication were being achieved. The HAM-A score had also decreased partially but needed to be reduced more.
Decision Two
The second decision that I selected was to increase Zoloft from 50 mg to 75 mg orally. The reason I selected this decision is that the medication was working as expected, and the patient had not experienced any major side effects. Therefore it was appropriate to increase the dosage rather than introducing a new medication since the body of the patient had gotten used to the medication. Another reason for selecting this decision is that medications should not be considered as being ineffective until the highest amount of dosage has been administered (Lader, 2015).
By making this decision, I was hoping to manage the symptoms of generalized anxiety disorder that the patient was experiencing further. I was also hoping to reduce the HAM-A score further to a suitable score. I was hoping to increase the daily functioning of the patient and manage the occasional feelings of impending doom and the need to escape or run from wherever he is at.
There was no difference between what I expected to achieve with decision two and the actual results. The HAM-A score had reduced to 8, which was a sign of significant improvement. Most of the symptoms that the patient was experiencing also been managed and only experienced a few symptoms that were not severe. This was an indication that the patient was progressing well as expected.
Decision Three
The third decision that I selected was to maintain the current dosage. The reason for selecting this decision is positive health outcomes had been recorded. It is, therefore, appropriate to measure the effectiveness of the treatment by maintaining the same dosage for approximately 12 weeks. Another reason for selecting this decision is to avoid changing the medication or increasing the dosage, which could lead to adverse health outcomes.
By making this decision, I was hoping to reduce the HAM-A score further and ensure that all the symptoms are fully managed. There was no difference between what I expected to achieve and the actual results because the HAM-A score of the patient reduced to 4, which was an indication that the anxiety level was minimal as expected.
Ethical Considerations
In this case, considering that the patient was suffering from anxiety disorder, it was necessary to educate him about medication adherence and how it can affect his health outcome. As a health provider, it is also important to ensure that the ethical principle of autonomy is respected. It is the right of the patient to decide whether to undertake the treatment or not. Also, when administering the treatment regimen, the ethical principle of beneficence should be considered. This principle addresses the idea that the actions of a health provider should promote good by doing what is best for the patient. The right amount of dosage should be prescribed to avoid the occurrence of medical errors, which can cause harm to the patient.
References
Clifford, K. M., Duncan, N. A., Heinrich, K., & Shaw, J. (2015). Update on managing generalized anxiety disorder in older adults. Journal of gerontological nursing, 41(4), 10-20.
Driot, D., Bismuth, M., Maurel, A., Soulie-Albouy, J., Birebent, J., Oustric, S., & Dupouy, J. (2017). Management of first depression or generalized anxiety disorder episode in adults in primary care: A systematic metareview. La Presse Médicale, 46(12), 1124-1138.
ER, I. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician, 91(9), 617-624.
Lader, M. (2015). Generalized anxiety disorder. Encyclopedia of psychopharmacology, 699-702.
Reinhold, J. A., & Rickels, K. (2015). Pharmacological treatment for generalized anxiety disorder in adults: an update. Expert opinion on pharmacotherapy, 16(11), 1669-1681.
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