Assignment_Generalized Anxiety Disorders
Question
CASE STUDY: The Patient is a 46-year-old- white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his primary care physician after a trip to the emergency in which he felt he was having a heart attack. He stated he felt chest tightness, shortness of breath, and a feeling of impending doom. He does have some mild hypertension which is treated with low sodium intake and he is about 15lbs overweight. He had his tonsil removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER, and his EKG was normal. The remainder of his physical exam was normal. He admits that he still has problems with tightness in his chest and episodes of shortness of breath he now terms these " anxiety" He will also report feelings of pending doom, and the need to "run" or "escape" from wherever he is at.
In your office, he confesses to the occasional use of alcohol ( ETOH) to combat worries about work. He admits to consuming 3-4 beers/night. Although he is single, he is attempting to care for his aging parents in his home. He reports that the management at his place of work is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26. The client has never been on any type of psychotropic medication. The client is alert and oriented to person, place, time, and events. He is appropriately dressed. Speech is clear, coherent, and goal-directed. The client's self-reported mood is " bleh" and he does endorse a feeling of " nervousness". Affect is somewhat blunted, but does brighten several times throughout the clinical interview process. Affect broad, client denies visual or auditory hallucination, no overt delusional paranoid thought process readily apparent. You administer the Hamilton anxiety rating scale(HAM-A) which yields a score of 26.
DIAGNOSIS: Generalized anxiety disorder.
To Prepare:
(a) Reflect on the medication to be used to treat generalized anxiety disorder.
(b) Reflect on the psychopharmacology treatment you might recommend for the assessment and treatment of patients requiring anxiolytic therapy.
Assignment: You Are 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 you research 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) (1) Briefly explain and summarize the case for the Assignment. Be sure to include the specific patient factors that may impact your decision-making when prescribing medication for the patient. DECISION POINT ONE: Select what you should do: Medications to work with are: (a) Begin Paxil 10mg orally daily.
(b) Begin Imipramine 25mg orally twice a day
(c) Begin Buspirone 10mg orally twice a day
Decision #1 (1 page):
(1)What decision did you select?
(2) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature
(3) Why did you not select the other two medication options provided in the exercise? Be specific and support your response with clinically relevant and patient and patient-specific resources, including the primary literature.
(4) What were you hoping to achieve by making this decision? Support your response with evidence and references including the primary literature.
(5) Explain how ethical consideration may impact your treatment plan and communication with the patient. Be specific and provide examples.
DECISION #2 (1 page):
(1)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
(2) 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.
(3) What were you hoping to achieve by making this decision? Support your response with evidence and reference to the primary literature.
(4) Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
DECISION #3 (1 Page) :
(1)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
(2) 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.
(3) 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.
(4) Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
CONCLUSION (1 Page)
Summarize your recommendation on the treatment options you selected for this patient. Be sure to justify your recommendation 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 and write clearly including a title page, Purpose statement, introduction, summaries, and references.
(7) please answer all parts of the assignment questions clearly with no grammar or spelling errors in APA writing rules and style.
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Solution
Generalized Anxiety Disorders
Anxiety disorders are mental health conditions characterized by increased anxiety causing difficulty in daily living. A forty-six-year-old white male presented with anxiety symptoms. He worked as a steel welder and presented after a referral by his primary care physician after he developed symptoms of a heart attack. The patient complained of chest tightness, impending doom, and difficulty breathing. The patient is a known mild hypertensive patient on a low sodium diet, and he is overweight, weighing 15 lbs. myocardial infarction has been ruled out, and the EKG is normal with no positives on the physical examination. The patient has a history of chest tightness and shortness of breath which he considers anxiety. Additionally, the patient feels pending doom, creating fear and a need to escape or run.
The patient confesses to alcohol abuse to try and combat the stress at work, where he consumes three to four beers at night. The patient has additional concerns about caring for his aging parents. On a HAM-A exam, the patient scored 26 and has not been on any psychotropic education before. Physical examination on mental status proves the patient is alert, conscious, well oriented, and cooperative with good speech. Thorough patient assessment and evaluation are vital in decision-making on treatment and medications. Based on the assessment, the patient has a generalized anxiety disorder, and it is vital to reflect and decide on medications to be prescribed. We shall cover three decisions based on the medications prescribed to the patient for the disorder.
Decision And Rationale
I decided to prescribe Paxil 10mg, a selective serotonin reuptake inhibitor. I selected the decision because serotonin selective reuptake inhibitors are recommended as the drug of choice for patients who have been newly diagnosed with anxiety disorders (Strawn et al., 2018). The patient has not been on any other antipychotropic drugs, so with Paxil, the patient can tolerate it as the first drug. I selected the drug because, in addition to its increased tolerability with patients using psychotropic medications for the first time, the drug is specific to inhibiting the absorption of serotonin, which is a neurotransmitter responsible for several brain functioning and responsible for increasing mood and anxiety (Bandelow et al., 2017). The drug-specific to serotonin neurotransmitters has less or no effect on other neurotransmitters and hence have fewer side effects than other drugs.
Why Not the Other Two drugs
Compared to the other drugs, I did not select Imipramine because, as tricyclic antidepressants, it acts better by inhibiting serotonin and norepinephrine; hence, it would not be specific to serotonin reabsorption inhibition (Melaragno, 2021). Additionally, Imipramine has more side effects than Paxil as it affects other receptors. Therefore, as a first-time psychotropic drug user, drug compliance is dependent on the adversity of side effects. Furthermore, considering the patient is a welder, Imipramine can affect his sight, causing blurred vision due to its effect on the cholinergic receptors; hence it could not be the first decision (Melaragno, 2021). Finally, Imipramine was not the first decision because, as tricyclic antidepressants, it interacts with alcohol more than Paxil and may cause more severe effects like increased weight and depressed central nervous system.
Buspirone was also not selected as it does not act on the Gamma-Aminobutyric acid-binding system; hence it would have had less or no effect on the patient’s state (Wilson & Tripp, 2020). Secondly, Buspirone would have taken longer to act due to its effect on suppressing the serotogenic and exacerbating the non-adrenergic system (Wilson & Tripp, 2020). Paxil takes faster to act compared to Buspirone. in making this decision, I hoped to achieve suppression of serotonin reabsorption, prevent rapid serotonin absorption in brain cells, and reduce anxiety (Bandelow et al., 2017). With this decision, the patient will receive brain balance, so he will not experience increased brain activity.
Ethical Consideration
On ethical considerations, medical professionals should always maintain confidentiality for every patient. Mental health patients’ identities should be discreet to avoid mental stigma and social isolation (Marks et al., 2021). Patients feel safer when they can trust their healthcare providers and their confidentiality is respected. Secondly, informed consent is vital as the patient should understand why he should take Paxil as a first-time psychotropic drug user. With better understanding, studies show that patients are more likely to comply with medications when they better understand the drug and why they should take it (Marks et al., 2021). Finally, on deciding on the drug to be prescribed, avoiding harm to the patient is a vital ethical consideration. Deciding to administer Paxil in place of Imipramine to reduce the side effects and interaction with alcohol is for the patient’s good and avoiding complications (Marks et al., 2021). On deciding this drug of choice, the Outcome should be more favorable compared to side effects, and so as an ethical consideration, Paxil has more minor side effects compared to the other two drugs.
Conclusion
In conclusion, I decided that the patient should be started on Paxil 10 mg orally daily, a selective serotonin reuptake inhibitor. It is more specific to serotonin and does not affect other receptors; hence, patients may experience more minor side effects than other drugs (Strawn et al., 2018). Additionally, as patients take Paxil, they may experience side effects on other systems affected by serotonin neurotransmitters like sleep and digestion. So, educating the patient on the expected side effects is essential. Studies prove that the drug of choice for newly diagnosed patients with generalized anxiety is the selective serotonin reuptake inhibitors, which are well tolerated with more minor side effects compared to other medications (Strawn et al., 2018). in addition to pharmacotherapy, we recommend cognitive behavioral therapy is needed for this patient as it is an effective psychotherapy for anxiety problems considering psychological (Melaragno, 2021). Finally, the patient should be back for follow-up and psychotherapy on how to progress, as well as education on dietary changes, need for physical activity, diet compliance, and prevention of complications (Marks et al., 2021). the patient should also be guided on how to deal with stress and avoid excessive alcohol intake as they interact with psychotropic drugs and may cause harm, including he is a known hypertensive.
References
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93–107. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/
Marks, J. A., Rosenblatt, S., & Knoll, J. L. (2021). Ethical Challenges in the Treatment of Anxiety. FOCUS, 19(2), 212–216. https://doi.org/10.1176/appi.focus.20210001
Melaragno, A. J. (2021). Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance. FOCUS, 19(2), 145–160. https://doi.org/10.1176/appi.focus.20200048
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
Wilson, T. K., & Tripp, J. (2020). Buspirone. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK531477/
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