Assessing and Treating Patients with Anxiety Disorder Essay Assignment

Assessing and Treating Patients with Anxiety Disorder Essay Assignment

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 patients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, patients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.

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To prepare for this Assignment: Assessing and Treating Patients with Anxiety Disorder Essay Assignment
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring anxiolytic therapy.
The Assignment: 5 pages
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 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) Assessing and Treating Patients with Anxiety Disorder Essay Assignment

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) Assessing and Treating Patients with Anxiety Disorder Essay Assignment

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.

***Case Study to use for Assignment***
BACKGROUND INFORMATION

The client 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 PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils 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. Remainder of physical exam was WNL.

He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at. Assessing and Treating Patients with Anxiety Disorder Essay Assignment

In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.

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Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorderRESOURCES

§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Decision Point One
Select what you should do:

Begin Paxil 10 mg po daily
Begin Imipramine 25 mg po BID
Begin Buspirone 10 mg po BID

***PLEASE READ AND FOLLOW THESE INSTRUCTIONS FOR THE DECISION TREE CASE ASSIGNMENT

 

This is your first interactive case study with a decision tree. In this case study, you will have 3 different decision points to address. The decisions you make will determine the next step scenario and eventually the final outcome. At each scenario/decision point, you will need to decide how to proceed, provide your answer, and support your answer with evidence including your rationale for your decision. For each decision, you will explain your decision and explain why you chose that decision-why it is the best for this patient. You will explain why you did not choose the other options and why they are not the best for this patient. Substantiate your rationale using at least 5 academic resources. Be sure to properly cite, paraphrase in your own words, and reference each of the sources. This will be submitted to SafeAssign, which I will review in great detail. Assessing and Treating Patients with Anxiety Disorder Essay Assignment

o While reading the case study, evaluate and research each option. Then select the option you choose (click on it) and continue forward through the 3 decision points. Do not start over or go back and repeat. Select your option and continue forward to the next screen which will reveal the outcome prior to giving you the next decision point. Not following instructions may result in a 0 or decreased grade.

o You must choose an option from the provided options at each step by clicking your choice. Then you will see the outcome/result of your decision and will be given the next decision. Choose your option for the next step by clicking your choice and you will be given the outcome/result followed by the last decision. Select your answer and you will be given the final outcome. Do not start over or go back. Assessing and Treating Patients with Anxiety Disorder Essay Assignment

o Follow the assignment instructions for each of the 5 pages, not including the title page or reference page, for this assignment. Do not exceed the page limits for any of the 5 parts. Therefore, you will only have a title page + 5 pages of text + a reference page for 7 pages total. You need to be concise and only include the required information. Exceeding the page limits for each part and/or providing excessive unnecessary information will only count against you in grading. It is acceptable to have more than 1 page of references, but you need to keep to the page limits for the other sections of your paper. Assessing and Treating Patients with Anxiety Disorder Essay Assignment

o The decisions you make will determine the outcome.

o There could be multiple viable options, so as long as you appropriately substantiate it (i.e. with POEM -Patient Oriented Evidence Medicine- guidelines, medication mechanism of action, side effects, time of onset, credible resources, etc.), you could still receive credit if it is an appropriate treatment for this patient specifically.

o This paper should follow APA 7 format with a title page, reference page, in-text citations, etc.

o Your case study must have at least 5 credible academic sources, and although you may use the textbook, it will not count as 1 of the 5 required sources. Therefore, if the textbook is used, you will still need to use at least 5 more sources per the assignment instructions. WebMD is not an acceptable reference.

o Whenever you refer to a medication, include the medication name, strength, frequency, etc. When writing this, it must be correct just as it must be when you prescribe medications. If any of these are incorrect, it can result in deadly medication errors for our patients. Deductions will result for any incorrect medication information on these and all assignments in this course. Before selecting medications, ensure the medication information is correct and appropriate.

o No direct quotes in your assignments, which will result in point deductions. I want to see that you understand the material and can apply this in patient case situations and in clinical situations with real patients.

INTRODUCTION to Case- 1 PAGE IN LENGTH:

o Give a concise summary of the assignment purpose, important disease state information, and the key aspects of the case study disease state including important information that affects your decision in selecting this patient’s medication you will prescribe. Remember this is a pharmacology and therapeutics course, so medications and treatment plans are the focus here. Therefore, do not write a page on diagnosis. Provide important case information and focus on the information in the case that helps you decide your treatment plan.

DECISION #1- 1 PAGE IN LENGTH, DECISION #2- 1 PAGE IN LENGTH, DECISION #3- 1 PAGE IN LENGTH:

See the assignment instructions which include the questions and information to be covered for each decision page. Each decision will be 1 page of your paper.
Include each option given, explain your option/decision, explain your rationale for your chosen option specifically, and substantiate your decision with evidence such as guidelines, drug studies, and resources.
Do not state you chose this medication because it is an SSRI. Instead be extremely specific and support your choice with information from credible, current sources which may include medication specific factors such as contraindications, warnings, adverse drug reactions, safety profile, drug-drug interactions, dosing, etc.; patient specific factors such as age, allergies, comorbidities because we do not want to exacerbate patient’s other medical conditions if we can avoid it; comparative drug studies; therapeutic guidelines, etc.
State specifically why you did not choose each of the other 2 options and substantiate this with sources. Be extremely specific for each.
o Include specific treatment goals for your chosen medication and substantiate these with resources. Be extremely specific.

o Include/explain your response to the provided decision outcome for your decision. Did you expect this to be the outcome or not? Why or why not? Be extremely specific.

o REPEAT EACH OF THE ABOVE BULLETS FOR EACH DECISION. For example, you will include and explain each of the above bullets for decision 1 on 1 page. Then, you will proceed to include and explain each of the above bullets for decision 2 on 1 page and again for decision 3 on 1 page.

o This should all be quality- quality work with quality resources- without exceeding quantity.

Conclusion- 1 page

o Explain and provide examples of ethical considerations which may affect your treatment plan and communication with the patient.

o Summarize your treatment plan for your selected treatment options for this patient.

o Substantiate/ support your recommendations and responses with credible, clinically relevant, patient specific sources.

Examples of Don’ts

o Bupropion (Wellbutrin) was chosen because it treats depression.

o I chose sertraline (Zoloft) because it’s a SSRI.

o Data supports using paroxetine (Paxil) for …

o Do not state you think or you feel…

 

Examples of Do’s

o Review the guidelines and recommend a first line medication if appropriate for this patient specifically. See why the guidelines recommend or don’t recommend certain medications. Include these in your decision making and your rationale.

o Tailor this to this specific patient. Consider all patient specific factors and medication specific factors as stated above. Be sure this is an appropriate medication for this patient. Include applicable black boxed warnings, contraindications, adverse drug reactions/side effects, etc. Do not include side effects which do not apply to this particular patient.

o Is there evidence to support a particular medication is more efficacy than another medication in comparative drug trials? Include this in your rationale for your decision if applicable.

o Consider special populations such as pediatrics, elderly, pregnancy when selecting and not selecting medications. Include this in your rationale for your decision. Assessing and Treating Patients with Anxiety Disorder Essay Assignment

Plagiarism/Cheating

o Read my Important Instructions announcement and follow it.

o All work must be your own work in your own words with proper citations. Use proper paraphrasing.

o Do not view or use other students work as this is cheating and will be treated as such.

o In-text citations are required for every assignment. Whenever you use a source, you must cite it to give credit to the author. Cite more often than not. Avoid improper or partial citations.

Introduction

According to Bandelow et al. (2022), anxiety disorders are a group of psychological illnesses characterized by intense feelings of anxiety and fear. Physical symptoms of fear and anxiety include nervousness and a fast heartbeat. Horenstein and Heimberg (2020) indicate that agoraphobia, panic disorder, social phobia, and generalized anxieties are examples of anxiety disorders. This assignment focuses on a 46-year-old male who presented with symptoms of anxiety disorder such as chest tightness, shortness of breath, and a sense of impending doom. The ECK and ER results were normal, ruling out myocardial infarction. Hamilton Anxiety Rating Scale (HAM-A) produced a scoring rate of 26, and GAD “generalized anxiety disorder” was diagnosed. Regarding the diagnosis, three decisions would be made regarding the client’s treatment protocol. Following each decision, a justification will be offered that is backed by patient data and clinical evidence. Furthermore, upon having made each decision, considerations likely to influence the client’s pharmacokinetic and pharmacodynamics operations will then be regarded. Lastly, ethical concerns that may have implications on the patient’s care plans will then be addressed.

Decision Point One

The patient’s first option should be to start taking Zoloft 50 mg orally each day. Such a decision was taken since Zoloft is an SSRI “selective serotonin reuptake inhibitor”, and SSRIs are first-line interventions for treating anxiety disorders. According to Horenstein and Heimberg (2020)Assessing and Treating Patients with Anxiety Disorder Essay Assignment, SSRIs function by raising the brain’s levels of serotonin. Serotonin is a chemical in the brain, which is essential for emotional regulation. As a result, SSRIs like Zoloft operate by inhibiting serotonin absorption in the brain, increasing the threshold of serotonin in the brain; the presence of serotonin thereby aids in mood regulation and thus enhances anxiety and depression symptoms. Furthermore, science indicates that Zoloft helps relieve anxiety levels associated with GAD. This is because anxiety diminishes serotonin levels that are resolved with an SSRI like Zoloft which also substitutes for the drained brain’s supply of serotonin.

Buspirone at 10 mg and Imipramine at 25 mg BID orally twice a day was not chosen since, as previously stated, SSRIs are the primary prescription drugs for the therapy for anxiety disorders (Bandelow et al., 2022). Furthermore, Saha et al. (2021) indicate that such two medications are not well considered acceptable as Zoloft and have serious adverse effects. It was anticipated that by deciding to start Zoloft 50 mg orally daily, the patient’s symptoms of generalized anxiety disorder will indeed eventually fade. It was additionally anticipated that the patient’s HAM-A score will further decrease substantially, implying an advancement in anxiety symptoms. This is because research indicates that Zoloft, as an SSRI, is efficient in alleviating GAD symptoms.

Furthermore, it was envisioned that the patient would experience few adverse effects and endure the prescription since research has shown that SSRIs have few adverse effects and are generally well accepted. The patient’s anxiety symptoms had diminished greatly by the time he showed up for the assessment and were manifested by his lack of symptoms like chest tightness and breathe shortness. There was, therefore, no large disparity between the decision’s outcome and the anticipated outcomes. Additionally, the patient claimed that he had managed to stop stressing regarding his career, and the HAM-A score decreased from 28 to 18. The score indicated that he was slightly responding to therapy. Assessing and Treating Patients with Anxiety Disorder Essay Assignment

Decision Point Two

The second choice is to increase the patient’s each day Zoloft dosage to 75 mg. The decision was made since the patient’s HAM-A score decreased from 28 to 18. The decrease indicated a slight treatment response and demonstrated that perhaps the patient is benefiting from it. Due to this, increasing the dosage from 50 mg to 75 mg may further boost serotonin presence inside the brain and help the patient’s anxiety symptoms. Research by Horenstein and Heimberg (2020) shows that if patients fail to respond to therapies adequately, the dosage of SSRIs should be gradually increased. This decision was also influenced by the client’s apparent good health and lack of adverse effects from the Zoloft medication.

Since dosage increases and titration should be moderate to guarantee that the patient persists to endure the prescription well with very few adverse effects, the alternative to boost Zoloft to 100mg was not chosen. On the other hand, since the patient’s reaction is only partial, it is necessary to raise the dosage to make sure full response to the prescription. Therefore, the choice to let the patient proceed with the exact dose and also have him reevaluated after four weeks was not chosen. Through making this decision, it was anticipated that the symptoms of anxiety will indeed continue to diminish, as shown by a noticeably lower HAM-A score. Since the patient’s anxiety symptoms had indeed decreased after arriving at the health center, as evidenced by the decline in the HAM-A score, there was no discernible distinction between the real decision and the anticipated decision Assessing and Treating Patients with Anxiety Disorder Essay Assignment.

Decision Point Three

The third option, having the patient continue taking 75 mg of Zoloft every day or as prescribed, was chosen. This choice was made since the subjective data and HAM-A score show that the patient is improving his anxiety levels with the current decision. The patient stated that he was no longer undergoing the ailments, and the HAM-A score showed a substantial decrease with the current dosage. This signifies that the patient is responding to the prescribed medications and dosages. The client is also not currently undergoing any adverse effects at the existing dosage and is enduring the medication appropriately.

In this case, the patient is reacting quite well, therefore there is no reason to titrate the prescription anymore. Clinical guidelines and evidence advise titrating prescription drugs based on the patient’s response. Given that the patient is responding satisfactorily to the existing dosage of 75 mg of Zoloft, it was decided against either adding Buspar to the existing course of treatment or boosting the dosages of Zoloft to 100 mg. Through making this choice, it is anticipated that the patient would then exhibit a full response to the therapy, where he will report entire symptom clearance and a massive drop in the HAM-A score (Saha et al. 2021)Assessing and Treating Patients with Anxiety Disorder Essay Assignment.

Impact of Ethical Considerations on the Treatment Plan

Ethical considerations are essential during the treatment plan. Jia et al. (2021) indicate that nurses must review the ethical guidelines for handling a patient during treatment.

Confidentiality, Informed consent, and autonomy will all be taken into account for this patient. Before him giving his consent to the treatment regimen, it is crucial to obtain his informed consent. This will guarantee that the individual is adequately informed concerning the suggested course of action. Second, the patient’s right to privacy must be honored. This implies that nothing, including the patient’s therapeutic process, should be shared with anyone else without the patient’s permission. The patient’s autonomy must also be recognized, which means that no treatment should be pressured or compelled upon the patient (Jia et al., 2021). However, the patient must be free to reject or accept the therapies. Any treatment-related decisions made by the patient must be respected. According to mainstream thinking, regardless of whether a patient suffers worse health outcomes, the real worth of respecting privacy and dignity must typically take precedence. The morals of doing good and preventing harm that was prioritized in the previous era when clinicians tended to be more patriarchal, must always be fully reviewed by clinicians. Given that individuals suffering from anxiety disorders are likely to have impeded decision-making abilities, this must be case-specific whenever they are being treated (Jia et al., 2021)Assessing and Treating Patients with Anxiety Disorder Essay Assignment.

Conclusion

The first option chosen is to start taking 50 mg of Zoloft every day by mouth. The justification for this decision is that SSRIs, like Zoloft, are the first line of therapeutic intervention for anxiety disorders, and research demonstrates that the drug is efficient in alleviating anxiety and depression. This choice represented a major advancement. The second choice was also to up the Zoloft dosage to 75 mg taken orally every day. Such a decision was made since the HAM-A score implied that the patient was responding partially and that raising the dose will further help them respond satisfactorily. The patient is demonstrating a satisfactory response to the therapy as evidenced by the decreased HAM-A score and minimized symptoms, according to the subjective information, so the third choice is to continue administering the existing dosages. Confidentiality, informed consent, and autonomy are the ultimate ethical considerations that need to be taken into account.

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References

Bandelow, B., Michaelis, S., & Wedekind, D. (2022). Treatment of anxiety disorders. Dialogues in clinical neuroscience.

Horenstein, A., & Heimberg, R. G. (2020). Anxiety disorders and healthcare utilization: A systematic review. Clinical psychology review, 81, 101894.

Jia, Y., Chen, O., Xiao, Z., Xiao, J., Bian, J., & Jia, H. (2021). Nurses’ ethical challenges caring for people with COVID-19: a qualitative study. Nursing ethics, 28(1), 33-45.

Saha, S., Lim, C. C., Cannon, D. L., Burton, L., Bremner, M., Cosgrove, P., … & J McGrath, J. (2021). Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depression and anxiety, 38(3), 286-306 Assessing and Treating Patients with Anxiety Disorder Essay Assignment