Therapy For Patients With Anxiety Disorders And PTSD Treatment

Therapy For Patients With Anxiety Disorders And PTSD Treatment

The case highlights a 46-year-old white male presenting with chest tightness, shortness of breath and feeling of impending doom. The patient has a history of mild hypertension and tonsillectomy, which has been accompanied by unremarkable medical history. The patient cites occasional shortness of breath, chest tightness, feelings of impending doom and the need to ‘escape’ or ‘run’ from one place. He confesses using ETOH to combat worries about work since the management at his place of work is harsh, and he fears for his job. The patient’s symptoms are characteristic of generalized anxiety disorder Therapy For Patients With Anxiety Disorders And PTSD Treatment.

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Anxiety can be a normal part of life, with concerns such as health, family challenges and money temporarily dominating individual experiences. Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder characterized by nightmares, flashbacks, and intrusive thinking related to catastrophic events in an individual’s life (Ostacher & Cifu, 2019). Exposure to traumatic and terrifying events triggers PTSD. It is a potentially debilitating condition that affects direct victims or witnesses of traumatic events such as accidents, natural disasters, loss of loved ones, violent assaults like rape, war and other life-threatening events. The events can trigger an obsessive, recurrent and repetitive behavior that increases the feeling of fear, worry, helplessness and hopelessness (Ostacher & Cifu, 2019)Therapy For Patients With Anxiety Disorders And PTSD Treatment . Nightmares, intrusive memories and flashbacks are common in individuals with past traumatic experiences increasing the risk of panic disorders.

Psychopharmacological therapy targets relieving symptoms rather than curing the disorders. The recommended medications in the management of anxiety disorders include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), antipsychotics, beta and adrenergic medications, antihistamines and GABAergic medications (Garakani et al., 2020)Therapy For Patients With Anxiety Disorders And PTSD Treatment . The treatment decisions will reflect the drug pharmacokinetics, pharmacodynamics, and ethical considerations in using the pharmacotherapeutic approach. The paper highlights three decisions on Generalized Anxiety Disorders.

Decision One

Which Decision did you Select?

The first-line treatment for the patient will be the first-line SSRI, oral paroxetine 10 mg daily.

Why did you select this Decision?

Anxiety disorders are managed using different pharmacological regimens. The approaches focus on alleviating the symptoms and restoring social, mental and physical wellbeing. However, SSRIs and SNRIs are recommended for the treatment of PTSD, although sertraline and paroxetine are FDA-Approved as the first-line medication for PTSD management. According to Ostacher and Cifu (2019), benzodiazepines are contraindicated in PTSD. Paxil is FDA-approved for treating anxiety disorders and PTSD and is considered the first-line pharmacotherapeutic option for anxiety disorders. Paxil is an SSRI that potentiates the serotonin action influencing the serotonergic neurotransmission (Davidson 2016)Therapy For Patients With Anxiety Disorders And PTSD Treatment . The medication restores serotonin balance, regulates mood changes, and reduces anxiety, fear, and panic attacks. Paxil has minimal anticholinergic and sedative effects and has a low cardiovascular impact. Its therapeutic window can range from 4-6 weeks and is significant in managing generalized anxiety disorder. It has less anticholinergic, adrenergic and antihistamine activity than tricyclic antidepressants.

Why did you not select the other two options provided in the exercise?

Paxil is safer and tolerable in diverse patients than other medications such as Buspirone and Imipramine, which have adverse reactions such as increased drowsiness, blurry vision, and dizziness. Besides, they are not approved for first-line treatment of anxiety and PTSD hence my choice of Paxil for anxiety treatment.

What were you hoping to achieve with this Decision?

Paxil is slowly absorbed with its half-life ranging between 11 to 20 hours and attains its peak concentration within 4 to 10 hours. It works by elevating the serotonin levels, which establish a mental balance. According to Strawn (2018)Therapy For Patients With Anxiety Disorders And PTSD Treatment , Paxil can elicit minimal adverse reactions and alleviate symptoms such as fear, worry, helplessness, chest tightness, and shortness of breath. In light, I targeted alleviating the anxiety symptoms by elevating the serotonin levels.

Explain how ethical considerations may impact your treatment plan and communication with patients

Paxil has minimal adverse effects that undermine individual ethical values and treatment models. Patient safety is at the center of the pharmacological therapeutic approaches hence a key consideration in medical ethics. However, the patient is not incapacitated and capable of making individual decisions; thus, the psychiatrist needs to highlight the psychotherapeutic and pharmacotherapeutic models available and educate the patient appropriately before consenting to the treatment.

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Decision Two

The first-line medication for the treatment of anxiety and PTSD is the most likely option for managing the patient. However, I would opt to retain Paxil as my second decision rather than change the medications. However, I will increase the dosage from 10mg to 20mg daily to enhance the therapeutic effect.

Why did you select this decision?

The reaction response to Paxil may take long to manifest. To boost the HAM-A score, I would opt for a higher dose. Paxil is well-tolerated in the body and elicits minimum side effects (Strawn, 2018)Therapy For Patients With Anxiety Disorders And PTSD Treatment . Although the drug’s reaction is slow, it attains its therapeutic effect after a significantly more extended period. Therefore, increasing the dose can immediately impact mood and anxiety symptoms. According to Slee (2022), using a higher SSRIs dose can elevate serotonin levels in the brain and enhance the treatment outcome. The client’s compliance with the treatment can HAM-A scores and attain optimal results.

Why did you not select other options in this exercise?

The anxiety medications exhibit diverse adverse effects. However, Paxil is well accommodated, with minimal side effects reported. In light, rather than changing to another first-line SSRIs with similar pharmacokinetic and therapeutic effects, I would rather increase the dose. Besides, it is recommended as the best first-line treatment for anxiety disorders and PTSD. According to Javed and Fountoulakis (2018)Therapy For Patients With Anxiety Disorders And PTSD Treatment , Paxil significantly reduces the symptoms more than other medications such as imipramine. Therefore, I did not see the need to change the medication rather than maintain the patient on a higher dose of Paxil.

What were you hoping to achieve by making this decision?

Although the medication might take time for the client to realize a significant decline in the clinical manifestations, the main objective of the decision was to lower the HAM-A score further and stabilize mood and anxiety symptoms.

Explain how ethical considerations may impact your treatment plan and communication with patients

The major ethical concerns in medication include patient consent and safety. The medication should align with the major ethical principles that advocate for the patient’s autonomy, beneficence, and nonmaleficence. Paxil dose is well tolerated; therefore, increasing the dose implies that the medication is likely to be well tolerated. Furthermore, patient education should be advocated to allow the patient to make informed consent.

Decision Three

The third decision will be to shift to an SSRI alternative. However, the drug withdrawal process might be lengthy; hence I would opt for 10 mg of oral buspirone. Buspirone will also need close monitoring to assess the need to alter the treatment plan Therapy For Patients With Anxiety Disorders And PTSD Treatment .

Why did you select this decision?

Buspirone is well tolerated in the body, although it is used in the short-term management of anxiety symptoms. It is also FDA-Approved for the management of Generalized Anxiety Disorder. In light, change from SSRI to azapirone can attain a higher therapeutic effect than non-responsive paroxetine. The drug is well tolerated in the body, although it might exhibit some adverse effects.

Why did you not select the other two options provided in this exercise?

The rationale for the choice of the medications was entirely based on the efficacy and tolerability of the drugs. Buspirone is well-tolerated, exhibits minimal adverse effects, and is FDA approved for treating anxiety disorders. Therefore, I opted for drug safety and FDA recognition in the decision for combination therapy.

What are you hoping for by making this decision?

Adopting a combined therapy aimed to improve the patient’s experiences by lowering the anxiety symptoms. Buspirone regulates neurotransmitters’ actions, reducing anxiety symptoms (Javed & Fountoulakis, 2018)Therapy For Patients With Anxiety Disorders And PTSD Treatment . Changing the medications from non-responsive or slow-responding SSRIs to azapirones can significantly reduce the HAM-A score alleviating the clinical manifestations of anxiety disorder.

Explain how ethical considerations may impact your treatment plan and communication with patients

The ethical concerns in the medical field are crucial, especially in managing mental health disorders. Patient autonomy may be impaired due to the involvement of the family members in the treatment process. However, the psychiatrist can establish the patient’s competence and compliance to determine the best approach for intervention. According to Javed and Fountoulakis (2018), buspirone elicits side effects such as chest pain, drowsiness, nausea, and increased sweating. However, some severe side effects such as blurred vision, uncontrollable shaking, agitation, hallucinations, confusion, irregular heartbeat and seizures can be reported. Clear communication should be established to allow the patient to make informed consent to the medication.

Conclusion

The management plan involved a shift from Paxil 10 mg to 20 mg once per day and further to azapirone therapy of 10 mg buspirone twice a day. The selection of Paxil and buspirone was based on the recommendation and approval by the FDA in treating anxiety disorders and PTSD. However, due to the low response and impact on the HAM-A score, increasing the dose increased serotonin concentration, low anxiety, and regulated mood. The third decision opted against change from SSRIs to azapirone. Buspirone has partial agonist properties on serotonin and can improve serotonin levels and reduce the HAM-A score Therapy For Patients With Anxiety Disorders And PTSD Treatment .

References

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: going beyond the guidelines. BJPsych Open, 2(6), e16-e18. http://bjpo.rcpsych.org/content/2/6/e16

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. Frontiers in psychiatry, 1412. https://doi.org/10.3389/fpsyt.2020.595584

Holmes, L. (2022). The 4 Major Classes of Anxiety Medications. Verywell Mind. Retrieved 2 July 2022, from https://www.verywellmind.com/mental-health-medications-for-anxiety-2337705.

Javed, A., & Fountoulakis, K. N. (Eds.). (2018). Advances in psychiatry. Springer.

Ostacher, M. J., & Cifu, A. S. (2019). Management of post-traumatic stress disorder. JAMA, 321(2), 200-201. https://doi.org/10.1001/jama.2018.19290

Slee, A. (2022). Generalized Anxiety Disorder: Incidence and Drug Treatment (Doctoral dissertation, UCL (University College London)). https://discovery.ucl.ac.uk/id/eprint/10146430

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%2F14656566.2018.1491966 Therapy For Patients With Anxiety Disorders And PTSD Treatment

Therapy for Patients with Anxiety Disorders and PTSD Treatment

Anxiety can be a normal part of life, with concerns such as health, family challenges and money temporarily dominating individual experiences. However, anxiety disorders are marked by an escalation in fear and worry interfering with daily activities such as relationship building, job performance and inconsistencies in school work. Exposure to traumatic and terrifying events triggers post-traumatic stress disorder (PTSD)Therapy For Patients With Anxiety Disorders And PTSD Treatment . PTSD is an anxiety disorder characterized by nightmares, flashbacks, and intrusive thinking related to catastrophic events in an individual’s life. It is a potentially debilitating condition that affects direct victims or witnesses of traumatic events such as accidents, natural disasters, loss of loved ones, violent assaults like rape, war and other life-threatening events. The events can trigger an obsessive, recurrent and repetitive behavior that increases the feeling of fear, worry, helplessness and hopelessness. Nightmares, intrusive memories and flashbacks are common in individuals with past traumatic experiences increasing the risk of panic disorders.

Generalized anxiety disorders are common in adults with PTSD manifestations evident several months after the exposure to the traumatic and terrifying event. The symptoms of the anxiety disorders can be detrimental, although they subside, reducing the struggle with coping and self-care. The case highlights a 46-year-old white male presenting with chest tightness, shortness of breath and feeling of impending doom. The patient has a history of mild hypertension and tonsillectomy, which has been accompanied by unremarkable medical history. The patient cites occasional shortness of breath, chest tightness, feelings of impending doom and the need to ‘escape’ or ‘run’ from one place. He confesses using ETOH to combat worries about work since the management at his place of work is harsh, and he fears for his job.

The patient’s symptoms are characteristic of generalized anxiety disorder. According to Holmes (2022), anxiety disorders are mental conditions that deteriorate the quality of life by altering the action of neurotransmitters. Individuals with anxiety disorders have elevated worry and fear. Psychopharmacological therapy targets relieving symptoms rather than curing the disorders. The recommended medications in the management of anxiety disorders include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), antipsychotics, beta and adrenergic medications, antihistamines and GABAergic medications (Garakani et al., 2020)Therapy For Patients With Anxiety Disorders And PTSD Treatment . The treatment decisions will reflect the drug pharmacokinetics, pharmacodynamics, and ethical considerations in using the pharmacotherapeutic approach. The paper highlights three decisions on treating anxiety disorders and post-traumatic stress disorder.

Decision One

Which Decision did you Select?

The first-line treatment for the patient will be the first-line SSRI, oral paroxetine 10 mg daily.

Why did you select this Decision?

Why did you not select the other two options provided in the exercise?

What were you hoping to achieve with this Decision?

Paxil is slowly absorbed with its half-life ranging between 11 to 20 hours and attains its peak concentration within 4 to 10 hours. It works by elevating the serotonin levels, which establish a mental balance. According to Strawn (2018), Paxil can elicit minimal adverse reactions and alleviate symptoms such as fear, worry, helplessness, chest tightness, and shortness of breath. In light, I targeted alleviating the anxiety symptoms by elevating the serotonin levels.

Explain how ethical considerations may impact your treatment plan and communication with patients

Decision Two

Why did you select this decision?

The reaction response to Paxil may take long to manifest. To boost the HAM-A score, I would opt for a higher dose. Paxil is well-tolerated in the body and elicits minimum side effects (Strawn, 2018). Although the drug’s reaction is slow, it attains its therapeutic effect after a significantly more extended period. Therefore, increasing the dose can immediately impact mood and anxiety symptoms. According to Slee (2022)Therapy For Patients With Anxiety Disorders And PTSD Treatment , using a higher SSRIs dose can elevate serotonin levels in the brain and enhance the treatment outcome. The client’s compliance with the treatment can HAM-A scores and attain optimal results.

Why did you not select other options in this exercise?

What were you hoping to achieve by making this decision?

Explain how ethical considerations may impact your treatment plan and communication with patients

Decision Three

Why did you select this decision?

Why did you not select the other two options provided in this exercise?

What are you hoping for by making this decision?

Explain how ethical considerations may impact your treatment plan and communication with patients

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Conclusion

References

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: going beyond the guidelines. BJPsych Open, 2(6), e16-e18. http://bjpo.rcpsych.org/content/2/6/e16

Holmes, L. (2022). The 4 Major Classes of Anxiety Medications. Verywell Mind. Retrieved 2 July 2022, from https://www.verywellmind.com/mental-health-medications-for-anxiety-2337705.

Javed, A., & Fountoulakis, K. N. (Eds.). (2018). Advances in psychiatry. Springer.

Ostacher, M. J., & Cifu, A. S. (2019). Management of post-traumatic stress disorder. JAMA, 321(2), 200-201. https://doi.org/10.1001/jama.2018.19290

Slee, A. (2022). Generalized Anxiety Disorder: Incidence and Drug Treatment (Doctoral dissertation, UCL (University College London)). https://discovery.ucl.ac.uk/id/eprint/10146430

Week 6: Therapy for Patients With Anxiety Disorders and PTSD Treatment
I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.

â€”P.K. Philips, PTSD patient

For individuals presenting with posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.

This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of patients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.
Reference:
Philips, P. K. (n.d.). My story of survival: Battling PTSD. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/personal-stories/my-story-survival-battling-ptsd Therapy For Patients With Anxiety Disorders And PTSD Treatment

Learning Objectives
Students will:

Assess patient factors and history to develop personalized plans of anxiolytic therapy for patients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring anxiolytic therapy
Synthesize knowledge of providing care to patients presenting with anxiolytic therapy
Analyze ethical and legal implications related to prescribing anxiolytic therapy to patients across the lifespan
Assess psychopharmacologic approaches to treatment for patients across the lifespanAssignment: Assessing and Treating Patients 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 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 weekâ€™s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.

To prepare for this Assignment:
Review this weekâ€™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 patientâ€™s pharmacokinetic and pharmacodynamic processes. Therapy For Patients With Anxiety Disorders And PTSD Treatment

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)

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)Therapy For Patients With Anxiety Disorders And PTSD Treatment

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)Learning Resources
Required Readings (click to expand/reduce)

Bui, E., Pollack, M. H., Kinrys, G., Delong, H., Vasconcelos e SÃ¡, D., & Simon, N. M. (2016). The pharmacotherapy of anxiety disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 61â€“71). Elsevier.

American Psychiatric Association. (2010a). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf

American Psychiatric Association. (2010c). Practice guideline for the treatment of patients with panic disorder (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf

Bendek, D. M., Friedman, M. J., Zatzick, D., & Ursano, R. J. (n.d.). Guideline watch (March 2009): Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd-watch.pdf

Cohen, J. A. (2010). Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 49(4), 414â€“430. https://jaacap.org/action/showPdf?pii=S0890-8567%2810%2900082-1 Therapy For Patients With Anxiety Disorders And PTSD Treatment

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16â€“e18. 10.1192/bjpo.bp.116.003707. http://bjpo.rcpsych.org/content/2/6/e16

Hamilton, M. (1959). Hamilton Anxiety Rating Scale (HAM-A). PsycTESTS. https://doi.org/10.1037/t02824-0

Ostacher, M. J., & Cifu, A. S. (2019). Management of posttraumatic stress disorder. JAMA, 321(2), 200â€“201. https://doi.org/10.1001/jama.2018.19290

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), 328â€“339. https://doi.org/10.1002/da.21913

Medication Resources (click to expand/reduce)

Required Media (click to expand/reduce)

Assignment: Assessing and Treating Patients 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 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 weekâ€™s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.

Introduction to the case (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.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

By Day 7
Submit your Assignment.

Submission and Grading Information
To submit your completed Assignment for review and grading, do the following: Therapy For Patients With Anxiety Disorders And PTSD Treatment

Please save your Assignment using the naming convention â€œWK6Assgn+last name+first initial.(extension)â€ as the name.
Click the Week 6 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 6 Assignment link. You will also be able to â€œView Rubricâ€ for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as â€œWK6Assgn+last name+first initial.(extension)â€ and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:

Week 6 Assignment Rubric

Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:

Submit your Week 6 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 6
To participate in this Assignment:

Week 6 AssignmentNote: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:

benzodiazepines
citalopram
desvenlafaxine
duloxetine
escitalopram
fluoxetine
paroxetine
sertraline
venlafaxine
vilazodone
vortioxetine
propranolol
prazosin
Required Media (click to expand/reduce)Therapy For Patients With Anxiety Disorders And PTSD Treatment

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) Therapy For Patients With Anxiety Disorders And PTSD Treatment

By Day 7
Submit your Assignment.

Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:

Week 6 Assignment Rubric

Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:

Submit your Week 6 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 6
To participate in this Assignment: Therapy For Patients With Anxiety Disorders And PTSD Treatment

Week 6 Assignment

By Day 7
Submit your Assignment.

Submission and Grading InformationGeneralized Anxiety Disorder
Middle-Aged White Male With Anxiety
Middle aged male Therapy For Patients With Anxiety Disorders And PTSD Treatment

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 â€œanxiety attacks.â€ He will also report occasional feelings of impending doom, and the need to â€œrunâ€ or â€œescapeâ€ from wherever he is at.

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.

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. Clientâ€™s self-reported mood is â€œblehâ€ and he does endorse feeling â€œnervousâ€. 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. Therapy For Patients With Anxiety Disorders And PTSD Treatment

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

Diagnosis: Generalized anxiety disorder

RESOURCES

Â§ 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 BIDRubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6630_Week6_Assignment_Rubric
Grid View
List View
Excellent

Point range: 90â€“100 Good

Point range: 80â€“89 Fair

Point range: 70â€“79 Poor

Point range: 0â€“69
Introduction to the case (1 page)Therapy For Patients With Anxiety Disorders And PTSD Treatment

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.
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.
8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.
7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
Decision #1 (1â€“2 pages) Therapy For Patients With Anxiety Disorders And PTSD Treatment

â€¢ Which decision did you select?
â€¢ Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
â€¢ 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.
â€¢ 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).
â€¢ Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%) Therapy For Patients With Anxiety Disorders And PTSD Treatment
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

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The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. Therapy For Patients With Anxiety Disorders And PTSD Treatment

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.
Decision #2 (1â€“2 pages)

â€¢ Which decision did you select?
â€¢ Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
â€¢ 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.
â€¢ 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).
â€¢ Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
18 (18%) – 20 (20%) Therapy For Patients With Anxiety Disorders And PTSD Treatment
The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.
16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. Therapy For Patients With Anxiety Disorders And PTSD Treatment

The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided support the decisions and responses provided.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.
0 (0%) – 13 (13%) Therapy For Patients With Anxiety Disorders And PTSD Treatment
The response inaccurately and vaguely explains in detail the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.
Decision #3 (1â€“2 pages)