Case Study Of A Middle-Aged Caucasian Man With Anxiety

Case Study Of A Middle-Aged Caucasian Man With Anxiety

Introduction

The mental health classification of generalized anxiety disorder is based on DSM-IV. Patients always present with exaggerated anxiety based on their daily activities in their occupation and general lifestyles. Generalized anxiety disorder is characterized by features such as severe anxiety, palpitations, fatigue and poor concentration at the workplace (Strawn et al., 2018). Treatment of generalized anxiety disorder is by using selective serotonin reuptake inhibitors (SSRI) such as fluoxetine, Zoloft, benzodiazepines such as clonazepam, and antidepressants such as Imipramine, anxiolytics such as buspirone and psychotherapy (Strawn et al., 2018). During the assessment of the patient, several factors should be considered before the prescription of the medication. These factors include age, race, occupation, drug allergies, underlying medical conditions and drug and alcohol use (Strawn et al., 2018)Case Study Of A Middle-Aged Caucasian Man With Anxiety. This paper will analyze the patient who has a generalized anxiety disorder characterized by severe anxiety, fear of losing his job, anxiety attacks and experiences shortness of breath.

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The drugs of choice that the patient will use are Zoloft which is an SSRI, anxiolytics drug (buspirone) and imipramine this will enable the patient to work as usual and relieve the patient’s anxiety. Zoloft (sertraline) is the first-line treatment of SSRI and works by inhibiting the uptake of a chemical messenger known as serotonin in the brain. The drug is very effective and has fewer side effects. The patient is able to use the drug even as he works in the factory since the drug cannot interfere with his occupation (Potter, 2019). The patient will use Zoloft 50mgs to be taken orally 50mgs per day at the beginning of treatment. The patient will take buspirone 10mgs twice per day as an anxiolytic drug that works by increasing the actions of serotonin receptors in the brain. This will lessen the anxiety in the patient (Wilson & Tripp, 2018)Case Study Of A Middle-Aged Caucasian Man With Anxiety. Since the patient has experienced chest tightness and shortness of breath the patient should be able to monitor the side effects and report back to the facility. Tricyclic antidepressants such as imipramine are used to treat anxiety disorder by inhibiting the reuptake of serotonin elevating the level of neurotransmitters in the brain and reducing anxiety levels (Agras, 2019). The patient will use imipramine 25mg twice per day. The treatment should be able to relieve the patient’s anxiety and the Hamilton Anxiety Rating Scale (HAM-A) to be from moderate to severe anxiety which is 26 on the scale to 20 which is mild. The ethical consideration that I will employ include:

Autonomy – this is the ability of the patient to deliberately make decisions regarding their health. The patient has been able to explain his condition and is able to adhere to the instructions given based on the treatment given. The patient is able to give consent before any test is done to them to get the proper diagnosis (Entwistle et al., 2010)Case Study Of A Middle-Aged Caucasian Man With Anxiety. The patient has been able to answer the questions properly during the mental health assessment and during the HAM-A anxiety assessment.
Confidentiality– the information that the patient has shared regarding his condition should not be shared with any other person it should be between the patient and the physician (Bani Issa et al., 2020). In the case where the patient felt the need to share the information, he should be able to give consent.
Informed consent– this is the agreement between the healthcare provider and the patient regarding the treatment plan. The patient should agree to be treated first before any procedure can be done. In this case, the patient has agreed to be brought to the facility for treatment and has consented to mental assessment for the treatment of the anxiety.

The second decision will be based on the patient’s response to medication after he has used them for a month. This can be done by assessing the patient’s mental status through the mental health assessment tool. The patient mood has improved and the affected part has improved too. There are improved breathing patterns and no chest tightness. The patient reported there is no feeling of impending doom and the occasional feeling of anxiety attacks has improved. The patient lifestyle has changed, he has limited the intake of ETOH that he was taking due to anxiety. The drug therapy will be analyzed and increase the dosage of Zoloft (sertraline) to 75mgs orally per day and continue to monitor the patient’s response at the next visit. The importance of increasing the dosage is to enable the production of serotonin to increase hence ensuring the anxiety is reduced (Potter, 2019)Case Study Of A Middle-Aged Caucasian Man With Anxiety. The ethical consideration that the physician will use is confidentiality protecting the patient’s information and details unless the patient has consented. The patient should sign a consent form to show that he has accepted to continue with treatment. The third ethical consideration is autonomy whereby the patient will make the decision if he is willing to continue with the treatment after explaining to him the reason as to why the dosage has been increased and its importance. The Hamilton Anxiety Rating Scale (HAM-A) should show some improvement.

The third decision will be based on the patient’s response to the treatment given after increasing the dosage of Zoloft. This will be based on the Hamilton Anxiety Rating Scale (HAM-A) which will show no anxiety. The patient will be able to report improved signs of anxiety such as no more anxiety attacks, normal breathing patterns, he does not see any impending doom, he is able to concentrate on his work without the fear of being fired and he is able to support his parents well. His moods have also improved and he is in his normal mental status, he has also stopped to take ETOH that he was taking due to the anxiety attacks that he was facing. In the case where the patient has shown great improvement, there is no need to increase the dosage since the patient is responding well and there are no effects reported. The dosage of Zoloft will remain the same 75mgs orally twice. The physician will stop administering imipramine and buspirone since the patient has really improved. The physician will ensure the patient has a follow-up to ensure he gets completely well and weaned off medication systematically. The ethical consideration that the physician will use include autonomy whereby the patient will be able to decide if he will continue taking the medication given and do follow-ups and confidentiality whereby the patient’s information should still remain between the patient and the physician unless he gives permission to be shared. Lastly, regarding informed consent, the patient allows the healthcare worker permission to attend to him. By doing the follow-up checkups and educating him on the importance of medication adherence Case Study Of A Middle-Aged Caucasian Man With Anxiety.

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Psychotherapy

This is a process whereby the patient is able to share his ailment with the psychologist to get more help. The procedure together with medication will enable the patient to recover well through sharing his feelings, moods, thoughts and behaviors that trigger the cause of his anxieties. Through the interaction, the patient will be able to change the behavior that is causing the anxiety and cope with recently learnt ideas that the psychiatrist will share in the recovery (Cuijpers et al., 2011).

Conclusion

The first-line treatment of generalized anxiety disorders is SSRI the physician selected Zoloft 50mgs orally daily which has been very effective in the treatment of the condition with fewer side effects. The patient has reported great improvement with completely no anxiety attacks and his mood has stabilizes. The use of buspirone in the first decision as an anxiolytic has enabled the patient to heal from the anxiety attacks that were often ensuring he recovers well. Imipramine has enabled the patient to heal from the blunt affect mood that was affecting him through the anxiety that he has been suffering from. The increase of Zoloft dosage from 50mgs to 75mgs as a maintenance dosage has enabled the patient to recover fully and prevent further anxiety attacks. Medication and psychotherapy have enabled the patient to recover.

The ethical considerations the physician applied during the treatment process include autonomy, informed consent and confidentiality. This has enabled the patient to fully recover and has gained confidence throughout the treatment process and ensuring there is good communication between the patient and the physician. The HAM-A scores have also reduced from severe anxiety to a normal score Case Study Of A Middle-Aged Caucasian Man With Anxiety.

References

Agras, W. S. (2019). Stress, panic, and the cardiovascular system. In Anxiety and the Anxiety Disorders (pp. 363-368). Routledge.

Bani Issa, W., Al Akour, I., Ibrahim, A., Almarzouqi, A., Abbas, S., Hisham, F., & Griffiths, J. (2020). Privacy, confidentiality, security and patient safety concerns about electronic health records. International Nursing Review, 67(2), 218-230. https://doi.org/10.1111/inr.12585

Cuijpers, P., Geraedts, A. S., Van Oppen, P., Andersson, G., Markowitz, J. C., & Van Straten, A. (2011). Interpersonal Psychotherapy for depression: A meta-analysis. American Journal of Psychiatry, 168(6), 581-592. https://doi.org/10.1176%2Fappi.ajp.2010.10101411

Entwistle, V. A., Carter, S. M., Cribb, A., & McCaffery, K. (2010). Supporting patient autonomy: The importance of clinician-patient relationships. Journal of General Internal Medicine, 25(7), 741-745. https://doi.org/10.1007/s11606-010-1292-2 Case Study Of A Middle-Aged Caucasian Man With Anxiety

Potter, D. R. (2019). Major depression disorder in adults: A review of antidepressants. International Journal of Caring Sciences, 12(3), 1936. https://www.internationaljournalofcaringsciences.org/docs/69_potter_review_12_3.pdf

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. (2021). Buspirone. StatPearls Publishing, Treasure Island (FL). https://europepmc.org/article/NBK/nbk531477
PMID: 30285372.

A Middle-Aged Caucasian Man With Anxiety. 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. Case Study Of A Middle-Aged Caucasian Man With Anxiety

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.

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

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.
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) Case Study Of A Middle-Aged Caucasian Man With Anxiety

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)Case Study Of A Middle-Aged Caucasian Man With Anxiety

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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 Of A Middle-Aged Caucasian Man With Anxiety