Posted: July 17th, 2022

Assignment: Assessing and Treating Clients with Anxiety Disorders

Assignment: Assessing and Treating Clients with Anxiety Disorders
Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.
Learning Objectives

Students will:
• Assess client factors and history to develop personalized plans of anxiolytic therapy for clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring anxiolytic therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing anxiolytic therapy to clients across the lifespan

To prepare for this Assignment:
• Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment
Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
• Decision #1
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
•
• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.

Generalized Anxiety Disorder

Middle-Aged White Male With Anxiety

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.
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. 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.
The PMHNP administers the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder

RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Decision Point One
Select what the PMHNP should do:

Begin Zoloft 50 mg po daily Click to see options it will take you to decision point two and three with increase or decrease or change of medication and results

Begin Imipramine 25 mg po BID Click to see options it will take you to decision point two and three with increase or decrease or change of medication and results

Begin Buspirone 10 mg po BID Click to see options it will take you to decision point two and three with increase or decrease or change of medication and results

Decision Point One This is an example one not to be used word for word. Thank you

Begin Zoloft 50 mg orally daily
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Client informs you that he has no tightness in chest, or shortness of breath
• Client states that he noticed decreased worries about work over the past 4 or 5 days
• HAM-A score has decreased to 18 (partial response)
Decision Point Two

Increase dose to 75 mg orally daily

RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Client reports an even further reduction in his symptoms
• HAM-A score has now decreased to 10. At this point- continue current dose (61% reduction in symptoms)
Decision Point Three

Maintain current dose

Guidance to Student
At this point, it may be appropriate to continue client at the current dose. It is clear that the client is having a good response (as evidenced by greater than a 50% reduction in symptoms) and the client is currently not experiencing any side effects, the current dose can be maintained for 12 weeks to evaluate full effect of drug. Increasing drug at this point may yield a further decrease in symptoms but may also increase the risk of side effects. This is a decision that the PMHNP should discuss with the client. Nothing in the client’s case tells us that we should consider adding an augmentation agent at this point as the client is demonstrating response to the drug. Avoid polypharmacy unless symptoms cannot be managed by a single drug.
Anxiolytic Therapy and PTSD Treatment Essay Assignment

All references require creditable sources, nothing less than 5 years. References require doi or http. Please add a conclusion
Tips:
– Always use the choices given
– Continuation of psych meds may be needed before switching as they take time.

—
– Free Essay Sample
Psychopharmacologic Approaches to Treatment of Psychopathology

Student’s Name
Institutional Affiliation
Course
Professor’s Name
Date

Psychopharmacologic Approaches to Treatment of Psychopathology
Introduction
Generalized anxiety disorder is a common condition in healthcare centers. Psychiatrists and clinicians address the condition using a series of decisions based on the progress of a patient. The current case study involves an adult male patient with an anxiety disorder. One of the best decisions is to prescribe Zoloft 50mg orally daily but the dosage can be increased depending on the outcomes of various decisions (Yonkers et al., 2017). The prescription of Zoloft shows the patient has achieved full recovery at the end of the treatment. Clinicians should also take ethical considerations to avoid legal issues during treatment. Treatment of generalized anxiety disorder requires a clear understanding of the impact of the drugs, their side effects, and the ethical considerations.
Decision #1
The first decision is to prescribe Zoloft 50mg orally daily. Zoloft is a popular and effective medication to treat anxiety disorders in both children and adults. Zoloft is one of the evidence-based antidepressants appropriate for the treatment of Generalized Anxiety Disorder (GAD) (Hoge et al., 2018). Antidepressants are relevant for the treatment of GAD since they balance the chemicals in the brain that affect mood and emotions. A proper balance of the chemicals improves the quality of sleep, appetite, mood, and concentration (Hoge et al., 2018). Evidence-based findings indicate that the drug is appropriate for adults since it has minimal side effects. It is also effective for long-time use without any habit-forming effects.
Patients should begin treatment with a low dose of Zoloft such as 50mg daily. The purpose of the low dose is to regulate and prevent cases of suicidal thoughts. FDA states that clinicians should prescribe the medication with moderation to prevent adverse effects (Haseth et al., 2019). However, it is important to caution the patient to stop taking alcohol. The reason is that taking alcohol alongside Zoloft can cause side effects such as feeling drowsy (Hoge et al., 2018). Drinking alcohol can also deteriorate the condition of anxiety attacks.
I expect that the drug will work effectively and generate positive results after four weeks. I expect the client to record a 50 percent reduction in the HAM-A score scale. I also expect a significant improvement in the symptoms. I did not select the other available medications since they did not match the requirements of the patient and the expected outcomes.
The client returned to the clinic after four weeks. The expected outcomes have little similarity with the expected improvement of the symptoms. For example, the client was subjected to the HAM-A score rating scale and it had 18 points, which is a partial improvement. The patient also complains of mild shortness of breath and tightness of the chest. However, the patient indicates he has experienced a reduction in the worry about work in the last week.
The difference between the expected outcome and the actual outcome is that the patient may require some extra time to recover (Dunn et al., 2017). Another reason is that the medication or dosage does not have the right therapeutic ability to suppress the symptoms.
Decision #2
The second decision involved various choices including increasing the dosage to 75mg orally daily, increase the dosage to 100mg orally daily or change the medication. The best decision depending on the current condition of the patient is to maintain Zoloft drug (Dunn et al., 2017). However, since the client has made some progress, it is important to increase the dosage to 75mg orally daily. Research evidence shows that it is critical to increasing the dosage consistently to avoid adverse effects of the drug on a patient. The purpose of increasing the dosage is to boost the therapeutic strength of the drug (Dunn et al., 2017). Therefore, the patient should continue taking the drug for another four weeks. Depending on the condition of the patient, it is not advisable to change the medication since it can interfere with the recovery process (Dunn et al., 2017). The patient should report back for further assessment to examine the condition including the HAM-A score rating scale.
The expectation of deciding to increase the dosage to Zoloft 75mg orally daily is to improve the recovery process. For example, I expect the patient will have a 100 percent improvement score in the HAM-A score rating scale and no anxiety attacks. Research shows that Zoloft is one of the best and reliable medication for generalized anxiety disorder (Hiriscau et al., 2016). For example, the medication is effective to change the mood of a patient thus eliminate anxiety attacks. I also expect the patient to have no more tightness of the chest and shortness of breath. Previously in decision #1, the patient reported some significant progress which is expected in the next four weeks. Therefore, I expect that the patient will not worry about his job again or experience other health issues. I have high expectations in the next four weeks since antidepressants may take several weeks to be effective, yet the patient will be taking the medication for the eighth week.
The patient reports to the clinic after four weeks for further assessment. An examination report shows the patient has further improvement in the symptoms. For example, the patient is no longer worried about his change. He is optimistic about life and his fear of a looming negative incidence has subsided significantly. Additionally, the HAM-A score has reduced to 10 which shows that the patient has 61 percent improvement. The improvement of the symptoms is a sign that the medication is effective.
The patient outcomes are similar to the expectations during the prescription of the drug. One of the reasons for the drastic improvement is that the high dosage has a higher strength to suppress the symptoms of a generalized anxiety disorder (Hiriscau et al., 2016). Therefore, if the patient continues to take the medication for another few weeks, it is expected that they will demonstrate full recovery.
Decision #3
The third decision involves a variety of choices based on the improvements the patient has made in decision #1 and decision #2. The decisions include maintaining the current medication and dose, increasing the dosage to 100mg orally daily or changing the medication. Another option is to add an augmentation agent such as BuSpar (Smith, 2019). The progress of the patient also shows no need for polypharmacy since a single drug is already achieving expected outcomes.
The best decision for the patient is to maintain the medication and dosage at 75mg orally daily. The reason is that the medication has demonstrated evidence of suppressing the symptoms and promoting 61 percent recovery. There is no need to increase the dosage since the current one has already achieved significant progress. It is also advisable not to change the drug or dosage since it is achieving positive results without any side effects (Yonkers et al., 2017). An increase in the dosage may improve the symptoms but also trigger other side effects. Another decision is to educate the patient about the side effects of the Zoloft. Research shows that one of the side effects of Zoloft use is adding weight (Yonkers et al., 2017). The patient should embrace the side effect since it will subside after completing the dosage. Therefore, the patient should not fail to take the medication consistently for fear that they will add unnecessary weight.
The expectation of maintaining Zoloft 75mg orally daily is to realize a full recovery. For example, it is expected that the patient will have a better HAM-A score to show 100 percent recovery. Zoloft is a common antidepressant and therefore I expect the patient will experience full recovery (Hoge et al., 2018). Evidence-based practice also shows that Zoloft can be administered for almost 12 weeks to realize the full effect of the drug.
The patient reports to the clinic after four weeks and demonstrates significant progress compared to two weeks ago. For example, the HAM-A score indicates the patient has a 100 percent improvement. Additionally, the patient is no longer experiences anxiety attacks or shortness of breath. Therefore, the patient shows a full recovery, and thus the patient should not take the medication any longer.
Ethical Considerations
Treatment of generalized anxiety disorder involves various ethical issues that impact treatment and communication. One of the ethical considerations is to inform the patient about the side effects of the drug such as adding weight or suicidal thoughts (Smith, 2019). The consideration requires clinicians to start the treatment with a low dosage. According to FDA guidelines, clinicians should progressively increase the dosage to prevent a surge of the side effects (Hiriscau et al., 2016). The side effects can also cause adverse effects especially among patients with depressive symptoms. Clinicians can be held responsible if they do not take the necessary precautions while treating patients.
Clinicians and psychiatrists should assure the patients that their information will be private and confidential. It is unethical for a psychiatrist to share information about the health condition of a patient (Smith, 2019). The assurance will improve the confidence of the patient to always come back for clinics. Treatment should be in line with human dignity and fairness. Psychiatrists should not mishandle patients due to their mental condition (Hiriscau et al., 2016). It is essential to assure the patient that the treatment will observe fairness and justice. The ethical considerations are important to avoid legal issues or mishandling of patients.
Conclusions
Treatment of generalized anxiety disorders is one of the common cases that clinicians and psychiatrists will encounter regularly. Psychiatrists should make the right decisions regarding the treatment. The right decisions involve taking the precautions regarding the side effects of a drug. It is also important to understand the legal and practice guidelines of the FDA regarding drugs such as Zoloft. In the current case study, Zoloft was the best medication to realize the expected outcomes. All the decisions were effective and the final result was the full recovery of the patient. However, clinicians should understand the need to increase the dosage to a certain limit and the need to avoid changing the drug. Changing a drug in the middle of a treatment process may interfere with the recovery and trigger side effects. Treatment should also include ethical considerations to align the delivery of care with the legal guidelines. Patients with generalized anxiety disorder can fully recover if clinicians take the right decisions.

References
Dunn, E. C., Sofer, T., Gallo, L. C., Gogarten, S. M., Kerr, K. F., Chen, C. Y., … & Qi, Q. (2017). Genome‐wide association study of generalized anxiety symptoms in the Hispanic Community Health Study/Study of Latinos. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 174(2), 132-143. https://doi.org/10.1002/ajmg.b.32448
Haseth, S., Solem, S., Baardsen, G. S., Bjørnstad, E., Grøtte, T., & Fisher, P. (2019). Group Metacognitive Therapy for Generalized Anxiety Disorder: A Pilot Feasibility Trial. Frontiers in Psychology, 10, 290. https://doi.org/10.3389/fpsyg.2019.00290
Hiriscau, E. I., Stingelin-Giles, N., Wasserman, D., & Reiter-Theil, S. (2016). Identifying ethical issues in mental health research with minors adolescents: results of a Delphi write my paper study. International Journal of Environmental Research and Public Health, 13(5), 489. https://doi.org/10.3390/ijerph13050489
Hoge, E. A., Bui, E., Palitz, S. A., Schwarz, N. R., Owens, M. E., Johnston, J. M., … & Simon, N. M. (2018). The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Research, 262, 328-332. https://doi.org/10.1016/j.psychres.2017.01.006
Smith, G. (2017). Ethical Issues in Mental Health Nursing. Key Concepts and Issues in Nursing Ethics, 7(3), 145-157. https://doi.org/10.1007/978-3-319-49250-6_11
Yonkers, K. A., Gilstad-Hayden, K., Forray, A., & Lipkind, H. S. (2017). Association of panic disorder, generalized anxiety disorder, and benzodiazepine treatment during pregnancy with risk of adverse birth outcomes. JAMA Psychiatry, 74(11), 1145-1152. DOI:10.1001/jamapsychiatry.2017.2733.

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