Posted: September 7th, 2022

Assessing and Treating Patients with Anxiety Disorders

Assessing and Treating Patients with Anxiety Disorders
Introduction
The case research includes a 46-year-old white male who’s affected by Generalized Anxiety Dysfunction. He’s a welder at an area metal fabrication manufacturing facility. He involves the emergency room presenting numerous signs much like a coronary heart assault. He presents with signs corresponding to tightness of the chest, shortness of breath, feeling impending doom, and anxiousness assaults. His HAM-A rating is 26. He’s obese and experiences occasional use of ETOH to suppress worries at his office. He admits that the work atmosphere is harsh, and he fears for his job.
The primary resolution is to start Zoloft 50 mg PO each day. Zoloft is the primary line of therapy for GAD since it’s efficient and has fewer uncomfortable side effects. The drug prevents the reabsorption of the serotonin hormone. The primary resolution reduces the signs by 31 p.c. The second resolution is to extend the dosage to Zoloft 75 mg PO each day. Growing the dosage enhances the therapeutic efficacy of the drug. The second resolution reduces the signs by 61 p.c. The affected person ought to proceed taking the drug for an additional 4 weeks and come again for additional examination. Zoloft is the most effective treatment in GAD therapy because it has a excessive therapeutic stage, fewer uncomfortable side effects, a excessive success charge. The opposite two choices aren’t the primary line of therapy for the illness. Imipramine 25mg PO BID might be relevant if Zoloft fails to generate the anticipated outcomes. It isn’t preferable to vary the drug because the motion may set off opposed reactions. The moral issues essential to watch within the case research embrace confidentiality, autonomy, knowledgeable consent, maleficence, beneficence, integrity, and justice. The aim of the essay is to research three selections related to the case research to deal with GAD.
Choice One
The primary resolution is to start Zoloft 50 mg PO each day to deal with Generalized Anxiety Dysfunction (GAD).
Rationale for the Choice
The aim of choosing Zoloft is as a result of it’s the first line of therapy for psychological circumstances corresponding to GAD. The drug has fewer uncomfortable side effects in comparison with different medication. Zoloft prevents presynaptic serotonin reabsorption resulting in a stability within the hormone (Salimi Kordasiabi et al., 2020). The serotonin hormone is accountable for regulating happiness, temper, and anxiousness. Regulating the hormone is important in modulating stress (Salimi Kordasiabi et al., 2020). Patients that take Zoloft for 4 consecutive weeks have a big enchancment of their signs.
Imipramine 25mg PO BID just isn’t an acceptable possibility since it’s a tricyclic antidepressant. The drug just isn’t an SSRI that can be utilized as a first-line therapy for GAD (Jafarnia et al., 2017). TCAs can solely be used when SSRI doesn’t generate the anticipated outcomes. Another excuse for not selecting Imipramine is as a result of it triggers opposed uncomfortable side effects like weight acquire, confusion, seizures, anticholinergic results, and delirium (Jafarnia et al., 2017). The uncomfortable side effects can undermine adherence to the therapy when sufferers notice they’re gaining weight. The drug is inappropriate because the affected person is already obese.
Buspirone 10mg PO BID just isn’t the most suitable choice since it may possibly solely be used when SSRI doesn’t generate the proper outcomes. It’s relevant when sufferers don’t reply to SSRI or expertise opposed reactions (Strawn et al., 2018). Research present that sufferers have poor well being outcomes to deal with anxiousness once they take Buspirone 10mg PO BID (Strawn et al., 2018).
The aim of prescribing Zoloft is to scale back the severity of the signs. The main focus is to scale back the signs by a minimum of 50 p.c within the subsequent 4 weeks. The affected person shouldn’t have any uncomfortable side effects since they’ll undermine the restoration course of (Hoge et al., 2018). For instance, the affected person ought to cut back signs corresponding to shortness of breath and chest tightness. Throughout the 4 weeks, the HAM-A scale ought to cut back considerably (Hoge et al., 2018).
The end result after 4 weeks exhibits that Zoloft was a great resolution. The end result exhibits a discount within the severity of the signs. For example, the HAM-A scale rating decreased from 26 to 18 factors. The discount exhibits a 31 p.c enchancment within the stage of hysteria. Though the affected person didn’t obtain the 50 p.c discount within the signs, the 31 p.c considerably progressed.
Choice Two
The second resolution is to prescribe Zoloft 75 mg PO each day. The prescription is a 25mg improve from the dose in resolution one.
Rationale for the Choice
The aim of accelerating the dose to 75mg is to deal with the partial enchancment within the first resolution. For instance, the affected person had solely a 31 p.c discount within the anxiousness signs than the anticipated 50 p.c (Stahl, 2013). The expectation is to generate a greater enchancment charge inside the subsequent 4 weeks. Another excuse for rising the dose is that the affected person had a greater tolerance of the drug with none uncomfortable side effects (Stahl, 2013).
Improve the drug dose to 100mg just isn’t secure since it’s too excessive for the affected person. Prescribing 100mg can set off uncomfortable side effects that may have an effect on the restoration course of. Therapy of psychological problems includes a stability between therapy and uncomfortable side effects (Slee et al., 2019). The numerous tolerance of the drug exhibits that it may be elevated to attain higher outcomes. Altering the drug just isn’t advisable after 4 weeks. Utilizing a number of medication to deal with psychological medication just isn’t secure for sufferers (Slee et al., 2019). It isn’t acceptable to vary the drug solely after 4 weeks of prescribing the primary drug.
Growing Zoloft to 75mg successfully enhances the therapeutic stage of the drug (Stahl, 2013). The drug will Help the affected person to attain a 50 p.c lower in anxiousness signs. One other expectation is to enhance the HAM-A rating. The affected person won’t expertise uncomfortable side effects. Unintended effects aren’t preferable since they’ll delay the restoration course of.
The outcomes present that the affected person had a 61 p.c discount within the signs. The HAM-A signs decreased from 18 to 10 scores. The optimistic response of the Zoloft 75 mg is efficient in addressing the GAD signs (Stahl, 2013). Prescribing the drug for an additional 4 weeks gives hope that the affected person will recuperate from the well being situation. Research point out that Zoloft 75 mg is efficient in treating sufferers with HAM-A scores of a minimum of 20 factors. The enhancements present that Zoloft 75 mg is best in comparison with 50mg of the drug. The excessive tolerance of the drug is efficient in attaining optimistic outcomes (Stahl, 2013). The affected person didn’t present any uncomfortable side effects, which signifies that the drug successfully addresses the anxiousness behaviors in sufferers with out inflicting uncomfortable side effects.
Choice Three
The third resolution is to keep up the present treatment and dose, Zoloft 75 mg PO each day.
The aim of sustaining the drug and dosage is as a result of it has a big influence on lowering the signs as much as 61 p.c. The discount is a optimistic signal that if the affected person takes the drug for an additional 4 weeks, he will probably be higher positioned to renew regular actions in life (Stahl, 2013). For example, the discount of the HAM-A rating to 10 was a big enchancment. Another excuse is that the drug was efficient with none uncomfortable side effects. The danger of uncomfortable side effects may improve if the affected person took 100mg of Zoloft (Stahl, 2013). One of many widespread uncomfortable side effects of taking a particularly excessive drug is erectile dysfunction. Such uncomfortable side effects may have an effect on the affected person’s high quality of life and set off the affected person to cease taking the drug.
The affected person can not begin taking Buspirone in the course of the therapy since he’s already responding positively to Zoloft. Altering medication for folks with a psychological well being situation just isn’t advisable since it may possibly set off opposed reactions. Research present that monotherapy is the most effective therapy for sufferers with psychological problems (Strawn et al., 2018). The affected person ought to proceed taking Zoloft 75mg PO each day till full restoration. The intention is to boost the discount of the signs by sustaining the therapeutic stage of the drug.
The affected person ought to proceed taking the drug for the subsequent 4 weeks. An additional examination is critical after the 4 weeks to find out the extent of enchancment. Analysis of the affected person’s signs and HAM-A rating will probably be very important to determine the therapy’s success (Strawn et al., 2018). Adherence to the therapy plan is essential within the subsequent 4 weeks of care provision. The affected person ought to keep on with the drug to keep away from relapse or gradual restoration.
Moral Concerns
Healthcare staff have a duty to watch moral requirements within the care provision. The moral issues essential to watch within the case research embrace confidentiality, autonomy, knowledgeable consent, maleficence, beneficence, integrity, and justice. Confidentiality is important within the care provision because it includes abiding by the HIPPA ideas (Ingham-Broomfield, 2017). The ideas stipulate that affected person’s private particulars needs to be non-public except below the exceptions stipulated in HIPPA legal guidelines (Ingham-Broomfield, 2017). A healthcare employee ought to observe equity and justice within the provision of care.
Autonomy refers back to the competence of a nurse to take cost within the therapy course of. A nurse ought to have the liberty and authority to make therapy selections. Equally, a nurse ought to respect affected person autonomy to make private selections concerning the care (Stahl, 2013). The moral consideration ought to contain knowledgeable consent, which offers a affected person with details about the prognosis and therapy plan. Patients have the liberty and authority to consent or decline care (Ingham-Broomfield, 2017). Maleficence and beneficence are moral issues that emphasize the necessity for care to keep away from harming a affected person through the use of professionalism.
Conclusion
Assessing and treating sufferers with anxiousness problems is a tasking train that includes making numerous selections. The primary resolution is to prescribe Zoloft 50 mg PO each day. The treatment is the most effective for GAD therapy because it improves serotonin absorption and has fewer uncomfortable side effects. The second resolution is to prescribe Zoloft 75 mg PO each day. The third resolution is to keep up the dosage. The supply of care ought to observe moral issues, together with confidentiality, autonomy, knowledgeable consent, maleficence, beneficence, integrity, and justice.

References
Hoge, E. A., Bui, E., Palitz, S. A., Schwarz, N. R., Owens, M. E., Johnston, J. M., … & Simon, N. M. (2018). The impact of mindfulness meditation coaching on organic acute stress responses in generalized anxiousness dysfunction. Psychiatry Analysis, 262, 328-332.
Ingham-Broomfield, R. (2017). A nurses’ information to moral issues and the method for moral approval of nursing analysis. Australian Journal of Superior Nursing, 35(1), 40-47.
Jafarnia, N., Ghorbani, Z., Nokhostin, M., Manayi, A., Nourimajd, S., & Razeghi Jahromi, S. (2017). Impact of saffron (Crocus sativus L.) as an add-on remedy to sertraline in delicate to average generalized anxiousness dysfunction: a double blind randomized managed trial. Archives of Neuroscience, four(four).
Laureate Training. (2016b). Case research: A middle-aged Caucasian man with anxiousness [Interactive media file]. Baltimore, MD: Creator.
Salimi Kordasiabi, A. H., Daneshzad, T., & Aminpour, A. (2020). Comparative Examine of the Efficacy of Cognitive-Behavioral Remedy and Sertraline in Generalized Anxiety Dysfunction. Tabari Biomedical Pupil Analysis Journal, 2(1), 33-38.
Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Freemantle, N. (2019). Pharmacological therapies for generalised anxiousness dysfunction: a scientific evaluate and community meta-analysis. The Lancet, 393(10173), 768-777.
Stahl, S. M. (2013). Stahl’s important psychopharmacology: Neuroscientific foundation and sensible purposes (4th ed.). New York, NY: Cambridge College Press.
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, Okay., & Levine, A. (2018). Pharmacotherapy for generalized anxiousness dysfunction in grownup and pediatric sufferers: an evidence-based therapy evaluate. Professional Opinion on Pharmacotherapy, 19(10), 1057-1070.

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