Posted: October 6th, 2022

Assessing and Treating Patients With Anxiety Disorders

Task: Assessing and Treating Patients With Anxiety Disorders
Widespread signs of hysteria problems embody chest pains, shortness of breath, and different bodily signs which may be mistaken for a coronary heart assault or different bodily ailment. These manifestations usually immediate sufferers to hunt care from their major care suppliers or emergency departments. As soon as it’s decided that there isn’t any natural foundation for these signs, sufferers are usually referred to a psychiatric psychological well being practitioner for anxiolytic remedy. For this Task, as you study the affected person case examine on this week’s Studying Assets, contemplate the way you would possibly assess and deal with sufferers presenting with nervousness problems.

To organize for this Task:
Assessment this week’s Studying Assets, together with the Treatment Assets indicated for this week.
Mirror on the psychopharmacologic therapies you would possibly advocate for the Assessment and therapy of sufferers requiring anxiolytic remedy.
The Task: 5 pages
Study Case Research: A Center-Aged Caucasian Man With Anxiety. You can be requested to make three selections regarding the treatment to prescribe to this affected person. Remember to contemplate elements that may impression the affected person’s pharmacokinetic and pharmacodynamic processes.

At every determination level, it is best to consider all choices earlier than choosing your determination and transferring all through the train. Earlier than you make your determination, just be sure you have researched every choice and that you simply consider the choice that you’ll choose. Remember to analysis every choice utilizing the first literature.

Introduction to the case (1 web page)

Briefly clarify and summarize the case for this Task. Remember to embody the particular affected person elements which will impression your determination making when prescribing treatment for this affected person.
Resolution #1 (1 web page)

Which determination did you choose?
Why did you choose this determination? Be particular and Help your response with clinically related and patient-specific sources, together with the first literature.
Why did you not choose the opposite two choices offered within the train? Be particular and Help your response with clinically related and patient-specific sources, together with the first literature.
What had been you hoping to realize by making this determination? Help your response with proof and references to the Studying Assets (together with the first literature).
Clarify how moral issues could impression your therapy plan and communication with sufferers. Be particular and present examples.
Resolution #2 (1 web page)

Why did you choose this determination? Be particular and Help your response with clinically related and patient-specific sources, together with the first literature.
Why did you not choose the opposite two choices offered within the train? Be particular and Help your response with clinically related and patient-specific sources, together with the first literature.
What had been you hoping to realize by making this determination? Help your response with proof and references to the Studying Assets (together with the first literature).
Clarify how moral issues could impression your therapy plan and communication with sufferers. Be particular and present examples.
Resolution #three (1 web page)

Why did you choose this determination? Be particular and Help your response with clinically related and patient-specific sources, together with the first literature.
Why did you not choose the opposite two choices offered within the train? Be particular and Help your response with clinically related and patient-specific sources, together with the first literature.
What had been you hoping to realize by making this determination? Help your response with proof and references to the Studying Assets (together with the first literature).
Clarify how moral issues could impression your therapy plan and communication with sufferers. Be particular and present examples.
Conclusion (1 web page)

Summarize your suggestions on the therapy choices you chose for this affected person. Remember to justify your suggestions and Help your response with clinically related and patient-specific sources, together with the first literature.
Notice: Help your rationale with a minimal of 5 educational sources. Whilst you could use the course textual content to Help your rationale, it won’t rely towards the useful resource requirement. Try to be using the first and secondary literature.
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Assessing and Treating Patients with Anxiety Disorders

Scholar’s Title
Institutional Affiliation
Course
Professor’s Title
Date

Assessing and Treating Patients with Anxiety Disorders
Introduction
The case examine 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 just like a coronary heart assault. He presents with signs reminiscent of tightness of the chest, shortness of breath, feeling impending doom, and nervousness assaults. His HAM-A rating is 26. He’s chubby and studies 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 determination 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 unintended effects. The drug prevents the reabsorption of the serotonin hormone. The primary determination reduces the signs by 31 %. The second determination is to extend the dosage to Zoloft 75 mg PO each day. Growing the dosage enhances the therapeutic efficacy of the drug. The second determination reduces the signs by 61 %. The affected person ought to proceed taking the drug for an additional 4 weeks and come again for additional examination. Zoloft is one of the best treatment in GAD therapy because it has a excessive therapeutic stage, fewer unintended effects, a excessive success fee. The opposite two choices are usually not the primary line of therapy for the illness. Imipramine 25mg PO BID might be relevant if Zoloft fails to generate the anticipated outcomes. It’s not preferable to vary the drug because the motion might set off antagonistic reactions. The moral issues crucial to look at within the case examine embody confidentiality, autonomy, knowledgeable consent, maleficence, beneficence, integrity, and justice. The aim of the essay is to research three selections related to the case examine to deal with GAD.
Resolution One
The primary determination is to start Zoloft 50 mg PO each day to deal with Generalized Anxiety Dysfunction (GAD).
Rationale for the Resolution
The aim of choosing Zoloft is as a result of it’s the first line of therapy for psychological situations reminiscent of GAD. The drug has fewer unintended effects in comparison with different medication. Zoloft prevents presynaptic serotonin reabsorption resulting in a steadiness within the hormone (Salimi Kordasiabi et al., 2020). The serotonin hormone is liable for regulating happiness, temper, and nervousness. 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 applicable choice 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 antagonistic unintended effects like weight achieve, confusion, seizures, anticholinergic results, and delirium (Jafarnia et al., 2017). The unintended effects can undermine adherence to the therapy when sufferers understand they’re gaining weight. The drug is inappropriate because the affected person is already chubby.
Buspirone 10mg PO BID just isn’t the best choice since it might solely be used when SSRI doesn’t generate the appropriate outcomes. It’s relevant when sufferers don’t reply to SSRI or expertise antagonistic reactions (Strawn et al., 2018). Research present that sufferers have poor well being outcomes to deal with nervousness after they take Buspirone 10mg PO BID (Strawn et al., 2018).
The aim of prescribing Zoloft is to cut back the severity of the signs. The main focus is to cut back the signs by a minimum of 50 % within the subsequent 4 weeks. The affected person should not have any unintended effects since they’ll undermine the restoration course of (Hoge et al., 2018). For instance, the affected person ought to cut back signs reminiscent of 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 reveals that Zoloft was a superb determination. The end result reveals a discount within the severity of the signs. For example, the HAM-A scale rating decreased from 26 to 18 factors. The discount reveals a 31 % enchancment within the stage of hysteria. Though the affected person didn’t obtain the 50 % discount within the signs, the 31 % considerably progressed.
Resolution Two
The second determination is to prescribe Zoloft 75 mg PO each day. The prescription is a 25mg improve from the dose in determination one.
Rationale for the Resolution
The aim of accelerating the dose to 75mg is to deal with the partial enchancment within the first determination. For instance, the affected person had solely a 31 % discount within the nervousness signs than the anticipated 50 % (Stahl, 2013). The expectation is to generate a greater enchancment fee inside the subsequent 4 weeks. Another excuse for growing the dose is that the affected person had a greater tolerance of the drug with none unintended 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 unintended effects that may have an effect on the restoration course of. Therapy of psychological problems includes a steadiness between therapy and unintended effects (Slee et al., 2019). The numerous tolerance of the drug reveals that it may be elevated to realize 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’s not applicable 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 realize a 50 % lower in nervousness signs. One other expectation is to enhance the HAM-A rating. The affected person won’t expertise unintended effects. Uncomfortable side effects are usually not preferable since they’ll delay the restoration course of.
The outcomes present that the affected person had a 61 % discount within the signs. The HAM-A signs diminished 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 provides hope that the affected person will get better 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 unintended effects, which signifies that the drug successfully addresses the nervousness behaviors in sufferers with out inflicting unintended effects.
Resolution Three
The third determination 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 impression on decreasing the signs as much as 61 %. The discount is a optimistic signal that if the affected person takes the drug for an additional 4 weeks, he can 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 unintended effects. The danger of unintended effects might improve if the affected person took 100mg of Zoloft (Stahl, 2013). One of many frequent unintended effects of taking a particularly excessive drug is erectile dysfunction. Such unintended effects might 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’t begin taking Buspirone in the midst of the therapy since he’s already responding positively to Zoloft. Altering medication for individuals with a psychological well being situation just isn’t advisable since it might set off antagonistic reactions. Research present that monotherapy is one of the best 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 extra examination is important after the 4 weeks to find out the extent of enchancment. Analysis of the affected person’s signs and HAM-A rating can be 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 persist with the drug to keep away from relapse or sluggish restoration.
Moral Concerns
Healthcare staff have a duty to look at moral requirements within the care provision. The moral issues crucial to look at within the case examine embody confidentiality, autonomy, knowledgeable consent, maleficence, beneficence, integrity, and justice. Confidentiality is important within the care provision because it includes abiding by the HIPPA rules (Ingham-Broomfield, 2017). The rules stipulate that affected person’s private particulars needs to be non-public until 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 in regards to the care (Stahl, 2013). The moral consideration ought to contain knowledgeable consent, which offers a affected person with details about the analysis 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 by utilizing professionalism.
Conclusion
Assessing and treating sufferers with nervousness problems is a tasking train that includes making numerous selections. The primary determination is to prescribe Zoloft 50 mg PO each day. The treatment is one of the best for GAD therapy because it improves serotonin absorption and has fewer unintended effects. The second determination is to prescribe Zoloft 75 mg PO each day. The third determination is to keep up the dosage. The availability 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 nervousness 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 gentle to average generalized nervousness dysfunction: a double blind randomized managed trial. Archives of Neuroscience, four(four).
Laureate Schooling. (2016b). Case examine: A middle-aged Caucasian man with nervousness [Interactive media file]. Baltimore, MD: Creator.
Salimi Kordasiabi, A. H., Daneshzad, T., & Aminpour, A. (2020). Comparative Research of the Efficacy of Cognitive-Behavioral Remedy and Sertraline in Generalized Anxiety Dysfunction. Tabari Biomedical Scholar Analysis Journal, 2(1), 33-38.
Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Freemantle, N. (2019). Pharmacological therapies for generalised nervousness dysfunction: a scientific assessment 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 nervousness dysfunction in grownup and pediatric sufferers: an evidence-based therapy assessment. Skilled Opinion on Pharmacotherapy, 19(10), 1057-1070.

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