NURS 6630 Assessing and Treating Patients With Anxiety Disorders Paper

NURS 6630 Assessing and Treating Patients With Anxiety Disorders Paper

NURS 6630 Assessing and Treating Patients With Anxiety Disorders Paper

Assessing and Treating Patients with Anxiety Disorders

Anxiety disorders make the patients constantly worry and persistently anxious. The patients with the condition present with various symptoms which complicate their daily lives. Some of the symptoms include nervousness, muscle trembling, chest tightness, and shortness of breath. Therefore, there is a need for patients with anxiety disorders to seek medical attention from psychiatric mental health specialists. Various approaches have been used to treat and manage the condition, including pharmacological and psychotherapy approaches (Horenstein & Heimberg, 2020). The implication is that the prescriber should use medications that can be monitored for dose adjustments and potential stoppage or change in case there are adverse reactions. Therefore, the purpose of this assignment is to summarize a case study of a patient with anxiety disorder and explore various decision points upon the administration of appropriate medication.

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The Case Summary

The case is of a forty-six-year-old white male patient who presented to the facility after a referral because he felt he was having a heart attack. The patient experiences a feeling of impending doom, breath shortness, and chest tightness. The patient also has mild hypertension and is overweight. The ER ruled out myocardial infarction, and he also had a normal EKG. While in the office, the patient indicated that he consumes alcohol occasionally to help him deal with his worries at work. The patient is single but currently takes care of his aging parent. He indicates that he fears for his job since the management at his workplace is harsh. The patient scored 26 upon administration of HAM-A, hence diagnosed with anxiety disorder.

Decision 1

The Selected Decision

The first decision made was to begin Paxil 10 mg PO daily

Why the Decision Was Selected

 The decision was made since Paxil has been approved and widely used as a first-line drug to treat anxiety disorder (Kowalska et al., 2021). While it has similar efficacy as tricyclic antidepressants, Paxil has fewer side effects hence a good choice. In addition, it has a better safety record and a higher response rate compared to other classes of drugs.

Why the Other Options Were Not Selected

The other two options included beginning Buspirone 10 mg Po BID or Begin Imipramine 25 mg Po BID. Buspirone was not chosen since it is recommended for use among patients with anxiety disorder only if the first line of treatment is not effective or presents safety concerns (Wilson & Trip, 2021). Therefore, it should be used as a second line of treatment (Garakani et al., 2020). This medication also has more side effects in comparison to Paxil, and patients also tend to abuse it after use. Imipramine, also an antidepressant, is only considered a second line of treatment for anxiety disorder. In addition, it has various undesirable side effects, such as urinary hesitancy, sedation, and weight gain (Chang et al., 2021). Therefore, it is not a good option since the patient also already has mild hypertension.

What I was Hoping to Achieve by Making the Decision

One of the goals I was hoping to achieve by making the decision was to help the patient have reduced anxiety symptoms and lead a normal life. The medication is expected to act within four weeks. Hence the patient should have fewer worries and experience reduced heart attack-like symptoms (Kowalska et al., 2021). I also expected the HAM-A scores to substantially reduce.

How Ethical Consideration May Impact the Treatment Pan and Communication

 One of the ethical considerations at this stage is to offer the patient education regarding the potential side effects of Paxil in addition to informing the patient regarding other available treatment options, such as psychotherapy (Haddad & Geiger, 2020). The patient’s autonomy has to be upheld and be allowed to choose the best option without influence. The patient also needs to be informed of risks connected to not treating the conditions.

Decision 2

The Selected Decision

 The second decision made is to increase the dose to 20 mg PO daily

Why the Decision Was Selected

 After the first medication dose, the patient came back to the facility, indicating that his symptoms had improved. For example, he no longer experiences breath shortness, chest tightness, and decreased worries. Besides, the HAM-A scores substantially reduced to 18, indicating a partial response implying that the medication is effective; hence an appropriate titration should be done for optimum results. Therefore, a gradual increase from 10 mg to 20 mg should be the choice (Melaragno, 2021). It is also important to note that the patient has not experienced any adverse side effects, indicating that he is tolerating the medication well.

Why the Other Options Were Not Selected

 The other two options include increasing the dose to 40 mg PO daily or no change to the drug or dose. It is worth noting that the patient’s improvement was partial; hence maintaining the dosage at 10 mg would give no further improvements or positive changes. In addition, increasing the dosage to 40 mg per day without gradually titrating the medication can lead to various side effects, such as delayed ejaculation, vomiting, nausea, and headaches (Garakani et al., 2020). A normal titration recommendation is usually 10 mg; hence increasing it to 40 mg would present a 30 mg increase which is way too high.

What I was Hoping to Achieve by Making the Decision

 I was hoping to achieve increased positive results by increasing the dosage to 20 mg. I was also hoping that the patient gets treated and not only relieves symptoms (Garakani et al., 2020). In addition, I was also hoping that the patient’s score on the HAM-A scale would reduce by at least half.

How Ethical Consideration May Impact the Treatment Pan and Communication

The improvements observed by the patients may lead to excitement, and the patient may even request that he stops taking the medication. However, it is important to advise the patient on the need to continue with the treatment at the end to prevent a potential recurrence of anxiety symptoms. The patient’s autonomy should also be respected, and his input should be considered in further plans.

Decision 3

The Selected Decision

The third decision selected was to maintain the current dose

Why the Decision Was Selected

 Upon increasing the dosage to 20 mg, the patient returned to the clinic and indicated that the symptoms had reduced even further. In addition, the patient also had a reduction of the HAM-A scores to 10 (Rabinowitz et al., 2023). There has been a sixty-one percent reduction in the symptoms. Therefore, it will be prudent to maintain the current medication dose as part of the maintenance therapy.

Why the Other Options Were Not Selected

The other two options included increasing the Paxil dosage to 30 mg PO daily or adding an augmentation agent like BuSpar. Increasing the dosage to 30 mg PO daily would further reduce anxiety symptoms. However, there is a high risk of increased side effects (Garakani et al., 2020). The patient data is also not showing any need for augmenting agents like BuSpar. Hence, this choice was also ignored.

What I was Hoping to Achieve by Making the Decision

The decision made was to maintain the dosage. Therefore, I was hoping for all the anxiety symptoms experienced by the patient clear out. I am also hoping that the patient will not suffer any consequences due to ignoring the other two options. I was also hoping that the patient should have improved feelings and not experience any heart attack-like symptoms.

How Ethical Consideration May Impact the Treatment Pan and Communication

 There are also ethical considerations that may impact the treatment and communication. One of them is that the patient needs to be educated on the potential risks and threats of increasing the dosage to more than 20 mg in case the patient requests it. The decision should also be made to ensure that the patient does not face any harm but ensure that the patient continues to experience improved symptoms.

Conclusion

 The patient in this case study was diagnosed with anxiety disorder; hence medication treatment decision points were taken. The patient presented with various symptoms, such as chest tightness, the feeling of impending doom, and shortness of breath. Therefore, there was a need for the patient with anxiety disorders to seek medical attention from a psychiatric mental health specialist. Various approaches have been used to treat and manage the condition, including pharmacological and psychotherapy approaches. In the case of this patient, the treatment used was 10 mg of Paxil initially. This decision was made while two other decisions were left out, such as beginning Buspirone 10 mg Po BID or Begin Imipramine 25 mg Po BID. The two choices were majorly ignored since both are considered a second line of treatment (Garakani et al., 2020). Therefore, they are only used when the first line of treatment, in this case, Paxil, is not effective or is presenting safety concerns for the patient. The dosage was increased to 20 mg after the patient initially showed improvement. Besides, two other choices were ignored to ensure that the patient goes on in his path to recovery. This dosage was to be maintained to help balance the risk factors and the expected benefits

References

Chang, G. R., Hou, P. H., Wang, C. M., Lin, J. W., Lin, W. L., Lin, T. C., … & Wang, Y. C. (2021). Imipramine accelerates nonalcoholic fatty liver disease, renal impairment, diabetic retinopathy, insulin resistance, and urinary chromium loss in obese mice. Veterinary Sciences, 8(9), 189. https://doi.org/10.3390/vetsci8090189

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, 11. https://doi.org/10.3389/fpsyt.2020.595584

Haddad, L. M., & Geiger, R. A. (2020, September 1). Nursing ethical considerations – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Horenstein, A., & Heimberg, R. G. (2020). Anxiety disorders and healthcare utilization: A systematic review. Clinical Psychology Review, 81, 101894. https://doi.org/10.1016/j.cpr.2020.101894

Kowalska, M., Nowaczyk, J., Fijałkowski, Ł., & Nowaczyk, A. (2021). Paroxetine—overview of the molecular mechanisms of action. International Journal of Molecular Sciences, 22(4), 1662. https://doi.org/10.3390/ijms22041662

Melaragno, A. J. (2021). Pharmacotherapy for anxiety disorders: from first-line options to treatment resistance. Focus, 19(2), 145-160. https://doi.org/10.1176/appi.focus.20200048

Rabinowitz, J., Williams, J. B., Hefting, N., Anderson, A., Brown, B., Fu, D. J., …& Schooler, N. R. (2023). Consistency checks to improve measurement with the Hamilton Rating Scale for Anxiety (HAM-A). Journal of Affective Disorders, 325, 429–436. https://doi.org/10.1016/j.jad.2023.01.029

Wilson, T. K., & Tripp, J. (2021, August 12). Buspirone – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK531477/

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 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 week’s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

Chapter 8, “Anxiety, Trauma, and Treatment” (pp. 359-378)

American Psychiatric Association. (2010a). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder

Links to an external site.. 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

Links to an external site. (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

Links to an external site.. 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

Links to an external site., 49(4), 414–430. https://jaacap.org/action/showPdf?pii=S0890-8567%2810%2900082-1

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry

Links to an external site., 2(6), e16–e18. 10.1192/bjpo.bp.116.003707. http://bjpo.rcpsych.org/content/2/6/e16

Hamilton, M. (1959). Hamilton Anxiety Rating Scale (HAM-A)

Links to an external site.. PsycTESTS. https://doi.org/10.1037/t02824-0

Ostacher, M. J., & Cifu, A. S. (2019). Management of posttraumatic stress disorder. JAMA

Links to an external site., 321(2), 200–201. 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

Links to an external site., 29(4), 328–339. https://doi.org/10.1002/da.21913

Medication Resources

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs

Links to an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Links to an external site.

Note: 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

Case Study: A Middle-aged Caucasian Man with Anxiety

Links to an external site.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’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 patient’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)

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)

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)

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

Links to an external site..

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