Assessing and Treating Anxiety Disorders
Introduction
Anxiety disorder is a common condition that causes shortness of breath, and anxiety attacks. Clients should seek immediate treatment to avoid adverse effects of the symptoms. In the current case study, the patient requires Zoloft, since it is a Food and Drug Authority (FDA) approved medication (Mula, 2018). The series of decisions depends on patient outcomes and expected outcomes. It is not necessary to introduce other drugs since evidence-based practice shows Zoloft can treat anxiety disorders alone. Psychiatrists should educate patients on anxiety disorders, the side effects of their drug, and the need to take the medication consistently (Stahl, 2013). They should also consider various ethical issues that guide the treatment of anxiety disorders. Patients of anxiety disorders should take medications such as Zoloft to suppress symptoms and avoid adverse effects.
Decision #1
The best medication at the beginning of treating anxiety disorders is Zoloft. The first decision will involve prescribing Zoloft 50mg orally daily. The patient should take the drug for four weeks. The drug is approved for use among adults and children to treat generalized anxiety disorders (Mula, 2018). It is one of the popular drugs among clinicians since it has high therapeutic strength and fewer side effects. The only known side effect of Zoloft is weight gain, which subsides when a client stops taking the medication (Mula, 2018). Clinicians also prefer the drug since it has no addictive capabilities compared to other drugs used to treat anxiety disorders.
Zoloft is an effective drug since it works on the brain by eliminating an imbalance of chemicals that trigger mood changes or depression. Patients with anxiety disorders experience anxiety attacks, chest tightness, and negativity about their life (Stahl, 2013). During the administration of the drug, it is essential to caution the patient against taking other drugs and substances. For example, the client should stop taking any alcohol or other illegal or over the counter drugs since they will interfere with the brain chemicals and hinder recovery.
The purpose of selecting the drug among other available options is to realize specific patient outcomes. One of the expectations was to eliminate anxiety attacks, relieve chest tightness, and fear about the future. Patients of generalized anxiety disorder suffer from various symptoms such as anxiety attacks or shortness of breath, feelings of impending doom, and chest tightness (Olthuis et al., 2016). The patient also comes to the clinic complaining of worrying about his job or a negative incidence that is about to unfold in his life.
The expectation is that the patient will report back to the clinic with minimal anxiety attacks, shortness of breath, and positivity about his job security. The patient should return to the clinic after four weeks to allow sufficient time for the drug to have a noticeable effect on the patient.
The patient reports back to the clinic after four weeks with only minor improvements. According to the HAM-A rating scale, the patient has 19 scores. This is a minimal improvement compared to the initial score of 26 when the patient first reported to the clinic. According to the patient, panic attacks are still evident including shortness of breath despite taking the medication consistently. One of the reasons for the differences between expectations and outcomes is the low dosage of the drug (Olthuis et al., 2016). The patient also reports he is not taking alcohol. Therefore, in the second decision, there is a need to increase the dosage. Another reason is the short time the patient has been taking the medication. Research shows that patients with generalized anxiety disorder can take even 12 weeks to experience a full recovery. Therefore, the administration of the drug for another four weeks will be essential to the treatment.
Decision #2
The second decision is based on the outcome of decision #1. According to the outcome, the patient is responding positively to the drug without any side effects. It is thus essential to continue with the drug without changing it. Evidence-based practice shows that during the treatment of mental disorders, clinicians should not constantly change the medication (Love & Love, 2019). The reason is that drugs may take several weeks before significant improvement is realized.
The decision is thus to continue with Zoloft but to increase the dosage to 75mg orally daily. One of the reasons for increasing the dose is to enhance the therapeutic ability of the drug. It is also recommendable to start with a low dosage in the treatment of mental conditions (Love & Love, 2019). High doses can cause side effects which can undermine recovery. For example, Zoloft causes suicidal thoughts if taken in large amounts. Clinicians thus take precautions to start with a low dose and make observations for the need to increase the dosage. Pediatricians treating such conditions with Zoloft should be extra cautious since their body systems respond differently.
The expectations while administering the drug is to reduce the HAM-A score considerably. A reduction in the HAM-A score is a sign that the patient is improving. Another expectation was to reduce the severity and frequency of symptoms such as anxiety attacks, chest tightness, and feelings of impending doom. For example, I expect that the client will come back to the clinic with an optimistic perspective on his job. Persistent symptoms of generalized anxiety disorder may undermine the quality of life of an individual (Vicario et al., 2019). Therefore, effective treatment is necessary to promote recovery. According to research, drugs prescribed for anxiety disorders may take several weeks, and thus I am hopeful for a positive report.
The client reports back to the clinic after four weeks. The client has made significant progress in the reduction of the severity of the symptoms. For example, the patient states that the panic attacks are no more and he is optimistic about his job security. He also explains that the chest rightness and anxiety attacks have improved significantly. According to the HAM-A score, the patient has 10 points, which indicate over 60 percent improvement in the symptoms. Therefore, if the patient continues to take the medication, there is a possibility that in the next four weeks the patient will have achieved complete recovery.
Decision #3
The third decision has several options. The first option is to continue with the medication, increase the dosage or change the medication. One of the best decisions is to continue with Zoloft 75mg orally daily since it is already achieving considerable improvements (Vicario et al., 2019). Zoloft is one of the antidepressant drugs that can be used alone in the treatment of generalized anxiety disorder. Clinicians can recommend a change of the drug or introduction of a new one in case the condition is not improving (Umylny et al., 2017). The patient is thus required to take the medication for another four weeks and report back to the clinic on the 12th week. Additionally, it is not advisable to introduce a new drug at such a stage of treatment. The reason is that the new drug may interfere with the current drug, trigger side effects or prolong the treatment (Umylny et al., 2017). Polypharmacy is thus not an option at this stage. The decision will also involve educating the patient about the weight gain weight but encourage them to take the medication consistently.
The expectation of continuing with the medication is that the patient will experience a complete recovery. After the four weeks, I expect that the client will record 100 percent in the HAM-A score rating scale. Another expectation is that the patient will remain positive about his job security. He should also not experience chest tightness. I also expect that the patient should not experience anxiety attacks (Umylny et al., 2017). The expectations are hinged on the purpose of administering Zoloft. The drug is approved by FDA for the successful treatment of generalized anxiety disorder.
The last clinic is on the 12th week since the initial visit to the health facility. According to the patient, he is still optimistic about his job security. He indicates that he reports to the workplace with joy and satisfaction without worries compared to one month ago. The HAM-A score also indicates the patient has a 100 percent improvement. The client also indicates there are no more anxiety attacks or shortness of breath.
The outcome is similar to the expectations which show that Zoloft is an effective antidepressant. Zoloft is approved by the FDA for the treatment of diverse anxiety disorders due to its ability to balance the brain chemicals (Gilbert et al., 2017). Therefore, the patient should cease taking the drug after full recovery.
Ethical Considerations Impacting Treatment and Communication
Treatment of anxiety disorders requires psychiatrists to inform their patients about drugs. A patient needs to know the drug they are taking and any side effects. For example, in the current case study, Zoloft will trigger weight gain (Gilbert et al., 2017). The clinicians should comprehensively explain to the patient that the side effect is normal. However, in the case that weight gain triggered adverse effects, the psychiatrist would need to change the medication.
Clinicians should also explain to the patient that a high dosage of the drug can cause suicidal thoughts. The dosage is aligned to the age of the patient due to pharmacodynamics and pharmacokinetics factors. Therefore, the patient should take the medication only as prescribed without increasing frequency or dosage (Vicario et al., 2019). Psychiatrists should also monitor patients during the clinics to ensure the drug is not causing adverse negative effects (Stahl, 2013). The psychiatrists must take the necessary precautions to avoid legal issues. Educating the patient is also essential to ensure accurate adherence to the prescription.
Conclusion
Treatment and management of generalized anxiety disorders require a series of accurate and evidence-based decisions. Clinicians should make decisions that can relieve shortness of breath, anxiety attacks, and improve positive thoughts. One of the best decisions is to prescribe Zoloft 50mg orally daily. The drug is approved by the FDA for the treatment of generalized anxiety disorders. Psychiatrists should increase the drug progressively depending on the patient outcomes. It is also essential to avoid polypharmacy since it can trigger negative effects that can undermine recovery. Treatment of anxiety disorders also requires ethical considerations. The considerations are important to minimize side effects and promote steady and quick recovery. The current case study of a patient with anxiety disorder requires a prescription of Zoloft which is accurate and reliable.
References
Gilbert, A. L., Balio, C., & Bauer, N. S. (2017). Making the legal and ethical case for universal screening for postpartum mood and anxiety disorders in pediatric primary care. Current Problems in Pediatric and Adolescent Health Care, 47(10), 267-277. https://doi.org/10.1016/j.cppeds.2017.08.001
Love, A. S., & Love, R. (2019). Anxiety Disorders in Primary Care Settings. Nursing Clinics, 54(4), 473-493. DOI: https://doi.org/10.1016/j.cnur.2019.07.002
Mula, M. (2018). Pharmacological treatment of anxiety disorders in adults with epilepsy. Expert Opinion on Pharmacotherapy, 19(17), 1867-1874. https://doi.org/10.1080/14656566.2018.1527905
Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2016). Therapist‐supported Internet cognitive behavioral therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews, (3). https://doi.org/10.1002/14651858.CD011565.pub2
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Umylny, P., German, M., & Lantiere, A. (2017). Treating postpartum mood and anxiety disorders in primary care pediatrics. Current Problems in Pediatric and Adolescent Health Care, 47(10), 254-266. https://doi.org/10.1016/j.cppeds.2017.08.003
Vicario, C. M., Salehinejad, M. A., Felmingham, K., Martino, G., & Nitsche, M. A. (2019). A systematic review of the therapeutic effectiveness of non-invasive brain stimulation for the treatment of anxiety disorders. Neuroscience & Biobehavioral Reviews, 96, 219-231. https://doi.org/10.1016/j.neubiorev.2018.12.012
