Assessing and Treating Patients with Anxiety Disorders
Introduction
The case study involves a 46-year-old white male who is suffering from Generalized Anxiety Disorder. He is a welder at a local steel fabrication factory. He comes to the emergency room presenting diverse symptoms similar to a heart attack. He presents with symptoms such as tightness of the chest, shortness of breath, feeling impending doom, and anxiety attacks. His HAM-A score is 26. He is overweight and reports occasional use of ETOH to suppress worries at his workplace. He admits that the work environment is harsh, and he fears for his job.
The first decision is to begin Zoloft 50 mg PO daily. Zoloft is the first line of treatment for GAD since it is effective and has fewer side effects. The drug prevents the reabsorption of the serotonin hormone. The first decision reduces the symptoms by 31 percent. The second decision is to increase the dosage to Zoloft 75 mg PO daily. Increasing the dosage enhances the therapeutic efficacy of the drug. The second decision reduces the symptoms by 61 percent. The patient should continue taking the drug for another four weeks and come back for further examination. Zoloft is the best medication in GAD treatment since it has a high therapeutic level, fewer side effects, a high success rate. The other two options are not the first line of treatment for the disease. Imipramine 25mg PO BID could be applicable if Zoloft fails to generate the expected outcomes. It is not preferable to change the drug since the action could trigger adverse reactions. The ethical considerations necessary to observe in the case study include confidentiality, autonomy, informed consent, maleficence, beneficence, integrity, and justice. The purpose of the essay is to analyze three decisions relevant to the case study to treat GAD.
Decision One
The first decision is to begin Zoloft 50 mg PO daily to treat Generalized Anxiety Disorder (GAD).
Rationale for the Decision
The purpose of selecting Zoloft is because it is the first line of treatment for mental conditions such as GAD. The drug has fewer side effects compared to other drugs. Zoloft prevents presynaptic serotonin reabsorption leading to a balance in the hormone (Salimi Kordasiabi et al., 2020). The serotonin hormone is responsible for regulating happiness, mood, and anxiety. Regulating the hormone is essential in modulating stress (Salimi Kordasiabi et al., 2020). Patients that take Zoloft for four consecutive weeks have a significant improvement in their symptoms.
Imipramine 25mg PO BID is not an appropriate option since it is a tricyclic antidepressant. The drug is not an SSRI that can be used as a first-line treatment for GAD (Jafarnia et al., 2017). TCAs can only be used when SSRI does not generate the expected results. Another reason for not choosing Imipramine is because it triggers adverse side effects like weight gain, confusion, seizures, anticholinergic effects, and delirium (Jafarnia et al., 2017). The side effects can undermine adherence to the treatment when patients realize they are gaining weight. The drug is inappropriate since the patient is already overweight.
Buspirone 10mg PO BID is not the best option since it can only be used when SSRI does not generate the right results. It is applicable when patients do not respond to SSRI or experience adverse reactions (Strawn et al., 2018). Studies show that patients have poor health outcomes to address anxiety when they take Buspirone 10mg PO BID (Strawn et al., 2018).
The purpose of prescribing Zoloft is to reduce the severity of the symptoms. The focus is to reduce the symptoms by at least 50 percent in the next four weeks. The patient should have no side effects since they can undermine the recovery process (Hoge et al., 2018). For example, the patient should reduce symptoms such as shortness of breath and chest tightness. Within the four weeks, the HAM-A scale should reduce significantly (Hoge et al., 2018).
The outcome after four weeks shows that Zoloft was a good decision. The outcome shows a reduction in the severity of the symptoms. For instance, the HAM-A scale score decreased from 26 to 18 points. The reduction shows a 31 percent improvement in the level of anxiety. Although the patient did not achieve the 50 percent reduction in the symptoms, the 31 percent significantly progressed.
Decision Two
The second decision is to prescribe Zoloft 75 mg PO daily. The prescription is a 25mg increase from the dose in decision one.
Rationale for the Decision
The purpose of increasing the dose to 75mg is to address the partial improvement in the first decision. For example, the patient had only a 31 percent reduction in the anxiety symptoms than the expected 50 percent (Stahl, 2013). The expectation is to generate a better improvement rate within the next four weeks. Another reason for increasing the dose is that the patient had a better tolerance of the drug without any side effects (Stahl, 2013).
Increase the drug dose to 100mg is not safe since it is too high for the patient. Prescribing 100mg can trigger side effects that can affect the recovery process. Treatment of mental disorders involves a balance between treatment and side effects (Slee et al., 2019). The significant tolerance of the drug shows that it can be increased to achieve better results. Changing the drug is not recommended after four weeks. Using multiple drugs to treat mental drugs is not safe for patients (Slee et al., 2019). It is not appropriate to change the drug only after four weeks of prescribing the first drug.
Increasing Zoloft to 75mg effectively enhances the therapeutic level of the drug (Stahl, 2013). The drug will help the patient to achieve a 50 percent decrease in anxiety symptoms. Another expectation is to improve the HAM-A score. The patient will not experience side effects. Side effects are not preferable since they can delay the recovery process.
The outcomes show that the patient had a 61 percent reduction in the symptoms. The HAM-A symptoms reduced from 18 to 10 scores. The positive response of the Zoloft 75 mg is effective in addressing the GAD symptoms (Stahl, 2013). Prescribing the drug for another four weeks offers hope that the patient will recover from the health condition. Studies indicate that Zoloft 75 mg is effective in treating patients with HAM-A scores of at least 20 points. The improvements show that Zoloft 75 mg is better compared to 50mg of the drug. The high tolerance of the drug is effective in achieving positive results (Stahl, 2013). The patient did not show any side effects, which indicates that the drug effectively addresses the anxiety behaviors in patients without causing side effects.
Decision Three
The third decision is to maintain the current medication and dose, Zoloft 75 mg PO daily.
The purpose of maintaining the drug and dosage is because it has a significant impact on reducing the symptoms up to 61 percent. The reduction is a positive sign that if the patient takes the drug for another four weeks, he will be better positioned to resume normal activities in life (Stahl, 2013). For instance, the reduction of the HAM-A score to 10 was a significant improvement. Another reason is that the drug was effective without any side effects. The risk of side effects could increase if the patient took 100mg of Zoloft (Stahl, 2013). One of the common side effects of taking an extremely high drug is erectile dysfunction. Such side effects could affect the patient’s quality of life and trigger the patient to stop taking the drug.
The patient cannot start taking Buspirone in the middle of the treatment since he is already responding positively to Zoloft. Changing drugs for people with a mental health condition is not advisable since it can trigger adverse reactions. Studies show that monotherapy is the best treatment for patients with mental disorders (Strawn et al., 2018). The patient should continue taking Zoloft 75mg PO daily until full recovery. The intention is to enhance the reduction of the symptoms by maintaining the therapeutic level of the drug.
The patient should continue taking the drug for the next four weeks. A further examination is necessary after the four weeks to determine the level of improvement. Evaluation of the patient’s symptoms and HAM-A score will be vital to ascertain the treatment’s success (Strawn et al., 2018). Adherence to the treatment plan is crucial in the next four weeks of care provision. The patient should stick to the drug to avoid relapse or slow recovery.
Ethical Considerations
Healthcare workers have a responsibility to observe ethical standards in the care provision. The ethical considerations necessary to observe in the case study include confidentiality, autonomy, informed consent, maleficence, beneficence, integrity, and justice. Confidentiality is essential in the care provision since it involves abiding by the HIPPA principles (Ingham-Broomfield, 2017). The principles stipulate that patient’s personal details should be private unless under the exceptions stipulated in HIPPA laws (Ingham-Broomfield, 2017). A healthcare worker should observe fairness and justice in the provision of care.
Autonomy refers to the competence of a nurse to take charge in the treatment process. A nurse should have the freedom and authority to make treatment decisions. Similarly, a nurse should respect patient autonomy to make personal decisions about the care (Stahl, 2013). The ethical consideration should involve informed consent, which provides a patient with information about the diagnosis and treatment plan. Patients have the freedom and authority to consent or decline care (Ingham-Broomfield, 2017). Maleficence and beneficence are ethical considerations that emphasize the need for care to avoid harming a patient by using professionalism.
Conclusion
Assessing and treating patients with anxiety disorders is a tasking exercise that involves making diverse decisions. The first decision is to prescribe Zoloft 50 mg PO daily. The medication is the best for GAD treatment since it improves serotonin absorption and has fewer side effects. The second decision is to prescribe Zoloft 75 mg PO daily. The third decision is to maintain the dosage. The provision of care should observe ethical considerations, including confidentiality, autonomy, informed 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 effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Research, 262, 328-332.
Ingham-Broomfield, R. (2017). A nurses’ guide to ethical considerations and the process for ethical approval of nursing research. Australian Journal of Advanced Nursing, 35(1), 40-47.
Jafarnia, N., Ghorbani, Z., Nokhostin, M., Manayi, A., Nourimajd, S., & Razeghi Jahromi, S. (2017). Effect of saffron (Crocus sativus L.) as an add-on therapy to sertraline in mild to moderate generalized anxiety disorder: a double blind randomized controlled trial. Archives of Neuroscience, 4(4).
Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.
Salimi Kordasiabi, A. H., Daneshzad, T., & Aminpour, A. (2020). Comparative Study of the Efficacy of Cognitive-Behavioral Therapy and Sertraline in Generalized Anxiety Disorder. Tabari Biomedical Student Research Journal, 2(1), 33-38.
Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Freemantle, N. (2019). Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. The Lancet, 393(10173), 768-777.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057-1070.
