NURS 6630 Assessing and Treating Patients With Anxiety Disorders

NURS 6630 Assessing and Treating Patients With Anxiety Disorders

NURS 6630 Assessing and Treating Patients With Anxiety Disorders

Therapy for Patients with Anxiety Disorders and PTSD Treatment

The case highlights a 46-year-old white male presenting with chest tightness, shortness of breath and feeling of impending doom. The patient has a history of mild hypertension and tonsillectomy, which has been accompanied by unremarkable medical history. The patient cites occasional shortness of breath, chest tightness, feelings of impending doom and the need to ‘escape’ or ‘run’ from one place. He confesses using ETOH to combat worries about work since the management at his place of work is harsh, and he fears for his job. The patient’s symptoms are characteristic of generalized anxiety disorder.

Anxiety can be a normal part of life, with concerns such as health, family challenges and money temporarily dominating individual experiences. Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder characterized by nightmares, flashbacks, and intrusive thinking related to catastrophic events in an individual’s life (Ostacher & Cifu, 2019). Exposure to traumatic and terrifying events triggers PTSD. It is a potentially debilitating condition that affects direct victims or witnesses of traumatic events such as accidents, natural disasters, loss of loved ones, violent assaults like rape, war and other life-threatening events. The events can trigger an obsessive, recurrent and repetitive behavior that increases the feeling of fear, worry, helplessness, and hopelessness (Ostacher & Cifu, 2019). Nightmares, intrusive memories and flashbacks are common in individuals with past traumatic experiences increasing the risk of panic disorders.

Generalized anxiety disorders are common in adults with PTSD manifestations evident several months after the exposure to the traumatic and terrifying event. The symptoms of the anxiety disorders can be detrimental, although they subside, reducing the struggle with coping and self-care. According to Holmes (2022), anxiety disorders are mental conditions that deteriorate the quality of life by altering the action of neurotransmitters. Individuals with anxiety disorders have elevated worry and fear.

Psychopharmacological therapy targets relieving symptoms rather than curing the disorders. The recommended medications in the management of anxiety disorders include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), antipsychotics, beta and adrenergic medications, antihistamines and GABAergic medications (Garakani et al., 2020). The treatment decisions will reflect the drug pharmacokinetics, pharmacodynamics, and ethical considerations in using the pharmacotherapeutic approach. The paper highlights three decisions on Generalized Anxiety Disorders.

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Decision One,

Which Decision did you Select?

The first-line treatment for the patient will be the first-line SSRI, oral paroxetine 10 mg daily.

Why did you select this Decision?

Anxiety disorders are managed using different pharmacological regimens. The approaches focus on alleviating

NURS 6630 Assessing and Treating Patients With Anxiety Disorders
NURS 6630 Assessing and Treating Patients With Anxiety Disorders

the symptoms and restoring social, mental and physical wellbeing. However, SSRIs and SNRIs are recommended for the treatment of PTSD, although sertraline and paroxetine are FDA-Approved as the first-line medication for PTSD management. According to Ostacher and Cifu (2019), benzodiazepines are contraindicated in PTSD. Paxil is FDA-approved for treating anxiety disorders and PTSD and is considered the first-line pharmacotherapeutic option for anxiety disorders. Paxil is an SSRI that potentiates the serotonin action influencing the serotonergic neurotransmission (Davidson 2016). The medication restores serotonin balance, regulates mood changes, and reduces anxiety, fear, and panic attacks. Paxil has minimal anticholinergic and sedative effects and has a low cardiovascular impact. Its therapeutic window can range from 4-6 weeks and is significant in managing generalized anxiety disorder. It has less anticholinergic, adrenergic and antihistamine activity than tricyclic antidepressants.

Why did you not select the other two options provided in the exercise?

Paxil is safer and tolerable in diverse patients than other medications such as Buspirone and Imipramine, which have adverse reactions such as increased drowsiness, blurry vision, and dizziness. Besides, they are not approved for first-line treatment of anxiety and PTSD hence my choice of Paxil for anxiety treatment.

What were you hoping to achieve with this Decision?

Paxil is slowly absorbed with its half-life ranging between 11 to 20 hours and attains its peak concentration within 4 to 10 hours. It works by elevating the serotonin levels, which establish a mental balance. According to Strawn (2018), Paxil can elicit minimal adverse reactions and alleviate symptoms such as fear, worry, helplessness, chest tightness, and shortness of breath. In light, I targeted alleviating the anxiety symptoms by elevating the serotonin levels.

Explain how ethical considerations may impact your treatment plan and communication with patients

Paxil has minimal adverse effects that undermine individual ethical values and treatment models. Patient safety is at the center of the pharmacological therapeutic approaches hence a key consideration in medical ethics. However, the patient is not incapacitated and capable of making individual decisions; thus, the psychiatrist needs to highlight the psychotherapeutic and pharmacotherapeutic models available and educate the patient appropriately before consenting to the treatment.

Decision Two

The first-line medication for the treatment of anxiety and PTSD is the most likely option for managing the patient. However, I would opt to retain Paxil as my second decision rather than change the medications. However, I will increase the dose from 10mg to 20mg daily to enhance the therapeutic effect.

Why did you select this decision?

The reaction response to Paxil may take long to manifest. To boost the HAM-A score, I would opt for a higher dose. Paxil is well-tolerated in the body and elicits minimum side effects (Strawn, 2018). Although the drug’s reaction is slow, it attains its therapeutic effect after a significantly more longer period. Therefore, increasing the dose can immediately impact mood and anxiety symptoms. According to Slee (2022), using a higher SSRIs dose can elevate serotonin levels in the brain and enhance the treatment outcome. The client’s compliance with the treatment can HAM-A score and attain best results.

Why did you not select other options in this exercise?

The anxiety medications exhibit diverse adverse effects. However, Paxil is well tolerated, with minimal side effects reported. In light, rather than changing to another first-line SSRIs with a similar pharmacokinetic and therapeutic effects, I would rather increase the dose. Besides, it is recommended as the best first-line treatment for anxiety disorders and PTSD. According to Javed and Fountoulakis (2018), Paxil significantly reduces the symptoms more than other medications such as imipramine. Therefore, I did not see the need to change the medication rather than maintain the patient on a higher dose of Paxil.

What were you hoping to achieve by making this decision?

Although the medication might take time for the client to realize a significant decline in the clinical manifestations, the main objective of the decision was to lower the HAM-A score further and stabilize mood and anxiety symptoms.

Explain how ethical considerations may impact your treatment plan and communication with patients

The major ethical concerns in medication include patient consent and safety. The medication should align with the major ethical principles that advocate for the patient’s autonomy, beneficence, and nonmaleficence. Paxil dose is well tolerated; therefore, increasing the dose implies that the medication is likely to be well tolerated. Furthermore, patient education should be advocated to allow the patient to make informed consent.

Decision Three

The third decision will be to shift to an SSRI alternative. However, the drug withdrawal process might be lengthy; hence I would opt for 10 mg of oral buspirone. Buspirone will also need close monitoring to assess the need to alter the treatment plan.

Why did you select this decision?

Buspirone is well tolerated in the body, although it is used in the short-term management of anxiety symptoms. It is also FDA-Approved for the management of Generalized Anxiety Disorder. In light, change from SSRI to Azapirone can attain a higher therapeutic effect than non-responsive paroxetine. The drug is well tolerated in the body, although it might exhibit some adverse effects.

Why did you not select the other two options provided in this exercise?

The rationale for the choice of the medications was entirely based on the efficacy and tolerability of the drugs. Buspirone is well-tolerated, exhibits minimal adverse effects, and is FDA approved for treating anxiety disorders. Therefore, I opted for drug safety and FDA recognition in the decision for combination therapy.

What are you hoping for by making this decision?

Adopting a combined therapy aimed to improve the patient’s experiences by lowering the anxiety symptoms. Buspirone regulates neurotransmitters’ actions, reducing anxiety symptoms (Javed & Fountoulakis, 2018). Changing the medications from non-responsive or slow-responding SSRIs to Azapirones can significantly reduce the HAM-A score alleviating the clinical manifestations of anxiety disorder.

Explain how ethical considerations may impact your treatment plan and communication with patients

The ethical concerns in the medical field are crucial, especially in managing mental health disorders. Patient autonomy may be impaired due to the involvement of the family members in the treatment process. However, the psychiatrist can establish the patient’s competence and compliance to determine the best approach for intervention. According to Javed and Fountoulakis (2018), buspirone elicits side effects such as chest pain, drowsiness, nausea, and increased sweating. However, some severe side effects such as blurred vision, uncontrollable shaking, agitation, hallucinations, confusion, irregular heartbeat and seizures can be reported. Clear communication should be established to allow the patient to make informed consent to the medication.

Conclusion

The management plan involved a shift from Paxil 10 mg to 20 mg once per day and further to Azapirone therapy of 10 mg buspirone twice a day. The selection of Paxil and buspirone was based on the recommendation and approval by the FDA in treating anxiety disorders and PTSD. However, due to the low response and impact on the HAM-A score, increasing the dose increased serotonin concentration, low anxiety, and regulated mood. The third decision opted against change from SSRIs to azapirone. Buspirone has partial agonist properties on serotonin and can improve serotonin levels and reduce the HAM-A score.

References

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: going beyond the guidelines. BJPsych Open, 2(6), e16-e18. http://bjpo.rcpsych.org/content/2/6/e16

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, 1412. https://doi.org/10.3389/fpsyt.2020.595584

Holmes, L. (2022). The 4 Major Classes of Anxiety Medications. Verywell Mind. Retrieved 2 July 2022, from https://www.verywellmind.com/mental-health-medications-for-anxiety-2337705.

Javed, A., & Fountoulakis, K. N. (Eds.). (2018). Advances in psychiatry. Springer.

Ostacher, M. J., & Cifu, A. S. (2019). Management of post-traumatic stress disorder. JAMA321(2), 200-201. https://doi.org/10.1001/jama.2018.19290

Slee, A. (2022). Generalized Anxiety Disorder: Incidence and Drug Treatment (Doctoral dissertation, UCL (University College London)). https://discovery.ucl.ac.uk/id/eprint/10146430

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 pharmacotherapy19(10), 1057-1070. https://doi.org/10.1080%2F14656566.2018.1491966