Running Head: ANXIETY DISORDER 1
Title: Anxiety disorder
There are different types of psychiatric disorders. Anxiety disorder is the most common type, a syndrome of mental disorders typified by the substantial feeling of anxiety and fear associated with behavioral disturbances. Such disorders are usually caused by the interaction of biopsychosocial factors, stress, and genetic vulnerability. It has also been related to muscle tension and vigilance in preparation for future danger alongside cautious behaviors. Different patients with anxiety disorder have been associated with various physical symptoms related to anxiety. Besides that, it has also been associated with older patients and anxiety, which may include neurologic conditions, cardiovascular diseases, and thyroid dysfunction (Salzer, 2014). Besides, drug abuse and alcohol intoxication has also been associated with significant anxiety.
There are different types of anxiety disorders, including social anxiety disorder, generalized anxiety disorder, and panic disorder. According to the case study, the patient is a 46-year-old male how had symptoms of anxiety disorder: chest tightness, breathe shortness, and feeling of impending doom. Both the ER and ECK outcomes were ruled out to be myocardial infarction, which was considered normal. The generalized anxiety disorder diagnosis was made after the scale yielded a score of 28 (Salzer, 2014). For an effective diagnosis to be made, three different decisions will be made towards the patient’s treatment regimen. Then nifty support will follow, which will be based on the clinical evidence and patient’s data. The decision-making will be based on the impacts of both the pharmacokinetics and pharmacodynamics process or the client and then the discussion of ethical considerations that can potentially impact the client’s treatment plan.
The first decision
Based on the client’s condition, the first decision will be based on the startup for the anxiety disorder patient. Even though there are different types of drugs used to start up medication for such clients with anxiety disorder, the best decision will be to start with Zoloft 50 mg PO BID. There are different reasons for selecting Zoloft 50 mg PO BID, but Zoloft is an SSRI recommended as the first and best line of treatment for the anxiety disorder. It increases the amount of serotonin within the patient’s brain. The increase of the serotonin is used to regulate the patient’s mood effectively, and it also helps in improving the symptoms of the anxiety manifest in GAD. That is due to the depletes serotonin within the brain, which is addressed by the SSRI like Zoloft since it replaces the depleted serotonin in the patient’s brain.
Both imipramine at 25 mg BID and Buspar at 10 mg was not suitable for the patient’s condition. Thus, they were not selected. The reason behind that is because, as was mentioned before, the evidence recommends SSRIs as the best and the first line of medication for the treatment of anxiety disorders. Also, both the medications are not well tolerated than the Zoloft and have different side effects, which are more serious than the Zoloft (Piotrovskaya, 2017).
By selecting to start with the Zoloft of 50 mg orally daily, the great expectation was that the generalized anxiety disorder symptoms would clear way. The HAM-A score was also expected to reduce, which could indicate an improvement of the anxiety symptoms. That is because Zoloft, like an SSRI, is one of the best treatments for GAD symptoms. The patient was then expected to have a few side effects and tolerate the medication due to the use of effective SSRI, which has always been associated with minimal side effects, which are well tolerated.
There was no great difference between the results of the decision which was made and the expected outcome. When the patient came for the review, it was evident that symptoms had reduced, and the client had no shortness of breath or chest tightness anymore. The client also reported having stopped worrying about his job anymore. The HAM-A score also had dropped by ten from the previous 28 to 18, which is evidence that the client was effectively responding to the treatment even if it was partially (Piotrovskaya, 2017).
The second decision was to increase the Zoloft to 75 mg orally daily. That decision was made because the HAM-A score had dropped by ten, from 28 to 18, as evidence of partial response to the treatment. Then the increase of the dose from 50 to 75 will increase the availability of the serotonin in the patient’s brain, which, as a result, will improve the anxiety symptoms for the patient. Besides that, the decision was also made because the patient seemed to be tolerating the Zoloft medication effectively without any sign of side effects.
The decision to increase the Zoloft to 100 mg was not considered. Both the dosage increase and titration should be gradual to ensure the patient continues to tolerate the medication effectively without any side effects (Del Giudice, 2018). On the other side, a continuation of the same dose and having the reassess after four weeks were not selected due to the client’s partial response.
By selecting that decision, the anxiety symptoms were expected to continue reducing, which could indicate a lowered HAM-A score. There was no form of difference between the actual decision and the expectations. That is because the patient anxiety symptoms had reduced as evidence of further HAM-A reduction.
The third decision was to maintain the current dose of Zoloft of 75 mg orally daily. That decision was made due to the patient’s results, which showed improvement of the symptoms of anxiety based on the subjective data and the HAM-A score. The patient had reported having stopped experiencing the symptoms. On the other side, the HAM-A score showered a reduction of the current dose. That shows that the patient is responding well to the current medication as well as the dose adequately. Besides that, the client was not experiencing any side effects of the current dose, and he was tolerating the medication effectively.
The other two options of either augmenting the current treatment with the Buspar and increasing the current dose of Zoloft up to 100 mg were not considered. The patient was already showing positive satisfaction with the current dose of Zoloft 75 mg (Afshari, 2020).
By taking a crucial step in selecting that decision, the client was expected to show a fully effective response to the treatment through the client reporting a clearance of the symptoms and the HAM-A score reduction.
In terms of the ethical consideration towards the client’s treatment plan, it will encompass information permission, confidentiality, and autonomy. It is important to seek informed permission from the client to ensure the client has full information towards recommended treatment before the patient gives consent to the treatment. The confidentiality of the client is supposed to be respected every time. That means the patient’s information and the treatment regimen should never be shown or disclosed to anyone without the patient’s permission (Del Giudice, 2018). Finally, the patient’s autonomy should also be given their necessary respect when the patient is not allowed to be forced to be treated. Thus he should be allowed to accept or refuse the treatment without any pressure; thus, the client’s decisions towards the treatment should always be respected fully.
To sum up, the first decision was the Zoloft 50 mg orally daily because it is the best SSRI mostly used for the first treatment of anxiety disorders. The evidence available showered that it is nifty in terms of treating the anxiety symptoms. Through it, there were various significant improvements with the decision. Secondly, the other decision was the increase in the dose from 50 to 75 mg orally daily. That was made because the patient’s results indicated that the client has a partial response towards the treatment. The HAM-A score had been reducing; thus, the dosage increase could facilitate response satisfaction. On the other side, the third decision was to maintain the current dose because the patient showed a nifty response to the treatment according to the results of the HAM-A score, which had a reduction (Shioiri, 2019). Finally, in terms of ethical consideration, different things are very crucial. They should be given the firsts priority, such as the confidentiality of the patient’s data and information, autonomy, and informed consent.
Afshari, B. (2020). Personality and anxiety disorders: Examination of revised reinforcement sensitivity theory in clinical generalized anxiety disorder, social anxiety disorder, and panic disorder. Current Issues in Personality Psychology, 8(1), 52-60. https://doi.org/10.5114/cipp.2020.95148
Del Giudice, M. (2018). Social anxiety disorder. Evolutionary Psychopathology, 347-352. https://doi.org/10.1093/med-psych/9780190246846.003.0019
Piotrovskaya, V. (2017). Inflammatory markers in mild cognitive impairment and anxiety disorders in middle-aged subjects with metabolic syndrome. https://doi.org/10.26226/morressier.5885d714d462b8028d8917fe
Salzer, S. (2014). Efficacy of manualized short-term psychodynamic therapy for separation anxiety disorder, generalized anxiety disorder, and social anxiety disorder in children. http://isrctn.com/. https://doi.org/10.1186/isrctn11333815
Shioiri, T. (2019). The neuroanatomical model of panic disorder. Anxiety Disorder Research, 11(1), 35-46. https://doi.org/10.14389/jsad.11.1_35