Assignment: Assessing And Treating Patients With Anxiety Dis ✓ Solved

Assignment Assessing And Treating Patients With Anxiety Disorderscomm

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.

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.

Sample Paper For Above instruction

Introduction and Case Summary

The presented case involves a 46-year-old Caucasian male experiencing symptoms consistent with generalized anxiety disorder (GAD). He reports chest tightness, shortness of breath, and feelings of impending doom, which initially prompted evaluation for a cardiac event. His medical history is significant only for mild hypertension and overweight status, with no history of psychotropic medication use. The recent presentation followed a visit to the emergency room, where myocardial infarction was ruled out, yet symptoms persisted, indicating a psychosomatic component characteristic of GAD.

The patient's occupational stressors, including job insecurity and harsh work environment, along with his social circumstances—caring for aging parents—compound his anxiety. His alcohol consumption of 3-4 beers nightly is noteworthy, as it may influence medication metabolism and efficacy, and highlights potential comorbid substance use issues. His Hamilton Anxiety Rating Scale (HAM-A) score of 26 indicates moderate to severe anxiety requiring pharmacologic intervention tailored to his medical history, lifestyle, and personal preferences.

Factors impacting his treatment include his age, comorbid hypertension, weight, alcohol use, and psychosocial stressors. These considerations influence pharmacokinetic processes such as drug absorption, distribution, metabolism, and excretion, as well as pharmacodynamic responses. Moreover, his first-time psychotropic medication use warrants a cautious approach with agents having favorable profiles regarding interactions and side effects.

Decisions on Pharmacologic Treatment

Decision 1

The initial treatment selection involves choosing an efficacious medication with a favorable safety profile for GAD. Based on evidence, I selected an SSRI—specifically escitalopram—to initiate therapy. SSRIs are first-line treatment for GAD due to their proven efficacy and relatively tolerable side effects (Bui et al., 2016). Escitalopram, in particular, offers minimal drug-drug interactions and is metabolized primarily via CYP2C19, making it suitable considering potential interactions with alcohol and other medications.

I considered other options such as benzodiazepines, which are effective for rapid anxiety relief but carry risks of dependence, sedation, and cognitive impairment, especially in a patient with mild hypertension and weight issues (American Psychiatric Association, 2010a). TCAs or SNRIs like venlafaxine could be used, but SNRIs require cautious dosing given possible blood pressure elevation and other side effects. Therefore, I chose escitalopram to establish symptom control while minimizing adverse effects and dependency risk.

Ethically, initiating an SSRI aligns with beneficence by promoting effective symptom management, and non-maleficence by avoiding medications with higher dependency potential or adverse cardiovascular effects. Patient education about medication purpose, expected benefits, and potential side effects is essential for shared decision-making.

Decision 2

After initial stabilization, I decided to add cognitive-behavioral therapy (CBT) as adjunctive treatment to enhance outcomes. Evidence indicates combined pharmacotherapy and psychotherapy produce better long-term anxiety management than medication alone (Bui et al., 2016). CBT addresses maladaptive thought patterns and provides coping strategies tailored to his psychosocial stressors.

I did not select augmentation with benzodiazepines because of concerns over dependency, especially given his alcohol use. Alternative agents such as buspirone could be considered but have a delayed onset of action (~2-4 weeks) and less robust efficacy compared to SSRIs. Implementing psychotherapy complements pharmacotherapy and targets underlying anxiogenic cognitions, aligning with ethical principles supporting patient autonomy and holistic care.

This decision aims to achieve sustained symptom reduction, improve functioning, and lessen reliance on pharmacologic agents, reducing dependency risks and side effects.

Decision 3

During follow-up, if residual anxiety symptoms persist, I might consider dose escalation of escitalopram or switching to another SSRI with a different receptor profile, such as sertraline. Alternatively, short-term use of a benzodiazepine like lorazepam may be justified for breakthrough symptoms, with strict duration and monitoring to mitigate dependence.

The choice between increasing the dose versus switching agents depends on clinical response and side effect profile. I avoided using high doses initially to prevent adverse effects, especially considering his weight and blood pressure. Using a different SSRI with different pharmacodynamics could offer additional benefits if initial response is inadequate.

Ethically, escalating medication must be justified by clear evidence of benefit and balanced against potential harm, emphasizing informed consent. Careful communication regarding risks and close monitoring are paramount to uphold patient autonomy and safety.

Conclusion

My primary recommendation for this patient involves initiating treatment with an SSRI, specifically escitalopram, combined with psychoeducational support and CBT to address both biological and psychological aspects of GAD. This approach aligns with current guidelines and literature demonstrating superior efficacy and safety profiles for first-line medications in GAD (Bui et al., 2016). Incorporating non-pharmacologic strategies and ongoing assessment ensures a personalized, ethical, and effective treatment plan.

References

• American Psychiatric Association. (2010a). Practice guideline for the treatment of patients with panic disorder (2nd ed.).
• Bui, E., Pollack, M. H., Kinrys, G., et al. (2016). The pharmacotherapy of anxiety disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 61–71). Elsevier.
• Hamilton, M. (1959). Hamilton Anxiety Rating Scale. PsycTESTS. DOI:10.1037/t XLearning Resources
• American Psychiatric Association. (2010). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder.
• Ostacher, M. J., & Cifu, A. S. (2019). Management of posttraumatic stress disorder. JAMA, 321(2), 200–201.
• 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, 49(4), 414–430.
• Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16–e18.
• 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, 29(4), 328–339.
• IBM Corporation. (2020). IBM Micromedex.
• Bendek, D. M., Friedman, M. J., Zatzick, D., & Ursano, R. J. (2009). Guideline watch: Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder.