Generalized Anxiety Disorder

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Identify the core assignment question and clarify the task. Remove any meta-instructions, grading criteria, due date comments, and repetitive or placeholder language. Focus solely on the essential prompt, which is to create an academic paper based on the provided clinical case and decision-making process regarding the treatment of a middle-aged male with generalized anxiety disorder (GAD).

The task is to write an approximately 1000-word scholarly paper that discusses the clinical presentation, diagnosis, and pharmacological management of GAD, specifically following the case of a 46-year-old white male patient treated with sertraline (Zoloft). The paper should include an introduction to GAD, analysis of the case, rationale for medication choices, the patient's response over time, and considerations for ongoing management, including dose adjustments and continuation strategies. Support your discussion with at least five credible scholarly references, properly cited in APA format.

Sample Paper For Above instruction

Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry about multiple aspects of daily life, persisting for at least six months and accompanied by physical symptoms such as muscle tension, restlessness, fatigue, and sleep disturbances. It significantly impairs functioning and is one of the most common anxiety disorders encountered in clinical practice (American Psychiatric Association, 2013). The case at hand involves a middle-aged white male, age 46, presenting with physical and psychological symptoms consistent with GAD, following a stressful event involving a cardiac workup and ongoing occupational and familial stressors.

Clinical Presentation and Diagnosis

The patient reports episodes of chest tightness, shortness of breath, and a sense of impending doom—symptoms that initially prompted emergency care. Although myocardial infarction was ruled out, these physical symptoms persisted, aligning with somatic manifestations of anxiety disorders. The mental status exam showed an alert, oriented individual with appropriate affect and insight, but with a reported “nervous” mood and a Hamilton Anxiety Rating Scale (HAM-A) score of 26, indicating moderate to severe anxiety (Hamilton, 1959). The diagnosis of GAD is confirmed based on the duration and severity of worry, physical symptoms, and the absence of alternative medical or psychiatric etiologies.

Pharmacological Management and Rationale

The initial management involved starting sertraline (Zoloft) at 50 mg daily. Sertraline, a selective serotonin reuptake inhibitor (SSRI), is widely regarded as first-line pharmacotherapy for GAD due to its efficacy, tolerability, and favorable side-effect profile (Bandelow et al., 2013). The choice of SSRIs is supported by clinical guidelines recommending their use as primary agents in GAD treatment (Bandelow et al., 2012). The patient responded well within four weeks, with decreased physical symptoms and a reduction in HAM-A scores from 26 to 18.

Progressive Dose Adjustment and Monitoring

Given the partial response, the decision was made to increase the dose from 50 mg to 75 mg daily after another four weeks. The subsequent assessment revealed further symptom reduction, with the HAM-A score decreasing to 10. This indicates a 61% overall reduction in symptoms—consistent with effective treatment response (Bystritsky & Stein, 2014). The gradual titration approach minimizes the risk of adverse effects while optimizing therapeutic benefits.

Ongoing Management and Considerations

At this point, maintaining the current dose for an additional 12 weeks is advisable. Evidence suggests that continued medication at an effective dose enhances the likelihood of sustained remission (Bystritsky et al., 2013). The clinician should also address potential side effects, monitor adherence, and evaluate the need for adjunctive psychotherapy, such as cognitive-behavioral therapy (CBT), which has demonstrated benefit in GAD patients (Hunot et al., 2007). Additionally, the patient's alcohol use—about 3-4 beers nightly—to cope with worries warrants counseling and possible intervention, as alcohol can interfere with medication efficacy and exacerbate anxiety symptoms (Petrakis et al., 2005).

The decision to maintain current medication rather than introduce augmentation agents aligns with best practices, which recommend polypharmacy only after inadequate response to monotherapy (Bandelow et al., 2012). The patient's positive trajectory supports continued monotherapy with sertraline, with plans for reassessment in 12 weeks.

In conclusion, the management of GAD in this middle-aged patient demonstrates the importance of a patient-centered, evidence-based approach. Pharmacotherapy with SSRIs remains a cornerstone, combined with regular follow-up, monitoring, and addressing comorbid issues like alcohol use. This case exemplifies the effective titration of medication dosage to achieve adequate symptom control while minimizing side effects, aligning with current clinical guidelines for GAD management.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Bandelow, B., Michaelis, S., & Wedekind, D. (2013). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 15(4), 439–446.
• Bandelow, B., Zohar, J., Hollander, E., et al. (2012). Treatment guidelines for anxiety disorders. International Journal of Neuropsychopharmacology, 15(2), 231–267.
• Bystritsky, A., & Stein, M. B. (2014). A review of pharmacological treatments for generalized anxiety disorder. The Journal of Clinical Psychiatry, 75(8), 870–878.
• Bystritsky, A., et al. (2013). Maintenance and discontinuation pharmacotherapy in GAD. Specialty in Psychiatry, 66(4), 340–350.
• Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32(1), 50–55.
• Hunot, V., et al. (2007). Cognitive-behavioral therapy for generalized anxiety disorder. Cochrane Database of Systematic Reviews.
• Petrakis, I. L., et al. (2005). Alcohol and anxiety disorders. Alcohol Research & Health, 28(4), 262–272.