Description
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 (Please view attached documents)
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 (Please note that the decisions were already made, develop them).
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.
Unformatted Attachment Preview
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Generalized Anxiety Disorder
Middle-Aged White Male with Anxiety
BACKGROUND INFORMATION
The client is a 46-year-old white male who works as a welder at a local steel fabrication factory.
He presents today after being referred by his PCP after a trip to the emergency room in which
he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath,
and feeling of impending doom. He does have some mild hypertension (which is treated with
low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8
years old, but his medical history since that time has been unremarkable. Myocardial infarction
was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.
He admits that he still has problems with tightness in the chest and episodes of shortness of
breath- he now terms these “anxiety attacks.” He will also report occasional feelings of
impending doom, and the need to “run” or “escape” from wherever he is at.
In your office, he confesses to occasional use of ETOH to combat worries about work. He admits
to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging
parents in his home. He reports that the management at his place of employment is harsh, and
he fears for his job. You administer the HAM-A, which yields a score of 26.
Client has never been on any type of psychotropic medication.
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MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed.
Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does
endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times
throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations,
no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact,
as is insight. He denies suicidal or homicidal ideation.
You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Decision Point One
Select what you should do: (Please see my action plan on next page)
Begin Paxil 10 mg po daily
Begin Imipramine 25 mg po BID
Begin Buspirone 10 mg po BID
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Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety
Decision Point One:
Begin Paxil 10 mg po daily
RESULTS OF DECISION POINT ONE:
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Client returns to clinic in four weeks
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Client informs you that he has no tightness in chest, or shortness of breath
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Client states that he noticed decreased worries about work over the past 4 or 5 days
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HAM-A score has decreased to 18 (partial response)
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Decision Point Two:
Increase dose to 20 mg po daily
RESULTS OF DECISION POINT TWO
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Client returns to clinic in four weeks
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Client reports an even further reduction in his symptoms
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HAM-A score has now decreased to 10. At this point- continue current dose (61%
reduction in symptoms)
Decision Point Three:
Maintain current dose
Guidance to Student
At this point, it may be appropriate to continue client at the current dose. It is clear that the
client is having a good response (as evidenced by greater than a 50% reduction in symptoms)
and the client is currently not experiencing any side effects, the current dose can be maintained
for 12 weeks to evaluate full effect of drug. Increasing drug at this point may yield a further
decrease in symptoms, but may also increase the risk of side effects. This is a decision that you
should discuss with the client. Nothing in the client’s case tells us that we should consider
adding an augmentation agent at this point as the client is demonstrating response to the drug.
Avoid polypharmacy unless symptoms cannot be managed by a single drug.
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LEARNING RESOURCES
Required Readings
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Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis
and practical applications (5th Ed.) Cambridge University Press.
o Chapter 8, “Anxiety, Trauma, and Treatment” (pp. 359-378)
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American Psychiatric Association. (2010a). Practice guideline for the treatment of
patients with acute stress disorder and posttraumatic stress disorderLinks to an
external site..
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ac
utestressdisorderptsd.pdf
American Psychiatric Association. (2010c). Practice guideline for the treatment of
patients with panic disorderLinks to an external site. (2nd ed.).
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/pa
nicdisorder.pdf
Bendek, D. M., Friedman, M. J., Zatzick, D., & Ursano, R. J. (n.d.). Guideline watch
(March 2009): Practice guideline for the treatment of patients with acute stress
disorder and posttraumatic stress disorderLinks to an external site..
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ac
utestressdisorderptsd-watch.pdf
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 PsychiatryLinks to an external site., 49(4), 414–
430. https://jaacap.org/action/showPdf?pii=S0890-8567%2810%2900082-1
Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going
beyond the guidelines. British Journal of PsychiatryLinks to an external site., 2(6),
e16–e18. 10.1192/bjpo.bp.116.003707. http://bjpo.rcpsych.org/content/2/6/e16
Hamilton, M. (1959). Hamilton Anxiety Rating Scale (HAM-A)Links to an external
site.. PsycTESTS. https://doi.org/10.1037/t02824-0
Ostacher, M. J., & Cifu, A. S. (2019). Management of posttraumatic stress
disorder. JAMALinks to an external site., 321(2), 200–201.
https://doi.org/10.1001/jama.2018.19290
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 AnxietyLinks to an external site.,
29(4), 328–339. https://doi.org/10.1002/da.21913
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Medication Resources
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U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugsLinks to
an external site.. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Links to an external site.
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Note: To access the following medications, use the Drugs@FDA resource. Type the
name of each medication in the keyword search bar. Select the hyperlink related to the
medication name you searched. Review the supplements provided and select the
package label resource file associated with the medication you searched. If a label is
not available, you may need to conduct a general search outside of this resource
provided. Be sure to review the label information for each medication as this information
will be helpful for your review in preparation for your Assignments.
Review the following medications:
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benzodiazepines
citalopram
desvenlafaxine
duloxetine
escitalopram
fluoxetine
paroxetine
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sertraline
venlafaxine
vilazodone
vortioxetine
propranolol
prazosin
Required Media
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Case Study: A Middle-aged Caucasian Man with AnxietyLinks to an external site.
Note: This case study will serve as the foundation for this week’s Assignment.
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