NURS 6630 Assignment Assessing and Treating Patients With Anxiety Disorders

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NURS 6630 Assignment Assessing and Treating Patients With Anxiety Disorders

Introduction to the Case Study

The case study portrays a 46-year-old white male referred by his primary care provider after visiting the ED due to a perception of having a heart attack. The client reported symptoms of chest tightness, dyspnea, and a feeling of looming doom. He has a history of mild hypertension managed with a low sodium diet, and he is overweight with about 15 lbs (Laureate Education, 2016). Myocardial infarction was ruled out after having a normal EKG and physical exam. The patient still reports chest tightness and dyspnea episodes, which he refers to as anxiety attacks. He also experiences occasional feelings of looming doom and a need to escape from the situation.

The patient admits taking alcohol, 3-4 beers/night, to suppress worries about work. He is single but cares for his aging parents in his home. The client also mentions that the management at his workplace is harsh, and he is concerned about his job. He scores 26 on the Hamilton Anxiety Rating Scale (Laureate Education, 2016). Pertinent positive MSE findings include a “blah” mood and admit feeling nervous. His affect is a bit blunted but brightens during the interview (Laureate Education, 2016). Judgment and insight are grossly intact, and he denies suicidal or homicidal ideation. He is diagnosed with generalized anxiety disorder (GAD).

Various patient factors determine the psychopharmacologic plan for a patient, and the PMHNP must consider these factors when developing the treatment plan. Patient factors that may influence decision-making on the patient’s treatment plan include age, medical history, the severity of the illness, history with previous treatment attempts, comorbidities such as personality disorders, and suicidality (Bandelow, Michaelis & Wedekind, 2017). The patient’s age will determine the anxiolytic medication to prescribe and the dosage of medication. The patient has a history of blood pressure and overweight which will influence his medication. Medication prescribed for the patient should not have potential side effects of increasing blood pressure or weight gain to promote overall better health outcomes (Bandelow et al., 2017). The HAMA score signifies moderate to severe anxiety. Consequently, the medication selected should be documented to be effective in treating moderate and severe anxiety. NURS 6630 Assignment: Assessing and Treating Patients With Anxiety Disorders

Decision Point One

Initiate Zoloft 50 mg orally daily.

Why I Selected This Decision

Zoloft is a Selective serotonin reuptake inhibitor antidepressant recommended as first-line therapy for treating GAD. I initiated the client on Zoloft therapy because SSRIs have been documented as the most effective treatment option for GAD (Guaiana et al., 2018). The FDA also approves Zoloft to treat GAD, which means its efficacy and safety have been established. Furthermore, I chose Zoloft because it is associated with few and mild side effects, which increases its compliance rate.

Why I Did Not Select the Other Two Options Provided

Imipramine was not an ideal drug for this client due to its high toxicity levels and its lethal potential in the event of an overdose. According to Bandelow et al. (2017), tricyclic antidepressants (TCAs) such as Imipramine are effective as 2^nd generation antidepressants in treating anxiety disorders. Imipramine has antihistaminic effects, which cause an increased appetite and weight gain. Therefore, Imipramine is not ideal for this patient due to his overweight status. I did not select Buspirone due to its prolonged onset of action and weak efficacy, limiting its use as a sole agent in treating GAD (Bandelow et al., 2017). According to Strawn et al. (2018), Buspirone is recommended as a second-line agent after SSRIs when a person does not respond to or cannot tolerate SSRIs’ side effects. NURS 6630 Assignment: Assessing and Treating Patients With Anxiety Disorders

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What I Was Hoping To Achieve By Making This Decision

I hoped that Zoloft would alleviate GAD symptoms’ severity to at least 16 in the HAM-A within four weeks. I also hoped that the patient would report reduced worries about his work and anxiety attacks with an improved overall mood. According to Strawn et al. (2018), SSRIs such as Zoloft have a 30-50% treatment response rate in GAD. The drug acts in the CNS by controlling serotonin levels, which regulate personality, mood, and wakefulness.

How Ethical Considerations May Impact the Treatment Plan and Communication with Patients

Ethical considerations of patient right to autonomy and beneficence may impact the patient’s treatment plan and communication.

NURS 6051 Assignment Ethical and Legal Implications of Prescribing Drugs

Autonomy requires that the PMHNP gives the patient a right to choose and the ability to act on that choice (Dolan, 2017). The PMHNP can uphold this by obtaining informed consent before initiating treatment and respecting his care decisions. Beneficence requires the PMHNP to provide benefits and balance the benefits and harms of treatment (Dolan, 2017). In this case, the PMHNP weighed each drug’s benefits and harms and selected the one with the greatest benefit and least harm.

Decision Point 2

Increase Zoloft dose to 75 mg daily.

Why I Selected This Decision

I selected this decision because the patient reported improved symptoms with Zoloft treatment. After four weeks of Zoloft therapy, the patient reported that anxiety symptoms, including chest tightness and shortness of breath, had diminished and he had reduced worries regarding his work. He scored 18 in the HAM-A from 26, which is a partial response (Laureate Education, 2016). I increased the dose to improve the HAM-A score further and prevent relapse of anxiety symptoms. Furthermore, the patient did not report any side effects with the initial dose, and thus gradually increasing the dose would allow monitoring of the drug.

Why I Did Not Select the Other Two Options Provided

The other options were to increase the Zoloft dose to 100 mg daily or maintain the drug and dose. It would have been inappropriate to increase Zoloft to 100 mg daily because it would have been impossible to monitor the drug’s side effects gradually. According to Guaiana et al. (2018), individuals with anxiety disorders are sensitive to antidepressant therapy and need slow titration for successful treatment. Besides, failing to change the dose would not have been ideal because the patient had a partial response to the initial dose. It was important to increase the dose to promote better outcomes and further decrease the HAM-A score.

I did not also select the option of not changing the dose because the client was only on the starting dose, which had demonstrated a partial response. Failing to increase the drug may result in the lack of a further decrease in anxiety symptoms. According to Mangolini et al. (2019), higher doses of SSRIs are associated with treatment response and symptomatic improvement.

What I Was Hoping To Achieve By Making This Decision

I hoped that increasing the Zoloft dose would improve the GAD symptom and reduce the HAM-A score to at least 10 within four weeks. A dose increase for SSRIs is associated with having a superior clinical response in GAD patients (Mangolini et al., 2019). Besides, Sertraline, unlike other SSRIs, is more effective at the higher end of its dose range than the recommended starting dose of 50 mg/day.

How Ethical Considerations May Impact the Treatment Plan and Communication with Patients

Ethical consideration that might influence treatment includes the principle of beneficence that requires the PMHPN to promote good and prevent harm when planning treatment interventions (Dolan, 2017). In this case, the PMHNP assessed the patient’s response to the initial Zoloft dose and medication tolerance. The PMHNP increased the dose to promote better patient outcomes and evaluated side effects to avoid harming the patient, thus promoting beneficence.

Decision Point 3

Maintain current Zoloft dose.

Why I Selected This Decision

I selected this decision because the 75 mg/day dose had achieved the desired outcome of a HAM-A score of 1, which is a 61% reduction in GAD symptoms. The patient had a further reduction in symptoms, and he reported no side effects after increasing the dose to 75 mg. According to Bandelow et al. (2017), SSRIs doses in the lower part of the therapeutic range, that is, 50 mg-100 mg, are sufficient in promoting the desired therapeutic effect.

Why I Did Not Select the Other Two Options Provided

Other treatment options were to increase the current dose to 100 mg daily or add an augmentation agent such as Buspirone. The option of increasing the dose to 100 mg/day was not ideal because the patient had an adequate treatment response of 75 mg/day. Increasing an SSRI dose can promote a further improvement in GAD symptoms, but it has the disadvantage of side effects, limiting medication compliance (Bandelow et al., (2017). I did not select the option of augmentation with Buspirone because the patient had a positive response to monotherapy with Zoloft. According to a study by Mangolini et al. (2019), augmentation strategy does not seem beneficial in persons with treatment-resistant anxiety disorders, such as generalized anxiety.

What I Was Hoping To Achieve By Making This Decision

I hoped that maintaining the current dose would increasingly reduce the GAD symptoms and result in complete remission, evidenced by a HAM-A score of below 5 within four weeks. According to a study by Strawn et al. (2018), flexibly dosed Zoloft was found to significantly reduce GAD symptoms and was associated with a decrease in anxiety symptoms.

How Ethical Considerations May Impact the Treatment Plan and Communication with Patients

The ethical principle of nonmaleficence may impact the treatment plan since the PMHNP has to assess the medication for any side effects that could be lowering the quality of life or causing non-compliance (Dolan, 2017). In this case, the PMHNP did not increase the dose due to associated side effects that could harm the patient. The principle of confidentiality may impact communication since the PMHNP has to obtain consent before sharing the patient’s information with a third party, including other providers.

NURS 6630 Assignment Assessing and Treating Patients With Anxiety Disorders Conclusion

The patient in the case study was diagnosed with GAD manifested by excessive worry, shortness of breath, chest tightness, and a feeling of incoming doom. My initial treatment recommendation was to begin Zoloft 50 mg daily to improve anxiety symptoms and reduce the HAM-A score. I selected Zoloft because it is approved for GAD treatment and is associated with fewer side effects. Imipramine was not selected because of its high toxicity and side effects of increased appetite and weight gain. Buspirone was not also selected because of its weak efficacy in the treatment of GAD. In the second decision, I increased Zoloft to 75 mg daily because the patient demonstrated a positive response with the initial dose. Besides, I increased the dose to improve the anxiety symptoms further, lower the HAM-A score, and promote better patient outcomes. I did not increase the dose to 100 mg at this point to allow monitoring of the drug’s associated side effects.

In the third decision, I maintained the dose at 75 mg daily because the patient had an adequate response to the dose. I did not increase the dose because of the associated side effects of high doses of Zoloft. The PMHNP did not add Buspirone as an augmentation agent because Zoloft was effective when used as monotherapy and the strategy is not effective in GAD. The treatment plan was influenced by ethical principles of beneficence and nonmaleficence, which require the PMHNP to promote better patient outcomes and prevent harm. Consequently, the PMHNP evaluated the medications and selected the drug with the best possible outcomes and least adverse effects.

NURS 6630 Assignment Assessing and Treating Patients With Anxiety Disorders References

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow

Dolan, C. (2017). Moral, ethical, and legal decision-making in controversial NP practice situations. The Journal for Nurse Practitioners, 13(2), e57-e65. https://doi.org/10.1016/j.nurpra.2016.10.017

Guaiana, G., Barbui, C., & Abouhassan, R. (2018). Antidepressants versus placebo for generalized anxiety disorder (GAD). The Cochrane Database of Systematic Reviews, 2018(2), CD012942. https://doi.org/10.1002/14651858.CD012942

Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.

Mangolini, V. I., Andrade, L. H., Lotufo-Neto, F., & Wang, Y. P. (2019). Treatment of anxiety disorders in clinical practice: a critical overview of recent systematic evidence. Clinics (Sao Paulo, Brazil), 74, e1316. https://doi.org/10.6061/clinics/2019/e1316

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 pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966

Anxiety disorders are characterized by pathologically elevated levels of anxiety. One of the common anxiety disorders is generalized anxiety disorder (GAD). It is characterized by anxiety, tension, worry, and fears about various day-to-day events and problems. Patients with GAD experience difficulties controlling excessive worries (DeMartini et al., 2019). GAD’s excessive anxiety and worry cannot be accounted for by a medical condition or substance use. The purpose of this paper is to discuss the case scenario of a patient with an anxiety disorder and describe the treatment and ethical considerations that may impact treatment.

Case Overview

The case scenario portrays a 46-year-old white male referred by his PCP after visiting the ER due to the fear of having a heart attack. The client mentions that he experienced chest tightness, dyspnea, and a feeling of impending doom. He has a history of mild hypertension and is overweight by roughly 15 lbs, but the rest of his medical history is unremarkable. His EKG and physical exam findings were normal, and myocardial infarction was ruled out. The client reports that he still experiences chest tightness and episodes of dyspnea, which he calls anxiety attacks. He also has infrequent feelings of impending doom and a need to escape. He scores 26 on the Hamilton Anxiety Rating Scale and is diagnosed with GAD.

The patient factors that may influence medication prescribing include age, the severity of the patient’s GAD, treatment preferences, current medical condition and medications, and previous medication trials (DeMartini et al., 2019). The clinician needs to consider the patient’s current hypertension and overweight and prescribe a drug that will not aggravate the conditions.

Decision #1

Start Zoloft 50 mg orally daily.

Why I Selected This Decision

Sertraline, a selective serotonin reuptake inhibitor (SSRI), was chosen because it is the most cost-effective SSRI. It is also indicated in the first-line treatment of GAD in adults. Strawn et al. (2018) found that the potential side effects of Zoloft are relatively well-tolerated, which leads to a higher compliance rate and better patient outcomes.

Why I Did Not Select the Other Options

Imipramine was not an ideal choice because it is a 2^nd line therapy used when SSRIs are unsuccessful in alleviating GAD symptoms. Besides, Imipramine is associated with anticholinergic unpleasant side effects such as dry mouth, sedation, and constipation (Strawn et al., 2018). The side effects may contribute to a low compliance rate, which delays achieving the desired treatment effects. In addition, Buspirone was not ideal since it has no antipanic activity. Thus, it would not adequately alleviate the anxiety attacks in the client. Furthermore, Buspirone has a prolonged onset of action and is not recommended as monotherapy in treating GAD (Strawn et al., 2018).

What I Was Hoping To Achieve

I hoped that Zoloft would improve the GAD symptoms by at least 50% by the fourth week, and the HAM-A score would improve to 12. According to Garakani et al. (2020), SSRIs such as Zoloft have been established to be efficacious in treating anxiety disorders.

How Ethical Considerations May Impact the Treatment Plan

Ethical principles that may affect the treatment plan include beneficence (duty to do good) and nonmaleficence (duty to cause no harm) (Bipeta, 2019). The PMHNP upheld beneficence and nonmaleficence by prescribing Zoloft, which is associated with the best treatment outcomes and least side effects. The other drugs were not prescribed due to their associated treatment outcomes and side effects.

Decision #2

Increase Zoloft to 75 mg daily.

Why I Selected This Decision

The Zoloft dose was increased because the patient’s anxiety symptoms had not fully abated. Although he reported that the chest tightness and dyspnea had abated, he still experienced some degree of worry, and the HAM-A sore showed a partial response. Increasing the dose was thus an ideal choice to promote full remission of GAD symptoms (Strawn et al., 2018). Besides, the dose increase was gradual since it allows the PMHNP to monitor the drug’s side effects adequately.

Why I Did Not Select the Other Options

Increasing Zoloft to 100 mg was inappropriate since it is a high dose increase. Thus, it does not allow the clinician to effectively monitor the drug’s effect on the patient and its side effects. It is recommended that the dose is gradually increased to promote successful therapy. In addition, changing the dose was not ideal because the patient exhibited a partial treatment response to the initial dose. Treatment guidelines recommend that the drug be changed only when there is no positive response to therapy after eight weeks or adverse effects (Garakani et al., 2020).

What I Was Hoping To Achieve

I hoped that gradually increasing the dose would help to fully alleviate the depressive symptoms while at the same time monitoring the drug’s associated side effects. The initial dose of Zoloft is 25 to 75 mg daily, while the usual dose range is 50-200 mg daily (Garakani et al., 2020). Thus, 75 mg is an acceptable dose for this patient.

How Ethical Considerations May Impact the Treatment Plan

Nonmaleficence was upheld in this decision by gradually increasing the dose, which would allow the PMHNP to monitor the drug’s effect, thus preventing harm to the patient (Bipeta, 2019). Besides, beneficence was upheld by increasing the dose to promote complete remission of symptoms and better patient outcomes.

Decision #3

Maintain the current dose.

Why I Selected This Decision

The current dose was maintained at 75 mg because the patient demonstrated an adequate positive response to the dose. The patient reported a further decrease in the depressive symptoms with a 61% reduction in symptoms, and the HAM-A score improved to 10. Besides, there were no reported side effects, and thus, maintaining the dose was ideal to avoid adverse effects if the dose was increased (He et al., 2019).

Why I Did Not Select the Other Options

Increasing Zoloft to 100 mg was not an appropriate choice because the patient had an adequate positive response to the current 75 mg dose. Increasing to 100 mg may alleviate the symptoms further but poses the risk of side effects which may affect the drug compliance rate (He et al., 2019). Besides, an augmenting agent was not added to the plan because the patient had an adequate response with Zoloft monotherapy. Besides, monotherapy is highly recommended to prevent polypharmacy.

What I Was Hoping To Achieve

I was hoping that maintaining the dose would promote a progressive remission of the GAD symptoms and further improve the HAM-A score while at the same time causing no harm to the patient through side effects. Strawn et al. (2018) found that Zoloft continues to improve GAD symptoms over time regardless of a fixed dose.

How Ethical Considerations May Impact the Treatment Plan

The ethical principle of autonomy may impact the treatment plan if the patient does not consent to the medications or requests a change in treatment due to side effects. The PMHNP must obtain informed consent and explain the benefit of the prescribed medication and potential side effects (Bipeta, 2019).

NURS 6630 Assignment Assessing and Treating Patients With Anxiety Disorders Conclusion

The specific patient factors that may influence decisions on medication in the above patient include age, the severity of GAD, patient’s treatment preferences, current medical condition and medications, and previous medication trials. The patient was initiated with Zoloft 50 mg daily. The drug was selected because it is indicated as a first-line treatment in GAD and is associated with effective treatment outcomes (Strawn et al., 2018). Besides, it is associated with minimal side effects compared to Imipramine. Buspirone was not selected due to the lack of antipanic activity, which is crucial in managing the patient’s anxiety attacks. The initial dose led to a partial decrease in GAD symptoms, which led to increasing Zoloft to 75 mg daily (Strawn et al., 2018). The aim of this decision was to alleviate the GAD symptoms further. The dose was not increased to 100 mg daily to allow monitoring of side effects. Besides, the drug was not changed because the patient demonstrated a positive response to the initial drug, and no side effects were reported.

The patient’s symptoms decreased with Zoloft 75 mg with a 61% remission in symptoms. The dose was then maintained at 75 mg to allow for a progressive decrease in symptoms and monitoring of side effects. Augmentation was not recommended to avoid polypharmacy (Garakani et al., 2020). Ethical principles of beneficence and nonmaleficence influenced the treatment plan. The clinician selected medication known to have the best treatment outcomes and the least adverse effects to promote better health outcomes (Bipeta, 2019). Autonomy should also be respected by considering the client’s decisions when developing the treatment plan.

NURS 6630 Assignment Assessing and Treating Patients With Anxiety Disorders References

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian journal of psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19

DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals of internal medicine, 170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020

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/10.1176/appi.focus.19203

He, H., Xiang, Y., Gao, F., Bai, L., Gao, F., Fan, Y., … & Ma, X. (2019). Comparative efficacy and acceptability of first-line drugs for the acute treatment of generalized anxiety disorder in adults: a network meta-analysis. Journal of psychiatric research, 118, 21-30. https://doi.org/10.1016/j.jpsychires.2019.08.009

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A Sample Answer For the Assignment: NURS 6630 Assignment Assessing and Treating Patients With Anxiety Disorders

Title: NURS 6630 Assignment Assessing and Treating Patients With Anxiety Disorders

Anxiety disorders make the patients constantly worry and persistently anxious. The patients with the condition present with various symptoms which complicate their daily lives. Some of the symptoms include nervousness, muscle trembling, chest tightness, and shortness of breath. Therefore, there is a need for patients with anxiety disorders to seek medical attention from psychiatric mental health specialists. Various approaches have been used to treat and manage the condition, including pharmacological and psychotherapy approaches (Horenstein & Heimberg, 2020). The implication is that the prescriber should use medications that can be monitored for dose adjustments and potential stoppage or change in case there are adverse reactions. Therefore, the purpose of this assignment is to summarize a case study of a patient with anxiety disorder and explore various decision points upon the administration of appropriate medication.

The Case Summary

The case is of a forty-six-year-old white male patient who presented to the facility after a referral because he felt he was having a heart attack. The patient experiences a feeling of impending doom, breath shortness, and chest tightness. The patient also has mild hypertension and is overweight. The ER ruled out myocardial infarction, and he also had a normal EKG. While in the office, the patient indicated that he consumes alcohol occasionally to help him deal with his worries at work. The patient is single but currently takes care of his aging parent. He indicates that he fears for his job since the management at his workplace is harsh. The patient scored 26 upon administration of HAM-A, hence diagnosed with anxiety disorder.

Decision 1

The Selected Decision

The first decision made was to begin Paxil 10 mg PO daily

Why the Decision Was Selected

The decision was made since Paxil has been approved and widely used as a first-line drug to treat anxiety disorder (Kowalska et al., 2021). While it has similar efficacy as tricyclic antidepressants, Paxil has fewer side effects hence a good choice. In addition, it has a better safety record and a higher response rate compared to other classes of drugs.

Why the Other Options Were Not Selected

The other two options included beginning Buspirone 10 mg Po BID or Begin Imipramine 25 mg Po BID. Buspirone was not chosen since it is recommended for use among patients with anxiety disorder only if the first line of treatment is not effective or presents safety concerns (Wilson & Trip, 2021). Therefore, it should be used as a second line of treatment (Garakani et al., 2020). This medication also has more side effects in comparison to Paxil, and patients also tend to abuse it after use. Imipramine, also an antidepressant, is only considered a second line of treatment for anxiety disorder. In addition, it has various undesirable side effects, such as urinary hesitancy, sedation, and weight gain (Chang et al., 2021). Therefore, it is not a good option since the patient also already has mild hypertension.

What I was Hoping to Achieve by Making the Decision

One of the goals I was hoping to achieve by making the decision was to help the patient have reduced anxiety symptoms and lead a normal life. The medication is expected to act within four weeks. Hence the patient should have fewer worries and experience reduced heart attack-like symptoms (Kowalska et al., 2021). I also expected the HAM-A scores to substantially reduce.

How Ethical Consideration May Impact the Treatment Pan and Communication

One of the ethical considerations at this stage is to offer the patient education regarding the potential side effects of Paxil in addition to informing the patient regarding other available treatment options, such as psychotherapy (Haddad & Geiger, 2020). The patient’s autonomy has to be upheld and be allowed to choose the best option without influence. The patient also needs to be informed of risks connected to not treating the conditions.

Decision 2

The Selected Decision

The second decision made is to increase the dose to 20 mg PO daily

Why the Decision Was Selected

After the first medication dose, the patient came back to the facility, indicating that his symptoms had improved. For example, he no longer experiences breath shortness, chest tightness, and decreased worries. Besides, the HAM-A scores substantially reduced to 18, indicating a partial response implying that the medication is effective; hence an appropriate titration should be done for optimum results. Therefore, a gradual increase from 10 mg to 20 mg should be the choice (Melaragno, 2021). It is also important to note that the patient has not experienced any adverse side effects, indicating that he is tolerating the medication well.

Why the Other Options Were Not Selected

The other two options include increasing the dose to 40 mg PO daily or no change to the drug or dose. It is worth noting that the patient’s improvement was partial; hence maintaining the dosage at 10 mg would give no further improvements or positive changes. In addition, increasing the dosage to 40 mg per day without gradually titrating the medication can lead to various side effects, such as delayed ejaculation, vomiting, nausea, and headaches (Garakani et al., 2020). A normal titration recommendation is usually 10 mg; hence increasing it to 40 mg would present a 30 mg increase which is way too high.

What I was Hoping to Achieve by Making the Decision

I was hoping to achieve increased positive results by increasing the dosage to 20 mg. I was also hoping that the patient gets treated and not only relieves symptoms (Garakani et al., 2020). In addition, I was also hoping that the patient’s score on the HAM-A scale would reduce by at least half.

How Ethical Consideration May Impact the Treatment Pan and Communication

The improvements observed by the patients may lead to excitement, and the patient may even request that he stops taking the medication. However, it is important to advise the patient on the need to continue with the treatment at the end to prevent a potential recurrence of anxiety symptoms. The patient’s autonomy should also be respected, and his input should be considered in further plans.

Decision 3

The Selected Decision

The third decision selected was to maintain the current dose

Why the Decision Was Selected

Upon increasing the dosage to 20 mg, the patient returned to the clinic and indicated that the symptoms had reduced even further. In addition, the patient also had a reduction of the HAM-A scores to 10 (Rabinowitz et al., 2023). There has been a sixty-one percent reduction in the symptoms. Therefore, it will be prudent to maintain the current medication dose as part of the maintenance therapy.

Why the Other Options Were Not Selected

The other two options included increasing the Paxil dosage to 30 mg PO daily or adding an augmentation agent like BuSpar. Increasing the dosage to 30 mg PO daily would further reduce anxiety symptoms. However, there is a high risk of increased side effects (Garakani et al., 2020). The patient data is also not showing any need for augmenting agents like BuSpar. Hence, this choice was also ignored.

What I was Hoping to Achieve by Making the Decision

The decision made was to maintain the dosage. Therefore, I was hoping for all the anxiety symptoms experienced by the patient clear out. I am also hoping that the patient will not suffer any consequences due to ignoring the other two options. I was also hoping that the patient should have improved feelings and not experience any heart attack-like symptoms.

How Ethical Consideration May Impact the Treatment Pan and Communication

There are also ethical considerations that may impact the treatment and communication. One of them is that the patient needs to be educated on the potential risks and threats of increasing the dosage to more than 20 mg in case the patient requests it. The decision should also be made to ensure that the patient does not face any harm but ensure that the patient continues to experience improved symptoms.

Conclusion

The patient in this case study was diagnosed with anxiety disorder; hence medication treatment decision points were taken. The patient presented with various symptoms, such as chest tightness, the feeling of impending doom, and shortness of breath. Therefore, there was a need for the patient with anxiety disorders to seek medical attention from a psychiatric mental health specialist. Various approaches have been used to treat and manage the condition, including pharmacological and psychotherapy approaches. In the case of this patient, the treatment used was 10 mg of Paxil initially. This decision was made while two other decisions were left out, such as beginning Buspirone 10 mg Po BID or Begin Imipramine 25 mg Po BID. The two choices were majorly ignored since both are considered a second line of treatment (Garakani et al., 2020). Therefore, they are only used when the first line of treatment, in this case, Paxil, is not effective or is presenting safety concerns for the patient. The dosage was increased to 20 mg after the patient initially showed improvement. Besides, two other choices were ignored to ensure that the patient goes on in his path to recovery. This dosage was to be maintained to help balance the risk factors and the expected benefits.

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