NURS 6630 Therapy for Patients With Anxiety Disorders and PTSD Treatment

Sample Answer for NURS 6630 Therapy for Patients With Anxiety Disorders and PTSD Treatment Included After Question

NURS 6630 Therapy for Patients With Anxiety Disorders and PTSD Treatment

 

I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.

—P.K. Philips, PTSD patient

For individuals presenting with posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.

This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of patients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.

NURS 6630 Therapy for Patients With Anxiety Disorders and PTSD Treatment
NURS 6630 Therapy for Patients With Anxiety Disorders and PTSD Treatment

NURS 6630 Therapy for Patients With Anxiety Disorders and PTSD Treatment Reference:

Philips, P. K. (n.d.). My story of survival: Battling PTSD. Anxiety and Depression Association of America. https://adaa.org/living-with-anxiety/personal-stories/my-story-survival-battling-ptsd

Learning Objectives

Students will:

  • Assess patient factors and history to develop personalized plans of anxiolytic therapy for patients
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring anxiolytic therapy
  • Synthesize knowledge of providing care to patients presenting with anxiolytic therapy
  • Analyze ethical and legal implications related to prescribing anxiolytic therapy to patients across the lifespan
  • Assess psychopharmacologic approaches to treatment for patients across the lifespan

Learning Resources

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NURS 6630 Therapy for Patients With Anxiety Disorders and PTSD Treatment

Required Readings (click to expand/reduce)

 

Bui, E., Pollack, M. H., Kinrys, G., Delong, H., Vasconcelos e Sá, D., & Simon, N. M. (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.

 

American Psychiatric Association. (2010a). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf

 

American Psychiatric Association. (2010c). Practice guideline for the treatment of patients with panic disorder (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.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 disorder. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd-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 Psychiatry, 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 Psychiatry, 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). PsycTESTS. https://doi.org/10.1037/t02824-0

 

Ostacher, M. J., & Cifu, A. S. (2019). Management of posttraumatic stress disorder. JAMA, 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 Anxiety, 29(4), 328–339. https://doi.org/10.1002/da.21913

 

 

Medication Resources (click to expand/reduce)

 

 

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

 

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:

  • benzodiazepines
  • citalopram
  • desvenlafaxine
  • duloxetine
  • escitalopram
  • fluoxetine
  • paroxetine
  • sertraline
  • venlafaxine
  • vilazodone
  • vortioxetine
  • propranolol
  • prazosin

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource

A Sample Answer For the Assignment: NURS 6630 Therapy for Patients With Anxiety Disorders and PTSD Treatment

Title: NURS 6630 Therapy for Patients With Anxiety Disorders and PTSD Treatment

Assessing and Treating Patients with Anxiety Disorders 

Generalized anxiety disorder (GAD) is a common psychiatric condition that presents with excessive and uncontrollable anxiety or worries about various things or events. The anxiety or worry occurs for more days than not for more than six months. The cause of GAD is unknown, but it usually coexists in individuals with panic disorder, major depression, and alcohol use disorder (Strawn et al., 2018). The purpose of this paper is to describe the treatment for a patient with GAD. 

Introduction to the Case 

The case depicts a 46-year-old man who comes to the psychiatric clinic following a referral by the PCP. The patient had gone to the ER after he experienced symptoms resembling a heart attack, including chest tightness, dyspnea, and a feeling of coming doom. He has a history of mild hypertension managed through a low sodium diet and weighs around 115 lbs. In addition, he has a history of tonsillectomy but no significant medical history. The patient’s EKG and physical exam were within the normal limits in the ER, and Myocardial infarction was excluded as a possible diagnosis. However, the patient mentions that he still experiences chest tightness and episodes of dyspnea. Besides, he experiences sporadic feelings of imminent doom and a need to flee from where he is.  

The patient reports occasionally taking alcohol to alleviate work-related worries. He is single but is trying to take care of his old parents. He states that his workplace management is harsh and worries for his job. The MSE findings are unremarkable except for the endorsement of nervousness and blunted affect that improves severally during the assessment. The patient was administered the HAM-A, which he scored 26, and was diagnosed with GAD. Specific patient factors that may influence treatment decisions include the patient’s age, medical history of hypertension, the severity of GAD, and the patient’s overweight state (Garakani et al., 2020). Therefore, the treatment interventions used should have no potential effect on the patient’s weight and blood pressure to avoid worsening his medical condition.  

Decision Point One 

Start Zoloft 50 mg orally daily. 

Why I Selected This Decision 

Zoloft was the ideal drug because it is recommended in the first-line treatment of GAD in adults, among other SSRIs (Strawn et al., 2018). Guaiana et al. (2018) found that SSRIs are superior in alleviating GAD symptoms, and Zoloft was established to be effective and well-tolerated due to its modest side effects. 

Why I Did Not Select the Other Options  

Imipramine was not selected because of its documented antihistaminic effects as a TCA, which increase appetite resulting in weight gain. This would worsen the client’s overweight condition. Garakani et al. (2020) explain that although TCAs have similar efficacy to SSRIs, they are rarely prescribed because of side effects like weight gain, sedation, dry mouth, urinary hesitancy, arrhythmias, and mortality risk with overdose. Buspirone was not the best option because it has been established to have a delayed onset of action and is weak effective (Strawn et al., 2018). Thus, it cannot be prescribed as monotherapy in GAD, limiting its use in this patient. 

What I Was Hoping To Achieve 

The clinician anticipated that Zoloft would reduce the GAD symptoms and lower the HAM-A score by half. The patient reported a significant decrease in worry, dyspnea, and feeling of imminent doom. Lewis et al. (2019) found that Zoloft improves anxiety, self-rated mental health, and quality of life in GAD patients, which is clinically important. Besides, Strawn et al. (2018) established that SSRIs like Zoloft have a significant treatment response rate of 30-50% in patients with GAD and would thus significantly reduce the patient’s GAD symptoms.  

Ethical Considerations Impact on the Treatment Plan and Communication 

The ethical principle of beneficence may affect the treatment since the clinician has to select the intervention established to have the best outcomes in GAD. For example, the PMHNP selected Zoloft because studies support its efficacy in suppressing GAD symptoms and is tolerable. In addition, autonomy may affect communication since the PMHNP had to obtain consent from the patient to begin treatment. 

Decision Point Two 

Increase dose to 75 mg OD. 

Why I Selected This Decision 

Zoloft was increased because of the evident improvement in the patient’s GAD symptoms and partial decrease in HAM-A score with Zoloft therapy. According to Edinoff et al. (2021), SSRIs like Zoloft should be gradually increased to enable the clinician to monitor the adverse effects. Strawn et al. (2018) found that patients increasingly demonstrated improvement in anxiety symptoms when the Zoloft dose was increased by 25 mg.  

Why I Did Not Select the Other Options  

Increasing Zoloft to 100 mg was not the best option because the PMHNP may be unable to monitor side effects with a high dose increase. Edinoff et al. (2021) explain that patients can be sensitive to SSRIs, and thus, gradually increasing SSRIs is vital in achieving the desired treatment outcomes. The dose was not also maintained at 50 mg since the client demonstrated only a partial response to treatment. Lewis et al. (2019) established that Zoloft leads to decreased anxiety symptoms and improved mental health within six weeks, but a complete reduction of symptoms takes longer and is more modest. Thus, maintaining the dose would have delayed achieving complete remission of GAD.  

What I Was Hoping To Achieve 

The clinician expected that the patient’s GAD symptoms would decrease further with an increased dose, and the patient would achieve a better clinical response after four weeks. Mangolini et al. (2019) found that increasing the SSRI dose results in a better clinical response in GAD. Furthermore, Edinoff et al. (2021) found sertraline to be more effective in the acute phase (6-12 weeks) of treatment than other SSRIs.  

Ethical Considerations Impact on the Treatment Plan and Communication 

The ethical principle of nonmaleficence (do no harm) impacted the treatment since the PMHNP had to make the decision associated with the least adverse effects. For example, the dose was increased to 75 mg rather than 100 mg for the clinician to monitor side effects. The right to autonomy affected communication since the PMHNP had to involve the patient in decision-making. The client was asked about his treatment response and was involved in deciding whether to increase the dose. 

Decision Point Three 

Maintain the Zoloft 75 mg dose. 

Why I Selected This Decision 

The PMHNP maintained Zoloft at 75 mg because the patient exhibited a satisfactory positive response to the dose, with a 61% reduction in anxiety symptoms. Furukawa et al. (2019) found that 80% occupancy of serotonin transporters occurs at minimum therapeutic doses in Zoloft. Besides, increasing transporter occupancy > 80% does not lead to better treatment efficacy. Strawn et al. (2018) also assert that SSRIs in the lower therapeutic range (50 mg-100 mg) are adequate in achieving the desired effect.  

Why I Did Not Select the Other Options  

Increasing Zoloft to 100 mg was not ideal because the patient had achieved a satisfactory therapeutic response. According to Edinoff et al. (2021), increasing Zoloft can lead to further reduction of symptoms, but it increases the risk of side effects, compromising treatment compliance. Augmenting treatment with Buspirone was not ideal since the client had an adequate therapeutic response with Zoloft. Mangolini et al. (2019) assert that augmentation causes polypharmacy and should thus be avoided if there is an adequate response with monotherapy.  

What I Was Hoping To Achieve 

The practitioner hoped that continuing with the 75mg dose would increasingly alleviate GAD symptoms and help achieve complete remission of symptoms within 4-6 weeks (Furukawa et al., 2019). Strawn et al. (2018) established that flexibly dosing Zoloft significantly reduces GAD symptoms. 

Ethical Considerations Impact on the Treatment Plan and Communication 

Beneficence (duty to do good) and confidentiality may impact treatment and communication in this case. For example, beneficence impacted treatment as the PMHNP had to select the decision that would have the best outcomes without compromising patient safety. Besides, the PMHNP has to be confidential with the patient’s information and seek consent before sharing it with other providers. 

Conclusion 

The patient was diagnosed with GAD based on his history of having excessive worries about his job and the presence of symptoms like dyspnea, chest tightness, and feeling of imminent doom. Specific factors that may influence treatment decisions include the patient’s age, weight, history of hypertension, and severity of GAD (Garakani et al., 2020). The patient was initiated on Zoloft 50 mg since it is recommended as a first-line agent in treating GAD in adults. Besides, it has been established to be effective and tolerable due to its modest side effects (Guaiana et al., 2018). Imipramine was not ideal because it causes weight gain and would have affected the patient’s weight. Buspirone was not selected because it is not effective as a monotherapy.  

Zoloft partially reduced the patient’s symptoms, leading to increasing the dose to 75 mg. The dose was gradually increased because it allowed the clinician to monitor the adverse effects (Strawn et al., 2018). Maintaining Zoloft at 50 mg was not ideal because the patient demonstrated a partial response. Increasing to 100 mg was not the best choice since the patient could have developed adverse effects from a high dose increase (Edinoff et al., 2021). The patient’s symptoms were further reduced to 61%, and the dose was then maintained at 75 mg. Increasing the dose to 100 mg would have had the disadvantage of side effects and, thus, not an ideal choice. Furthermore, augmenting with Buspirone was not ideal because it would have led to polypharmacy.  

 

 

References 

Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., Viswanath, O., Urits, I., Boyer, A. G., Cornett, E. M., & Kaye, A. M. (2021). Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review. Neurology International, 13(3), 387–401. https://doi.org/10.3390/neurolint13030038 

Furukawa, T. A., Cipriani, A., Cowen, P. J., Leucht, S., Egger, M., & Salanti, G. (2019). Optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: a systematic review and dose-response meta-analysis. The Lancet Psychiatry, 6(7), 601-609. 

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/10.3389/fpsyt.2020.595584 

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 

Lewis, G., Duffy, L., Ades, A., Amos, R., Araya, R., Brabyn, S., … & Lewis, G. (2019). The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomized trial. The Lancet Psychiatry, 6(11), 903-914. 

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