Anxiety Assessment and Treatment in a Middle-Aged Caucasian Male

Anxiety Assessment and Treatment in a Middle-Aged Caucasian Male

Introduction

Anxiety disorders encompass a range of mental health conditions characterized by significant feelings of fear and anxiety, often accompanied by physical symptoms such as trembling and an elevated heart rate. Various forms of anxiety disorders include panic disorder, social anxiety disorder, agoraphobia, generalized anxiety disorder (GAD), among others (Locke et al., 2015). This assignment focuses on a 46-year-old male who presented with symptoms indicative of an anxiety disorder, including shortness of breath, chest tightness, and a pervasive sense of impending doom.

Initial examinations, including an electrocardiogram (EKG) and an emergency room visit, ruled out myocardial infarction. A Hamilton Anxiety Rating Scale (HAM-A) assessment yielded a score of 26, leading to a diagnosis of generalized anxiety disorder (GAD). This paper will make three treatment decisions for the client, providing a rationale based on clinical evidence and patient data for each decision. Additionally, we will consider factors affecting pharmacokinetics and pharmacodynamics and discuss ethical considerations relevant to the client’s treatment plan.

Decision Point One

The initial decision is to initiate a daily oral dose of Zoloft at 50 mg. This choice stems from the recommendation of selective serotonin reuptake inhibitors (SSRIs) as first-line treatments for anxiety disorders. SSRIs work by increasing serotonin levels in the brain, a critical neurotransmitter for mood regulation (Locher et al., 2017). Zoloft, as an SSRI, inhibits serotonin reuptake, thereby elevating serotonin levels in the brain, which aids in mood regulation and reduces anxiety symptoms. Evidence supports Zoloft’s efficacy in alleviating anxiety symptoms associated with GAD, as anxiety depletes serotonin levels, and Zoloft replenishes these levels (Patel et al., 2018).

Imipramine (Tofranil) at 25 mg BID and Buspirone (Buspar) at 10 mg orally twice daily were not selected due to evidence-based recommendations favoring SSRIs as the primary medication choice for anxiety disorders. Furthermore, Zoloft is better tolerated and has fewer side effects compared to these alternatives.

The U.S. Nursing Shortage: A State-by-State Breakdown

The expected outcomes of initiating Zoloft at 50 mg daily were a gradual reduction in the client’s GAD symptoms, as evidenced by a significant decrease in the HAM-A score. Moreover, it was anticipated that the client would tolerate the medication well with minimal side effects, as SSRIs are known for their favorable tolerability profile (Clevenger et al., 2018).

The actual outcomes aligned with expectations, as the client reported a significant reduction in anxiety symptoms, including the absence of shortness of breath and chest tightness. Additionally, the HAM-A score dropped from 28 to 18, indicating a positive response to treatment, albeit partial.

Decision Point Two

The second decision is to increase the Zoloft dose to 75 mg daily. This choice is based on the client’s partial response to the initial treatment, as indicated by the reduction in the HAM-A score from 28 to 18. An increase in the dose from 50 mg to 75 mg is expected to further elevate serotonin levels in the brain, leading to improved anxiety symptom management. Clinical evidence supports dose escalation if a client exhibits an unsatisfactory response to SSRIs (Jakubovski et al., 2016). Additionally, the client has tolerated Zoloft well with no reported side effects.

The option to raise the Zoloft dose to 100 mg was not chosen due to the need for gradual dose increases to ensure continued tolerability and minimal side effects. Similarly, maintaining the same dose and reassessing the client after four weeks was not selected, as the client’s response remained partial, warranting a dose adjustment (Jakubovski et al., 2016).

The anticipated outcomes of increasing the Zoloft dose to 75 mg daily were a further reduction in anxiety symptoms, evidenced by a significant decrease in the HAM-A score. No significant difference was expected between the actual and expected outcomes, as the client’s symptoms continued to diminish with the higher dosage.

Decision Point Three

The third decision is to maintain the current dose of Zoloft at 75 mg daily. This decision was made because the client has exhibited a satisfactory response to the treatment, as indicated by the reduced HAM-A score and subjective reports of symptom alleviation. The client is not experiencing side effects and is tolerating the medication well. Clinical guidelines recommend medication titration based on the client’s response, and in this case, the client has responded positively to the current dose (Jakobsen et al., 2017).

The options of augmenting the current treatment with Buspar or increasing the Zoloft dose to 100 mg were not chosen because the client is showing a satisfactory response to the current Zoloft regimen, and further adjustments are not currently necessary (Jakobsen et al., 2017).

This decision is expected to lead to a complete response to treatment, with the client reporting the complete absence of anxiety symptoms and a significant reduction in the HAM-A score.

Impact of Ethical Considerations on the Treatment Plan

Ethical considerations for this client’s treatment plan include informed consent, confidentiality, and autonomy. Informed consent ensures that the client possesses comprehensive information about the recommended treatment before providing consent (Millum, 2013). Confidentiality mandates that the client’s information and treatment plan remain confidential, with no disclosure to any third party without the client’s consent. Autonomy guarantees that the client has the freedom to decide whether to accept or decline treatment, and any decision made by the client regarding their treatment plan should be respected (Millum, 2013).

Conclusion

The initial decision to start Zoloft at 50 mg daily was based on the evidence supporting SSRIs as first-line treatments for anxiety disorders. The client exhibited a satisfactory response, which led to the decision to increase the Zoloft dose to 75 mg daily. Subsequently, as the client continued to respond well to the treatment, the decision was made to maintain the current dose. Ethical considerations surrounding informed consent, confidentiality, and autonomy are vital in ensuring the client’s well-being and adherence to treatment.

References

Clevenger, S., Devvrat, M., Dang, J., Vanle, B., & William, I. (2018). The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Therapeutic Advances in Psychopharmacology, 8(1), 49–58.

Jakubovski, E., Anjali, V., Freemantle, N., Taylor, M. J., & Bloch, M. H. (2016). Systematic Review and Meta-Analysis: Dose-Response Relationship of Selective-Serotonin Reuptake Inhibitors in Major Depressive Disorder. American Journal of Psychiatry, 173(2), 174–183.

Jakobsen, J. C., Kumar, K., Timm, A., Gluud, C., Ebert, E. B., et al. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry, 17(58).

Locke, A., Krist, N., Schultz, C., & Shultz, C. (2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. American Family Physician, 91(9), 617–624.

Locher, C., Koechlin, H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I., & Kossowsky, J. (2017). Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Psychiatry, 74(10), 1011–1020.

Millum, J. (2013). Introduction: Case Studies in the Ethics of Mental Health Research. The Journal of Nervous and Mental Disease, 200(3), 230–235.

Patel, D., Feucht, C., Brown, K., & Ramsay, J. (2018). Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners. Translational Pediatrics, 7(1), 23–35.