Assessing and Treating Clients with Anxiety Disorders

Decision #1 

I selected a daily Zoloft intake of 50mg. I selected this decision because, as per the patients description, the attributes of the drug was able to alleviate His depressive feeling. According to the FDA, the drug is the first prescription for patients suffering from psychological issues like PTSD as exhibited in this scenario ( Commerce Clearing House, 1963). Sertraline (Zoloft), which is a potent SUI, is effective in OCD treatment and effective in the improvement of aggression in adults in patient determined diseases and autism (Schopler, Mesibov, & Kunce, 1998). Sertraline is thought to work by enhancing the activities of serotonin. With the client’s history of alcohol consumption during the night hours, Sertraline reduces the motivation to consume it (Loughlin &    Generali , 2006). The patients HAM-A score declined from 26 to 18 after the Zoloft intake, which represented a four-week intake and a mild improvement. In this case, the dosage can be increased on the event that it is tolerant to the patient. I expected to achieve a downward spiral of the HAM-A because of the Zoloft 50mg intake of less than 17 which would have indicated mild severity. 

Decision #2 

I selected the increment of Zoloft to 75mg daily. I selected this decision because the recommended dosage for any adult taking Zoloft is always between 50mg to 200mg ( Schatzberg & American Psychiatric Association, 2017). In this case, the expectation was to attain a gradual change in the therapeutic response and to avoid other unnecessary occurrence if the increment passed 75mg. The expectation in this case was that the HAM-A would be lowered to a level of less than 14. This is because it would have suggested that the anxiety levels experienced before by the patient had lowered and was mild. What I expected was exceed in this case because the patients HAM-A scores lowered to 10, which indicated that a tremendous improvement had been observed. The drug tolerance by the patient was positive and the 61 percent reduction in the symptoms indicated that the daily oral intake of Zoloft (75mg) was having an immense therapeutic response. The patient may also experience some moderate side effect because of the first time intake of the drugs, which will fade as the dosage progresses. The risk of side effect also might be altered when the dosage are administered at various times. This will reduce the sedation effect of the drug and may reduce anxiety effect especially when administered during sleep time. 

Decision #3 

For this decision, I decided to maintain the dosage of 75mg orally daily of Zoloft. This was because a tremendous improvement had been observed. Maintaining the dosage was vital because the situation had improved because of the patient showing further symptoms reduction. In addition, the HAM-A scores had not reported any increase as per the patients result therefore increasing the doses to 100mg of Zoloft was not an option as his depressive condition had steadily been improving over the 4 weeks. The great reduction of the symptoms exhibited by the client calls for the dosage maintenance of up to 12 weeks in order to evaluate the drugs effect. 

Ethically, the progressive improvement of the patient and the reduction in the HAM-A scores is an indication that the drug therapy and the dosage adjustment works for the case. Altering the drugs without any adverse impact of the initial drug taken by the patient would be inappropriate. Unless inappropriate behavior is observed, the dosage should not be discontinued ( Ahronheim, Moreno, & Zuckerman, 2005).  The well response and the drug tolerance exhibited by the patient further indicate that the therapeutic application was gradually working to alleviate the effects presented by the patient. 

References  

Ahronheim, J. C., Moreno, J. D., & Zuckerman, C. (2005).  Ethics in clinical practice . Boston: Jones and Bartlett Publisherxs. 

Commerce Clearing House. (1963).  Food, drug, cosmetic law reporter . Chicago: Commerce Clearing House. 

Loughlin , K. R. & ,  Generali . A. J. (2006). The Guide to Off-label Prescription Drugs:  New Uses for FDA-approved Prescription Drugs. New York, NY: Simon and Schuster 

Schatzberg, A. F., & American Psychiatric Association. (2017).  The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA : American Psychiatric Association Publishing 

Schopler, E., Mesibov, G. B., & Kunce, L. J. (1998).  Asperger syndrome or high-functioning autism? . New York, NY: Plenum Press.