At one point in life, everyone experience anxiety. Someone might feel nervous before taking a driving test, exam, or a job interview, and so on. But, the above-stated form of anxiety last for a short time and usually stops when the events come to an end. The kind of anxiousness in people suffering from anxiety disorder tends to persist for a long duration and can change from bad to worse. Examples of anxiety disorder included separation and generalized anxiety disorder. Parekh (2017), states that individuals with GAD will often try to avoid events that may trigger fear in their life. The main aim of this paper is to review a case of middle-aged male suffering from anxiety disorder and develop a treatment plan that can be successfully applied to manage the disease.
Decision Point One
Initiate patient on Zoloft 50 mg PO daily
Zoloft is classified as a selective serotonin reuptake inhibitor (SSRI) which is majorly used to treat a variety of mental sicknesses, such as depression and anxiety. The drug is attributed to have less severe side effects on patients. Since the patient’s had not used any psychotropic medication before, it is recommended to begin treating him with a less active psychoactive drug an example being Zoloft which clears the patient’s symptoms quite fasters as compared to other medicines (Stahl, 2013).
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Imipramine is an example of Tricyclic antidepressants and is considered to be more effective than the selective serotonin reuptake inhibitor. However, Imipramine remains in the patient’s body for a long time, and therefore, it can potentiate adverse side effect on the patient for a longer time. Previously, Imipramine has been linked with various side effects on patients which includes, low blood pressure, change in the electrocardiogram, increased heart rate. Given that the patient has a history of heart problems rule out the use of Imipramine drug (Rothschild, 2014).
Another antidepressant drug that could help lessen the patient’s symptoms is known as buspirone. Unlike Zoloft, which induces the patient’s symptom changes instantly, buspirone takes time before making any symptom change. Besides that, the impact of buspirone loses effectiveness over time, while the patient’s symptoms needed instant aid and lasting treatment (Procyshyn et al., 2015 ). Given the pharmacokinetics and pharmacodynamics limits of both buspirone and Imipramine makes Zoloft the best choice of medicine to manage the patient’s generalized anxiety disorder.
By administering Zoloft 50 mg PO daily, the expected result was that the patient’s generalized anxiety disorder symptoms would have reduced generally by the end of the fourth week. The patient was anticipated to return with at least a 50% reduction rating on the HAM-A scale. The client is also expected to report a decrease in worry concerning nervousness and work. The symptoms such as chest constriction and short breath should have improved by the end of the fourth week.
The client returned to the clinic, after four weeks affirming that most of the anxiety symptoms have reduced. For examples, the feeling of chest constriction has improved, and he no longer felt short of breath. The reading of the HAM-A scale had reduced from 26 to 18, which is less than the anticipated 50%. The only slight difference between the results and my expectation is the time taken by the client to report changes to the clinic. This is linked to drug metabolism, which has taken much longer.
Decision Point 2
Increase the Zoloft dose to 75 mg PO daily
Since the drug initiated progressive changes, it is, therefore, recommendable to increase the dosage to 75mg orally daily. The reason linked with this decision is that a small dose of Zoloft drug had minimized the shortness of breath and chest pains symptoms to a certain level but not completely. Therefore a higher concentration would significantly reduce the symptoms. According to studies conducted before depicts that Zoloft can be prescribed gradually to a maximum level that realizes maximum outcome to the patients. It is not recommended to increase the dose to 100mg since a psychotropic medication dosage should relatively be increased while observing the psychological reactions to evade unwanted effects (Rothschild, 2014).
By administering Zoloft dose to 75 mg PO daily, the expected results are to see a great improvement on patient’s anxiety symptoms change as compared to the changes initiated by the first dose. The client will report having encountered side effects linked to the drug such, insomnia, headache and dry mouth and reduction of HAM-A score by at least 60% by the end of four weeks. After four weeks, the client reported back to the clinic, stating that the symptoms had declined further than reported earlier. The HAM-A reading was 10. This indicates a 61% reduction in symptoms. The only difference between expectations and the result is that the client did not report any side effect.
Decision point 3
Continue Zoloft dose of 75 mg PO daily
Since the previous treatment plan has shown tremendous results. Whereby the client’s symptoms have significantly reduced with zero side effects have. In this case, it is appropriate to maintain a Zoloft dose of 75 mg PO orally daily. Therefore, the client should be instructed to continue taking the current dose for twelve weeks, and a full medical evaluation should be carried after reporting back to the clinic. It is expected that the current treatment plan will progress to being useful in curing the patient’s symptoms and is anticipated to report back with no signs of anxiety. After four weeks, the client reported back to the clinic with fully resolved symptoms. This result perfectly corresponds to the expectation, which clearly shows that maintaining the dosage helped to solve the patient generalized anxiety disorder entirely.
Ethical Consideration and Conclusion
In the healthcare sector, ethical concerns frequently complement decision making opinions, particularly ideas that are linked with alternative treatment. At any moment, when making an essential and urgent choice that impacts patient wellbeing, it always vital to include them during the decision making the process. Confidentiality and privacy of the patient information is another crucial ethical consideration which should be upheld. Medical officers have the mandate to observe, protect, and respect all type of information related to the patient. To sum up, people in distress due to anxiety disorder should seek treatment in hospital, and the above mentioned ethical consideration should guide the kind of care given to patients.
References
Parekh, R. (2017). What Are Anxiety Disorders? Psychiatry.org. Retrieved 23 June 2019, from https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
Procyshyn, R. M., Bezchlibnyk-Butler, K. Z., & Jeffries, J. J. (Eds.). (2015). Clinical handbook of psychotropic drugs. Hogrefe Verlag.
Rothschild, A. J. (2014). The evidence-based guide to antipsychotic medications. Washington, DC: American Psychiatric Pub.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press
Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiological basis of the treatment in children and adolescents with a generalized anxiety disorder. Depression and Anxiety, 29(4), 328–-339. doi:10.1002/da.21913
