Assessing and Treating Clients with Anxiety Disorders

Assessing and Treating Clients with Anxiety Disorders

Anxiety disorders refer to a series of mental disorders, which are characterized by excessive episodes of fear. These conditions usually result from worry about an anticipated future event (Lissek et al., 2014). The symptoms of anxiety disorder are quite similar to heart attack making the diagnosis challenging. However, with a proper review of symptoms, nurses can come up with an effective care plan for the patient. For instance, in the case provided, the 46-year-old white male reported to the emergency unit thinking that he was suffering from a heart attack. The patient reported symptoms of chest tightness, shortness of breath and sensations of impending doom. He has a history of mild hypertension, which was managed with a low sodium diet. Even though he is 15lbs overweight, his EKG is normal, and hence myocardial infarction was ruled out in the emergency room. He claimed that he has been using ETOH for the management of work-related stress, while at the same time taking about 3-4 beers every night. A rating using the HAM-A scale yielded 26, which indicates that the patient is suffering from Generalised Anxiety. Therefore, the primary aim of this paper is to review the patient’s case scenario and come up with medications that can be applied in the successful management of the generalised disorder why considering factors affecting the pharmacodynamics and pharmacokinetics of the elected drug regimen. Moreover, psychiatric practice nurses have to take into account the ethical aspect of prescription while formulatin

g a pharmacotherapy for any mental health patient.

Decision Point One

Selected Decision

Initiate patient on Zoloft 50 mg PO daily

Reason for Selection

In the management of generalized anxiety disorder, the first decision is normally to administer Zoloft 50mg orally twice a day. Zoloft is a selective serotonin reuptake inhibitor (SSRI) used in the management of several mental disorders, including anxiety and depression and is also associated with minimal severe side effects. Consequently, the patient has not been using any other psychotropic drugs before, and it is advisable to start such patients on less active psychotropic agents such as Zoloft, which can clear the patient’s symptoms quite faster (Rothschild, 2014). This drug takes 26 hours to be eliminated from the system hence implying that its OD administration makes it safe. Further, the fact that it achieves its steady state a week into its administration makes it an effective medication for the present condition.

Tricyclic antidepressants such as Imipramine, while more effective than SSRIs, have a longer duration of action, and hence can potentiate their adverse effects for an extended time. Imipramine has also been associated with several side effects such as increased heart rate, changes in EKG and low blood pressure (Stahl, 2013). These side effects disqualify the use of the drug given the patient history of heart problems. Buspar is classified as a drug for the management of generalized anxiety disorder by the FDA (Rothschild, 2014). Ideally, it is not a GABA receptor analog and will thus elicit lower withdrawal symptoms. The drug is however metabolized slowly, and hence a twice a day dose might be of higher concentration, hence high toxicity. This leaves as with Zoloft 50mg twice a day as the best choice of drug in managing the patient’s generalized anxiety disorder.