Anxiolytic Therapy and PTSD Treatment

Generalized anxiety disorder has become a significant public health issue owing to its impact on individuals suffering from it. The condition impairs varied spheres of life including work, education, and families, as well as interpersonal interactions. To this end, it becomes important for one to diagnose it and formulate an effective treatment plan. The diagnosis of the condition has demonstrated some complexities yet the treatment plan depends on accurate diagnosis. However, these limitations can be overcome through an interview process that adapts important screening questions. Consequently, this allows a PMHNP nurse to create an intervention strategy that is focused on remedying the situation. This intervention, according to Stahl (2013), considers the safety and efficacy of the available drugs. If the drugs do not work as expected, the nurse is expected to either alter dosage or change the medication to ensure that the symptoms subside after a certain period. In the current paper, a case of middle-aged white male whose Hamilton Anxiety Rating Scale (HAM-A) revealed that he has generalized anxiety disorder, and the treatment options available to the PMHNP will be analyzed. Anxiolytic Therapy and PTSD Treatment

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Decision Point One

Selected decision

Begin Zoloft 50 mg po daily

Reason for selection

Zoloft has been shown to be safe, well-tolerated and effective when it comes to the treatment of anxiety disorders. In the case under analysis, the patient’s score on the HAM-A score was 26, indicative of generalized anxiety disorder. From the medications presented as options, Imipramine and Buspirone cannot be used as they are not the first line of medications regarding anxiety treatment (Stahl & Grady, 2010). Also, while they could also be effective, they are not well-tolerated by the body system. Therefore, beginning Zoloft 50mg po daily is the ideal decision.

Expected results

The patient is expected to see the results of Zoloft from the second week of the therapy. To this end, he should indicate relief in the chest tightness. Further, the shortness of breath symptom that he currently displays should abate by the fourth week (Stahl & Grady, 2010). The frequency of the feeling of impending doom ought to have reduced when he comes for checkup after four weeks. By the fourth week, therefore, the patient is expected to have made significant recovery from the generalized anxiety disorder.

Difference between Expected Results and Actual Results

When the client reported to the clinic on the fourth week of the intervention, he reported significant improvement as expected by the nurse. The tightness in the chest had disappeared together with shortness of breath. In addition, he reported that he did not overly worry about the security of his job. Therefore, the results after four weeks were consistent with the expectations from the PMHNP as shown by the score of 18 from the HAM-A scale.

Decision Point Two

Selected decision

Increase dose to 75mg orally daily.

Reason for selection

Remission of symptoms formed the decision to use Zoloft. Given that the drug has achieved that during the first for weeks, it implies that it is effective. However, at the first dose, no noticeable side-effect was reported. Thus, the right decision would be to increase the dosage to increase the effect of the drug. Maintaining the dose at 50 mg is not advisable as the symptoms may not improve on the next visit (Strawn et al., 2012). On the other hand, increasing the dosage to 100mg orally may predispose the patient to safety issues. Hence, these two decisions are eliminated.

Difference between Expected Results and Actual Results

Upon increasing the dosage, the client again visited the clinic after four weeks. The nurse expected the increased dosage to reduce the generalized anxiety disorder symptoms even further (Stahl & Grady, 2010). The patient reported that his symptoms had significantly reduced. This was proven by a HAM-A score (Hamilton, 1959) of 10, which was a 61% reduction. The results reflected the anticipated results, even though the rate was not as quickly as the nurse would have desired. Anxiolytic Therapy and PTSD Treatment

Decision Point Three

Selected decision

Maintain current dose

Reason for selection

It is appropriate to continue the dose at 75mg daily orally. Given that the symptoms have reduced by more than 50% and there are no side effects, the current dose needs to be maintained for at least 12 weeks as the nurse evaluates Zoloft’s full effect. Also, should the dosage be increased, there is a high possibility that side effects will start appearing even though the symptoms may reduce further (Lupi et al., 2014). This is an unnecessary risk that should not be entertained. Moreover, Zoloft currently manages the symptoms so there is no need for an augmentation agent.

Expected results

Maintaining the dose at level is expected to reduce the symptoms even further. The response of the patient towards the 75 mg dose is already remarkable. Therefore, it is expected that the drug will continue working and eventually reach its full-effect if the dose is maintained (Stahl, 2013). Also, no side effect is expected because there are none so far.

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Difference between Expected Results and Actual Results

The choice to maintain the dosage at 75 mg is consistent with the standard procedure of managing generalized anxiety disorder. A different drug cannot be used as the symptoms have been reduced by a significant percentage (Stahl & Grady, 2010). For this reason, studies suggest that it is imperative to maintain the dose.

Impact of Ethical Considerations on Treatment Plan

Formulation of interventions to treat generalized anxiety disorder is complicated as the drugs involved possess uncomfortable side effects. Most of the drugs produce side effects such as suicidal ideations plus others (Stahl, 2013). Therefore, before choosing on the drug, the nurse was required to discuss with the patient the possible side effects. Additionally, the patient will need to be advised regarding the choice to increase the dosage and how this could affect them. Afterwards, the nurse can proceed to prescribe the medications. Anxiolytic Therapy and PTSD Treatment

Conclusion

Generalized anxiety disorder has debilitating effects on a patient, their immediate family members, and friends. These effects make it vital for a nurse to accurately diagnose it and offer appropriate interventions. The medication regimen used is subject to changes as the situation may demand. Moreover, other intervention measures such as cognitive behavioral therapy can be added to the pharmacological one.

References

Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., & … Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. doi:10.1155/2014/537306

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD. New York, NY: Cambridge University Press.

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. doi:10.1002/da.21913 Anxiolytic Therapy and PTSD Treatment.