In this post, the choice of diagnostic questions, tests, and prescribed drugs for a 74-year-old widow with symptoms of anxiety will be discussed. Prior to making any decisions, I would ask the patient what outlets she uses to cope with the death of her beloved one. It is essential for an older person not to be left alone and has support from her relatives. The second question will be about the patient’s daily schedule and if there have been any changes since her husband’s death. Any changes may indicate the existence of unhealthy habits, irregularities in food intake, or other adverse factors that indicate the presence of anxiety disorder (Balsamo et al., 2018). The third issue I would like to know is the patient’s perception of her well-being and satisfaction with life. This would be a significant indicator of the necessity of any changes in daily routine alongside medications that can help with the patient’s sleep issues.
First of all, I would like to contact the patient’s children, if any, to ensure that she has the social support she needs. If there are any caretakers, they may provide beneficial information regarding her well-being as well. I would ask them if they have noticed the patient falling asleep during the daytime or behaving sluggishly, dizzy, disoriented to determine the extent of sleep deprivation experienced by the patient. Moreover, I would like to ask them about changes in the patient’s daily routine to determine how does she cope with the loss of her husband. The differential diagnosis for the patient is a generalized anxiety disorder, although there is the possibility for a major depressive disorder, as these are the most common mental health issues in such a situation (Frost et al., 2018). The Adult Manifest Anxiety Scale for older adults may prove to be helpful with establishing the correct diagnosis (Balsamo et al., 2018). There are no physical examinations necessary to conduct this diagnosis.
Trazodone can be used to treat the patient’s condition, focusing on both insomnia and depression. It is recommended to prescribe 50-300mg before bedtime (Fava, & Papakostas, 2016). The first week would be 100mg before bed, while after the first week, the dose will increase by 100mg every week up to 300mg (Fava & Papakostas, 2016). Trazodone may cause headaches and sedation, which may lead to fall incidents, and should be used with care by patients with cardiac diseases (Fava & Papakostas, 2016). Its interactions with other drugs are rare, yet there is a slight possibility for the condition called serotonin syndrome (Fava & Papakostas, 2016). In case of any issues with a heart condition, Mirtazapine can serve as a secondary choice for drug therapy. This α2 adrenoceptor possesses sedative qualities that would be optimal for use for older generations (Fava & Papakostas, 2016). Mirtazapine would be taken once a day before bedtime, with a starting dose of 7,5mg, gradually increasing weekly up to 30 (Fava & Papakostas, 2016). Although it possesses risks similar to trazodone, it has milder side effects overall (Fava & Papakostas, 2016). The final choice would depend on the presented side effects after the first week.
Other considerations must include the patient’s living conditions and availability of social support for additional safety against falls or dizzy spells. As a checkpoint, once-a-month visits may help with indicating any progress. In the case of unsatisfactory results, psychiatrist sessions or other non-pharmacological interventions may be necessary to help the widow deal with her grief. In conclusion, trazodone treatment should help the patient cope with the symptoms that followed the loss of her husband.
References
Balsamo, M., Cataldi, F., Carlucci, L., & Fairfield, B. (2018). Assessment of anxiety in older adults: A review of self-report measures.Clinical Interventions in Aging, 13, 573-593. Web.
Everitt, H., Baldwin, D. S., Stuart, B., Lipinska, G., Mayers, A., Malizia, A. L., Manson, C. C., & Wilson, S. (2018). Antidepressants for insomnia in adults. Cochrane Database of Systematic Reviews, 2018(5). Web.
Fava, M., & Papakostas, G. I. (2016). Antidepressants. In T. A. Stern, T. E. Wilens, J. F. Rosenbaum, & M. Fava (Eds.), Massachusetts general hospital psychopharmacology and neurotherapeutics (pp. 27-43). Elsevier.
Frost, R., Bauernfreund, Y., & Walters, K. (2018). Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: Systematic review and meta-analysis. International Psychogeriatrics, 31(08), 1121-1136. Web.