Introduction
The client, a white male welder at a nearby steel fabrication facility, is 46 years old. He visited the emergency hospital after feeling like he had a heart attack, and his primary care physician recommended that he visit the facility. He described feeling his chest tighten, his breathing becoming labored, and a sense of impending doom. He is roughly 15 lbs. overweight and has some minor hypertension, managed with a low-salt diet.
Since having his tonsils removed at 8, he has had an uneventful medical history. Myocardial infarction was ruled out in the emergency room, and his electrocardiogram was normal. The remainder of the physical exam was within normal limits.
He acknowledges that he still struggles with chest pain and breathlessness, which he now refers to as “anxiety attacks.” He will also occasionally describe sensations of approaching doom, and he wants to “run” or “escape” from whatever he is doing. The client occasionally uses alcohol to combat worries about work and to consume about 3-4 beers at night.
He looks after his aging parents at home while being unmarried. He claims that his employer’s management is strict, and he worries about losing his job. The client was awake and aware of their surroundings during the mental status examination. He was appropriately dressed, and his speech was clear and coherent.
The client’s self-reported mood is “bleh,” and he does feel “nervous.” The effect is blunted and broad but brightens several times throughout the clinical interview. The client denies visual or auditory hallucinations, and no overt delusional or paranoid thought processes are readily apparent.
Judgment is grossly intact, as is insight. He has never been on psychotropic medication and denies suicidal or homicidal ideation. Considering all the factors and symptoms, the final diagnosis is a generalized anxiety disorder, and the Hamilton anxiety rating scale indicated 26 scores.
Treatment Decisions
Initial Prescription
The first decision is to prescribe the man to begin Paxil 10 mg PO daily. This medication is supposed to reduce anxiety and stabilize the patient’s mental health for a little bit. This course should last four weeks and aims to study the condition further to understand what treatment should follow next.
This decision was selected to identify the seriousness of the problem and improve the man’s current condition so that he could be relatively stable during further procedures. This medication is supposed to reduce the symptoms and increase the amount of serotonin in the organism (Potter, 2019). Other options were incompatible with the purpose of the first treatment stage.
Therefore, the current one seemed more appropriate for the situation. Research stated that “response and remission rates were significantly greater in patients with an anxiety disorder who received paroxetine” (Li et al., 2020, p. 2). Generalized anxiety disorder, sometimes referred to as a common anxiety disorder, has a chronic course and adversely affects a patient’s ability to operate (Beheshti et al.,2018).
The primary goal of this decision was to decrease the intensity of the generalized anxiety disorder symptoms in the patient. This approach would prepare him for the treatment’s next steps and allow him to assess his reaction to the specific medication and its amount (Strawn et al., 2019). Eventually, the patient felt slight changes in his state, although the disorder still affected him significantly.
A four-week check-up with the client showed that he has no tightness in his chest or shortness of breath. Moreover, he stated that he noticed decreased worries about work over the past 4 or 5 days, and his Hamilton anxiety rating scale score has decreased to 18 (partial response). Some ethical considerations served as guidance for the prescribed treatment. The main one was that the symptoms would become more disturbing and complicate the healing process. Thus, to avoid it, specific treatments and medications were prescribed to decrease the symptoms or at least prevent them from worsening.
Increasing the Dose
After four weeks, the client returned to the clinic for the evaluation and discussion of further direction for the course. He reported a slight decrease in symptoms but still experienced anxiety. The Hamilton anxiety rating scale indicated that the initial scores decreased, evidence of progress. The following step was to increase the dose of Paxil to 20 mg PO daily. This decision was to achieve better outcomes in the patient’s mental health so that he could feel less anxious during the course.
Other options would not serve the purpose of the treatment. However, it must be considered that “its use is associated with more dropouts due to adverse effects” (Williams et al., 2020, p. 16). Therefore, the patient must be under constant supervision to limit the possibility of adverse treatment outcomes. The decision’s primary goal was to significantly increase the client’s psychological well-being, considering the choice of medication for his age group (Strawn et al., 2019).
After four weeks, the symptoms notably decreased, and the most expected outcome was the decrease in scores by the Hamilton anxiety rating to 10. This indicated the effectiveness of the implemented methods, and the decision was made to continue the current dose due to a 61% reduction in symptoms. Regarding the ethical considerations, there was a need to recognize the client’s fears and eliminate them by talking about all the possible outcomes of the treatment and explaining the necessity of following all the recommendations.
Continuing Treatment
The next decision was to continue the same dose of Paxil and meet the client after 12 weeks for the check-up. This is due to the excellent results of treatment that seemed to suit the patient and contributed to the successful cure of the mental disorder. A sufficient trial may last up to 12 weeks, and there is no need to increase the drug, as it is unknown how much the client’s symptoms will improve with the present dosage. (Shaughnessy, 2022). This medication is desirable since it causes “increased positive affect and agreeable behavior, along with decreased negative affect and quarrelsome behavior” (Rappaport et al., 2021, p. 62).
It is possible to increase the dose, but this could increase the risk of side effects. There is currently no indication in the client’s report that additional agents are required. That decision aims to provide the patient with the possibility of being in a stable condition with a regular sleeping schedule and the lowest possible level of anxiety (Thom et al., 2020). However, the primary ethical concern the client might have been worried about was the safety of the treatment and how it would affect his everyday life. Thus, it is necessary again to have a conversation about his conditions and supposed outcomes so that there are no misunderstandings between both sides.
Conclusion
In conclusion, the patient with a generalized anxiety disorder was provided with specific treatments that demonstrated positive results. As a practitioner, it is critical to gather primary client data, screen for drug usage, identify causes of stress that may cause anxiety, and discuss the benefits and drawbacks of various medications.
The initial plan is to start the patient on 10 mg of Paxil taken orally each day. This drug is intended to help decrease anxiety and provide short-term stabilization of the patient’s mental health. Buspirone treatment, for example, was necessary since it could reverse the anxious pattern of behavior (Thom et al., 2020). The primary purpose of this decision was to reduce the severity of the patient’s generalized anxiety disorder symptoms.
The following step was to continue Paxil and increase the dose to 20 mg PO daily. The reason for this decision was the positive outcomes in the patient’s mental health and fewer feelings of anxiety during the course. Alternative options would not effectively achieve the treatment goals for this patient.
The most effective approach would be to keep taking medicine at the same dose, but meet the patient after 12 weeks of treatment. This is due to the high success rate of taking this medication and the positive results in the fight against the individual’s anxiety. Therefore, all the recommendations aim to ensure that the man’s well-being improves over time and that he can deal with the anxiety and reach a critical state. Prescribing certain medications in specific amounts is a primary source for successful recovery.
References
Beheshti, N., Zemestani, M., & Rezaei, F. (2018). Comparing the effectiveness of cognitive behavioral therapy focused on intolerance of uncertainty and pharmacotherapy on worry, intolerance of uncertainty, and cognitive avoidance in patients with generalized anxiety disorder. Iranian Journal of Psychiatry and Clinical Psychology, 24(3), 240-255.
Li, X., Hou, Y., Su, Y., Liu, H., Zhang, B., & Fang, S. (2020). Efficacy and tolerability of paroxetine in adults with social anxiety disorder: A meta-analysis of randomized controlled trials. Medicine, 99(14). Web.
Potter, D. R. (2019). Major depression disorder in adults: a review of antidepressants. International Journal of Caring Sciences, 12(3) 1936. Web.
Rappaport, L. M., Hunter, M. D., Russell, J. J., Pinard, G., Bleau, P., & Moskowitz, D. S. (2021). Emotional and interpersonal mechanisms in community SSRI treatment of social anxiety disorder. Journal of Psychiatry and Neuroscience, 46(1), 56-64. Web.
Shaughnessy, A. F. (2022). Selective serotonin reuptake inhibitors are probably the best first option for patients with panic disorder. American Family Physician, 105(6). Web.
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: An evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057-1070. Web.
Thom, R. P., Keary, C. J., Waxler, J. L., Pober, B. R., & McDougle, C. J. (2020). Buspirone for treating generalized anxiety disorder in Williams syndrome: A case series. Journal of Autism and Developmental Disorders, 50(2), 676-682. Web.
Williams, T., McCaul, M., Schwarzer, G., Cipriani, A., Stein, D. J., & Ipser, J. (2020). Pharmacological treatments for social anxiety disorder in adults: A systematic review and network meta-analysis. Acta Neuropsychiatrica, 32(4), 169-176. Web.