Posted: February 17th, 2022
Practice guideline for treating patients with acute stress disorder
Assessment and Treatment of Patients with Anxiety Disorders
According to (), almost 20% of adults grapple with anxiety disorders such as generalized anxiety disorder (GAD) every year. Generalized anxiety disorder produces excessive worry, fear, and constant overwhelming feelings. Typically, the worry is persistent, excessive, and unrealistic concerning daily activities. Also, the worry may be multifocal like health, family, finance, and future and is not easy to manage. () highlight the excessive worry is generally alongside several vague physical and psychological symptoms such as insomnia, irritability, muscle tension, easily fatigued, and restlessness. The precise pathophysiology mechanism of GAD is unknown, but some scholars argue that serotonergic, noradrenergic, and other neurotransmitter systems are instrumental in the body’s reaction towards stress. The serotonin and the noradrenergic systems are often the routes involved in anxiety. According to (), several medical researchers perceive that low activity of the serotonin system and increased activity of noradrenergic systems can trigger the development of GAD. In this manner, the first-line treatment for this condition should be selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI). This paper emphasizes three decision points regarding the psychopharmacological treatment approach for a 46-year old white man reporting generalized anxiety disorder symptoms, including events of shortness of breath, chest tightness, and impending doom feelings. Also, it will discuss the associated ethical and legal considerations while undertaking the treatment. The patient reports mild hypertension currently treated with low sodium and is overweight (15lbs). Additionally, the patient agrees that he usually consumes almost three to four bottles of beer every night. The patient factors that could lead to the decision points include ethnicity, gender, and presence of stressors, poor health, and being unmarried.
Decision Point One
The first drug recommendation for this patient is Paxil 10mg PO daily, a brand name for paroxetine. It is an antidepressant belonging to the selective serotonin reuptake inhibitor (SSRI) class whose main job is to restore specific natural brain components known as serotonin (Bandelow et al., 2017). Ideally, serotonin is a hormone in the brain charged with stabilizing a person’s mood, beliefs, perceptions, and happiness. The Food and Drug Administration (FDA) recognizes Paxil as one of the first-line medication treatments for depression, panic attacks, generalized anxiety disorder, and posttraumatic stress disorder. According to Braun et al. (2020), paroxetine potently prevents the reuptake of 5-HT and hinders norepinephrine reuptake. Since Paxil is an approved treatment for GAD in adults, its use has been studied broadly; several studies advocate for its efficacy in adults grappling with GAD. For instance, in the first double-blind, placebo-controlled study, adults suffering from GAD were randomized to paroxetine (n=161; 20–50 mg/day) or placebo (n=163) for eight weeks. The result was a relief in both anxiety symptoms and daily functioning in patients treated with paroxetine relative to placebo. In the subsequent double-blind, placebo-controlled study, Braun et al. (2020) assessed paroxetine efficacy in adults having GAD over an 8-week double-blind study. The result was an improved HAM-A score for doses relative to placebo realized that Paxil is entirely well-tolerated. Buspirone was not considered because medical research indicates that it increases blood pressure via activating the sympathetic nervous system and directly activating alpha1-adrenergic receptors following a severe haemorrhage (Strawn et al., 2018). Imipramine was also not considered for this patient because it contains inactive ingredients such as polyethene glycol or talc, which may contribute to allergic reactions (Chen et al., 2019). My aim of administering Paxil 10mg every day was to balance, improve the patient’s mood and enthusiasm levels, and eradicate his job fears, worry, and panic attacks.
Decision Point Two
The patient’s presentation informs the second decision after four weeks, including no tightness in the chest, shortness of breath, and reduced job-related worries. Also, the HAM-A indicates a reduction in symptoms’ severity from 26 to 18. In this regard, my recommendation would be to increase the dosage of Paxil from 10mg PO daily to 20mg PO per day. The client’s presentations show that Paxil is efficient and effective as the patient demonstrates a significant improvement or reduction in the symptoms. Therefore, it is wise to maintain Paxil but increase the dosage so that the medication does obtain the maximum benefits (Melaragno, 2021). In Braun et al. (2020) study, 278 patients were randomly subjected to double-blind treatment with a 10-week placebo course or paroxetine at doses ranging from 10, 20, to 40 mg every day. The outcomes revealed that at 40 mg/day, Paxil was robust to placebo across several measures of outcome. 86% of the patients taking 40 mg, 65.2% taking 20 mg, and 67.4% taking 10 mg of Paxil, and 50.0% of the placebo-treated individuals were entirely relieved of panic attacks in the first two weeks (Braun et al., 2020). Comparing those who took 10mg of Paxil with those who took either 20mg or 40mg, the latter experienced a more significant improvement and tolerance. Substituting Paxil with either Imipramine or Buspirone was not considered because they remain in the body for an extended period; thus, changing the medication could result in potential drug interactions and side effects (Melaragno, 2021). The aim of increasing Paxil dosage to 40mg was to reach an accurate Paxil balance for this client and do away with any side effects. Additionally, I aimed to allow the patient’s body to adapt to Paxil and find the optimum dose to improve daily functioning.
Decision Point Three
After the patient reported to the facility with further reduction in symptoms, the third decision entailed maintaining Paxil 20mg daily for additional twelve weeks. Also, the HAM-A score of 10 demonstrates a 61% reduction in symptoms meaning that the patient is experiencing a positive response towards the dosage (Bandelow et al., 2017). Also, he does not report having any side effects or drug interactions. In this manner, Paxil 20mg can be seen as effective such that it has induced an accurate therapeutic effect; thus, there was no need to change the regimen (Chen et al., 2019). The third decision of maintaining the current dose was also informed that the patient would realize a placebo effect.
Additionally, maintaining the current dose was considered due to its associated cost savings as manifested in retrospective claims of pharmacy such that using half a tablet of Paxil costs $1 per day, accumulating to more than $175 in annual cost savings (Bandelow et al., 2017). According to Strawn et al. (2018), cost savings can be linked to better clinical outcomes, reduced severe events, and improved adherence to treatment regimens. Increasing the drug dosage or substituting Paxil with Tofranil would increase the risk of side effects. Schuck et al. (2019) argue that when the drug dosage is drastically increased, it can result in quicker health outcomes but can at the same time increase the concentration of the drug concentration in the blood, which may prove poisonous, contributing to medical complications. Maintaining the dosage at 20mg per day for another twelve weeks achieved the placebo impact. The patient understands and is aware that he is being administered an effective drug at a low dose and a lower price. The objective is also to avoid any avoidable drug interactions or side effects.
Ethical Considerations
The medical provider considered the maleficence and benevolence principles that ensured that the client was safe with maximized benefits (American Psychiatric Association, 2010a). The provider also allowed the client to propose his choice of delivery, share insights and consider the patient’s right of self-determination to allow him to determine his treatment values and his dignity considered (Chen et al., 2019). I considered values like accountability and responsibility to continue and maintain the Paxil dosage at 20mg. This allowed me to openly elucidate for the patient the impacts of our actions, including non-adherence to medication implications.
Conclusion
The paper has outlined and discussed in detail the three primary decisions made regarding the assessment and treatment of the 46-year old client with symptoms associated with generalized anxiety disorder. The first decision is to administer Paxil 10mg every day, increase the dosage to 20mg per day, and then maintain the current dose for 12 weeks. The medical provider considered Paxil first because it is effective and efficient in restoring serotonin levels with no side effects. Buspirone was not selected first because of its potential risk of increasing blood pressure. Additionally, Imipramine was avoided because it contains inactive ingredients that could result in allergic reactions or drug interactions. The second approach entailed increasing Paxil dosage to 20mg to balance and prevent drug interaction because of substituting Paxil with Buspirone. The third decision involved maintaining the dosage at 20mg per day to enhance a placebo effect as the patient’s health outcomes would be remarkable due to his knowledge regarding the effectiveness and appropriateness of Paxil, no associated side effects, and is cheap. During treatment, the provider considered various ethical considerations, including the maleficence and benevolence principles, right to self-determination, patient autonomy, and values such as responsibility.
References
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93. http://doi: 10.31887/DCNS.2017.19.2/bbandelow
Braun, C., Adams, A., Rink, L., Bschor, T., Kuhr, K., & Baethge, C. (2020). In search of a dose-response relationship in SSRIs—a systematic review, meta‐analysis, and network meta‐analysis. Acta Psychiatrica Scandinavica, 142(6), 430-442.https://doi.org/10.1111/acps.13235
Bui, E., Pollack, M. H., Kinrys, G., Delong, H., Vasconcelos e Sá, D., & Simon, N. M. (2016). The pharmacotherapy of anxiety disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital Psychopharmacology and neurotherapeutics (pp. 61–71). Elsevier
Chen, T. R., Huang, H. C., Hsu, J. H., Ouyang, W. C., & Lin, K. C. (2019). Pharmacological and psychological interventions for generalized anxiety disorder in adults: a network meta-analysis. Journal of psychiatric research, 118, 73-83.https://doi.org/10.1016/j.jpsychires.2019.08.014
Melaragno, A. J. (2021). Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance. Focus, 19(2), 145-160.https://doi.org/10.1176/appi.focus.20200048
Schuck, R. N., Pacanowski, M., Kim, S., Madabushi, R., & Zineh, I. (2019). Use of titration as a therapeutic individualization strategy: an analysis of food and drug administration–approved drugs. Clinical and translational science, 12(3), 236-239.https://doi.org/10.1111/cts.12626
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.https://doi.org/10.1080/14656566.2018.1491966
Get Professional Assignment Help Cheaply
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.
Why Choose Our Academic Writing Service?
- Plagiarism free papers
- Timely delivery
- Any deadline
- Skilled, Experienced Native English Writers
- Subject-relevant academic writer
- Adherence to paper instructions
- Ability to tackle bulk assignments
- Reasonable prices
- 24/7 Customer Support
- Get superb grades consistently
Online Academic Help With Different Subjects
Literature
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Finance
Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.
Computer science
Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!
Psychology
While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
Nursing
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Sociology
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
Business
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
Statistics
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Law
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
What discipline/subjects do you deal in?
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Are your writers competent enough to handle my paper?
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
What if I don’t like the paper?
There is a very low likelihood that you won’t like the paper.
Reasons being:
- When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
- We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.
In the event that you don’t like your paper:
- The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
- We will have a different writer write the paper from scratch.
- Last resort, if the above does not work, we will refund your money.
Will the professor find out I didn’t write the paper myself?
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
What if the paper is plagiarized?
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
When will I get my paper?
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
Will anyone find out that I used your services?
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
How our Assignment Help Service Works
1. Place an order
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
2. Pay for the order
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
3. Track the progress
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
4. Download the paper
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!
Expert paper writers are just a few clicks away
Place an order in 3 easy steps. Takes less than 5 mins.
