Assignment: Assessing and Treating Patients With Anxiety Disorders

Common symptoms of anxiety disorders include
chest pains, shortness of breath, and other physical symptoms that may
be mistaken for a heart attack or other physical ailment. These
manifestations often prompt patients to seek care from their primary
care providers or emergency departments. Once it is determined that
there is no organic basis for these symptoms, patients are typically
referred to a psychiatric mental health practitioner for anxiolytic
therapy. For this Assignment, as you examine the patient case study in
this week’s Learning Resources, consider how you might assess and treat
patients presenting with anxiety disorders.

To prepare for this Assignment:

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend
  for the assessment and treatment of patients requiring anxiolytic
  therapy.

The Assignment: 5 pages

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You
will be asked to make three decisions concerning the medication to
prescribe to this patient. Be sure to consider factors that might impact
the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all
options before selecting your decision and moving throughout the
exercise. Before you make your decision, make sure that you have
researched each option and that you evaluate the decision that you will
select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure
  to include the specific patient factors that may impact your decision
  making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your
  response with clinically relevant and patient-specific resources,
  including the primary literature.
• Why did you not select the other two options provided in the
  exercise? Be specific and support your response with clinically relevant
  and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support
  your response with evidence and references to the Learning Resources
  (including the primary literature).
• Explain how ethical considerations may impact your treatment plan
  and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your
  response with clinically relevant and patient-specific resources,
  including the primary literature.
• Why did you not select the other two options provided in the
  exercise? Be specific and support your response with clinically relevant
  and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support
  your response with evidence and references to the Learning Resources
  (including the primary literature).
• Explain how ethical considerations may impact your treatment plan
  and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your
  response with clinically relevant and patient-specific resources,
  including the primary literature.
• Why did you not select the other two options provided in the
  exercise? Be specific and support your response with clinically relevant
  and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support
  your response with evidence and references to the Learning Resources
  (including the primary literature).
• Explain how ethical considerations may impact your treatment plan
  and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected
  for this patient. Be sure to justify your recommendations and support
  your response with clinically relevant and patient-specific resources,
  including the primary literature.

CASE STUDY:

Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a
local steel fabrication factory. He presents today after being referred
by his PCP after a trip to the emergency room in which he felt he was
having a heart attack. He stated that he felt chest tightness, shortness
of breath, and feeling of impending doom. He does have some mild
hypertension (which is treated with low sodium diet) and is about 15
lbs. overweight. He had his tonsils removed when he was 8 years old, but
his medical history since that time has been unremarkable. Myocardial
infarction was ruled out in the ER and his EKG was normal. Remainder of
physical exam was WNL.

He admits that he still has problems with tightness in the chest and
episodes of shortness of breath- he now terms these “anxiety attacks.”
He will also report occasional feelings of impending doom, and the need
to “run” or “escape” from wherever he is at.

In your office, he confesses to occasional use of ETOH to combat
worries about work. He admits to consuming about 3-4 beers/night.
Although he is single, he is attempting to care for aging parents in his
home. He reports that the management at his place of employment is
harsh, and he fears for his job. You administer the HAM-A, which yields a
score of 26.

Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He
is appropriately dressed. Speech is clear, coherent, and goal-directed.
Client’s self-reported mood is “bleh” and he does endorse feeling
“nervous”. Affect is somewhat blunted, but does brighten several times
throughout the clinical interview. Affect broad. Client denies visual or
auditory hallucinations, no overt delusional or paranoid thought
processes readily apparent. Judgment is grossly intact, as is insight.
He denies suicidal or homicidal ideation.

You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorder

RESOURCES

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

Decision Point One

Select what you should do:

Begin Zoloft 50 mg po daily

Begin Imipramine 25 mg po BID

Begin Buspirone 10 mg po BID