: 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.
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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.
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In your o�ce, 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”. A�ect is somewhat blunted, but does brighten several
times throughout the clinical interview. A�ect 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 Paxil 10 mg po daily
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Begin Imipramine 25 mg po BID
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Begin Buspirone 10 mg po BID
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Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety
Decision Point One
Begin Paxil 10 mg po daily
RESULTS OF DECISION POINT ONE
� Client returns to clinic in four weeks
� Client informs you that he has no tightness in chest, or
shortness of breath
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� Client states that he noticed decreased worries about work
over the past 4 or 5 days
� HAM-A score has decreased to 18 (partial response)
Decision Point Two
No change in drug/dose at this time
RESULTS OF DECISION POINT TWO
� Client returns to clinic in four weeks
� Client reports no further decreases in anxiety and is
wondering if this means that the medication will not be
e�ective for him
Decision Point Three
Increase drug to 75 mg po daily
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Guidance to Student
Increasing the drug to 75 mg po daily would be a prudent next
step. At 4 weeks follow up, the client already demonstrated a
partial response to this medication, so it would be appropriate to
increase to 75 mg po daily. Nothing indicates that augmentation
would be necessary as the client has not had an adequate trial of
this drug at a therapeutic dose (only a starting dose). Similarly,
nothing indicates failure of SSRI therapy and there is no compelling
evidence that switch to an SNRI should occur at this time.
Start Over (index.html)
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.
Please I have attached the case study. Add five references. I appreciate you.
