Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay

Assessing and Treating Patients With Anxiety Disorders

Introduction

Anxiety is a natural condition under threat conditions and is believed to be one of the adaptive struggles or escape flight response. Increased fear or distress are found in anxiety disorders, varying from ordinary feelings of anxiety or nervousness . A subset of mental health conditions that contribute to extreme nervousness, anxiety, apprehension, and concern are established from this community of disorders. There can also be clinical signs, such as high blood pressure and nausea, which greatly interfere with everyday life. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay.  The most prevalent psychiatric disorders are depressive disorders, affecting about 35 percent of people at some stage in their lives (Murray and Jitender, 2015). Sufficient control over observable stressors and restrictions on future causes can be restored with adequate care and therapy, allowing the production of nervous feelings to be controlled within safe limits.

The patient, a 46-year-old Caucasian man, shows an intense event of chest tightness, difficulty in breathing and sense of imminent despair as a referral from his PCP. On the facility visit, he mentioned continuing panic attacks, identifying them as prolonged periods of anxiety or thoughts of doom that cause extreme physical responses, involving tightness in the chest and difficulty in breathing. He endorses fears about work instability combined with requests from home and admits to the sporadic use of liquor to deal with them. The Hamilton Anxiety Scale (HAM-A) administration suggested mild to extreme signs of anxiety needing medical referral. This paper would differentiate between separate therapeutic approaches with the intention of providing effective treatment. Chosen decisions would go hand-in-hand with supportive justifications and anticipated consequences compared to deviations between real and anticipated outcomes. Evidence would be compiled and incorporated to justify the reasons and considerations of change proposed, if necessary.

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Decision #1

Which Decision did you select?

Wellbutrin 75 Mg is a standard mood stabilizer, and by modifying and fixing certain brain neurotransmitters to their usual limits, it is supposed to revert the client’s mood to normal. Nevertheless, the medication can induce sleeplessness (Murray & Jitender, 2015). To decrease overdosing and concentration and, the dose should be administered at 75 mg two times a day, while also ensuring that the client is guarded whatsoever. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay.

Why did you select this Decision?

At lower doses, the medication is effective. The client’s health assessment showed that the dimensions were within the established range. As such, the medication would not have serious side effects as there are not any underlying illnesses or reactions (Murray & Jitender, 2015). Nevertheless, it is noteworthy that the medication causes poor appetite and dry mouth as the major side effect. The client also requires supplements to increase appetite in order to mitigate the adverse reaction if anxiety is gone.

What were you hoping to achieve by making this decision?

The goal was to lift the client’s mood and to raise his appetite. The reason for this is to help the client feel better and uplifted.

Explain any difference between what you expected to achieve with Decision #1 and the Results of the Decision. Why were they Different?

After the use of Wellbutrin, the patient returned, but no psychological improvement in anxiety occurred. He also said that he could not sleep anymore. Often, sleeplessness is one of Wellbutrin’s adverse effects. The medication might have not helped manage anxiety, which might be attributable to the dose (Vitiello & Ordóñez, 2016). Worse still, as an adverse effect, sleeplessness could not assist in dealing with anxiety, and for positive results, the dosage had to be modified.

Decision #2

Shift the morning dose to 150mg twice every day, from rapid to moderate-release. The first dose will be taken in the morning, whereas the other will be taken around 1 pm.

Why did you select this Decision?

There are many justifications for the modification. One reason is to guarantee that the boy is always kept safe. Another reason is that the dose originally given appeared to be inadequate for the patient and increasing it would be necessary to maximize its effectiveness (Duval et al., 2015). Finally, because making a change could trigger adverse effects like manic anxiety and mood swings, the medication could not be halted instantly.

What were you hoping to achieve by making this decision?

Because the drug was administered before going to bed so that it would be absorbed by the body by the moment the patient goes to bed, the present treatment plan was to combat sleeplessness (Duval et al., 2015). It would also be anticipated that the depressive mood would be greatly diminished. The patient should be able to return to normal mood and life.

Explain any difference between what you expected to achieve with Decision #2 and the Results of the Decision. Why were they Different?

The anxiety has not decreased on the subsequent assessment, and the patient did not react to the prescribed medication. As a result of Owing to the shift in the drug delivery hours, the sleep cycles went back to their normal state. In the treatment of depressive mood, nevertheless, the medication proved unsuccessful. Wellbutrin is a norepinephrine-dopamine reuptake inhibitor antidepressant medication that works on neurotransmitters in the brain (Duval et al., 2015). Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay. The current result shows that the strategy for the treatment of the health issue was incorrect and modification was necessary.

Decision #3

Transition to anxiety treatment with selective inhibitors of serotonin reuptake (SSRIs) from norepinephrine-dopamine reuptake inhibitors (NDRIs)

Why did you select this Decision?

The patient was introduced to NDRI, and no changes were evident. The appropriate testing time for the medication is the eight weeks that the patient has been treated (Bandelow et al., 2017). There is no reason to place the patient on Zoloft 75 mg because he was on Wellbutrin and also took an elevated dose with no major desirable impacts. Both medications are antidepressants (Bandelow et al., 2017). Moving to SSRIs offers an opportunity for a healthcare professional to switch the action plan.

What were you hoping to Achieve by making this Decision?

The goal was to alter the process of action associated with anxiety treatment because there were no substantial benefits demonstrated by the previous treatment option. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay.

Explain any difference between what you expected to achieve with Decision #3 and the Results of the Decision. Why were they Different?

The medication works for long-term anxiety treatment, and thus, for the outcomes to be measurable, the patient has to be introduced to the latest treatment plan for a minimum of four weeks. Nonetheless, it is also worth remembering that the dose given to the patient is also an influential factor as to whether or not outcomes can be noticed. Consequently, with continuous monitoring, a progressive rise in the dose can be needed.

Summary and Ethical Considerations

The therapeutic options implemented by the PMHNP did not improve the client’s condition efficiently. The reasoning is that the assessment of the patient’s underlying source of anxiety has not been reviewed and assessed and, thus, the application of pharmacotherapeutic interventions seemed insufficient. If the therapists were willing to take part in psychoanalysis and assessment to better explain and evaluate the source of the anxiety, the patient could have improved greatly (McHenry, 2016). If the two treatment plans were taken into account, it could have driven the decision-making on whether it would be pragmatic to administer selective serotonin inhibitors or norepinephrine-dopamine reuptake inhibitors.

When handling a patient suffering from anxiety, there are also ethical issues that must be taken into account. The client and close relatives should be well enlightened about the treatment plan (McHenry, 2016). Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay. This covers the drug’s benefits against its risks. In this given scenario the therapist has the responsibility to notify the patient’s parents of the drug’s potential gains and possible health risks as the patient is under lawful age for informed consent.

References

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93-107. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/

Duval, E., Javanbakht, A., & Liberzon, I. (2015). Neural circuits in anxiety and stress disorders: A focused review. Therapeutics and Clinical Risk Management, 11(5), 115-126. doi: 10.2147/TCRM.S48528

McHenry, L. (2016). Ethical issues in psychopharmacology. Journal of Medical Ethics, 32(7), 405-410. doi: 10.1136/jme.2005.013185

Murray, B., Jitender, S. (2015). Generalized anxiety disorder. The New England Journal of Medicine, 373, 2059-2068. doi: 10.1056/NEJMcp1502514

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. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay.

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 (https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_05/index.html

 ). 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. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay.
• 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. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay.

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_05/index.html

STRICTLY FOLLOW THE FOLLOWING FROM THE PROFESSOR

Decision Tree Assignment – Same drill as your previous decision tree assignment.  Please be sure to incorporate the feedback I provided into this week’s decision tree.

Treating patients with Anxiety Disorders

I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest.  The course page suggests writing 1 page per decision – my opinion is that it will be very difficult to justify your treatment decisions and provide scientific evidence in 1 page (especially for decision #1). I do not need you to tell me about the patient or the treatment options available to you – I am very familiar with the cases.  Your introductory page should be an overview of the disease state you are treating along with a purpose statement for the assignment.  Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data).

Introduction to the case (1 page)

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

Decision #1 

• 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. Again, provide STRONG scientific evidence.  Clinical studies or treatment guidelines are a good place to start!
• 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. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay.

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. Again, provide STRONG scientific evidence.  Clinical studies or treatment guidelines are a good place to start!

• 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. Again, provide STRONG scientific evidence. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay.   Clinical studies or treatment guidelines are a good place to start!
• 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.

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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.

After writing up your rationale at each decision point, I would ask yourself the following questions:

• Have I provided clinical data from a meta-analysis, case report or clinical trial to support the drug I picked being safe, efficacious and the best choice for this patient?
• Have I provided clinical data, etc. to support a clear rationale as to why the other treatment options are NOT optimal?
• Is the focus of my discussion on mechanism of action and receptors/neurotransmitters that the drug acts on? If the answer is YES, you should consider doing additional research to address the above two questions

Also include how ethical considerations might impact your treatment plan and communication with clients. 

The rubric, as I interpret it, suggests 5 references cited with every assignment for full credit on this portion (20 points).  References used for your introductory paragraph, ethical considerations or conclusion do not count towards the 5 references required.  As a general rule of thumb, I would encourage you to reference AT LEAST two sources (not including the textbook) for each decision point – this will result in 6 references total for your clinical decision making. Treatment of Anxiety Disorders Dialogues in Clinical Neuroscience Essay.