The Journal of Nervous And Mental Disease Discussion Paper

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The Journal of Nervous And Mental Disease Discussion Paper

Anxiety disorder is a mental disorder that is manifested by social fear and lack of confidence. Daitch (2018) has noted that key symptoms of an anxiety disorder include irritability, anger, restlessness, and an inability to focus and concentrate. Anxiety is expressed in many forms varying in severity. Common forms of anxiety include social anxiety, panics, and generalized anxiety among others (Zimmerman et al., 2018). The case study for this assessment is a 46-year-old male who shows signs of anxiety disorder and whose HAM-A score of 26. The man has reported persistent shortness of breath chest tightness and an innate fear that something bad will happen. Drawing from this, a set of three decisions that are subsequent to each other are connected. These are treatments intended at managing and treating the man. To begin, Zoloft was considered and used at an amount of 50 mg daily doses and later increased to a level of 75 mg. In the end, the three decisions led to the patient being given an optimum dose that contained his anxiety and HAM-A score to recommended low levels. The Journal of Nervous And Mental Disease Discussion Paper

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Decision #1

`The first decision on the patient would be a daily intake of 50 mg of Zoloft orally. Zoloft is a selective serotonin reuptake inhibitor (SSRIs) and these are the ones that are recommended first for patients with anxiety disorder. Serotonin is a chemical that is required by the brain as it works to regulate mood. According to Liu et al. (2020), SSRIs increase the amount of serotonin chemical in the brain. The intake of Zoloft regularly on a daily basis reduces the uptake of serotonin by the brain leading to its increase in concentration. Jahan (2021) notes that once the level of serotonin is maintained at a relatively high level, it aids in the mood regulation of the patient. Another aspect of serotonin is that it reduces anxiety because anxiety acts by utilizing serotonin. The intake of Zoloft acts to replenish the utilized serotonin (Zimmerman et al., 2018). The reason why the choice to use Imipramine (Tofranil) at 25 mg BID and Buspirone (Buspar) were ignored is because they are not first-line medications.

In comparison with Zoloft, the two mentioned medications are not SSRIs and have associated relatively more side effects. It was hoped that by taking 50 mg of Zoloft daily the symptoms of anxiety disorder would subside with time. In addition to this, it was also expected that the HAM-A score of 26 would also reduce marginally pointing towards a decline in anxiety. Daitch (2018) has stated that an additional feature of Zoloft is that it effectively treats the symptoms of GAD because it is an SSRI. There was no evident significant difference between the actual outcome of the treatment and what was expected. Their clinical visit after treatment showed significant improvement with reduced anxiety episodes. In addition, there was a reported significant reduction in the patient’s HAM-A score. The Journal of Nervous And Mental Disease Discussion Paper

Decision #2

The second decision that I would have made in treating the patient is to increase the Zoloft daily oral dose from 50 mg to 75 mg. The rationale for making this adjustment is that the patient has positively responded to the intake of 50 mg of Zoloft leading to a decline in HAM-A score from 26 to 18. According to Liu et al. (2020), an increase of the dosage by 25 mg will further increase the amount of serotonin in the brain and further suppress the incidences of anxiety by the patient. Clinical research in anxiety treatment has proposed a constant increase in the SSRIs if the response by patients is less than hoped for by the physician or nurse (Ramdan, 2019). This decision is further justified by the fact that the current patient has responded well to medication and has not shown any side effects.

A choice would have been made to increase the Zoloft dosage from 50 mg to 100 mg but this is not recommended. Clinical practice dictates that Zoloft dosages be increased gradually to allow the patient’s body to get accustomed to the incremental amounts. By selecting the choice to gradually increase the Zoloft oral intake the patient, it was hoped that the patient would continue to show signs of improvement and ultimately reduce the HAM-A score to the recommended levels. The difference between the expected outcome and the actual one was not significant further justifying the choice of using 75 mg of Zoloft for the period. The results upn the patient making their third visit that the anxiety had reduced even further and that their HAM-A score was further reduced. The Journal of Nervous And Mental Disease Discussion Paper

Decision #3

The third decision is faced on the fact that the anxiety disorder patient has constantly elicited improvement and that the symptoms have been slowing by the day. The third decision is to maintain the oral daily intake of 75 mg of Zoloft. The HAM-A score has yielded very positive results and the incidences of anxiety disorder have significantly reduced. Since the objective of the treatment intervention is to make the anxiety disorder disappear, the fact that the current data shows that this has been realized justifies the maintenance of a 75 mg Zoloft ingestion. According to Ramdan (2019), it is important that health care providers base their medical titration n the degree of response of patients based on the objectives. Drawing from this, the case for the anxiety disorder patient shows that the current titration is sufficient and should be maintained.

Following this, little consideration was made on increasing the Zoloft dosage from 75 mg to 100 mg or augmenting it with Buspar. The justification for this was that the patient was responding well to the current medication and other additional treatments were not necessary. The continued use of the suggested medical dosages is hoped to lead to full recovery by the patient with the anxiety disorders clearing completely and the HAM-A score reduced even further. The Journal of Nervous And Mental Disease Discussion Paper

Impact of Ethical Considerations on the Treatment Plan

The two ethical considerations that will be prioritized for this patient are confidentiality and informed consent. Consideration will apply in the sense that all discussions and submissions made regarding the patient’s condition will be kept confidential. Importantly, the clinician will guarantee the patient that the ethical code of conduct that guides their practice dictates full confidence of all personal and medical records and reports shared unless it is in the furtherance of their treatment. Informed consent as Jahan (2021) notes applies when the care provider duly informs the patient of the planned medical intervention, the reasons why it (they) are selected what they are expected to achieve. Upon reading through the formally detailed consent, the patient then consents to the procedures and treatments.

Conclusion

Simply put, the reason why Zoloft was selected as the medication of choice in the three decisions is that it is SSRIs and is resourceful in introducing serotines into the brain and effectively leading to the treatment of anxiety disorder. With the benefit that there were immediate positive outcomes for the patient especially when the dosage was increased from 50 mg to 75 mg, there was a notable reduction in the HAM-A score. What is more, there were no identified side effects of Zoloft during treatment. Although the initial decision to use 50 mg of Zoloft per day, it was determined that this was not sufficient despite the indicated improvements in HAM-A score drop and reduced incidences of anxiety disorder. Drawing from this, it was decided to slightly increase the dosage by 25 milligrams to try and realize faster and better results. The ethical considerations that were used in treating the patient were justified by the need to maintain an ethical and moral code of practice where confidentiality and informed consent were especially necessary. The Journal of Nervous And Mental Disease Discussion Paper

References

Daitch, C. (2018). Cognitive behavioral therapy, mindfulness, and hypnosis as treatment methods for generalized anxiety disorder. American Journal of Clinical Hypnosis, 61(1), 57-69. https://doi.org/10.1080/00029157.2018.1458594

Jahan, S. (2021). Can Low Dose Sertraline Cause Serotonin Syndrome in Pediatric Patients? 2 Case Reports. CNS spectrums, 26(2), 155-155. https://doi.org/10.1017/S1092852920002485

Liu, Z., Kariya, M., Chute, C., Pribadi, A. K., Leinwand, A. T., Curran, K. P., … & Sreekanth, H. (2019). The Chemistry of Fear. Natural History. Retrieved March, 24, 2020.

Ramdan, I. M. (2019). Reliability and validity test of the Indonesian version of the Hamilton anxiety rating scale (ham-a) to measure work-related stress in nursing. Jurnal Ners, 14(1), 33. https://dx.doi.org/10.20473/jn.v13i1.10673

Zimmerman, M., Clark, H., McGonigal, P., Harris, L., Holst, C. G., & Martin, J. (2018). Relationship between the DSM-5 anxious distress specifier and the hamilton depression rating scale anxiety/somatization factor. The Journal of nervous and mental disease, 206(2), 152-154. https://dx.doi.org/10.1097/NMD.0000000000000767 The Journal of Nervous And Mental Disease Discussion Paper

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) The Journal of Nervous And Mental Disease Discussion Paper

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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. The Journal of Nervous And Mental Disease Discussion Paper