Patient Prefer Adherence Essay

The case study is about a 46-year-old man who was referred for evaluation after fears that he was having a heart attack. The presenting symptoms for this client included breath shortness, a feeling of impending doom, and tightness of the chest. The ER and EKG findings were okay and this ruled out a heart attack. The client reported being anxious and even admitted he sometimes used ETOH to treat his anxiety about work. The client is anxious about possible job loss. The HAM-A scale for this client was 26 and this confirmed a diagnosis of generalized anxiety disorder. Therefore, this paper will present three treatment decisions for this client and finally discuss ethical issues that may impact his treatment.  Patient Prefer Adherence Essay

Decision Point One

The initial treatment decision for this client is beginning Zoloft 50 mg. Zoloft is an SSRI that elevates the levels of serotonin within the brain by preventing the reuptake of serotonin and hence treatment symptoms associated with generalized anxiety disorder (GAD). Moreover, pharmacotherapy studies have illustrated that Zoloft is well tolerated among patients and thus has minimal side effects, making the medication the best treatment choice for this client (Stahl, 2014).

Selection of Zoloft expects that symptoms of GAD such as shortness of breath and tightness of chest for this client would improve because evidence has demonstrated the efficacy of Zoloft in improving GAD symptoms. Secondly, it is expected that the client will tolerate Zoloft 50 mg well without any significant side effects because the tolerability of the medication in individuals with GAD has been proved (Stahl, 2014).

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The actual outcome of Zoloft on improving GAD symptoms for this client is similar to the expected outcome. As per the expectations, there was notable symptom improvement because the client reported that he was not experiencing symptoms such as chest tightness and shortness of breath. In addition, the client stated that he was no longer worrying about work and also the HAM-A score showed a partial response to treatment as it reduced. This shows that Zoloft is effective in improving GAD symptoms as the evidence shows (Stahl, 2014). Moreover, as per the expectations the client never experienced any side effect indicating tolerability of Zoloft for this client. Patient Prefer Adherence Essay

Decision Point Two

The selected second decision is increasing the Zoloft dose to 75 mg.  This is to ensure a higher response to treatment for this client because a greater dose of Zoloft will increase the amount of serotonin within the brain and hence ensuring better response (Carvalho et al, 2016).

By selecting the decision to increase the dose to 75 mg, the expectation was that the client would manifest a complete response to treatment which will be indicated by complete remission of GAD symptoms. As per Steven et al (2018) increased doses of Zoloft elevate the level of serotonin within the brain resulting in higher response to treatment and thus further improving symptoms. It is also expected that the client will be able to tolerate a higher dose of Zoloft and not have significant side effects.

The actual outcome of Zoloft on improving GAD symptoms for this client is similar to the expected outcome. Evidently, after increasing the dose to 75 mg, there was more symptom reduction as indicated by further reduction for the HAM-A score. This is because higher doses of Zoloft elevate the level of serotonin within the brain, leading to increased response to treatment and therefore further improving GAD symptoms (Crocco et al, 2017). Additionally, even with increased dose the client tolerated the drug well, as there was no report of side effects.

Decision Point Three

The last decision is to maintain the Zoloft dose at 75 mg. This is because the client is showing a good response to this dose and also, he is tolerating the dose well. According to Steven et al (2018), the higher the dose the higher the likelihood of side effects and hence it is safe to maintain the dose at 75 mg.

By maintaining the dose at 75 mg, the expectation is that symptoms will continue reducing, and eventually a full symptom remission will be achieved. Secondly, it is hoped that the client will not experience significant side effects as he will continue tolerating the medication because evidence shows that Zoloft is well tolerable (Carvalho et al, 2016). Patient Prefer Adherence Essay

Ethical Considerations

Ethical issues in the treatment of this client encompass seeking informed consent from the client and issues associated with dependency when it comes to SSRIs. For informed consent, the PMHNP should inform the client about all information and issues associated with all the available treatment choices to enable the client to make an informed treatment choice. Moreover, is important to educate the client about the possibility of dependency with Zoloft and ensure the necessary measures to prevent abuse are implemented (Cartwright et al, 2016).

Conclusion

The initial treatment decision is to have the client begin taking Zoloft 50 mg due to the medication’s efficacy in treating GAD symptoms. The second decision that was chosen is to have the dose increased to 75 mg in order to further increase the response to treatment. Since with the Zoloft dose of 75 mg the client is showing a good response to treatment, without any side effects, the third decision would be to maintain the current dose. Ethical issues in treatment of the client involve dependency allied to SSRIs such as Zoloft and ensuring informed consent is sought from the client before starting any treatment.

References

Cartwright C, Gibson K, read J, Cowan O & Dehar T. (2016). Long-term antidepressant use: patient perspectives of benefits and adverse effects. Patient Prefer Adherence. 1(10), 1401–1407.

Carvalho A, Sharma M, Brunoni A, Vieta E & Fava G. (2016). The Safety, Tolerability, and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychiatry. 85(5).

Crocco E, aramillo S, Ortiz C & Camfield K. (2017). Pharmacological Management of Anxiety Disorders in the Elderly. Curr Treat Options Psychiatry. 4(1): 33–46.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Steven S, Devvrat M,  Dang J,  Vanle B & IsHak W. (2018). The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Ther Adv Psychopharmacol. 8(1), 49–58. Patient Prefer Adherence Essay