Treatment of Anxiety Disorders Discussion & Reimbursement Rates
Week 6: Anxiety Disorders, PTSD, and Related Disorders
Oh no! It is happening again. I am having a heart attack… I know it. My heart is racing, I can’t breathe, and I am shaking all over. I can’t go to the ER again. They will say what they always say… I am not having a heart attack. It is all in my head.
Barbara, age 68
The anxiety disorders provide us a good opportunity to take a close look at the nature/nurture debate as well as the gene/environment interactions that influence the nervous system and neurochemistry. A significant part of most of Sigmund Freud’s theories, the concept of anxiety has been debated and discussed over many years in the psychiatric literature. While Freud’s theories focused on the “mind” and the unconscious, another way to look at anxiety is with Hans Selye’s concept of “fight or flight” in which the sympathetic nervous system is activated as a response to stress. As you explore the concept of anxiety, you will notice that no two cases of anxiety are the same.
This week, you will explore evidence-based treatment methods for clients with anxiety disorders. You will complete a midterm exam and analyze reimbursement rates for treatment of mental health disorders.
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
- Chapter 9, “Anxiety Disorders” (pp. 387–417)
- Chapter 11, “Trauma- and Stressor-Related Disorders” (pp. 437–451)
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
- Chapter 16, “Panic Disorder”
- Chapter 18, “Social Anxiety Disorder (Social Phobia)”
- Chapter 19, “Generalized Anxiety Disorder”
- Chapter 20, “Specific Phobia”
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
- “Anxiety Disorders”
- “Trauma- and Stressor-Related Disorders”
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://stahlonline.cambridge.org/
To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.
| Anxiety | Generalized anxiety disorder | Panic disorder | |
|---|---|---|---|
| alprazolam amitriptyline amoxapine buspirone chlordiazepoxide citalopram clomipramine clonazepam clonidine clorazepate cyamemazine desipramine diazepam dothiepin doxepin duloxetine escitalopram fluoxetine fluvoxamine gabapentin (adjunct) hydroxyzine imipramine isocarboxazid lofepramine |
loflazepate lorazepam maprotiline mianserin mirtazapine moclobemide nefazodone nortriptyline oxazepam paroxetine phenelzine pregabalin reboxetine sertraline tiagabine tianeptine tranylcypromine trazodone trifluoperazine trimipramine venlafaxine vilazodone |
alprazolam citalopram desvenlafaxine duloxetine escitalopram fluoxetine fluvoxamine mirtazapine paroxetine pregabalin sertraline tiagabine (adjunct) venlafaxine |
alprazolam citalopram clonazepam desvenlafaxine escitalopram fluoxetine fluvoxamine isocarboxazid lorazepam mirtazapine nefazodone paroxetine phenelzine pregabalin reboxetine sertraline tranylcypromine venlafaxine |
| Posttraumatic stress disorder | Reversal of benzodiazepine effects | Social anxiety disorder |
|---|---|---|
| citalopram clonidine desvenlafaxine escitalopram fluoxetine fluvoxamine mirtazapine nefazodone paroxetine prazosin (nightmares) propranolol (prophylactic) sertraline venlafaxine |
flumazenil | citalopram clonidine desvenlafaxine escitalopram fluoxetine fluvoxamine isocarboxazid moclobemide paroxetine phenelzine pregabalin sertraline tranylcypromine venlafaxine |
Maples-Keller, J. L., Price, M., Rauch, S., Gerardi, M., & Rothbaum, B. O. (2017). Investigating relationships between PTSD symptom clusters within virtual reality exposure therapy for OEF/OIF veterans. Behavior Therapy, 48(2), 147–155. doi:10.1016/j.beth.2016.02.011
Hayes, J. P., Logue, M. W., Reagan, A., Salat, D., Wolf, E. J., Sadeh, N., & … Miller, M. W. (2017). COMT Val158Met polymorphism moderates the association between PTSD symptom severity and hippocampal volume. Journal of Psychiatry & Neuroscience: JPN, 42(2), 95–102. doi:10.1503/jpn.150339
Quinn, B. L., & Peters, A. (2017). Strategies to reduce nursing student test anxiety: A literature review. Journal of Nursing Education, 56(3), 145–151. doi:10.3928/01484834-20170222-05
Document: Reimbursement Rate Template (Word document)
Required Media
Wolpe, J. (Producer). (n.d.). Joseph Wolpe on systematic desensitization [Video file]. Mill Valley, CA: Psychotherapy.net.
Optional Resources
Acosta, M. C., Possemato, K., Maisto, S. A., Marsch, L. A., Barrie, K., Lantinga, L., . . . Rosenblum, A. (2017). Web-delivered CBT reduces heavy drinking in OEF-OIF veterans in primary care with symptomatic substance use and PTSD. Behavior Therapy, 48(2), 262-–276. doi:10.1016/j.beth.2016.09.001
Substance Abuse and Mental Health Services Association (SAMHSA). (2014). TIP 57: Trauma-informed care in behavioral health services. Retrieved from: http://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-Services/SMA14-4816
Note: This document is available as a free download.
Discussion: Treatment of Anxiety Disorders
Anxiety disorders are common in both primary care and psychiatric practice. Clients with anxiety disorders including generalized anxiety disorders, agoraphobia, and other specific phobias will present to the PMHNP’s office with a significant level of distress. Successful recognition and treatment of anxiety disorders includes an accurate diagnostic assessment with a treatment plan that includes a combination of psychopharmacology and psychotherapy. Although psychoanalytic theories are based on the concept of anxiety, the more recent standard of care is with the cognitive-behavioral therapies.
In this Discussion, you will analyze evidence-based treatment plans for clients with anxiety disorders.
Learning Objectives
Students will:
- Analyze differences between adjustments disorders and anxiety disorders
- Analyze diagnostic criteria for anxiety disorders
- Analyze evidence-based psychotherapy and psychopharmacologic treatment for anxiety disorders
- Compare differential diagnostic features of anxiety disorders
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!
To prepare for this Discussion:
- By Day 5 of Week 5, your Instructor will have assigned you an anxiety disorder, which will be your focus for your initial post for this Discussion.
- Review the Learning Resources.
By Day 3
Post:
- Explain the difference between an adjustment disorder and anxiety disorder. Provide examples to illustrate your rationale.
- Explain the diagnostic criteria for your assigned anxiety disorder.
- Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned anxiety disorder.
- Support your rationale with references to the Learning Resources or other academic resource.
By Day 6
Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 6 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 6 Discussion
Assignment 1: Midterm Exam
This exam is designed to assess how well you have synthesized the information from all your PMHNP courses. It draws upon the material from all the textbooks from NURS 6630, NURS 6640, NURS 6670, NURS 6660, and NURS 6670. It is very similar to what you will experience in your certification exam.
Learning Objectives
Students will:
- Assess knowledge of adult and older adult psychotherapy concepts and principles
This exam will cover the following topics:
- Psychiatric Assessment of the Adult and Older Adult
- Depressive Disorders
- Personality Disorders
- Substance-Related and Addictive Disorders
- Bipolar Disorders
- Anxiety Disorders, PTSD, & Related Disorders
By Day 7
Complete the Midterm Exam. Prior to starting the exam, you should review all of your materials. There is a 2-hour time limit to complete this 75-question exam. You may only attempt this exam once.
This exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.
By Day 7
Submission and Grading Information
Submit Your Exam by Day 7
To submit your Exam:
Week 6 Midterm Exam
Assignment 2: Week 6 Practicum Journal: Reimbursement Rates
Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with.
In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.
Learning Objectives
Students will:
- Analyze reimbursement rates for mental health treatments
To prepare for this Practicum Journal:
- Research reimbursement rates for various treatment modalities.
- Compare NP rates to other provider rates.
For this Practicum Journal:
Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.
By Day 7 of Week 7
Submit your Assignment.
Making Connections
This week, you explored evidence-based treatment methods for clients with anxiety disorders. You completed a midterm exam and analyzed reimbursement rates for treatment of mental health disorders.
Next week, you will, once again, become “captain of the ship” as you take full responsibility for a client with an obsessive-compulsive disorder by recommending psychopharmacologic treatment and psychotherapy, identifying medical management needs and community support, and recommending follow-up plans.
To go to the next week:
Week 7
