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.
*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.
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 a 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. The remainder of the physical exam was WNL.
He admits that he still has problems with tightness in the chest and episodes of shortness of breathe 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.
In your office, 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”. Affect is somewhat blunted, but does brighten several times throughout the clinical
interview. Affect 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
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. (TEll
Decision #1 (1 page)
● Which decision did you select? (I chose START PAXIL 10MG DAILY
● 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. (Tofranil has a side effect to cause
hypotension which will cause increase dizziness & will lead to falls as well as
affect patients quality of life)
● 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. Explain and give examples.
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
● 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 #2 (1 page):
*second decision : Increased Paxil to 20 mg PO daily
● Why did you select this decision? (one reason I made this decision: The
patient’s symptoms seem to decrease tremendously, so I decided to increase
the dosage). 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. (I did not choose the other two
options because If I maintained the current dosage, the patient would not be
at the comfort level needed to decrease his anxiety. The patient needed a
medication increase. However, I did not choose to increase the patients
dosage immediately from 10mg to 30 mg PO daily due to medication titration
must start off slowly as meds are gradually increased. This is also done to
avoid possible side effects or adverse reactions)
● 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). (I was hoping to a great reduction in the patients
anxiety s/s.
● Explain how ethical considerations may impact your treatment plan and
communication with patients. Be specific and provide examples.
*RESULTS OF DECISION POINT TWO
● Client returns to clinic in four weeks
● Client reports an even further reduction in his symptoms
● HAM-A score has now decreased to 10. At this pointcontinue current dose (61% reduction in symptoms)
Decision #3 (1 page)
(Maintain the patient’s current dosage)
● Why did you select this decision? (The client’s HAM-A score is 10. The
patients s/s reduced by 61%). The client is currently not experiencing any
side effects, the current dose can be maintained for 12 weeks to
evaluate the full effect of the drug). 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?
(Increasing drugs at this point may yield a further decrease in
symptoms, but may also increase the risk of side effects). 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? (Trying to achieve
medication effectiveness for the patient to avoid unnecessary medication
changes via trail and error with possible side effects). 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.