Assessing and Treating Patients With Anxiety Disorders
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.
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. 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.
- 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.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
*** The following is specific instructions from the professor
Decision Tree Assignment – Treating patients with Anxiety Disorders
Given that this is your first decision tree case study, I would suggest reviewing the REST OF THE INFORMATION IN THIS ANNOUNCEMENT very closely:
To be clear on the instructions – you are to work through the three decision points in the case. You will read the background on the patient and evaluate the 3 options for decision 1 (details below). Once you have done all the research on decision 1, click the medication you feel is most appropriate and this will bring you to decision 2 in the case. Again, evaluate the background information including how the patient responded to your treatment. Once you have searched your options at decision 2, click on the therapy you deem to be most appropriate and this will bring you to decision 3. Then repeat the same process you did for Decision 1 and Decision 2. If you have questions about these instructions, please contact me.
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. I want you to tell me why you selected an option – why is it the best option, using clinically relevant data from primary literature (clinical trials, treatment guidelines) and patient specific data AND why you did not choose the other options (with clinically relevant data from primary literature 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.
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.
- At each decision point stop to complete the following:
Decision #1 (1.5+ pages)
-
-
- Which decision did you select?
- Why did you select this decision? Support your response with strong scientific evidence discussing efficacy, safety, tolerability and patient outcomes from primary literature (not information from Micromedex, Epocrates or UpToDate) and references. Why did you NOT select the other treatment options available? Again, provide STRONG scientific evidence from the primary literature. 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.
- What ethical considerations impacted your treatment plan and communication plan with the patient?
-
Decision #2 (1+ pages)
-
-
- Which decision did you select?
- Why did you select this decision? Support your response with strong scientific evidence discussing efficacy, safety, tolerability and patient outcomes from primary literature (not information from Micromedex, Epocrates or UpToDate) and references. Why did you NOT select the other treatment options available? Again, provide STRONG scientific evidence from the primary literature. 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.
- What ethical considerations impacted your treatment plan and communication plan with the patient?
-
Decision #3 (1+ pages)
-
-
- Which decision did you select?
- Why did you select this decision? Support your response with strong scientific evidence discussing efficacy, safety, tolerability and patient outcomes from primary literature (not information from Micromedex, Epocrates or UpToDate) and references. Why did you NOT select the other treatment options available? Again, provide STRONG scientific evidence from the primary literature. 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.
- What ethical considerations impacted your treatment plan and communication plan with the patient?
-
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. You should provide new data here – not a repeat of the data you used previously in the paper.
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? If the answer is NO, you’ll want to start over
- Have I provided clinical data, etc. to support a clear rationale as to why the other treatment options are NOT optimal? If the answer is NO, you’ll want to start over
- 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.
WHAT DOES GOOD LOOK LIKE?
Here are some examples of what I do NOT want:
- I chose sertraline (ZOLOFT) because it is an SSRI that treats depression and is FDA approved.
- Paroxetine (PAXIL) was chosen because paroxetine increases the levels of serotonin in the brain.
- I decided to prescribe bupropion (Wellbutrin) because data supports the use of bupropion in……
- Think about the patient you are treating. I have had students discuss concerns with erectile dysfunction in pediatric patients and female patients on multiple occasions. You want to consider the patient you are treating.
Here are some examples of what I DO want:
- “As the PMHNP caring for this client, Zoloft 25 mg daily would be the first choice of therapy for this patient. Selective Serotonin Reuptake Inhibitors (SSRIs) are known to be the first line of treatment for children with depression (DeFilippis & Wagner, 2014). Sertaline was shown to be safe and efficacious in a randomized clinical trial comparing sertraline to placebo in which 76% of patients achieved the primary outcome of reduction in depressive symptoms by week 12. Only 5% of patients were forced to discontinue sertraline therapy during the study due to ________. While sertraline and paroxetine are both SSRIs, sertraline is FDA approved when treating children whereas paroxetine has been found to be affective when treating children with depression, it is not specifically approved by the FDA at this point in time (Stahl, 2014b).â€
- “Paroxetine is not recommended in use for children due to its short half-life which can lead to withdrawal when the medication is stopped abruptly (Nathan & Gorman, 2015). Paroxetine has not been shown to be safe and effective in pediatric studies as outlined in ________(summarize studies)â€
- Evidence supporting the effectiveness of one agent over another. How did one agent perform when compared to another medication in clinical trials. I really like seeing these types of comparisons.
- What do the guidelines recommend? You can typically find the reason for their recommendation in the body of the guidelines.
- What side effects are the most concerning for the patient case study? For example: you wouldn’t want to prescribe a medication that causes excessive sedation in a patient that operates heavy machinery or drives transport trucks across the country.
- Consider genetics and the role genetics have in drug metabolism.
- Evaluate for the potential for drug-drug interactions.
Resoursces
Bui, E., Pollack, M. H., Kinrys, G., Delong, H., Vasconcelos e Sá, D., & Simon, N. M. (2016). The pharmacotherapy of anxiety disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 61–71). Elsevier.
