Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

General Anxiety Disorder

General Anxiety disorder is fear that interferes with one’s everyday life, it is characterized by excessive worry about different things (finances, work family and sometimes things we think are simple). General anxiety is not the normal anxious/ worry stressor of life, these individuals’ anxiety is like manic behavior. General anxiety disorder causes symptoms like difficulty concentrating, constant restlessness/anxious feeling, Indecisiveness, and fear of making the wrong decision, inability to let the worry go, trouble overthinking plans and solutions physical symptoms can lead to Fatigue, trouble sleeping, muscle tension or muscle aches, trembling, feeling twitchy, nervousness or being easily startled, Sweating some cases nausea, diarrhea or irritable bowel syndrome (General Anxiety Disorder. 2021). Some factors are genetics and a person’s experience As a provider it is important to understand the dangers a patient with GAD can face treatment should be prompt and appropriate.

Treatment options for general anxiety disorder often involve a combination of therapies like psychotherapy, cognitive behavior therapy which helps with redirecting a patient fears/worry (Locke. 2015). There is also chemical treatment such as antidepressants (ssri) which SSRIs prevent serotonin from being reabsorbed (reuptake) in the brain, allowing more serotonin to be accessible. SSRIs also appear to influence just serotonin and not other neurotransmitters. Some of the most popular drug of choice for treatment of GAD is Cymbalta, paxil, effector (General Anxiety Disorder. 2021). Another option for treatment is a class of medication known as benzo diazepam this drug class can often relive anxiety. These sedatives are generally used only for relieving acute anxiety on a short-term basis (Locke. 2015).

As a cardiac critical care nurse patients with general anxiety disorder would already be diagnosed and on SSRI long-term prior to admission. In my practice what id did see is more of the acute episodes of anxiety like COPD exacerbation and asthma attacks mostly medical issues that cause a Panic attack or post op surgical patient who are intubated with light sedation and new stroke patient can display a lot of characteristics of GAD. As a nurse I can say that in the setting I was working earlier in my career I was more reactive in steady of recognizing the signs and anticipating a plan of action which I have seen how sever and more stressful it can be for the patient

Refences

General Anxiety Disorder. 2021. Anxiety Depression Association of America.    https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Amy Locke. 2015. Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adult. American Family Physician. https://www.aafp.org/afp/2015/0501/p617.html

Kessler RC, Petukhova M,.2017. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res.

RE: Week 8 Initial Discussion Post

Week 8 Discussion

Generalized anxiety disorder is characterized by excessive or unrealistic anxiety about two or more aspects of life such as work, social relationships, financial matters, etc., often accompanied by symptoms such as palpitations, shortness of breath, or dizziness. Consequently, generalized anxiety disorders (GAD) are usually accompanied by restlessness, feeling on edge, easily fatigued, difficulty concentrating,  mind going blank, irritability, muscle tension, and sleep disturbance.

Regarding inhibiting factors, people with GAD are prone to ambivalence about relinquishing their worries. On the one hand, they may be motivated to reduce the distress that worries cause, yet, on the other hand, they may experience fear as an adaptive mechanism of readiness and control. ( Muir, H. J. & Antony, M. M., 2021).

While on the cardiovascular unit, a 48-year-old male, Mr. F.T., visited his family who had just had surgery, and all of a sudden, he started having chest pain and could not keep his thought process, SOB,  and was restless. Therefore, the charge nurse took the patient to the ED ( Emergency Department), Where they did a cardiac workup which came back negative for MI (Myocardial Infarction). Consequently, Mr. F.T. had been referred for a psychological evaluation.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

Upon psychological evaluation, the patient reports that he is currently taking care of his aging patients in his own home and has concerns about his job. Because of these issues, he drinks  a few beers a night to help calm himself. Upon mental exam, the patient admits feeling

anxious with an overall broad affect. Otherwise, the exam is relatively routine, with no thoughts of suicidal ideation. The Hamilton Rating Anxiety Scale, a 14-item scale used to measure the severity of anxiety symptoms, was administered,  yielding a score of 26, which is considered moderate to severe anxiety (Gang, Y. & Han, N., 2019).

Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

First Decision

I chose  to start the patient on Buspirone 10mg PO BID, as Zoloft is not indicated for initial treatment in GAD, and Imipramine is used to treat clinical depression. Benzodiazepines are considered first-line treatment for anxiety disorders, but given none of those were an option, I chose buspirone as it is just as effective as benzos with no abuse potential (Rosenthal & Burchum, 2018). After four weeks of use, the client reports a slight decrease in symptoms but still feels very anxious. The HAM-A score decreased to 23, considered mild to moderate anxiety (Thompson, 2015). Even though Buspirone anxiolytic effects develop slowly (Rosenthal & Burchum, 2018), the patient should have seen some relief of anxiety within the first four weeks. Even though he did have a slight decrease in the HAM-A score, he still feels very anxious.

The second decision

I chose to discontinue buspirone and begin Lexapro 10mg orally daily. The patient needs to see relief, and although increasing the buspirone may improve his anxiety a little bit, it might take several more weeks to see improvement. At this point, I think it would be an excellent option to try a different medication, and Lexapro is one of the only SSRIs approved to treat GAD. Although the anxiolytic effects are slow, they can be seen in a week, are better at decreasing cognitive and psychic symptoms of anxiety and are effective even when depression is absent (Rosenthal & Burchum, 2018).

The third decision

I chose to continue the same dose of Lexapro but change the administration time to bedtime. The patient reports that he feels “great” and that his anxiety is “better,” with a decrease in his HAM-A score down to 13, which is now considered mild anxiety (Thompson, 2015). Since the patient states he feels a bit tired a few hours after taking the medication, and it would be good to change admin time to bedtime. That way, he is already sleeping during that “sleepy” and should feel refreshed when he wakes in the morning. Otherwise, if the patient is feeling good, there is no need to add any additional medications or increase the dose currently.

 

 Impact of Pharmacotherapeutics

Since Lexapro is a Selective Serotonin Reuptake Inhibitor (SSRI), its primary mechanism of action is to block the neuronal reuptake of serotonin, a monoamine neurotransmitter (Rosenthal & Burchum, 2018). SSRIs block serotonin leading to its accumulation in the neural junction, thus allowing appropriate transmission relating to emotions and stabilizing levels of serotonin leading to anxiety (Christensen et al., 2014). Lexapro is generally well tolerated and has no potential for abuse, therefore may be more appropriate for this patient since he drinks typically every night.

References

Batterham, P. J.& Hickie, I. (2019). The effectiveness of an online e-health application compared

to attention placebo or sertraline in the treatment of generalized anxiety disorder. Internet Interventions, 1(4), 169-174

Gang, Y. & Han, N. (2019). Chart review of patients receiving valsartan-amlodipine single-pill

combination versus valsartan and amlodipine combination for blood pressure goal achievement and effects on the Hamilton anxiety rating/Hamilton depression rating scales. Medicine98(51), 1–8. https://doi.org/10.1097/MD.0000000000018471

Muir, H. J. & Antony, M. M. (2021). Integrating Responsive Motivational Interviewing With

Cognitive-Behavioral Therapy (CBT) for Generalized Anxiety Disorder: Direct and Indirect Effects on Interpersonal Outcomes. Journal of Psychotherapy Integration31(1), 54–69. https://doi.org/10.1037/int0000194

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice

providers. St. Louis, MO: Elsevier

Participation for MSN

Threaded Discussion Guiding Principles

The ideas and beliefs underpinning the threaded discussions (TDs) guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of TDs provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The TD’s ebb and flow is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the TDs generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. TDs foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.

Participation Guidelines

Each weekly threaded discussion is worth up to 25 points. Students must post a minimum of two times in each graded thread. The two posts in each individual thread must be on separate days. The student must provide an answer to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week. If the student does not provide an answer to each graded thread topic (not a response to a student peer) before the Wednesday deadline, 5 points are deducted for each discussion thread in which late entry occurs (up to a 10-point deduction for that week). Subsequent posts, including essential responses to peers, must occur by the Sunday deadline, 11:59 p.m. MT of each week.

Direct Quotes

Good writing calls for the limited use of direct quotes. Direct quotes in Threaded Discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the Grammar, Syntax, APA category.

Grading Rubric Guidelines

Performance Category 10 9 8 4 0

Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic decisions.

  • Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions
  • Evaluates literature resources to develop a comprehensive analysis or synthesis.
  • Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion
  • Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.
  • Evaluates information from source(s) to develop a coherent analysis or synthesis.
  • Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.
  • Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
  • Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.
  • Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.
  • Demonstrates little or no understanding of the topic.
  • Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
  • Information is taken from source(s) without any interpretation/evaluation.
  • The posting uses information that is not valid, relevant, or reliable
  • No evidence of the use of scholarly inquiry to inform or change professional or academic decisions.
  • Information is not valid, relevant, or reliable
Performance Category  10 9 8 4 0

Application of Course Knowledge –

Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations

  • Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;
  • Applies concepts to personal experience in the professional setting and or relevant application to real life.
  • Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.
  • Applies concepts to personal experience in their professional setting and or relevant application to real life
  • Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content
  • Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.
  • Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
  • Does not demonstrate a solid understanding of the principles and concepts presented in the lesson
  • Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.
  • Posts are superficial and do not reflect an understanding of the lesson content
  • Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
  • Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored
  • No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category  5 4 3 2 0

Interactive Dialogue

Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.

(5 points possible per graded thread)

  • Exceeds minimum post requirements
  • Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days.
  • Replies to a post posed by faculty and to a peer
  • Summarizes what was learned from the lesson, readings, and other student posts for the week.
  • Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days
  • Replies to a question posed by a peer

Summarizes what was learned from the lesson, readings, and other student posts for the week.

  • Meets expectations of 2 posts on 2 different days.
  • The main post is not made by the Wednesday deadline
  • Does not reply to a question posed by a peer or faculty
  • Has only one post for the week
  • Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments
  • Does not post to the thread
  • No connections are made to the topic
Minus 1 Point Minus 2 Point Minus 3 Point Minus 4 Point Minus 5 Point
Grammar, Syntax, APA

Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted.

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

  • 2-3 errors in APA format.
  • Written responses have 2-3 grammatical, spelling, and punctuation errors.
  • Writing style is generally clear, focused, and facilitates communication.
  • 4-5 errors in APA format.
  • Writing responses have 4-5 grammatical, spelling and punctuation errors.
  • Writing style is somewhat focused.
  • 6-7 errors in APA format.
  • Writing responses have 6-7 grammatical, spelling and punctuation errors.
  • Writing style is slightly focused making discussion difficult to understand.
  • 8-10 errors in APA format.
  • Writing responses have 8-10 grammatical, spelling and punctuation errors.
  • Writing style is not focused, making discussion difficult to understand.
  • Post contains greater than 10 errors in APA format.
  • Written responses have more than 10 grammatical, spelling and punctuation errors.
  • Writing style does not facilitate communication.
  • The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
0 points lost -5 points lost

Total Participation Requirements

per discussion thread

The student answers the threaded discussion question or topic on one day and posts a second response on another day. The student does not meet the minimum requirement of two postings on two different days

Early Participation Requirement

per discussion thread

The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Wednesday of the eighth week.