Posted: December 15th, 2022
Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
The case study is about a 46-year who presented with complaints about chest tightness, shortness of breath, and a feeling of impending doom. ECK and ER findings excluded myocardial infarction while the client HAM-A score was 26 indicating generalized anxiety disorder (GAD) diagnosis. With this diagnosis, this paper will make decisions on the treatment of the client in the case study. Each decision will be supported by a rationale basing on the latest evidence and patient data. The paper will conclude by discussing the factors that may impact the treatment of the client.Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.ORDER A PLAGIARISM-FREE PAPER HERE
Decision Point One
The initial decision involved prescribing Zoloft 50 mg orally daily for the client. This is because the medication is an SSRI and as Clevenger et al (2018) explain SSRIs are the first-line treatment choices in people with anxiety disorders. SSRIs elevate the quantity of serotonin within the brain; serotonin is responsible for mood regulation. SSRIs thus elevate the quantity of serotonin within the brain by obstructing the reuptake of serotonin within the brain. As a result, the mood is regulated which reduces anxiety symptoms (Stahl, 2013). Moreover, the efficacy of Zoloft in treating GAD has been demonstrated in several studies.Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
Prescription of Zoloft 50 mg hoped to reduce the symptoms of GAD in the client. The improved symptoms will be indicated by a decrease of symptoms such as chest tightness, shortness of breath, and a feeling of impending doom. It is also expected that the client would stop worrying about job loss. The HAM-A score is also expected to reduce as an indication of reduced symptoms of anxiety. These outcomes are expected because the efficacy of Zoloft in reducing anxiety symptoms has been demonstrated in various studies (Stahl, 2013). Secondly, it was anticipated that the client will have minimal side effects because SSRIs such as Zoloft have been shown to have good safety profile and few side effects(Stahl, 2013).Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
The expected outcome and the actual outcome of the selected decision were similar. This is because the client indicated improvement in symptoms such as chest tightness and breath shortness and also his worry about job loss had reduced. The symptom improvement was further indicated by the drop of the HAM-A score from 28 to 18, indicating partial response to treatment. This is due to the efficacy of Zoloft in improving anxiety symptoms (Clevenger et al, 2018).Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
Decision Point Two
Decision two is to increase the dose of Zoloft from 50 mg to 75 mg. The reason behind this decision is because the client is manifesting partial response indicating his response to treatment. Thus, increasing the dose to 75 mg will increase more serotonin in the brain and lead to more decrease in the anxiety symptoms (Stahl, 2013). Studies indicate that the dose of SSRIs can be increased for patients not manifesting satisfactory response to treatment (Clevenger et al, 2018). In addition, the client did not report any side effects indicate good tolerance to the medication.Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
Selecting the decision to increase the dose hoped to further reduce anxiety symptoms for the client because evidence indicates that an increased dose of SSRIs like Zoloft avails more serotonin within the brain and thus further improves anxiety symptoms(Jakubovski et al, 2016).Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
The expected outcome and the actual outcome of the selected decision were similar. When the client came for review, the anxiety symptoms had reduced significantly and so was the HAM-A score. This was due to the increased efficacy of Zoloft because of the increased dose which availed more serotonin in the brain, further improving anxiety symptoms (Locher et al, 2017).Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
Decision Point Three
The last decision was for the client to maintain the dose of Zoloft 75 mg. This is because with this dose the client manifested significant improvement as demonstrated by the subjective data as well as by the HAM-A score. The client did not also report any side effect. According to Jakobsen et al (2017),medication titration should be done in accordance with the patient’s response and therefore for this client, it was not necessary to further titrate the dose.Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
The decision to maintain the dose of 75 mg hopes that the client will fully respond to the treatment and report complete symptom remission.
Impact of Ethical Considerations
Ethical considerations applicable to this client include autonomy, informed consent, and confidentiality. Regarding informed consent, the PMHNP is obligated to provide full information about the available treatment options to enable the client to make informed treatment choices. On confidentiality, the PMHNP should not disclose any information about the client to any other person, unless the client consents. Finally, the client should willingly accept or refuse the treatment as this will ensure his autonomy is respected (Schneider, 2016).Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
The first pharmacological client for the client was Zoloft 50 mg orally daily because the medication is an SSRI whose efficacy has been demonstrated. The outcome of this decision was partial response to treatment and thus the second decision was to increase the dose of Zoloft from 50 mg to 75 mg. With the increased dose, the client manifested further improvement and thus the third decision is to maintain the current dose of Zoloft 75 mg. the ethical considerations applicable to the client consist of informed consent, autonomy, and confidentiality.Week 5 Decision Tree: Anxiolytic Therapy & PTSD Treatment.
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