General Anxiety Disorder

  • Respond to a colleague who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.


    General Anxiety Disorder

    I selected the middle-aged white male with a generalized anxiety disorder. He has been to the ER with chest pain and myocardial infarction was ruled out with a normal EKG. The physical manifestations of anxiety and panic commonly account for people presenting to Emergency Departments (Derrick, Green, and Wand, 2019). He gets short of breath, feeling of impending doom, and reports these are his anxiety attacks. He is drinking beer on a nightly basis after work to help calm his nerves. He is trying to take care of his aging parents and also reports that work is stressful and harsh. Caregiving has been associated with the negative physical and psychological impact on the caregivers’ health, as well as, with higher prevalence rates of depression, anxiety, and a higher risk of mortality (Semenova and Stadtlander, 2016)

    I elected to start buspirone 10mg BID. He reports back to the office 4 weeks later and says the symptoms are slightly less but he is still feeling very anxious. His HAM-A score decreased from 26 to 23. I then decided to discontinue the buspirone and start him on Lexapro 10mg daily. SSRIs have proven to be effective for GAD, SAD, and panic disorder (Blumenthal, Feger, Smith, Watkins, Jiang, Davidson, Hoffman, Ashworth, Mabe, Babyak, Kraus, Hinderliter, and Sherwood, 2016). The client returns to the clinic in four weeks and reports that he feels “great,” his anxiety is getting “better,” and his HAM-A score has decreased from 23 to 13. However, he reports that he sometimes feels sleepy for a few hours after taking the medication, but “perks up” by early to midafternoon. I then decide to keep the same dose of Lexapro but have him take it at bedtime since it makes him tired.

    He reports a 50% decrease in symptoms in just 4 weeks. There might not be any need to increase the dosage at this point since his symptoms are improved and increasing the dose could instigate unwanted side effects. I would discuss this with him and how he can continue improving his symptoms with non-pharmacological treatment such as psychotherapy to help him better manage his symptoms even more. I would encourage him to continue monitoring his symptoms and to continue being seen on a routine basis to see if an adjustment in the medication would be warranted in the future.

    Anxiety can have profound effects on general health and well being. Many people do not think they have anxiety and continue with attempts in trying to get a medical diagnosis so they can find a cure. Anxiety can be very complicated as it is manifested with many physical ailments. It is important for the practitioner to approach the subject carefully with the client as many of them could be in denial.

    ****Here’s the link to the interactive step approach if you want to check this out. Just pick a different process and write 2 paragraphs about it. Just do your best I just need something to post. Thanks Jane!

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