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Generalized Anxiety Disorder
Discussion replay 1
Generalized anxiety disorder (GAD) is one of the commonest anxiety disorders, characterized by excessive and persistent worrying and anxiety about normal day-to-day circumstances such as job security, children’s well-being, health, and so forth (Newman et al.,2017). The DSM-V manual diagnostic criterion for GAD entails the presence of the described symptoms, with worry being the core criterion for most days for six months. There is also difficulty in controlling worry (Newman et al.,2017). For the assignment case study, a 56-year-old presented to the clinic having been referred by his primary care provider. He had earlier gone to the emergency room with symptoms of shortness of breath, chest tightness, and a feeling of impending doom. The tests run at the emergency room ruled out a myocardial infarction; hence he was referred to the psychiatric clinic for further evaluation.
On evaluation, the patient reports a history of alcohol consumption to help deal with his job concerns. The patient also reported consuming 3 to 4 beers in the evening to calm him as he was responsible for caring for his aging parents. Using the Hamilton Rating Anxiety Scale (HAM-A), the patient’s score was 26, indicating severe anxiety (Thompson, 2015). Therefore, history and evaluation indicated that the patient had GAD. This paper seeks to discuss how to evaluate and prescribe medication for clients requiring anxiolytic therapy, pharmacokinetics, and pharmacodynamics to be considered, and how they alter drug response.
Decision Steps based on Patient Factors
The patient was initially begun on 50 mg of Zoloft orally. Zoloft, a Selective Serotonin Reuptake Inhibitor (SSRI), is among the first lines for treating GAD alongside SNRIs, benzodiazepines, α2δ ligands, and buspirone. SSRIs have shown better and faster responses than serotonin-norepinephrine reuptake inhibitors (SNRIs). While imipramine, a tricyclic antidepressant, is also effective as an anxiolytic, it has adverse effects like cardiac arrhythmias, extrapyramidal symptoms, and so forth (Newman et al., 2017). It is also a sedative; hence may worsen sedative effects in someone taking alcohol and even promote suicidal ideation. Buspirone has no immediate anxiolytic effects as it takes 2 to 4 weeks for the onset of action and is typically administered to augment the actions of SSRIs and SNRIs. The client returns to the clinic in four weeks with reduced symptoms and a HAM-A of 18, down from 26. Also, there are no reported side effects.
For the second decision point, I decided to up the dosage of Zoloft to 75 mg since the patient experienced no side effects from the medication. The choice was to increase to 75 and not 100 to monitor response and avoid
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