Psychiatric Nursing

Anxiolytic Therapy & PTSD Treatment

“I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.”
—P.K. Philips, PTSD patient

For individuals suffering from posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge.

Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments.

As a psychiatric mental health nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.

This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of clients with PTSD and other anxiety disorders. You also explore the ethical and legal implications of these therapies.

 

• Assignment: Assessing and Treating Clients 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 clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.

Learning Objectives

Students will:

• –Assess client factors and history to develop personalized plans of anxiolytic therapy for clients
• –Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring anxiolytic therapy
• –Evaluate the efficacy of treatment plans
• –Analyze ethical and legal implications related to prescribing anxiolytic therapy to clients across the lifespan.

the sample that can be an audit and submit with plagiarism less than 15%

• Assessing and Treating Clients with Anxiety Disorder

Anxiety disorders are the most prevalent category of mental illness and are characterized by chronic anxiety causing distress and interference in the individual’s life. According to DSM-5, excessive anxiety and worry must cause significant distress or impairment and occurs on more days than not for at least six months for diagnostic criteria (Stein et al., 2015) The disorder can be effectively treated with medication, psychotherapy, or a combination of the two modalities.

This paper addresses the pharmacology approach in treating a 46 year- old white male who is experiencing anxiety, and the impact pharmacokinetic and pharmadynamic processes will be explored to guide for the appropriate treatment.

Case Scenario

A 46-year-old white male who initially presented to ER with a complaint of chest pain and cardiac workup was negative, and a PMHNP consult was sought for psychiatric evaluation. The client ‘s Hamilton Anxiety Rating Scale( HAM-A) was 26 indicating moderate to severe anxiety phase. The PMHNP decides to start the client on medications.

Options: Zoloft 50 mg Po Daily, imipramine 25 mg po BID, buspirone 10 mg BID. 

Decision: Zoloft 50 mg PO daily.

Rationale: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs ) benzodiazepines, buspirone, and α2δ ligands such as pregabalin and gabapentin are recommended as first-line treatments for anxiety disorders spectrum (Stahl, 2017) However,  SSRI and SNRIs are efficacious in the treatment of generalized anxiety disorder (GAD) and panic attack as in the case of our patient in the scenario. Additionally, in cases of co-occurring GAD and depression, a common comorbidity, SSRIs can provide effective treatment for both GAD and major depression ( Johnson & Coles, 2014).

Selecting sertraline (Zoloft) was based on the fact it belongs to the family of SSRI, and well recognized in the treatment of GAD and panic attack. Secondly, possible side effects of Zoloft which include sexual dysfunction, gastrointestinal abnormalities (nausea and diarrhea), insomnia, weight gain, and agitation and/or hyperactivation (Kamo et al.,2016) were explored prior selecting Zoloft. The patient was overweight (15 lb), hence a healthy lifestyle will be important for education, and the rest of the side effects can be monitored and managed early in treatment.

Sertraline affects the serotonin neurotransmitter in the synaptic cleft by blocking the serotonin transporter from returning the remaining serotonin to the presynaptic cell. Sertraline is well absorbed in the gastrointestinal tract, highly protein bound, predominantly metabolized by CYP 450 system with a half-life of 24- 26 hrs and removed primarily by kidneys ( Woo & Wayne, 2013).

Imipramine, a tricyclic antidepressant was not my first choice because of its possible side effects: blurred vision, dry mouth, urinary retention, drowsiness, weight gain, hypotension, and seizures (Stahl,2017)

Buspirone (Buspar), a serotonin receptor partial agonist can be appropriate for augmentation but not as first-line treatment of GAD. Additionally, Buspirone takes longer (2 – 4 weeks) to have a full effect, and due to its sedation side effect, it would not be appropriate in our patient who has a history of increased alcohol intake.

The goals of treatment of anxiety disorders are a resolution of symptoms and prevention of relapse.

The client returns in four weeks, responding well to medication, anxiety decreased HAM-A 18 from 26.

Options: Increase dose to 75 mg daily, increase the dose to 100 mg daily, no change in drug/ dosage

Decision # 2 Increase dose to 75 mg daily. 

Rationale: Sertraline dosing in panic, PTSD, and social anxiety begin with 25 mg/day; increase to 50 mg/day after 1 week thereafter, usually wait a few weeks to assess drug effects before increasing dose; maximum generally 200 mg/day; single dose (Stahl,2017).

Moreover, increasing dosage slowly will reduce the possibility of acquiring side effects from the medication (Stein et al., 2014)

The client returns in four weeks report a further reduction in anxiety symptoms HAM-A 10 (mild anxiety)

Options: Maintain current dose, increase to 100 mg daily, add Buspirone. 

Decision: Maintain current dose

Rationale: Major errors in the psychopharmacological treatment of anxiety disorders include not achieving full remission of symptoms but instead accepting the partial response, and not providing an adequate trial of medications (8 to 12 weeks ) before switching, discontinuing, or augmenting ( Woo & Wayne, 2013). The patient was responding pretty well to medication ( 50% reduction in symptoms) and reported no side effects. Therefore, continuing the same dosage, providing regular follow up with the patient to ensure medication adherence would be appropriate to meet the goals of remission.