For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.
To Prepare
- Review this week’s interactive media pieces and select one to focus on for this Discussion.
- Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.
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Generalized Anxiety DisorderMiddle-Aged White Male With Anxiety:
BACKGROUND INFORMATION
The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.
He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.
In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.
Client has never been on any type of psychotropic medication.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
You administers the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
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RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.
Expert Answer and Explanation
Decision Making When Treating Psychological Disorders
Healthcare givers need to exercise a high level of precaution when treating patients with psychological disorders, as most of them do not have the capability of defining their care needs. There are, however, several complications that are found in these patients, and can help a healthcare giver to identify the best form of therapy for them (Osei-Bonsu et al., 2017). A 46 y.o. pt. presents to the facility with a fear of heart attack, and several indications of the presence of a mental illness. An application of an interactive media file from CDN files helps to project some of the decisions that could help the patient.
After assessing the mental state of the patient, it is clear that he is alert, and sensitive to time, place and event, including being well-dressed and having a clear speech. He has a bleh mood, indicating an indifference to the situation, but his affect is blunted. He also denies having thought processes that are paranoid or suicidal thoughts. He also has a HAM-A score of 26.
In the decision point one from the interactive media file, I would begin Tofranil (imipramine) 25 mg orally BID. The results of the decision would be a return of the client to the facility in four weeks, a slight decrease of symptoms, and HAM-A score would decrease to 22 (CDN Files, 2020). Also, administering the tofranil (imipramine) 25 mg orally BID would remove chest tightness, but the patient would still have occasional shortness of breath.
In the decision point two, I would add an augmentation agent such as BuSpar (buspirone) 5 mg orally TID. The result would be a return of the client to the facility in four weeks, and the symptoms would be pretty much unchanged, as he would still encounter things such as dizziness. However, the therapy would reduce the HAM-A score from 22 to 19 (CDN Files, 2020).
In decision point three of the interactive media file, I would discontinue Tofranil and BuSpar and begin Paxil 20 mg orally daily. Other alternatives such as increasing the Tofranil would lead to problems as the side effects would still persist, and this could negatively affect the quality of life of the patient (CDN Files, 2020). Also, Buspar should not be continued as it was only used as a second line therapy, and has not received enough trial as a first line therapy. It would be prudent to discontinue Tofranil and BuSpar, as they have not had significant results with the patient, and introduce Paxil, which is an SSRI and is likely to have more significant results (Melville et al., 2010). Nevertheless, it is crucial for the patient to return to the clinic after four weeks, so as to assess the action of Paxil.
The pharmacotherapy recommended may impact the patients’ pathophysiology as they have a direct effect on the hormonal balance of the body. Specifically, the drugs are likely to result in some conditions such as hypertension (Hundt et al., 2016). I would therefore suggest treatment plans that help the patient to solve some of the negative pathophysiological changes initiated by the body (Fisher et al., 2018). For example, since he works in a steel welding company where the temperatures are likely to be extremely high, part of the therapy would entail asking him to take a sick live to avoid the chances of occupational-induced hypertension or reaction to the drugs.
References
CDN Files, (2020). Generalized Anxiety Disorder. Retrieved from http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_05/index.html
Hundt, N. E., Harik, J. M., Barrera, T. L., Cully, J. A., & Stanley, M. A. (2016). Treatment decision-making for posttraumatic stress disorder: The impact of patient and therapist characteristics. Psychological Trauma: Theory, Research, Practice, and Policy, 8(6), 728.
Fisher, A., Manicavasagar, V., Sharpe, L., Laidsaar-Powell, R., & Juraskova, I. (2018). A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder. Journal of Mental Health, 27(1), 66-79.
Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2010). Dropout from Internet‐based treatment for psychological disorders. British Journal of Clinical Psychology, 49(4), 455-471.
Osei-Bonsu, P. E., Bolton, R. E., Stirman, S. W., Eisen, S. V., Herz, L., & Pellowe, M. E. (2017). Mental health providers’ decision-making around the implementation of evidence-based treatment for PTSD. The journal of behavioral health services & research, 44(2), 213-223.
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