Treatment Plan of Anxiety Disorders Therapy Essay
Plans of Anxiety Disorders Therapy
Decision #1
Begin Zoloft 50 mg orally daily
Reason for the Decision
Zoloft is a Selective Serotonin Reuptake Inhibitors (SSRIs), with proven efficacy and tolerability for treatment of generalized anxiety disorder. Selective Serotonin Reuptake Inhibitors (SSRIs) are the recommended first-line agents for the treatment of generalized anxiety disorders (Stahl, 2013). The other options at this point include Imipramine 25 mg PO BID and Buspirone 10 mg PO BID. Both Imipramine and Buspirone are a second-line agent for treatment of generalized anxiety disorder. Therefore it would not be appropriate to use second-line agent before giving the patient therapy with a first line agent (Connolly, 2007). Treatment Plan of Anxiety Disorders Therapy Essay
Expectation
According to Stahl (2013), the onset of therapeutic action of Zoloft is usually 2-4 weeks. The patient should be responding to the medication by the fourth week. At this point, the presenting symptoms such as chest tightness and shortness of the breath should begin to improve. The (HAM-A) score should decrease by over 25%.
Result and Expectation Difference
After four weeks, the client returns to the clinic and reports that he no longer feels chest tightness and shortness of breath. Additionally, his worries about his job have decreased over the past 4 to 5 days. HAM-A score has decreased from 26 to 18 representing a 30% decrease, which indicates a partial response to the medication. The result indicates that the patient is responding to the medications according to the expectation as he no longer feels chest tightness and shortness of breath. Additionally, the worries have also decreased.
Decision #2
Increase the dose to 75 mg orally daily
Reason for the Decision
The patient has shown a partial response to the medication and increasing the dosage will help enhance the treatment process. Since some improvement has been seen, it would be appropriate to increase the dosage and reassess after four weeks (Stahl, 2011). It would not be an appropriate decision to increase to 100 mg orally daily because this may cause dose-dependent side effects and offer insignificant therapeutic benefit. Additionally, it would not be appropriate to retain the same dosage because the patient has only shown a partial response to the medication. The same dosage may not yield any significant therapeutic benefit. Treatment Plan of Anxiety Disorders Therapy Essay
Expectation
The decision at this point will further improve the patient symptoms. Patient’s worry regarding his job will diminish. The patient’s (HAM-A) score will reduce by over 50%.
Expectation and Results Differences
The patient returns to the clinic after four weeks and reports even further reduction in the symptoms. The HAM-A has decreased to 10, which represents a 61 decrease in the symptoms. The outcome is according to the expectation. The patient has shown a significant response to the medication and the symptoms have greatly improved.
Decision #3
Maintain the current dose
Reason for the Decision
Based on the outcome of the decision, the patient is clearly having a good response to the medication as evidenced by over 61% reduction in the symptoms. Additionally, the patient has not reported any side effects associated with the current dosage. Therefore, it would be an appropriate decision to maintain the current dosage to the full effect of the medication (Strawn et al., 2012). Increasing the current dosage of medication to 100 mg orally daily is not appropriate because of the risk of potential side effects. Additionally, since the patient is responding well to the medication, adding an augmentation agent is not necessary.
Expectation
The patient will be allowed to continue the same dosage to the full effect of the medication. Complete alleviation of the symptoms is expected by the end of the twelfth week. The chest tightness, shortness of breath and the worries would have completely disappeared.
Ethical Consideration
Ethical considerations should be at the center of any therapeutic plan especially in the treatment of generalized anxiety disorder. It is appropriate to discuss the potential side effects of the medication, especially where dose increase may cause severe side effects (Kay, & Tasman, 2006). APA ethical codes require practitioners to obtain the patient’s consent before sharing any confidential information regarding the treatment to a third party. The informed consent should be frequently revisited during the entire treatment process. It is essential to involve the patient in making critical decisions including changing the agent, increasing and decreasing the medication dosage. Treatment Plan of Anxiety Disorders Therapy Essay
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Treatment Plan of Anxiety Disorders Therapy
Decision Point One
Begin Zoloft 50 mg orally daily
Rationale for the Decision
Zoloft was selected because it is a Selective Serotonin Reuptake Inhibitors (SSRI) that has demonstrated to be effective in treating generalized anxiety disorder (GAD). Zoloft is also well tolerated. Additionally, SSRIs such as Zoloft are the first-line recommended medications in the treatment of GAD (Stahl, 2013). The options of Buspirone 10 mg PO BID and Imipramine 25 mg PO BID were not selected because these two medications are second-line medications in the treatment of GAD. It is always recommended to use a first-line mediation before prescribing a second-line medication for a patient (Bandelow et al., 2017).
Expectation
The onset of Zoloft’s therapeutic action is normally between two to four weeks (Stahl, 2013). Therefore, it is expected that the client would start showing symptom improvement by the fourth week. The symptom improvement would manifest by a reduction of symptoms such as breath shortness or chest tightness.
Outcome and Expectation Difference
The client returned for a review after four weeks and he reported that both breath shortness and chest tightness had cleared. The client also reported that he was no longer worrying about his job. Moreover, the HAM-A score reduced from 26-16, indicating a 30% symptom reduction. This demonstrated a partial response to Zoloft medication. According to these results, just as it was expected, the client responded to the medication as he had stopped worrying about his job and he was no longer experiencing breath shortness or chest tightness.
Decision Point Two
Increase the dose to 75 mg orally daily
Rationale for the Decision
The decision to increase the Zoloft dose was selected since the client has manifested a partial response to the agent. Therefore, an increased dose would help in enhancing the treatment process (Stahl, 2011). The decision to have the dose increased to 100 mg was not selected since this may cause significant side effects. Moreover, it is not recommendable to maintain the dose since the patient is manifesting a partial response to Zoloft 50 mg. The same dose might not produce the maximum therapeutic benefit.
Expectation
It is expected that increased the Zoloft dose to 75 mg would lead to further symptom improvement and that the client would tolerate the increased dose.
Expectation and Results Differences
After four weeks, the client returned and reported a further symptom decrease. Symptom improvement was further indicated by the reduced HAM-A score to 10, representing a 61-symptom reduction. As per the expectation, the client manifested further symptom reduction. Treatment Plan of Anxiety Disorders Therapy Essay
Decision Point Three
Maintain the current dose
Rationale for the Decision
The client adequately responded to the Zoloft 75 mg as indicated by more than 62% symptom reduction. Moreover, the client tolerated the increased dose. Therefore, a suitable decision is maintaining the current dose of Zoloft 75 mg (Feng et al., 2018). The decision to increase the Zoloft dose to 100 mg was not chosen to avoid possible side effects. The decision to augment the dose was not selected as there is no clinical reason since the client is already responding well to the dose of Zoloft 75 mg.
Expectation
It is expected that by the client continuing with the same dose of Zoloft 75 mg, this would lead to complete symptom remission.
Ethical Consideration
It is important to integrate ethical aspects in patients’ treatment plans. Informed consent is a very important ethical aspect to consider during the treatment process. Therefore, it is very important to discuss the possible side effects of the available treatment options to allow the patient to make informed treatment choices (Darby & Weinstock, 2018). Moreover, confidentiality and privacy are important ethical considerations during the treatment process. According to the APA ethical codes, healthcare providers should obtain the consent of patients before disclosing patients’ health information to a third party. It is also important to ensure that the client is involved in the treatment process, including decisions to change medications, increase or decrease the dose.
References
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107.
Darby, W. C., & Weinstock, R. (2018). The Limits of Confidentiality: Informed Consent and Psychotherapy. Focus (American Psychiatric Publishing), 16(4), 395–401. https://doi.org/10.1176/appi.focus.20180020.
Feng, R., Wang, P., Gao, C., Yang, J., Chen, Z., Yang, Y., Jiao, J., Li, M., Fu, B., Li, L., Zhang, Z., & Wang, S. (2018). Effect of sertraline in the treatment and prevention of poststroke depression: A meta-analysis. Medicine, 97(49), e13453. https://doi.org/10.1097/MD.0000000000013453.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
