Assignment: Assessing
and Treating Patients 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 patients to seek care from their primary care providers or
emergency departments. Once it is determined that there is no organic basis for
these symptoms, patients are typically referred to a psychiatric mental health
practitioner for anxiolytic therapy. For this Assignment, as you examine the
patient case study in this week’s Learning Resources, consider how you might
assess and treat patients presenting with anxiety disorders.
To prepare for this
Assignment:
Review this week’s Learning Resources, including the
Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might
recommend for the assessment and treatment of patients requiring
anxiolytic therapy.
The Assignment: 5
pages
Examine Case Study: A Middle-Aged
Caucasian Man With Anxiety. You will be asked to make three decisions
concerning the medication to prescribe to this patient. Be sure to consider
factors that might impact the patient’s pharmacokinetic and pharmacodynamic
processes.
At each decision point, you should evaluate all
options before selecting your decision and moving throughout the exercise.
Before you make your decision, make sure that you have researched each option
and that you evaluate the decision that you will select. Be sure to research
each option using the primary literature.
Introduction to the
case (1 page)
Briefly explain and summarize the case for this
Assignment. Be sure to include the specific patient factors that may
impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and
support your response with clinically relevant and patient-specific
resources, including the primary literature.
Why did you not select the other two options provided
in the exercise? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this
decision? Support your response with evidence and references to the
Learning Resources (including the primary literature).
Explain how ethical considerations may impact your
treatment plan and communication with patients. Be specific and provide
examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and
support your response with clinically relevant and patient-specific
resources, including the primary literature.
Why did you not select the other two options provided
in the exercise? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this
decision? Support your response with evidence and references to the
Learning Resources (including the primary literature).
Explain how ethical considerations may impact your
treatment plan and communication with patients. Be specific and provide
examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and
support your response with clinically relevant and patient-specific
resources, including the primary literature.
Why did you not select the other two options provided
in the exercise? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision?
Support your response with evidence and references to the Learning
Resources (including the primary literature).
Explain how ethical considerations may impact your
treatment plan and communication with patients. Be specific and provide
examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options
you selected for this patient. Be sure to justify your recommendations and
support your response with clinically relevant and patient-specific
resources, including the primary literature.
Note: Support your rationale with a minimum of five
academic resources. While you may use the course text to support your
rationale, it will not count toward the resource requirement. You should be
utilizing the primary and secondary literature.
Reminder : The College of
Nursing requires that all papers submitted include a title page, introduction,
summary, and references. The Sample Paper provided at the Walden Writing Center
provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632).
All papers submitted must use this formatting.
Grading Rubric:
Introduction to the case (1 page)
Briefly explain and summarize the case for this
Assignment. Be sure to include the specific patient factors that may impact
your decision making when prescribing medication for this patient.
The response accurately, clearly, and fully summarizes in
detail the case for the Assignment.
The response accurately and clearly explains in
detail the specific patient factors that impact decision making when
prescribing medication for this patient.
Decision #1 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific
and support your response with clinically relevant and patient-specific
resources, including the primary literature.
• Why did you not select the other two options
provided in the exercise? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this
decision? Support your response with evidence and references to the Learning
Resources (including the primary literature).
• Explain how ethical considerations may impact
your treatment plan and communication with patients. Be specific and provide
examples.
The response accurately and clearly explains in detail the
decision selected.
The response accurately and clearly explains in
detail why the decision was selected, with specific clinically relevant
resources that fully support the decision selected.
The response accurately and clearly explains in
detail why the other two responses were not selected, with specific clinically
relevant resources that fully support the response.
The response accurately and clearly explains in
detail the outcome the student was hoping to achieve with the selected
decision, with specific clinically relevant resources that fully support the
response.
The response accurately and clearly explains in
detail how ethical considerations impact the treatment plan and communication
with patients.
Examples provided fully support the decisions and
responses provided.
Decision #2 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific
and support your response with clinically relevant and patient-specific
resources, including the primary literature.
• Why did you not select the other two options
provided in the exercise? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this
decision? Support your response with evidence and references to the Learning
Resources (including the primary literature).
• Explain how ethical considerations may impact
your treatment plan and communication with patients. Be specific and provide
examples.
The response accurately and clearly explains in detail the
decision selected.
The response accurately and clearly explains in
detail why the decision was selected, with specific clinically relevant
resources that fully support the decision selected.
The response accurately and clearly explains in
detail why the other two responses were not selected, with specific clinically
relevant resources that fully support the response.
The response accurately and clearly explains in
detail the outcome the student was hoping to achieve with the selected
decision, with specific clinically relevant resources that fully support the
response.
The response accurately and clearly explains in
detail how ethical considerations impact the treatment plan and communication
with patients.
Exam Decision #3 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific
and support your response with clinically relevant and patient-specific
resources, including the primary literature.
• Why did you not select the other two options
provided in the exercise? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this
decision? Support your response with evidence and references to the Learning
Resources (including the primary literature).
• Explain how ethical considerations may impact
your treatment plan and communication with patients. Be specific and provide
examples.
The response accurately and clearly explains in detail the
decision selected.
The response accurately and clearly explains in
detail why the decision was selected, with specific clinically relevant resources
that fully support the decision selected.
The response accurately and clearly explains in
detail why the other two responses were not selected, with specific clinically
relevant resources that fully support the response.
The response accurately and clearly explains in
detail the outcome the student was hoping to achieve with the selected
decision, with specific clinically relevant resources that fully support the
response.
The response accurately and clearly explains in
detail how ethical considerations impact the treatment plan and communication
with patients.
Examples provided fully support the decisions and
responses provided.
Conclusion (1 page)
• Summarize your recommendations on the treatment
options you selected for this patient. Be sure to justify your recommendations
and support your response with clinically relevant and patient-specific
resources, including the primary literature.
The response accurately and clearly summarizes in detail the
recommendations on the treatment options selected for this patient.
The response accurately and clearly explains a
justification for the recommendations provided, including clinically relevant
resources that fully support the recommendations provided.
Written Expression and Formatting – Paragraph
Development and Organization:
Paragraphs make clear points that support
well-developed ideas, flow logically, and demonstrate continuity of ideas.
Sentences are carefully focused—neither long and rambling nor short and lacking
substance. A clear and comprehensive purpose statement and introduction are
provided that delineate all required criteria.
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity.
A clear and comprehensive purpose statement,
introduction, and conclusion are provided that delineate all required criteria.
Use at least five peer reviewed sources dated 5
years or less (2016 – 2021).
Click on the “tabs” in the case study attached
to revealed decision 1, 2, and 3.
Generalized Anxiety Disorder
Middle-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 administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Decision Point One
Select what you should do:
Begin Zoloft 50 mg po daily
Begin Imipramine 25 mg po BID
Begin Buspirone 10 mg po BID
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