Explain how ethical considerations may impact your treatment plan and communication with patients.

Formal Decision Tree 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.
Be
aware that the writing template and grading rubric require your
introduction to end with one sentence that is your thesis
statement. See the writing template for format and the grading
rubric for details on how you are graded on this statement.
Body of your document
The
body of your document should contain three sections that are labeled as
follows: decision #1, decision #2, and decision #3. Each
section should address the topics below. In your writing, you should
be concise, clear, and thorough. Pharmacokinetics, pharmacodynamics,
and specific patient factors must be considered in your writing in order
to get full credit.
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. *Ethical
considerations must be clearly identified/labeled. You can identify
them within the decision section (“My ethical considerations are…”), or
you can identify them separately in a section labeled “Ethical
Considerations.” Either option is acceptable.
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.
Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety
Decision Point One

Begin Buspirone 10 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client reports slight decrease in symptoms
Client states that he still feels very anxious
HAM-A score decreased from 26 to 23
Decision Point Two

Increase buspirone to 10 mg orally TID
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client reports no change in his anxiety
HAM-A score has decreased from 23 to 22
Decision Point Three

Discontinue buspirone and begin Zoloft 50 mg orally daily
Guidance to Student
It is clear that buspirone has resulted in treatment failure as the client’s original HAM-A score was 26- a change in score from 26 to 22 is less than a 25% improvement in symptoms which constitutes treatment failure. It would not be appropriate to continue the same dose and reassess in 4 weeks as onset of therapeutic action for buspirone is around 2 weeks. At least a modest improvement should have been noted by now, if the drug were to work. If the client is having no side effects, you can discuss the possibility of increasing dose and re-evaluating in another 4 weeks. However, if the client remains distressed by his symptoms, the appropriate course of action would be to discontinue the buspirone and begin SSRI therapy with an agent such as Zoloft 50 mg orally daily.

Augmentation with an agent such as lorazepam 0.5 mg orally TID would not be appropriate at this time as the client needs a treatment plan for the long-term. You should never start someone on a benzodiazepine for an indefinite course of treatment as this could lead to addiction. Benzodiazepines should be used for a limited course of treatment for very specific therapeutic endpoints (for instance, to combat the initial activation which may be seen in the first few weeks after beginning an SSRI or SNRI).

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