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Disorder (GAD) is a mental health situation that makes the patient constantly worry about issues. It interferes with the ability to concentrate, affects sleeping patterns, and increases the feeling of possible terror. In the case of the male client, aged 46 years, he narrated experiencing cases of impending doom. In addition, the patient iterates the need to run to escape the situations within his surroundings. The client uses ethanol alcohol (ETOH) to enable him to withstand the worries he encounters at work. Furthermore, the patient consumes a significant amount of beer each night to slow down his nervous system and make him feel relaxed. According to the provided background information and the results of the mental diagnosis, it is clear that the client is suffering from GAD. The use of ETOH, impending doom, and feeling of nervousness are critical factors that I will consider while prescribing the medication.
Decision #1: Begin Paxil 10 mg PO Daily
Based on the patient’s background details and the Hamilton Anxiety Rating Scale (HAM-A) outcome that indicated 26, I will prescribe Paxil 10 mg PO daily to the client. I chose to administer Paxil since it is appropriate for treating GAD. The patient’s condition and HAM-A results showed that he was suffering from GAD, which can be managed by the drug (Strawn et al., 2018). Paxil is categorized among the antidepressants known as selective serotonin reuptake inhibitors (SSRIs).
I did not pick the Imipramine 25mg PO BID since the dosage is less for adults, and the drug does not treat GAD symptoms effectively. Similarly, Buspirone 10 mg PO BID is not an appropriate choice since it offers short-term management of the disorder (Rappaport et al., 2021). The patient responded effectively to the medications, and there was no need to add other forms of augmentation to the treatment.
By opting to use Paxil, I was hoping to manage and reduce the GAD symptoms exhibited by the patient. Paxil medication can induce a significant change in the client’s mood, which is essential for reducing anxiety (Giatti et al., 2021). Furthermore, I wanted to decrease the HAM-A rating from the previous 26. In addition, I was hoping to reduce the aspect of worries that the client has been having.
On matters of ethical concern, I will have to enhance autonomy by engaging the patient in decision-making on the possible treatment. In order to make the client corporative, I have to give him assurance of the confidentiality of his medical information (Mohsenabadi et al., 2019). Furthermore, I will engage in decision-making on issues such as changing medication to enhance his autonomy in the treatment process.
Decision #2: Increase the Dose to 20 mg PO Daily
Increasing the dose to 20mg is essential because it allows the monitoring of possible side effects associated with the drug. The slight adjustment will enable the patient’s body to adapt effectively to the medication. It will reduce the GAD symptoms and make the client feel relieved of the terror of anxiety (Strawn et al., 2018). In addition, the patient has been taking alcohol; therefore, having more dosage might negatively affect the health.
I did not increase the dosage to 40mg PO daily since the patient responded positively to the treatment. Furthermore, the symptoms reduced significantly, and the HAM-A reached 10. Increasing the dosage to 40 mg PO might enhance the occurrence of side effects. When the patient overdoses Paxil, he can experience nausea, vomiting, and headache, affecting his overall health outcome (Rappaport et al., 2021). Similarly, I did not opt to replace the drug since the patient already had no record in the client’s assessment that would prompt the change.
By choosing to increase the dosage to 20mg PO per day, I hope to measure and record the reaction of increased Paxil to the GAD symptoms. In addition, I expect severe symptoms such as work worries and nervousness to decline (Rappaport et al., 2021). The overall aim is to make the HAM-A rating drop significantly to indicate a reduction in the patient’s state of anxiety disorder.
Dealing with patients suffering from GAD is challenging, and precaution is necessary to ensure the individual completes medication. Several ethical aspects, such as the client’s safety concerns, determine the treatment method (Mohsenabadi et al., 2019). Failure to communicate effectively with the client on issues such as the type of medication or a change in medication may make them less corporative, leading to poor healthcare outcomes.
Decision #3: Maintain the Current Dose
The patient showed signs of improvement and a positive response to the dose. The client’s body is adapting accordingly, and the level of anxiety is decreasing. The GAD symptoms have already reduced, and the patient is no longer experiencing impending doom and other critical issues. Allowing the patient to continue with the same dose makes it easier to trace the side effects of the drug (Strawn et al., 2018). The HAM-A declined to the desired level; thus, there was no urgent need to increase the dosage. Furthermore, the patient might still be taking beer; hence, maintaining the dose will ensure no significant impact.
I choose not to increase the dose to 30 mg PO daily because of the possible side effects of the drug. Similarly, adding an augmentation agent such as Buspar (buspirone) is not appropriate since the combination of Paxil and Buspar might cause a serious condition known as serotonin syndrome. The imbalance of the chemical in the body might cause muscle rigidity and fevers (Giatti et al., 2021). The patient was already experiencing chest pain; thus, giving him Buspar might increase the problem.
By choosing to maintain the current dose, my focus is to fully evaluate the possible side effects of the drug. The current dosage of 20 mg PO daily has proven effective in treating the patient’s condition. In addition, I intend to limit possible side effects that might occur upon using excessive dosage or combining different medications (Giatti et al., 2021). Increasing the medication to 30 mg PO daily might increase negative effects, thus making the patient suffer.
In order to maintain the treatment approach, I must consider possible side effects that might be detrimental to the health of the patient. For instance, I will discuss with the client impacts of misusing the medication on his well-being. In case of increasing the dosage to 30 mg PO daily, I will discuss together with the patient to make him aware of the changes (Mohsenabadi et al., 2019). Furthermore, before making any change in the treatment method, I have to inform the client to make him feel part of the process
Conclusion
After examining the patient’s condition, the preferred treatment is Paxil 10 mg PO daily. The medication is directly linked with reducing the symptoms of GAD. Paxil facilitates the creation of serotonin chemicals needed by the brain to improve a person’s mood. After some time, the dosage should be increased to 20 mg PO daily. The sight adjustment is aimed at enabling the body of the client to adjust to the treatment for a better outcome. Finally, maintaining the dosage is crucial in preventing possible side effects that might complicate the health of the patient, such as serotonin syndrome.
References
Giatti, S., Diviccaro, S., Cioffi, L., Falvo, E., Caruso, D., & Melcangi, R. C. (2021). Effects of paroxetine treatment and its withdrawal on neurosteroidogenesis. Psychoneuroendocrinology, 132, 105364.
Mohsenabadi, H., Shabani, M. J., & Zanjani, Z. (2019). Factor structure and reliability of the mindfulness attention awareness scale for adolescents and the relationship between mindfulness and anxiety in adolescents. Iranian Journal of Psychiatry and Behavioral Sciences, 13(1).
Rappaport, L. M., Hunter, M. D., Russell, J. J., Pinard, G., Bleau, P., & Moskowitz, D. S. (2021). Emotional and interpersonal mechanisms in community SSRI treatment of social anxiety disorder. Journal of Psychiatry and Neuroscience, 46(1), E56-E64.
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: An evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057-1070.
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