Week 5: Anxiolytic Therapy & PTSD Treatment

“I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.”
—P.K. Philips, PTSD patient

For individuals suffering from posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric mental health nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.

This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of clients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.

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Assignment: Assessing and Treating Clients 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 clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.

Learning Objectives

Students will:

• –Assess client factors and history to develop personalized plans of anxiolytic therapy for clients
• –Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring anxiolytic therapy
• –Evaluate efficacy of treatment plans
• –Analyze ethical and legal implications related to prescribing anxiolytic therapy to clients across the lifespan.

sample that can be audit and submit with plagiarism less than 15% 

  

Assessing and Treating Clients with Anxiety Disorder 

  Assessing and Treating Clients with Anxiety Disorders.

Anxiety disorders are the most prevalent category of mental illness and are characterized by chronic anxiety causing distress and interference in the individual’s life. According to DSM-5, excessive anxiety and worry must cause significant distress or impairment and occurs on more days than not for at least six months for diagnostic criteria (Stein et al., 2015) The disorder can be effectively treated with medication, psychotherapy, or a combination of the two modalities. 

This paper addresses the pharmacology approach in treating a 46 year- old white male who is experiencing anxiety, and the impact pharmacokinetic and pharmadynamic processes will be explored to guide for the appropriate treatment. 

Case Scenario

A 46-year-old white male who initially presented to ER with a complaint of chest pain and cardiac work- up was negative, and a PMHNP consult was sought for psychiatric evaluation. The client ‘s Hamilton Anxiety Rating Scale( HAM-A) was 26 indicating moderate to severe anxiety phase. The PMHNP decides to start the client on medications. 

 Options: Zoloft 50 mg Po Daily, imipramine 25 mg po BID, buspirone 10 mg BID. 

 Decision: Zoloft 50 mg PO daily.

Rationale: Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs ) benzodiazepines, buspirone, and α2δ ligands such as pregabalin and gabapentin are recommended as first line treatments for anxiety disorders spectrum (Stahl, 2017) However,  SSRI and SNRIs are efficacious in the treatment of generalized anxiety disorder (GAD) and panic attack as in the case of our patient in the scenario. Additionally, in cases of co-occurring GAD and depression, a common comorbidity, SSRIs can provide effective treatment for both GAD and major depression ( Johnson & Coles, 2014) .

Selecting sertraline (Zoloft) was based on the fact it belongs to the family of SSRI, and well recognized in the treatment of GAD and panic attack. Secondly, possible side effects of Zoloft which include sexual dysfunction, gastrointestinal abnormalities (nausea and diarrhea), insomnia, weight gain, and agitation and/or hyperactivation (Kamo et al.,2016) were explored prior selecting Zoloft. The patient was overweight (15 lb), hence a healthy lifestyle will be important for education, and the rest of side effects can be monitored and managed early in treatment.   

Sertraline affects the serotonin neurotransmitter in the synaptic cleft by blocking the serotonin transporter from returning the remaining serotonin to the presynaptic cell. Sertraline is well absorbed in gastrointestinal tract, highly protein bound, predominantly metabolized by CYP 450 system  with half-life of 24- 26 hrs and removed primarily  by kidneys ( Woo & Wayne, 2013).  

Imipramine, a tricyclic antidepressant was not my first choice because its possible side effects: blurred vision, dry mouth, urinary retention, drowsiness, weight gain, hypotension, and seizures (Stahl,2017)

Buspirone (Buspar), a serotonin receptor partial agonist can be appropriate for augmentation but not as first line treatment of GAD. Additionally, Buspirone takes longer (2 – 4 weeks) to have a full effect, and due to its sedation side effect, it would not be appropriate in our patient who has history of increased alcohol intake.

 The goals of treatment of anxiety disorders are resolution of symptoms and prevention of relapse. 

The client returns in four weeks, responding well to medication, anxiety decreased HAM A 18 from 26. 

Options : Increase dose to 75 mg daily, increase dose to 100 mg daily, no change in drug/ dosage

Decision # 2 Increase dose to 75 mg daily. 

Rationale: Sertraline dosing in panic, PTSD, and social anxiety begin with 25 mg/day; increase to 50 mg/day after 1 week thereafter, usually wait a few weeks to assess drug effects before increasing dose; maximum generally 200 mg/day; single dose (Stahl,2017).

 Moreover, increasing dosage slowly will reduce the possibility of acquiring side effects from the medication (Stein et al., 2014)

The client returns in four weeks, reports further reduction in anxiety symptoms HAM- A 10 (mild anxiety) 

Options: Maintain current dose, increase to 100 mg daily, add Buspirone. 

Decision: Maintain current dose 

Rationale: Major errors in psychopharmacological treatment of anxiety disorders include not achieving full remission of symptoms but instead accepting partial response, and not providing an adequate trial of medications (8 to 12 weeks ) before switching, discontinuing, or augmenting ( Woo & Wayne, 2013) . The patient was responding pretty well to medication ( 50% reduction in symptoms) , and reported no side effects. Therefore, continuing the same dosage, providing regular follow up with the patient to ensure medication adherence would be appropriate to meet the goals of remission. 

References

Johnson, E. M., & Coles, M. E. (2014). Failure and Delay in Treatment-Seeking Across Anxiety Disorders. Community Mental Health Journal, 49(6), 668-674. Retrieved from https://web-a-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=29&sid=7eabbc3a-b3a4-4cbf-b934-aa75c2e5b6fd%40sessionmgr4007

Kamo, T., Maeda, M., Oe, M., Kato, H., Shigemura, J., Kuribayashi, K., & Hoshino, Y. (2016). Dosage, effectiveness, and safety of sertraline treatment for posttraumatic stress disorder in a Japanese clinical setting: a retrospective study. BMC Psychiatry, 16(1). Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=6&sid=2ee0b7c6-b1c7-44e7-9b93-42c3b9a745c3%40sessionmgr102

Stein, D. J., Craske, M. A., Friedman, M. J., & Phillips, K. A. (2014). Anxiety Disorders, Obsessive-Compulsive and Related Disorders, Trauma- and Stressor-Related Disorders, and Dissociative Disorders in DSM-5. American Journal of Psychiatry, 171(6), 611-613. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14010003

Woo, T. M., & Wynne, A. L. (2013). Pharmacotherapeutics for nurse practitioner prescribers(3rd ed.). Philadelphia, PA: F.A. Davis Co.

 

• Decision #1
  • Which decision did you select?
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.

Questions:

1. On the initial home visit by the nurse, what assessments should be made?
2. The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
3. During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?                  2 pages not including title page and reference page

Role of Opioid Education for the Youth

Discussion:Results

Opioid misuse is decreasing. For example, among high school seniors, the year past misuse of pain medication, heroine excluded, went down from a peak of 9.5 in the year 2004 to 3.4 percent in the year 2018. In the past year, the use misuse of Vicodin went down from peak of 10.5 percent in the year 2003 to a percentage of 1.7 in 2018, lastly the misuse of OxyContin has dropped from a peak rate of 5.5 percentage in the year 2005 to 2.3 percent in the year 2018. In addition, students in the 12th grade believe that it is harder to obtain opioid now than in the past. In 2010, 54% of 12th grade students believed that it was easy to access opioids as compared to 32.5% in 2018 (Hubbell & Reid, 2018). In this case this can be attributed to the awareness that has been created by educating youths about these substances and their effects towards someone. Commercials in the media also work very well in creating an awareness.

Adolescence is a critical stage of life for one to become addicted to a substance. This is due to a lot of factors that were mentioned by some students. This is a stage of self-realization and to some may be confusing and containing mixed emotions. This is due to a teenager trying to understand themselves and what they are meant to become in future, at the same time trying to keep up with the current trends as well as blending with his/her age mates. This can lead to a teenager to take the drugs to escape reality or to fit in with other teenagers who are using opioids for recreational purposes (McDONOUGH, 2016). 

The brain’s reward center, matures rapidly during the years preceding adolescence. During this period, children begin to discriminate more carefully between less and more meaningful rewards, a capacity that underlies goal driven behaviors and internal motivation. As much as kids are easily rewarded, even using abstract tokens, as they get to their adolescence, they become more selective in terms of the goals they think are worth pursuing. This phenomenon gets to its peak when children get to their adolescence, at which time presentation of small and meaningless reward will result into deactivation of the brain’s reward center (Reid, Wild, & Bozarth, 2020). This means that, adolescents are developmentally conditioned to look for high stimulating behavior so as to acquire a large neurologic reward, this trait is recognizable in the risk taking behaviors that are often associated with people in this stage of life. Unlike the rewards that happen naturally, psychoactive substances trigger signaling in the reward center through the direct receptor binding (Bain & Kornetsky, 2020). Although this is unhealthy, substance use fills a developmental drive for stimulation in this particular area of the brain effectively. As one would predict, the peak ages of substance use initiation occurs during adolescence and early childhood.

At the end of the behavioral control hardware, the prefrontal cortex, that is responsible for executive functions which are crucial to decision making, this are functions such as self-monitoring, impulse control and error correction and thus this serves as a behavioral brake system, it does not mature to its full potential until the middle of the third decade of living. As a result of this, adolescents are unable and unskilled to conduct these functions and deterred by risk than the adults. In addition to this, immaturity of the prefrontal cortex during this developmental stage appear to leave the brain’s reward center more vulnerable and prone to developing the changes which might result into a neurologic disorder of addiction (Knopf, 2017). 

Relatively fewer exposures result in substance use disorder symptoms among teenagers compared to adults, and also the risk of developing a substance use disorder (SUD) is in a way related with age of initiation. For example, children who are initiated into drinking alcohol before the age of 14 years are 5 times more likely to develop an addiction as compared to those that started drinking from the age of 19.this pattern is similar to one seen with both marijuana and the misuse of prescription opioid medication (Satterley & Anitescu, 2015). Indeed, delayed substance use initiation into adulthood is associated with a reduced risk of one ever developing an SUD. This is one of the reasons and importance for the government early interventions and prevention strategies that are designed to delay initiation as well as a reduced use in this group.

Psychologic vulnerability to substance use is aggravated by environmental factors, these include the availability, promotion and modeling of substance use behaviors (Bain & Kornetsky, 2020). Through science it has been said that teenagers are particularly sensitive to the influence of cultural messaging. The three most used substances by the adolescents are marijuana, alcohol and tobacco. The three choices are driven by either the availability and also cultural acceptability, this includes the perceived harm they bring. In the late 1990s, availability of prescription pain medications served as a perfect invitation to start using opioids for recreational purposes by teenagers as well as developing its addiction. The combination of the promotion of opioid medication to be safe with easy access through diverted prescription (McDONOUGH, 2016). They can be found in family medicine cabinet. Unlike heroin in the 1970s, which was induced by injection, opioid pills could be swallowed or snorted after being crushed into a powder, this further lowering the bars of invitation.

What the Professor said: “You should not interpret the findings in the Results Section! Please fix!”

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Role of Opioid Education for the Youth 2

Discussion:Limitations & Implication/Conclusion

Limitations & Conclusion

Creating awareness of these substances and how they are abused has had its dark sides too. For instance through raising awareness many teenagers have gained information about the opioids and due to teenagers and young adults curiosity, they might get tempted to try them out without having considered the consequences. The TV commercials might be the best way for students finding out where and how to acquire the substance (Knopf, 2017). This has seen the media make the use of opioids for their euphoric feel more acceptable and common in people’s minds. This is opposite to what is usually the case with marijuana, cocaine and heroin. Due to them not being televised against, the society still holds them with the same perspective as they did in the past. Opioids on the other hand have grown to being more acceptable thanks to the media.

In schools it is hard for every school to talk about the subject. This is because teachers cannot control what happens outside the school compound and most students will still use their free time from school to use all these substances for their euphoric feel despite having taught against opioids in class (Bain & Kornetsky, 2020). This has been supported by just how available the opioids are and the nature of conditions they are used to treat, this is to mean that they are basic drugs and can be found in almost all chemists and can be used to ease pain which might mean a lot of different pain. This is to say that the reason for one to go and buy an opioid is common and this supports the continued usage of opioids (McDONOUGH, 2016).

Conclusion

Opioid abuse has become a national disaster and requires more intense methods of stopping it to the ones that are being used at the moment. This should be inclusive of teaching youths on the adverse effects that using the drug might bring to them as well as their health. The approach towards the youths too should change a little too (Drake, 2017). This is because experts should understand that they are dealing with young, creative minds with a lot of energy and this should influence their way of delivery. Finding ways that will capture youth’s attention and use it to administer the kind of learning that the youths will find most effective and can relate to. This will make their listening skills better. A lot of young lives are being wasted or even die due to addiction to opioids. This is sad and needs to be addressed with a lot of vehemence. The government should continue teaching about the substances and advising against them too. The availability of opioids needs to be cut and made a little more complicated for anyone to get the drugs with or without a prescription (Pfeiffer, 2019). The government has been really trying to work their course of eliminating the opioid abuse by youths. As it is, more and more youths have developed an addiction towards opioids. The role of opioid education in the youth is most needed now.

What the professor said: “Incomplete! You need to provide detailed explanation on all limitations and their corresponding implications. “

The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and acceptance of a diversity of faith expressions.

The purpose of this paper is to complete a comparative ethical analysis of George’s situation and decision from the perspective of two worldviews or religions: Christianity and a second religion of your choosing. For the second faith, choose a faith that is unfamiliar to you. Examples of faiths to choose from include Sikh, Baha’i, Buddhism, Shintoism, etc.

In your comparative analysis, address all of the worldview questions in detail for Christianity and your selected faith. Refer to Chapter 2 of Called to Care for the list of questions. Once you have outlined the worldview of each religion, begin your ethical analysis from each perspective.

In a minimum of 1,500-2,000 words, provide an ethical analysis based upon the different belief systems, reinforcing major themes with insights gained from your research, and answering the following questions based on the research:

1. How would each religion interpret the nature of George’s malady and suffering? Is there a “why” to his disease and suffering? (i.e., is there a reason for why George is ill, beyond the reality of physical malady?)
2. In George’s analysis of his own life, how would each religion think about the value of his life as a person, and value of his life with ALS?
3. What sorts of values and considerations would each religion focus on in deliberating about whether or not George should opt for euthanasia?
4. Given the above, what options would be morally justified under each religion for George and why?
5. Finally, present and defend your own view.

Support your position by referencing at least three academic resources (preferably from the GCU Library) in addition to the course readings, lectures, the Bible, and the textbooks for each religion. Each religion must have a primary source included. A total of six references are required according to the specifications listed above. Incorporate the research into your writing in an appropriate, scholarly manner.

Prepare this assignment according to the guidelines found in the APA Style Guide