FD is a 55-year-old businessperson who lives in a very rural area and travels 2 out of 4 weeks every month
Module 12 Discussion
Case Study: Anxiety Case
FD is a 55-year-old businessperson who lives in a very rural area and travels 2 out of 4 weeks every month. Throughout his adulthood, he had been in excellent health, maintained an appropriate weight, and worked out regularly. This past year, he lost some weight without trying or making any adjustments to his lifestyle or diet. FD has no known drug allergies. His only medication is Atorvastatin 10mg po daily.
More important, however, he reported to his primary care provider that lately he had been irritable, restless, and easily angered. He also said he had difficulty falling asleep and was tired all the time. On a recent out-of-town trip, he awakened in the middle of the night with intense clammy sweating, shortness of breath, heart pounding and racing, and an overwhelming sense of dread. He could not focus his thinking and was sure he was going to die.
By the time he decided to call the front desk to ask for a doctor, his symptoms seemed to abate. However, he told you, his primary care provider, that he has become increasingly anxious around traveling and was no longer comfortable taking another out-of-town trip
His physical examination revealed no abnormalities nor did a regular electrocardiogram (ECG) and a stress echo ECG. You suggest that FD had experienced a panic attack.
What would you prescribe for FD? What counseling points do you give FD? What type of follow-up do you recommend?
Expert Answer and Explanation
Treatment of Panic Disorder
Prescription for FD
Assessment of the FD’s health history reveals that he takes a 10mg of Atorvastatin, a pharmacological intervention for high amount of the blood cholesterol. This medication is associated with aggression among other psychiatric issues, which accounts for the manifestations of FD’s symptoms. Considering FD’s health information, the drug that would be ideal for him is the fluoxetine which is the generic name for the Prozac. When using this medication to treat FD, it is important to start the treatment with 10mg, which FD will be taking during morning hours. Beginning the treatment with 10mg is important because it would help reduce the clinical manifestations.
The dosage would be adjusted depending on how FD responds to the treatment (Kryst, Majcher-Maślanka, & Chocyk, 2022). Choosing Prozac as a treatment option is important in this case in the sense that it poses a limited risk of interacting with the atorvastatin. Although it is associated with certain adverse events including anxiety, Prozac may start working within a week. Thus, it should be considered as a viable treatment option for FD’s symptoms.
Counseling Points to consider for FD
In addition to administering the medication, it is important to stress counseling when working with FD, focusing on key areas of interest. One of the things to consider during this process is traveling including how it is likely to heighten FD’s anxiety. Thus, it is important to involve the patient in practicing the methods of managing anxiety. In this case, it would be appropriate to let them to breathe in and out.
The other point to consider is avoidance of the substances that may alter FD’s behavior or interfere with the working of the prescribed medication (Kim, 2019). This includes and is not limited to the alcoholic substances. When engaging the patient, it is equally important to discuss with them the adverse events associated with the Prozac. Even when discussing with them the negative side effects of the drug, it is crucial to remind the patient to adhere to the medication.
Follow-Up Recommendations
To ensure the patient complies with the prescription information, it is important to schedule appointment with them. One of the things to consider when following up with the patient is how they respond to the recommended intervention. This is necessary because it can help inform whether there is need to increase or reduce the dosage (Iversen et al., 2022). The other thing to take into consideration during this phase of the treatment is the patient’s progress in terms of how they cope with the symptoms.
References
Iversen, H. M., Eide, T. O., Harvold, M., Solem, S., Kvale, G., Hansen, B., & Hagen, K. (2022). The Bergen 4-day treatment for panic disorder: replication and implementation in a new clinic. BMC psychiatry, 22(1), 728. https://doi.org/10.1186/s12888-022-04380-6.
Kim, Y. K. (2019). Panic Disorder: Current Research and Management Approaches. Psychiatry investigation, 16(1), 1–3. https://doi.org/10.30773/pi.2019.01.08.
Kryst, J., Majcher-Maślanka, I., & Chocyk, A. (2022). Effects of chronic fluoxetine treatment on anxiety- and depressive-like behaviors in adolescent rodents – systematic review and meta-analysis. Pharmacological reports : PR, 74(5), 920–946. https://doi.org/10.1007/s43440-022-00420-w.
Module 13 Discussion
Case Study: Depression Case
AM is a 54-year-old married woman with three adult children. She has been the office manager of a small law firm for 20 years and has enjoyed her work until this past year. She has rheumatoid arthritis with minimal impairment that has been managed well with scheduled NSAIDs. She has been taking conjugated estrogens for 8 years and decided to stop taking them because of her concern of their risks without sufficient medical benefit. She has tolerated the discontinuation without difficulty.
At her annual medical checkup appointment, she told her primary care provider that she seemed to be tired all the time, and she was gaining weight because she had no interest in her usual exercise activities and had been overeating, not from appetite but out of boredom. She denied that she and her husband have had marital difficulties beyond the ordinary and she was pleased with the achievements of her children.
She noticed that she has difficulty falling asleep at night and awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep even though she still feels tired. She finds little joy in her life but cannot pinpoint any particular concern. Although she denies suicidal feelings, she does not feel that there is meaning to her life: “My husband and kids would go on fine if I died and probably wouldn’t miss me that much.”
You ask AM to fill out a Beck’s Depression Scale, which indicated she has moderate depression. You decide to prescribe AM an antidepressant to treat her depression.
What antidepressant do you prescribe for AM? Why did you select that specific agent? What counseling points and follow up instructions do you give AM?
Expert Answer and Explanation
Treatment Plan for AM’s Depression: Sertraline Prescription
Diagnosis and Medication Choice
AM’s presentation of moderate depression prompts the prescription of sertraline, a selective serotonin reuptake inhibitor (SSRI). The decision is grounded in sertraline’s proven efficacy in treating depression and anxiety disorders, coupled with its favorable side effect profile. Notably, sertraline is chosen for its minimal sedative effects, addressing AM’s complaints of insomnia (Wang et al., 2021). Given AM’s profile and the prevalence of insomnia, sertraline is a suitable option as it does not have the sedative effects associated with some other antidepressants. I would start AM on sertraline 50 mg once daily, usually in the morning.
The dosage may be adjusted based on her response and tolerance, with a gradual titration if needed. I would explain to AM that antidepressants like sertraline may take a few weeks to show their full therapeutic effect, and it’s essential to continue taking the medication even if she starts feeling better. The initiation of treatment with sertraline aligns with its known efficacy and a lower incidence of side effects compared to other antidepressants.
Counseling Points and Follow-Up Instructions
AM’s counseling on depression will focus into the understanding of depression as a medical condition, emphasizing the physiological and psychological aspects involved. The comprehensive nature of the counseling will elucidate the multifaceted nature of depression, covering the potential impact on mood, energy levels, and daily functioning (Lewis et al., 2019). In addition to discussing the anticipated benefits of sertraline, the counseling will provide AM with insights into how the medication addresses neurotransmitter imbalances associated with depression, fostering a clearer comprehension of the treatment’s mechanisms.
During the counseling, particular emphasis will be placed on the delayed onset of action associated with sertraline (Lewis et al., 2019). This information serves to manage expectations, as AM will be informed that the therapeutic effects may not be immediately apparent. Instead, improvements in mood and overall well-being may manifest gradually over the initial weeks of treatment. This emphasis on patience aims to equip AM with a realistic timeframe for assessing the medication’s effectiveness and encourages adherence to the prescribed treatment plan.
Therapeutic Goals and Follow-Up Plan
The overarching therapeutic goals encompass the amelioration of depressive symptoms and an enhancement in AM’s overall quality of life. Regular follow-up appointments will be scheduled to monitor treatment progress, address concerns, and potentially adjust the medication dosage for optimal efficacy (Joshi et al., 2022). Complementary counseling or therapy will be recommended to foster a holistic approach to AM’s well-being.
Conclusion
In conclusion, the prescription of sertraline for AM represents a tailored and evidence-based approach to address her moderate depression. The treatment plan incorporates comprehensive counseling, vigilant monitoring of side effects, and a commitment to therapeutic goals. By fostering open communication and offering ongoing support, the aim is to guide AM towards a path of emotional well-being and improved quality of life.
References
Joshi, A., Todd, S., Finn, D. P., McClean, P. L., & Wong-Lin, K. (2022). Multi-dimensional relationships among dementia, depression and prescribed drugs in England and Wales hospitals. BMC Medical Informatics and Decision Making, 22(1), 1-11.
Lewis, G., Duffy, L., Ades, A., Amos, R., Araya, R., Brabyn, S., … & Lewis, G. (2019). The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. The Lancet Psychiatry, 6(11), 903-914.
Wang, G., Si, T., Imperato, J. S., Yang, L., Zou, K. H., Jin, Y. O., … & Yu, W. (2021). Impact of sertraline daily treatment regimen on adherence, persistence and healthcare resource utilisation in patients with major depressive disorder or obsessive‐compulsive disorder: A real‐world evidence analysis from the United States. International Journal of Clinical Practice, 75(10), e14522.
Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level assignment writers.
Use Coupon Code: NEW30 to Get 30% OFF Your First Order
