General Anxiety disorder is fear that interferes with one’s everyday life, it is characterized by excessive worry about different things (finances, work family and sometimes things we think are simple). General anxiety is not the normal anxious/ worry stressor of life, these individuals’ anxiety is like manic behavior. causes symptoms like difficulty concentrating, constant restlessness/anxious feeling, Indecisiveness, and fear of making the wrong decision, inability to let the worry go, trouble overthinking plans and solutions physical symptoms can lead to Fatigue, trouble sleeping, muscle tension or muscle aches, trembling, feeling twitchy, nervousness or being easily startled, Sweating some cases nausea, diarrhea or irritable bowel syndrome (General Anxiety Disorder. 2021). Some factors are genetics and a person’s experience As a provider it is important to understand the dangers a patient with GAD can face treatment should be prompt and appropriate.
Treatment options for general anxiety disorder often involve a combination of therapies like psychotherapy, cognitive behavior therapy which helps with redirecting a patient fears/worry (Locke. 2015). There is also chemical treatment such as antidepressants (ssri) which SSRIs prevent serotonin from being reabsorbed (reuptake) in the brain, allowing more serotonin to be accessible. SSRIs also appear to influence just serotonin and not other neurotransmitters. Some of the most popular drug of choice for is Cymbalta, paxil, effector (General Anxiety Disorder. 2021). Another option for treatment is a class of medication known as benzo diazepam this drug class can often relive anxiety. These sedatives are generally used only for relieving acute anxiety on a short-term basis (Locke. 2015).
As a cardiac critical care nurse patients with general anxiety disorder would already be diagnosed and on SSRI long-term prior to admission. In my practice what id did see is more of the acute episodes of anxiety like COPD exacerbation and asthma attacks mostly medical issues that cause a Panic attack or post op surgical patient who are intubated with light sedation and new stroke patient can display a lot of characteristics of GAD. As a nurse I can say that in the setting I was working earlier in my career I was more reactive in steady of recognizing the signs and anticipating a plan of action which I have seen how sever and more stressful it can be for the patient
General Anxiety Disorder. 2021. Anxiety Depression Association of America.
Amy Locke. 2015. Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adult. American Family Physician.
Kessler RC, Petukhova M,.2017. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res.
Week 8 Discussion
Generalized anxiety disorder is characterized by excessive or unrealistic anxiety about two or more aspects of life such as work, social relationships, financial matters, etc., often accompanied by symptoms such as palpitations, shortness of breath, or dizziness. Consequently, generalized anxiety disorders (GAD) are usually accompanied by restlessness, feeling on edge, easily fatigued, difficulty concentrating, mind going blank, irritability, muscle tension, and sleep disturbance.
Regarding inhibiting factors, people with GAD are prone to ambivalence about relinquishing their worries. On the one hand, they may be motivated to reduce the distress that worries cause, yet, on the other hand, they may experience fear as an adaptive mechanism of readiness and control. ( Muir, H. J. & Antony, M. M., 2021).
While on the cardiovascular unit, a 48-year-old male, Mr. F.T., visited his family who had just had surgery, and all of a sudden, he started having chest pain and could not keep his thought process, SOB, and was restless. Therefore, the charge nurse took the patient to the ED ( Emergency Department), Where they did a cardiac workup which came back negative for MI (Myocardial Infarction). Consequently, Mr. F.T. had been referred for a psychological evaluation.
Upon psychological evaluation, the patient reports that he is currently taking care of his aging patients in his own home and has concerns about his job. Because of these issues, he drinks a few beers a night to help calm himself. Upon mental exam, the patient admits feeling
anxious with an overall broad affect. Otherwise, the exam is relatively routine, with no thoughts of suicidal ideation. The Hamilton Rating Anxiety Scale, a 14-item scale used to measure the severity of anxiety symptoms, was administered, yielding a score of 26, which is considered moderate to severe anxiety (Gang, Y. & Han, N., 2019).
I chose to start the patient on Buspirone 10mg PO BID, as Zoloft is not indicated for initial treatment in GAD, and Imipramine is used to treat clinical depression. Benzodiazepines are considered first-line treatment for anxiety disorders, but given none of those were an option, I chose buspirone as it is just as effective as benzos with no abuse potential (Rosenthal & Burchum, 2018). After four weeks of use, the client reports a slight decrease in symptoms but still feels very anxious. The HAM-A score decreased to 23, considered mild to moderate anxiety (Thompson, 2015). Even though Buspirone anxiolytic effects develop slowly (Rosenthal & Burchum, 2018), the patient should have seen some relief of anxiety within the first four weeks. Even though he did have a slight decrease in the HAM-A score, he still feels very anxious.
The second decision
I chose to discontinue buspirone and begin Lexapro 10mg orally daily. The patient needs to see relief, and although increasing the buspirone may improve his anxiety a little bit, it might take several more weeks to see improvement. At this point, I think it would be an excellent option to try a different medication, and Lexapro is one of the only SSRIs approved to treat GAD. Although the anxiolytic effects are slow, they can be seen in a week, are better at decreasing cognitive and psychic symptoms of anxiety and are effective even when depression is absent (Rosenthal & Burchum, 2018).
The third decision
I chose to continue the same dose of Lexapro but change the administration time to bedtime. The patient reports that he feels “great” and that his anxiety is “better,” with a decrease in his HAM-A score down to 13, which is now considered mild anxiety (Thompson, 2015). Since the patient states he feels a bit tired a few hours after taking the medication, and it would be good to change admin time to bedtime. That way, he is already sleeping during that “sleepy” and should feel refreshed when he wakes in the morning. Otherwise, if the patient is feeling good, there is no need to add any additional medications or increase the dose currently.
Impact of Pharmacotherapeutics
Since Lexapro is a Selective Serotonin Reuptake Inhibitor (SSRI), its primary mechanism of action is to block the neuronal reuptake of serotonin, a monoamine neurotransmitter (Rosenthal & Burchum, 2018). SSRIs block serotonin leading to its accumulation in the neural junction, thus allowing appropriate transmission relating to emotions and stabilizing levels of serotonin leading to anxiety (Christensen et al., 2014). Lexapro is generally well tolerated and has no potential for abuse, therefore may be more appropriate for this patient since he drinks typically every night.
Batterham, P. J.& Hickie, I. (2019). The effectiveness of an online e-health application compared
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Gang, Y. & Han, N. (2019). Chart review of patients receiving valsartan-amlodipine single-pill
combination versus valsartan and amlodipine combination for blood pressure goal achievement and effects on the Hamilton anxiety rating/Hamilton depression rating scales. Medicine, 98(51), 1–8. https://doi.org/10.1097/MD.0000000000018471
Muir, H. J. & Antony, M. M. (2021). Integrating Responsive Motivational Interviewing With
Cognitive-Behavioral Therapy (CBT) for Generalized Anxiety Disorder: Direct and Indirect Effects on Interpersonal Outcomes. Journal of Psychotherapy Integration, 31(1), 54–69.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice
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