Generalized Anxiety Disorder (GAD)
General anxiety disorder occurs in 20% of the population, and it comes at any age of life. Most people do not realize they have the disorder. The condition, if not treated early, may lead to secondary depression. It is diagnosed through performing an electrocardiogram (ECG), blood tests for thyroid disease, adrenal disease, and blood sugar (Munir & Takov, 2020). The case study presented is in line with a patient showing the symptom of GAD. A review of the case has been done exploring its diagnoses, medication monitoring, and health promotional education need by the patient.
Diagnosis
L.P.’s likely diagnosis is generalized anxiety disorder (GAD). Of note, GAD symptoms include excessive worry lasting up to 6 months (National Institute of Mental Health, 2018). It affects various aspects of life, such as personal health, social relationships, and day-to-day routines. When a patient suffers from GAD, the symptoms present include feeling restless, fatigue, going mind blank, and irritability. Others include muscle tension, uncontrollable feeling of worries, and having sleep problems such as staying awake longer than required and unsatisfying sleep. L.P reports getting easily fatigued, irritable, difficulties in concentration, and falling asleep. She also says of the mind going blank and worries about her job if the symptoms persist. The patients’ symptoms align with the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). DSM- 5 instructs that a patient needs to display at least five symptoms discussed to have a significant anxiety disorder. (American Psychiatric Association, 2013). In this case, the patient lies in the category of a patient with a significant anxiety disorder.
Pharmacotherapeutic Treatment Goals
The goal of pharmacotherapeutic treatment is to reduce the symptoms of worry and anxiety. Thus in choosing the therapy option, the severity of the symptoms is factored. In reducing the symptoms, pharmacotherapeutic treatment needs to achieve remission, achieving a satisfactory patient recovery. Thus, improving the patient’s life quality and minimizing the drugs’ adverse reaction. The other goal of pharmacotherapeutic treatment aims to avoid patient relapsing (William, 2017). As seen in the case study, the patient the pharmacotherapeutic goals; thus, a keen follow-up is essential to achieve patient recovery.
Recommended Drugs
Depending on the symptoms, a need may arise to take both medicines for physical symptoms and psychological ones. The First-line medication recommended includes selective serotonin reuptake inhibitors (SSRIs), which raise serotonin levels in the brain. Noteworthy, the example is Sertraline, Escitalopram, and Paroxetine. The other first-line treatment is serotonin and noradrenaline uptake inhibitor. It works by increasing serotonin and noradrenaline in the brain. Examples include Venlafaxine, Duloxetine (National Health Service [NHS], 2019). The other medication option is Pregabalin, Benzodiazepines, and they are in the category of sedatives. Remarkably, the patient should follow the doctor’s instructions in the medication.
Monitoring the Success of the Therapy
The parameter for monitoring patient success is response and remission to the pharmacotherapeutic treatment. The response means that the symptoms should be reduced by half; remission means that the symptoms are treated, and the patient is not in the diagnostic range. To monitor progress, the patient needs to be seen every 1-2 weeks after starting the treatment and response reassessed after 4-6 weeks of administration. During the patient visits other than medication administration, the patient gets monitored for treatment adherence and the potential adverse effects of therapy. Once the symptom stabilizes, the monitoring may reduce to after every three months (William, 2017). The patients’ blood pressure, thyroid levels, heartbeat rate, and toxin level are also monitored during the visits. (Munir & Takov, 2020).
Specific Patient Monitoring Based on Therapy
Based on the recommended therapy of SSRIs or SNRIs, the patient needs to be monitored of the medication’s effect on day-to-day activities. The two drugs have adverse effects and may make the patient abandon the medication; thus, after two weeks, the patient gets monitored for compliance. In most cases, patients withdraw from treatment due to increased anxiety symptoms though lowering the start dosage may reduce the symptoms. SSRIs and SNRI have other side effects; for example, it is known to cause women not to reach orgasm; thus, they need monitoring because this may result in more stress. If these effects are present, the medication needs to be changed (William, 2017). In the case of L.P, she is 23 years, and sexual dysfunctions may lead to a more stressful life, and thus the nurse needs to monitor it to prevent further symptoms and achieve remission. The CNP requires exploring the therapeutic effects to monitor their functioning in the body again; not everyone is open to say them.
Adverse Reactions for the Selected Agent
The first line of therapy, as discussed earlier, is SSRIs and the SNRIs. For both, they should be changed when the patient develops confusion, agitation, muscle twitch, sweating, shivers, and diarrhea. It also needs to be changed if the symptom becomes more severe, for instance, developing a high fever of 38C, seizures, irregular heartbeat and goes unconscious. Also should be changed if the patient develops suicidal thoughts, which happens mostly in young people (NHS, 2018). The effect can also drive a patient to withdraw from treatment, and therefore CNP should keep a check on them.
CNP Response to Klonopin Request
In this case, the drug L.P has in mind is clonazepam, a benzodiazepine used for the GDA’s short-term management. Its utilization in more extended periods may result in its dependency (Bandelow et al., 2017). In this case, it not advisable to prescribe the drug to L.P. The CNP needs to take the patient through the evidence-based treatment of the disease and understand the need to follow a specific treatment. The CNP should follow a patient-centered approach that brings the patient into collaborative communication (William, 2017).
Health Promotion Activities
L.P to attain a satisfactory response to the treatment and reduce the chance of relapse, needs to be educated on healthy activities that can assist improve the condition. The patient’s health promotional activities include taking part in physical exercise, for example, aerobics, jogging as the patient goes on taking the standard treatment. Besides, the patient needs to combine cognitive-behavioral therapy (CBT) with pharmacotherapy. CBT targets one’s thoughts and the physical symptom characterizing GAD (Anxiety and Depression Association of America, 2018). The patient also needs to have sufficient sleep and education on substance use, including coffee, alcohol, tobacco, and drugs that can worsen the patient’s condition. The patient needs knowledge on ways the medication works, the adverse effect, the length of drugs. Ultimately, she needs education on practices to self-report on her progress. The friend also needs to be educated on the patient’s condition(William, 2017). Health promotion gears the patient toward healthy living and understanding their situation, thus taking care of themselves.
- P.’s Long-Term Prognosis
GAD requires treatment to avoid secondary depression development if the disease remains untreated, though not curable, the patients’ quality of life declines. According to Harvard Health Publishing (2018), about half of the patients with appropriate treatment improve in three weeks, and 77% improve in 9 months. In this case, L.P needs to adhere to the treatment. In a matter of concern, she should engage the CNP just as she did on Klonopin’s question when uncomfortable with medication provided.
Conclusion
L.Ps symptom displayed over the last nine months falls under the general anxiety disorder. The select line of medication is SSRI and SNRI, which should be administered from a low dosage as the CNP gradually increases. After four-six weeks, the patient should go for reassessment. Monitoring for adherence, response, and remission is done. The patient should not self-medicate but should be educated on self-care. General anxiety disorder is not recovered fully, but with proper care and adherence, the patient can have a quality life. Change of lifestyle and health education is vital to achieving a satisfactory recovery for L.P.
References
American Psychiatric Association. (2013). Diagnostic And Statistical Manual Of Mental Disorders (5th ed.).
Anxiety and Depression Association of America. (2018). Understanding the facts: Generalized anxiety disorder. https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93-107.
Harvard Health Publishing. (2018, December). Generalized Anxiety Disorder. https://www.health.harvard.edu/a_to_z/generalized-anxiety-disorder-a-to-z
Munir, S., & Takov, V. (2020). Generalized Anxiety Disorder. StatPearls Publishing.
National Health Service. (2018, October 2). Side effects Selective serotonin reuptake inhibitors (SSRIs). https://www.nhs.uk/conditions/ssri-antidepressants/side-effects/
National Health Service. (2019, December 19). Treatment: Generalised anxiety disorder in adults. https://www.nhs.uk/conditions/generalised-anxiety-disorder/treatment/
National Institute of Mental Health. (2018, July). Anxiety Disorders. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
William, A. K. (2017). Generalized Anxiety Disorder. ACSAP.