CASE STUDY:
The Patient is a 46-year-old- white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his primary care physician after a trip to the emergency in which he felt he was having a heart attack. He stated he felt chest tightness, shortness of breath, and a feeling of impending doom. He does have some mild hypertension which is treated with low sodium intake and he is about 15lbs overweight. He had his tonsil removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER, and his EKG was normal. The remainder of his physical exam was normal. He admits that he still has problems with tightness in his chest and episodes of shortness of breath he now terms these ” anxiety” He will also report feelings of pending doom, and the need to “run” or “escape” from wherever he is at.
In your office, he confesses to the occasional use of alcohol ( ETOH) to combat worries about work. He admits to consuming 3-4 beers/night. Although he is single, he is attempting to care for his aging parents in his home. He reports that the management at his place of work is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26. The client has never been on any type of psychotropic medication. The client is alert and oriented to person, place, time, and events. He is appropriately dressed. Speech is clear, coherent, and goal-directed. The client’s self-reported mood is ” bleh” and he does endorse a feeling of ” nervousness”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview process. Affect broad, client denies visual or auditory hallucination, no overt delusional paranoid thought process readily apparent. You administer the Hamilton anxiety rating scale(HAM-A) which yields a score of 26.
DIAGNOSIS: Generalized anxiety disorder.
To Prepare:
(a) Reflect on the medication to be used to treat generalized anxiety disorder.
(b) Reflect on the psychopharmacology treatment you might recommend for the assessment and treatment of patients requiring anxiolytic therapy.
Assignment: You Are Asked to make three DECISIONS concerning the Medication to prescribe to this patient, Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes At each decision POINT, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure you research each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
INTRODUCTION TO THE CASE: (1 Page) (1) Briefly explain and summarize the case for the Assignment. Be sure to include the specific patient factors that may impact your decision-making when prescribing medication for the patient. DECISION POINT ONE: Select what you should do: Medications to work with are:
(a) Begin Paxil 10mg orally daily.
(b) Begin Imipramine 25mg orally twice a day
(c) Begin Buspirone 10mg orally twice a day
Decision #1 (1 page):
(1)What decision did you select?
(2) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature
(3) Why did you not select the other two medication options provided in the exercise? Be specific and support your response with clinically relevant and patient and patient-specific resources, including the primary literature.
(4) What were you hoping to achieve by making this decision? Support your response with evidence and references including the primary literature.
(5) Explain how ethical consideration may impact your treatment plan and communication with the patient. Be specific and provide examples.
DECISION #2 (1 page):
(1)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
(2) Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources including the primary literature.
(3) What were you hoping to achieve by making this decision? Support your response with evidence and reference to the primary literature.
(4) Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
DECISION #3 (1 Page) :
(1)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
(2) Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources including the primary literature.
(3) What were you hoping to achieve by making this decision? Support your response with evidence and references to the learning resources including the primary literature.
(4) Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
CONCLUSION (1 Page)
Summarize your recommendation on the treatment options you selected for this patient. Be sure to justify your recommendation and support your response with clinically relevant and patient-specific resources, including the primary literature.
NOTE: Support your rationale with a minimum of five academic resources and write clearly including a title page, Purpose statement, introduction, summaries, and references.
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