Generalized Anxiety Disorder Middle-Aged White Male With Anxiety

Middle age maleMiddle age maleDecision Point One

Begin Buspirone 10 mg orally BID

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Client reports slight decrease in symptoms
  • Client states that he still feels very anxious
  • HAM-A score decreased from 26 to 23

Decision Point Two

Increase buspirone to 10 mg orally TID

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client reports no change in his anxiety
  • HAM-A score has decreased from 23 to 22

Decision Point Three

Continue current dose and reassess in 4 more weeks

Guidance to Student
It is clear that buspirone has resulted in treatment failure as the client’s original HAM-A score was 26- a change in score from 26 to 22 is less than a 25% improvement in symptoms which constitutes treatment failure. It would not be appropriate to continue the same dose and reassess in 4 weeks as onset of therapeutic action for buspirone is around 2 weeks. At least a modest improvement should have been noted by now, if the drug were to work. If the client is having no side effects, the PMHNP can discuss the possibility of increasing dose and re-evaluating in another 4 weeks. However, if the client remains distressed by his symptoms, the appropriate course of action would be to discontinue the buspirone and begin SSRI therapy with an agent such as Zoloft 50 mg orally daily.

Augmentation with an agent such as lorazepam 0.5 mg orally TID would not be appropriate at this time as the client needs a treatment plan for the long-term. The PMHNP should never start someone on a benzodiazepine for an indefinite course of treatment as this could lead to addiction. Benzodiazepines should be used for a limited course of treatment for very specific therapeutic endpoints (for instance, to combat the initial activation which may be seen in the first few weeks after beginning an SSRI or SNRI).
Start Over

Guidance to Student
It is clear that buspirone has resulted in treatment failure as the client’s original HAM-A score was 26- a change in score from 26 to 22 is less than a 25% improvement in symptoms which constitutes treatment failure. It would not be appropriate to continue the same dose and reassess in 4 weeks as onset of therapeutic action for buspirone is around 2 weeks. At least a modest improvement should have been noted by now, if the drug were to work. If the client is having no side effects, the PMHNP can discuss the possibility of increasing dose and re-evaluating in another 4 weeks. However, if the client remains distressed by his symptoms, the appropriate course of action would be to discontinue the buspirone and begin SSRI therapy with an agent such as Zoloft 50 mg orally daily.

Augmentation with an agent such as lorazepam 0.5 mg orally TID would not be appropriate at this time as the client needs a treatment plan for the long-term. The PMHNP should never start someone on a benzodiazepine for an indefinite course of treatment as this could lead to addiction. Benzodiazepines should be used for a limited course of treatment for very specific therapeutic endpoints (for instance, to combat the initial activation which may be seen in the first few weeks after beginning an SSRI or SNRI).
Start Over

Guidance to Student
It is clear that buspirone has resulted in treatment failure as the client’s original HAM-A score was 26- a change in score from 26 to 22 is less than a 25% improvement in symptoms which constitutes treatment failure. It would not be appropriate to continue the same dose and reassess in 4 weeks as onset of therapeutic action for buspirone is around 2 weeks. At least a modest improvement should have been noted by now, if the drug were to work. If the client is having no side effects, the PMHNP can discuss the possibility of increasing dose and re-evaluating in another 4 weeks. However, if the client remains distressed by his symptoms, the appropriate course of action would be to discontinue the buspirone and begin SSRI therapy with an agent such as Zoloft 50 mg orally daily.

Augmentation with an agent such as lorazepam 0.5 mg orally TID would not be appropriate at this time as the client needs a treatment plan for the long-term. The PMHNP should never start someone on a benzodiazepine for an indefinite course of treatment as this could lead to addiction. Benzodiazepines should be used for a limited course of treatment for very specific therapeutic endpoints (for instance, to combat the initial activation which may be seen in the first few weeks after beginning an SSRI or SNRI).
Start Over

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client reports nausea, dizziness, nervousness, headaches, and dry mouth
  • HAM-A score reveals no change and he reports that he still feels anxious

Decision Point Three

Decrease BuSpar to 15 mg orally TID

Guidance to Student
It is apparent that the higher dose of buspirone was successful only in causing side effects and offered minimal therapeutic benefit to the client. Decreasing buspirone to 15 mg orally TID may alleviate some of the side effects, but would also likely result in decreased therapeutic effect (which in this case was minimal). The goal of therapy is to treat the client’s anxiety- not just alleviate side effects.

It would not be appropriate to explain to the client that these are “normal side effects” and continue the same dose with a plan to reassess in 4 weeks. Recall that the onset of therapeutic action for buspirone is around 2 weeks. At least a modest improvement should have been noted by now, if the drug were to work at all.

The buspirone at this point meets the criteria for treatment failure (as it failed to result in at least a 25% decrease in symptoms), thus it would be appropriate to discontinue and begin a first line agent such as an SSIR (like Zoloft 50 mg orally daily) at this point.
Start OverExplain to the client that these are normal side effects of buspirone and maintain current dose for another 4 weeks

Guidance to Student
It is apparent that the higher dose of buspirone was successful only in causing side effects and offered minimal therapeutic benefit to the client. Decreasing buspirone to 15 mg orally TID may alleviate some of the side effects, but would also likely result in decreased therapeutic effect (which in this case was minimal). The goal of therapy is to treat the client’s anxiety- not just alleviate side effects.

It would not be appropriate to explain to the client that these are “normal side effects” and continue the same dose with a plan to reassess in 4 weeks. Recall that the onset of therapeutic action for buspirone is around 2 weeks. At least a modest improvement should have been noted by now, if the drug were to work at all.

The buspirone at this point meets the criteria for treatment failure (as it failed to result in at least a 25% decrease in symptoms), thus it would be appropriate to discontinue and begin a first line agent such as an SSIR (like Zoloft 50 mg orally daily) at this point.
Start OverDiscontinue buspirone and begin Zoloft 50 mg orally daily

Guidance to Student
It is apparent that the higher dose of buspirone was successful only in causing side effects and offered minimal therapeutic benefit to the client. Decreasing buspirone to 15 mg orally TID may alleviate some of the side effects, but would also likely result in decreased therapeutic effect (which in this case was minimal). The goal of therapy is to treat the client’s anxiety- not just alleviate side effects.

It would not be appropriate to explain to the client that these are “normal side effects” and continue the same dose with a plan to reassess in 4 weeks. Recall that the onset of therapeutic action for buspirone is around 2 weeks. At least a modest improvement should have been noted by now, if the drug were to work at all.

The buspirone at this point meets the criteria for treatment failure (as it failed to result in at least a 25% decrease in symptoms), thus it would be appropriate to discontinue and begin a first line agent such as an SSIR (like Zoloft 50 mg orally daily) at this point.
Start Over

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client reports that he feels “great”
  • Client states that his anxiety is getting “better”
  • HAM-A score has decreased from 23 to 13
  • Client does report that he sometimes feels sleepy for a few hours after taking the medication, but “perks up” by early to midafternoon

Decision Point Three

Increase Lexapro to 15 mg orally daily in AM

Guidance to Student
At this point, the client reports that he is feeling “great” with a decrease in symptoms from an initial HAM-A score of 26 down to 13. This represents a 50% decrease in symptoms in just 4 weeks. Recall that an adequate trail can be as long as 12 weeks, we may not need to increase the drug any more at this point as we do not know how much more the current dose will improve the client’s symptoms. The PMHNP could increase the dose but this could increase the risk of side effects- especially the sleepiness that the client is complaining about in the morning after taking the medication. It is plausible that an increase in the dose would increase morning sedation.

The most prudent course of action would be to continue the same dose of medication, but change the administration time to bedtime. This way, the client will not be troubled by the sedating effects of the medication, and sleep may be enhanced which could also improve overall anxiety.

At this point, nothing in the client presentation suggests the need to augment his Lexapro with any other agents. Therefore, buspirone augmentation would not be an appropriate response.
Start OverContinue same dose of Lexapro but change administration time to bedtime

Guidance to Student
At this point, the client reports that he is feeling “great” with a decrease in symptoms from an initial HAM-A score of 26 down to 13. This represents a 50% decrease in symptoms in just 4 weeks. Recall that an adequate trail can be as long as 12 weeks, we may not need to increase the drug any more at this point as we do not know how much more the current dose will improve the client’s symptoms. The PMHNP could increase the dose but this could increase the risk of side effects- especially the sleepiness that the client is complaining about in the morning after taking the medication. It is plausible that an increase in the dose would increase morning sedation.

The most prudent course of action would be to continue the same dose of medication, but change the administration time to bedtime. This way, the client will not be troubled by the sedating effects of the medication, and sleep may be enhanced which could also improve overall anxiety.

At this point, nothing in the client presentation suggests the need to augment his Lexapro with any other agents. Therefore, buspirone augmentation would not be an appropriate response.
Start OverRe-start BuSpar at 10 mg orally TID

Guidance to Student
At this point, the client reports that he is feeling “great” with a decrease in symptoms from an initial HAM-A score of 26 down to 13. This represents a 50% decrease in symptoms in just 4 weeks. Recall that an adequate trail can be as long as 12 weeks, we may not need to increase the drug any more at this point as we do not know how much more the current dose will improve the client’s symptoms. The PMHNP could increase the dose but this could increase the risk of side effects- especially the sleepiness that the client is complaining about in the morning after taking the medication. It is plausible that an increase in the dose would increase morning sedation.

The most prudent course of action would be to continue the same dose of medication, but change the administration time to bedtime. This way, the client will not be troubled by the sedating effects of the medication, and sleep may be enhanced which could also improve overall anxiety.

At this point, nothing in the client presentation suggests the need to augment his Lexapro with any other agents. Therefore, buspirone augmentation would not be an appropriate response.

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
$26
The price is based on these factors:
Academic level
Number of pages
Urgency
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our Guarantees

Money-back Guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism Guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision Policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy Policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation Guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
error: