Anxiolytic Therapy for a 46-Year-Old Caucasian Male with GAD

Anxiolytic Therapy for a 46-Year-Old Caucasian Male with GAD Introduction Anxiety is a common psychiatric disorder that has features of excessive fear and behavioral disturbances. In particular, anxiety disorders are related to somatic signs. Their emotional distress is accompanied by dizziness, shortness of breath, sweating, muscle aches, insomnia, and restlessness. An excessive, uncontrollable, and unmanageable anxiety in everyday life can cause generalized anxiety disorder (GAD). Based on the Diagnostic and Statistical Manual V (DSM-V), persistent worry is the primary cause of GAD (Garakani et al., 2020, pg. 2). Some of the things that make people have anxiety are thoughts about fitness, job safety, performance at work, the health of their parents or offspring, and assets. In the scenario at hand, a 46-year-old Caucasian man showed up in the emergency room (ER) after his primary care provider (PCP) referred him for presenting symptoms of a heart attack. The individual said that he experienced shortness of breath, the feeling of impending doom, and chest tightness. In addition, he has mild hypertension that he treats with a diet of low sodium and is approximately 15 lbs. overweight. His medical history has been unremarkable after his tonsils were removed when he was eight years old. The person’s electrocardiogram (EKG) was normal and his remaining physical examination was within normal limits (WNL). The patient confesses that he uses ethyl alcohol (ETOH) occasionally, about 3-4 beers per night. Despite the man being single, he takes care of his aging parents. His greatest worry is about job security since he cites that the management is harsh. Additionally, the client appears alert and oriented to the event, time, person, and place. He dresses well, and his speech is coherent, goal-directed, and clear. In some instances, he feels nervous but denies overt delusional or auditory or visual hallucinations. He has no suicidal thoughts, and the Hamilton Anxiety Rating Scale (HAM-A) gives a score of 26. As such, the client is diagnosed with generalized anxiety disorder. Decision #1 My first decision is to prescribe the client Paxil 10mg by mouth every daily, 10mg of Buspirone by mouth twice a day, and 25mg of Imipramine orally twice a day. Paxil is effective in treating GAD and it belongs to a class of antidepressants called Selective Serotonin Reuptake Inhibitor (SSRI) (Pollack et al., 2001, pg. 351). Some drugs that can be considered as the first option when treating GAD include SSRIs, Buspirone, Imipramine, Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), and benzodiazepines. However, among these medications mentioned above, the most effective is Paxil. Imipramine refers to a tricyclic antidepressant, which is effective, but not when compared to SSRIs. As a result, the reason for selective Paxil is because it is the most effective antidepressant. Although the other two options, namely Imipramine and Buspirone, can be used, their effectiveness is lower than that of Paxil. As such, one had to put them aside and start with the option that would help the client. Moreover, if Imipramine and Buspirone are used and the patient uses ETOH, since he admitted to drinking 3-4 beers per night, they might cause adverse consequences. My ...