Week 5: Anxiolytic Therapy & PTSD Treatment

Posted: February 15th, 2023

Week 5: Anxiolytic Therapy & PTSD Treatment

“Thanks to the proper diagnosis and treatment, I’m no longer a captive of my PTSD. Seeking help, no matter how late, is a beacon of hope.”

—P.K. Philips, a resilient PTSD patient

Living with posttraumatic stress disorder (PTSD) and grappling with anxiety disorders can turn daily life into an uphill battle. Clients grappling with these challenges often present a complex array of symptoms, ranging from anxiousness and depression to substance abuse issues and physical manifestations like cardiovascular or gastrointestinal ailments. As a psychiatric mental health nurse practitioner, it’s crucial to adeptly address the multifaceted needs of individuals seeking respite from PTSD and other anxiety disorders.

Throughout this week, as we delve into anxiolytic therapies and PTSD treatments, we delve into the nuanced assessment and treatment of clients facing these conditions. Additionally, we scrutinize the ethical and legal dimensions surrounding the administration of these therapies.

Assignment: Crafting Personalized Plans for Clients With Anxiety Disorders

Symptoms of anxiety disorders can manifest in myriad ways, often mirroring physical ailments like chest pains or shortness of breath, which might initially mislead clients into seeking care from their primary care providers or emergency rooms. Once it’s determined that these symptoms lack an organic basis, clients are typically directed towards psychiatric mental health practitioners for anxiolytic therapy. In this Assignment, we embark on a journey to assess and treat clients grappling with anxiety disorders by examining the provided client case study and formulating tailored interventions.

Learning Objectives:

Assess client-specific factors and history to design individualized anxiolytic therapy plans.
Scrutinize the factors influencing pharmacokinetic and pharmacodynamic processes in clients necessitating anxiolytic therapy.
Evaluate the effectiveness of treatment plans.
Delve into the ethical and legal dimensions associated with prescribing anxiolytic therapy across different age groups.
Required Readings:

This week’s required readings, including seminal works by Stahl and insights from Strawn et al., lay the groundwork for our understanding of anxiety disorders, anxiolytic therapies, and PTSD treatments.

Required Media:

We explore a compelling case study, providing a practical framework for our Assignment.

Optional Resources:

For those seeking deeper insights, optional resources delve into pharmacological treatments in gambling disorder, broadening our understanding of therapeutic interventions.

To Prepare for this Assignment:

Reflect on the Learning Resources and contemplate the nuances involved in assessing and treating clients necessitating anxiolytic therapy.

The Assignment:

Dive into the Case Study: A Middle-Aged Caucasian Man With Anxiety. Within this scenario, you’ll be prompted to make pivotal decisions regarding medication prescription for the client, bearing in mind factors influencing pharmacokinetics and pharmacodynamics.

For each decision point, pause to complete the following:

Decision #1:

Which decision did you choose?
Why did you opt for this decision? Substantiate your rationale with evidence from the Learning Resources.
What were your anticipated outcomes with Decision #1? Support your projections with references from the Learning Resources.
Address any disparities between your expectations and the actual results of Decision #1. Why did they diverge?
Continue the process for Decisions #2 and #3, elucidating your choices, anticipated outcomes, and any discrepancies encountered.

Additionally, illuminate how ethical considerations might shape your treatment strategy and interactions with clients, enriching the holistic understanding of your therapeutic approach.

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Week 5: Anxiolytic Therapy & PTSD Treatment

“I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.”

—P.K. Philips, PTSD patient

For individuals suffering from posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric mental health nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.

This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of clients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.
Assignment: Assessing and Treating Clients With Anxiety Disorders

Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.
Learning Objectives
Students will:

Assess client factors and history to develop personalized plans of anxiolytic therapy for clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring anxiolytic therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing anxiolytic therapy to clients across the lifespan

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through this link provided.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 9, “Anxiety Disorder and Anxiolytics”

Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD. New York, NY: Cambridge University Press.

To access the following chapters, click on the Illustrated Guides tab and then the Anxiety, Stress, and PTSD tab.

Chapter 4, “First-Line Medications for PTSD”
Chapter 5, “Second-Line, Adjunct, and Investigational Medications for PTSD”

Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety, 29(4), 328-339. doi:10.1002/da.21913

Hamilton, M. (1959). Hamilton Anxiety Rating Scale. PsycTESTS, doi:10.1037/t02824-0

Required Media

Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., & … Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. doi:10.1155/2014/537306

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.
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Week 5: Navigating Anxiolytic Therapy & PTSD Treatment
“Thanks to the proper diagnosis and treatment, I’m no longer a captive of my PTSD. Seeking help, no matter how late, is a beacon of hope.” -P.K. Philips, a resilient PTSD patient
Living with posttraumatic stress disorder (PTSD) and grappling with anxiety disorders can turn daily life into an uphill battle. As psychiatric mental health practitioners, it is crucial to adeptly address the multifaceted needs of individuals seeking relief from these debilitating conditions. This paper will examine approaches to assessing and treating clients with anxiety disorders and PTSD through an evidence-based lens.
Assessment and Formulation
A thorough assessment is paramount in devising effective treatment plans tailored to individual client factors and histories. According to NICE (2018), assessment of anxiety disorders should involve a comprehensive history and mental state examination to establish diagnoses, severity, impact on functioning, risk factors and comorbidities. Formulation of biopsychosocial factors maintains the client’s perspective while illuminating targets for intervention (NICE, 2018).
In the provided case study, a middle-aged man presented with generalized anxiety disorder (GAD) following his father’s death. His symptoms were complicated by substance abuse, highlighting the importance of evaluating potential contraindications or drug-drug interactions prior to initiating pharmacotherapy (Strawn et al., 2021). A formulation considering predisposing, precipitating and perpetuating elements aids treatment planning (NICE, 2018).
Anxiolytic Therapy Options
When opting for pharmacological management of anxiety, properties like metabolism, half-life and drug interactions must be weighed to determine the safest, most efficacious options. Benzodiazepines carry abuse and dependence risks due to GABAergic mechanisms of action, suggesting selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) as preferable first-line treatments for most anxiety disorders (Baldwin et al., 2014).
SSRIs offer several advantages over benzodiazepines for clients with comorbidities. For instance, escitalopram exhibits minimal drug-drug interactions and no active metabolites, making it well-suited for the case study client with substance abuse issues (Strawn et al., 2021). SSRIs establish therapeutic effects gradually over 4-6 weeks via serotonin potentiation rather than direct receptor activation, reducing risk of dependence (Stahl, 2019).
Individualized Treatment Planning
In the case study, Decision 1 involved initiating escitalopram 10mg daily along with cognitive-behavioral therapy (CBT), in line with recommendations for SSRI monotherapy to establish efficacy and tolerability prior to augmenting treatment (Strawn et al., 2021). CBT effectively targets maladaptive thoughts and behaviors underlying GAD (NICE, 2011).
The anticipated outcomes of reduced anxiety symptoms within 4-6 weeks on escitalopram and functional improvements with CBT skills aligned with the actual positive results at follow-up evaluation. For Decision 2, adding pregabalin 75mg twice daily was appropriate to target residual physiological symptoms as SSRIs may be less effective for somatic aspects of GAD (Baldwin et al., 2014). Pregabalin’s complementary anxiolytic, analgesic and sleep-promoting properties made it a suitable adjunct to escitalopram (Stahl, 2019).
At Decision 3, continuing the optimized regimen long-term with regular monitoring was recommended to sustain gains and prevent relapse, supported by guidelines advising continuation treatment (NICE, 2011). This case study exemplifies how a nuanced formulation lends itself to individualized, evidence-based pharmacological and psychosocial interventions.
PTSD Treatment Considerations
While SSRIs, SNRIs and other anxiolytics also show efficacy for PTSD symptoms, specialized trauma-focused psychotherapies constitute the first-line treatments for PTSD (NICE, 2018; ISTSS, 2018). For instance, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy demonstrate the strongest evidence for reducing PTSD symptoms and functional impairment compared to other interventions (ISTSS, 2018).
Combining pharmacotherapy with trauma-focused psychotherapy yields optimal outcomes for PTSD (NICE, 2018; ISTSS, 2018). Medications may help manage co-occurring depression, anxiety or sleep disturbances to facilitate engagement in psychotherapy (ISTSS, 2018). Regular evaluation of progress and potential need for treatment modifications is prudent when managing PTSD to optimize outcomes over the long-term course of care.
Conclusion
Addressing the complex needs of clients with anxiety disorders and PTSD requires a nuanced, evidence-based and formulation-driven approach. Thorough assessment and individualized case formulations inform treatment planning, whether utilizing anxiolytic medications, specialized trauma-focused psychotherapies, or integrated care. Ongoing evaluation and modification of treatment strategies maintain optimal outcomes by safely managing symptoms while supporting functional recovery and relapse prevention.
References
Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., … & Wittchen, H. U. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of psychopharmacology, 28(5), 403-439.
International Society for Traumatic Stress Studies. (2018). Establishing standards for evidence-based practice in psychosocial treatment of posttraumatic stress disorder: Frequently asked questions. Retrieved from https://istss.org/public-resources/establishing-standards-for-evidence-based-practice-in-psychosocial-treatment-of-posttraumatic-stress-disorder-frequently-asked-questions
National Institute for Health and Care Excellence. (2011). Generalised anxiety disorder and panic disorder in adults: management. Retrieved from https://www.nice.org.uk/guidance/cg113
National Institute for Health and Care Excellence. (2018). Post-traumatic stress disorder. Retrieved from https://www.nice.org.uk/guidance/ng116
Stahl, S. M. (2019). Stahl’s essential psychopharmacology: Prescriber’s guide. Cambridge University Press.
Strawn, J. R., Whitton, A. E., DelBello, M. P., Welge, J. A., & Adler, C. M. (2021). Psychopharmacology of anxiety disorders in children and adolescents. Child and Adolescent Psychiatric Clinics, 30(1), 75-99.