Week 8 Initial Post
The patient is a 46-year-old male who presented to the emergency room for shortness of breath, chest tightness, and the feeling of impending doom, which he thought was a heart attack. The patient has mild hypertension and is 15 lbs. overweight. The patient reports he has had these episodes in the past, which he describes as “anxiety attacks.” He scored a 26 on the Hamilton Anxiety Scale, HAM-A, which is severe anxiety. The scale is widely used interview scale that “measures the severity of a patient’s anxiety, based on 14 parameters, including anxious mood, tension, fears, insomnia, somatic complaints and behavior at the interview” (Pomerantz, 2013, p. 1). It is used to diagnose an anxiety disorder.
Patient is not having any hallucinations or delusions, he is alert and oriented, and denies any SI/HI. My first judgment was that he was having panic disorder, first line treatment for panic disorder is an SSRI. So, I started the patient with 50 mg of Zoloft daily. A serotonin uptake inhibitor blocks reuptake of serotonin in the presynaptic neuron causing more serotonin in the synapse to activate the postsynaptic neurons (Rosenthal and Burchum, 2018). “The identification of many serotonin receptor types has stimulated the search for the role of serotonin in the pathogenesis of anxiety disorders” (Sadock, Sadock, and Ruiz, 2015, p. 390). By increasing serotonin, we can decrease the patients anxiety.
A side effect that can affect the patient is sexual dysfunction, decrease sexual interest, which is one of the most common side effects. I would discuss this with the patient seeing as he a single 46-year-old male. Adding another drug to the regimen like Viagra could help (Rosenthal and Burchum, 2018). Another side effect is weight gain, so I would educate patient on healthy eating habits and exercise.
Psychiatric Times [e-newsletter]. HAM-A Hamilton Anxiety Scale.
Retrieved from https://www.psychiatrictimes.com/clinical-scales-anxiety/ham-hamilton-anxiety-scale
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Saddock, B., Saddock, V., & Ruiz, P. (2015). Synopsis of Psychiatry. Philadelphia : Lippincott Williams & Wilkins
