. Generalized Anxiety Disorder-diagnosis and treatment

. Generalized Anxiety Disorder-diagnosis and treatment

Generalized anxiety disorder (GAD) is a psychological problem of nervousness where the person affected tends to worry about almost everything around them with no valid reason. People with this condition tend to always expect the worst in life and can’t help worrying about their future, finances, family, school and/or work. The main causes of this condition are reportedly childhood abuse and a history of family anxiety. In the case of Bob’s diagnosis, he suffered from moderate GAD which can b,e traced back to his troubled past characterized by a history of divorce in his immediate as well as his nuclear family.

After a number of sessions with a counselor, generalized anxiety disorder is diagnosed by asking therapy questions. The client’s symptoms and response guides the counselor to diagnose the condition and refer the patient to mental health consultants. Upon diagnosis, a psychiatrist will most likely prescribe antidepressant medication which is the main pharmacological treatment for GAD. With reference to Bob, the physician prescribed a dosage of Alprazolam (commonly known as Xanax) which is the short term treatment of anxiety disorders resulting from depression. Xanax should not be used in high doses for long as they pose fatal withdrawal problems which many patients such as Bob don’t understand when their physician prescribe it in lesser dosage. Xanax is a benzodiazepine that directly affects the brain and should not be prescribed to depressed people or those with suicidal behavior. This is the reason why the case of Bob’s cousin attempted suicide was important to tell the physician. Lastly, the physician can also educate the affected person on some physical activity that relaxes the brain such as jogging, controlled breathing and massage therapy. It is such mindfulness techniques that the physician in this case offers Bob during his first assessment.

2. Client’s response to GAD treatment and additional therapy

With the correct use of pharmacological medications and behavioral interventions, anxiety disorders can be effectively treated in patients who regularly attend therapy. However, the success of the treatment greatly depends on the patient’s commitment towards therapy, physical exercise and drug administration. Failure to use the medication and employ these behavioral interventions is demonstrated by little or no progress in the patient’s condition. This is evident in Bob’s case in which his counselor noticed little improvement one week after his first assessment.

There are a number of measures the counselor should put in place after noticing little in their client’s condition. First, he should try to understand the client’s willingness and commitment to therapy. This is because, little development have been reported among clients who are forced to attend therapy by their spouses, family members or colleagues. This is relative to Bob case where he says that his wife has been nagging him to attend the sessions. Such clients tend to develop withdrawal symptoms towards family and anger issues. On analyzing these, the counselor should hence re-educate the client on the cognitive behavioral techniques as well offer them anger management materials such as worksheets for goal setting.

3. Benefits and detriments of using medication class Xanax

As stated above, alprazolam (widely known as Xanax) is a strong benzodiazepine drug commonly used to treat anxiety and panic disorders. It is administered orally either as a tablet or an oral solution and is highly soluble. In its effectiveness, Xanax causes brain and muscle relaxation and is eases restlessness. It is helpful to anxiety patients as it calms them down making them feel good and at ease. However, every drug has its side effects and dangers of use. Xanax is an easy drug to abuse as it causes relaxation and hence can easily lead to overdose. Secondly, the drug has been reported to cause withdrawal symptoms such as nausea and seizures after a long time of use. Also, Xanax can easily cause addiction due to its feel good sensation especially in clients who use alcohol. Lastly, prolonged use of the drug renders it ineffective to some patients as it may longer work at all.

Pharmacodynamics and pharmacokinetics of the anxiolytic class of drugs

The anxiolytic class of drugs centrally affects the functions of the nervous system. Though their mechanism is not well known, Xanax for example, has been reported to cause brain depressant activity. Upon its administration, alprazolam readily dissolves in the mouth and only takes 1 to 2 hours for high plasma concentrations. These levels are proportional to the dosage; for instance, peak levels of 8.0 to 37 ng/ml were observed in a dose range of 0.5 to 3.0mg. In healthy adults, the mean alprazolam elimination half-life in the plasma is recorded to be about 11 hours. Anxiolytic drugs are comprehensively metabolized in healthy individuals. For example, alprazolam and its wastes are excreted predominantly in the urine.

Pharmacodynamics and pharmacokinetic principles

Pharmacokinetics refers to the study of drug flow in the body. It is mainly elaborated by four principles namely, drug absorption, drug distribution, metabolism and drug elimination. Pharmacodynamics on the other hand deals with the resulting effect of a drug after its course of action. The main principle in this case is drug concentration. Below is a chart summarizing the five principles of pharmacology.

4. Ethical considerations in the discussion about medications with a client

Before prescribing any medication to a client, the physician needs to carefully and thorough evaluate a patient’s history. Basically, this should start with a diagnosis of symptoms and an enquiry into any previous treatment. It is also important for the consultant to discuss family history as some of the illnesses and disorders are generational. With reference to Bob’s case, the counselor ought to collect crucial information regarding Bob’s family psychiatric history as well as an interest to find out whether Bob drinks or not.

However, consultants and other professionals are advised not to dig deep into a patient’s private life unless the patient opens up. Either, information of such kind is highly confidential. Lastly, before prescribing any medication, doctors should inform the client on the dosage, manner and frequency of administration as well as side effects of the drug to be prescribed.

5. Additional therapy on withdrawal and isolation and medication changes

The third session of Bob’s therapy reveals development of another behavioral disorder characterized by withdrawal from family, isolation and crying spells. His wife revealed new episodes of mood swings, anger, an unsatisfactory sex life, arguments and complaining which are all reported in Bob’s case. He isolates after an argument, complains about work and even quarreled a colleague. These are symptoms of depression which the counselor should consider discussing with Bob as well as other topics such as suicidal thoughts and prevention.

In conclusion, Mood swings, changes in appetite, weight loss or gain, fatigue and irritability are some of the tools the consultant can use to diagnose Bob with depression. Upon this diagnosis, the consultant can recommend a change in medication for Bob. He can stop prescribing Xanax and adopt Eye Movement Therapy (EMDR) from their next session.