Case Study: A Middle-Aged Caucasian Man With Anxiety

Introduction

A 45-year-old Caucasian man presents to the clinic with a 10-year history of generalized anxiety disorder (GAD). He reports that his anxiety has been worsening in recent months, and he is now having difficulty sleeping, concentrating, and making decisions. He also reports that he is feeling irritable and restless, and he is having trouble enjoying activities that he used to enjoy.

The patient has no other major medical conditions and is not taking any other medications. He is married with two young children, and he works full-time as a software engineer. He denies any history of substance abuse or alcohol abuse.

Decision #1

Which decision did you select?

I would select escitalopram (Lexapro) as the first-line medication for this patient.

Why did you select this decision?

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) that is commonly used to treat GAD. SSRIs are generally considered to be safe and effective for the treatment of anxiety disorders. They have a lower risk of side effects than other classes of antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).

Escitalopram has also been shown to be particularly effective for the treatment of GAD in middle-aged adults. In a study published in the Journal of Clinical Psychiatry, escitalopram was found to be more effective than placebo in reducing the symptoms of GAD in middle-aged adults. The study also found that escitalopram was well-tolerated, with a low rate of side effects.

Why did you not select the other two options provided in the exercise?

I did not select the other two options, venlafaxine (Effexor) and buspirone (Buspar), because they are not as well-established as escitalopram in the treatment of GAD in middle-aged adults. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is also effective for the treatment of GAD. However, it has a higher risk of side effects than escitalopram, such as nausea, insomnia, and sexual dysfunction. Buspirone is a non-benzodiazepine anxiolytic that is also effective for the treatment of GAD. However, it can take several weeks to start working, and it is not as effective as SSRIs for the treatment of moderate and severe GAD.

What were you hoping to achieve by making this decision?

I was hoping to achieve the following by selecting escitalopram as the first-line medication for this patient:

• Reduce the patient’s symptoms of anxiety and improve his quality of life.
• Improve the patient’s sleep, concentration, and decision-making.
• Reduce the patient’s irritability and restlessness.
• Help the patient enjoy activities that he used to enjoy.

How ethical considerations may impact your treatment plan and communication with patients.

Ethical considerations that may impact the treatment plan and communication with patients include:

• Informed consent: The patient must be informed of the potential benefits and risks of the medication before he gives his consent to treatment.
• Autonomy: The patient has the right to make his own decisions about his treatment.
• Beneficence: The treatment plan should be designed to promote the patient’s well-being.
• Nonmaleficence: The treatment plan should be designed to avoid harming the patient.

When communicating with patients, it is important to be honest and transparent about the potential benefits and risks of medication. It is also important to listen to the patient’s concerns and to respect their right to make their own decisions about their treatment.

Here are some specific examples of how ethical considerations can impact the treatment plan and communication with patients:

• If a patient is hesitant to start taking medication, the clinician should discuss the potential benefits and risks of the medication in detail. The clinician should also listen to the patient’s concerns and try to address them.
• If a patient is experiencing side effects from medication, the clinician should work with the patient to adjust the dose or switch to a different medication.
• If a patient is suicidal, the clinician should take steps to protect the patient from harm. This may include hospitalization or referral to a mental health professional.

It is important to note that ethical considerations can vary depending on the specific situation. It is always best to consult with an ethicist if you have any questions or concerns about an ethical issue.