The client is a 46-year-old white male working as a welder at the local factory. He reported signs similar to a heart attack, such as chest tightness, shortness of breath, and a feeling of impending doom. He has some mild hypertension and is overweight. However, after the examination, the myocardial infarction was ruled out. However, he still suffers from anxiety attacks and unpleasant feelings. He confesses using ETOH to combat worries about work and consuming 3 or 4 beers per night. The client is alert and well-oriented. He is well-dressed; his speech is clear and goal-directed. The self-reported mood is low, with nervousness. He denies hallucinations or paranoid thoughts. The client also denies suicidal or homicidal ideation. The additional test, HAM-A, yields a score of 26. In such a way, he is diagnosed with generalized anxiety disorder.
Considering the current client’s state, the decision to prescribe Paxil was chosen. It is an antidepressant belonging to the group of selective serotonin reuptake inhibitors (Kowalska et al., 2021). It affects chemicals in the brain that may be unbalanced among patients with anxiety (Kowalska et al., 2021). It is expected that the drug will help to reduce symptoms and improve the overall patient’s condition and feeling. The choice of medicine is also linked to its proven efficiency (Kowalska et al., 2021). The research shows that patients who received Paxil experienced significant improvements in the number of full panic attacks (Kowalska et al., 2021). This factor is critical for a patient who suffers from anxiety-caused panic attacks and shortness of breath.
Speaking about alternatives, such as Imipramine and Buspirone, Paxil was selected because of several factors. First, it is available in a cheaper form which is better for the client (Kowalska et al., 2021). Second, the medicine can be taken once a day, which is comfortable for patients with panic attacks (Cipriani et al., 2018). At the same time, it remains effective in treating anxiety disorders and associated states (Cipriani et al., 2018). In such a way, it was expected that Paxil would help to achieve several goals. First, the frequency of anxiety and panic attacks was expected to reduce. Second, the improvement in the patient’s state, such as the absence of shortness of breath and tightness in the chest, was expected. In general, it was critical to meet primary ethical considerations. The treatment should not cause harm to the patient (Marks et al., 2021). Moreover, it should be available, affordable, and cause a reduced number of adverse effects (Marks et al., 2021). For this reason, the decision to start using Paxil was aligned with the ethical issues and the necessity to help a patient and address his problem.
The next meeting with the patient indicated the effectiveness of the used treatment. He reported the absence of tightness in his chest or shortness of breath and decreased worries about work over the past five days. It proves the correctness of the previous choice; however, it also means that the treatment should be continued. In general, the recommended dose of Paxil is 20 mg daily, which explains the choice (Strawn et al., 2018). The initial prescription was needed to see the patient’s reaction to the medicine. At the same time, the improvements reported by the client show that there is no need for a more significant dose as it might be unnecessary and trigger the development of undesired effects. At the same time, the shift to recommended dose was necessary to ensure the patient acquires the correct treatment and might recover.
Several factors impacted the decision to start using 20 mg of Paxil. First, the research shows that patients taking the recommended dose are more likely to report significant improvements in the course of treatment (Strawn et al., 2018). These include reduced anxiety levels, fewer cases of panic attacks, and the absence of shortness of breath or tightness in the chest (Strawn et al., 2018). Moreover, the scheme is proven by the information from similar cases, meaning it is possible to start using it as the primary treatment approach. From the ethical perspective, the increase in the dosage is critical as it helps to address the significant patient’s problem and guarantees the man experiences relief and can remain functional, work, and provide care for his aging parents at home (Marks et al., 2021). At the same time, no severe adverse effects were discovered. For this reason, the selected decision is ethical and practical.
Finally, the decision to maintain the current dose was accepted during the third meeting. First of all, the client reports a further reduction of symptoms with a HAM-A score decrease to 10. It evidences the effectiveness of the selected approach and treatment method. At the same time, no panic attacks or new symptoms emerged. For this reason, it is possible to continue treatment using the same scheme, as it has a positive impact on the patient’s state, well-being, and anxiety levels. Moreover, there is no need to increase trying to attain better results. First, it might have a too strong impact on the patient and trigger the development of adverse effects (Strawn et al., 2018). Second, the treatment process shows that he tolerates Paxil and feels better. For this reason, no augmentation agents such as BuSpar are required. It is vital to continue treatment using the selected scheme.
It is expected that the selected scheme can help to achieve a significant improvement in the patient’s state. At the moment, it is clear that a patient has a good response, which proves the efficiency of the treatment, and no side effects should be considered. For this reason, it is necessary to continue using Paxil during the next 12 weeks to admit the changes in the individual’s state and determine whether additional interference might be required (Strawn et al., 2018). At the same time, it is vital to discuss the process with the client to ask about his visions of the progress and improvements he wants to achieve (Marks et al., 2021). It will help to modify the cooperation if required and introduce necessary changes to consider the client’s needs.
Altogether, the peculiarities of the patient and his condition explain the use of the specific treatment. To address the panic attacks, shortness of breath, feeling of impending doom, and other anxiety symptoms, Paxil was selected as an appropriate antidepressant. The initial dose of 10 mg showed that the patient tolerated the drug, and it was increased up to 20 mg daily. The correctness of choice is evidenced by the significant improvement reported by the patient. He suffers from a reduced number of anxiety symptoms and can avoid negative thinking about work and other associated factors. At the same time, the treatment was selected to consider ethical issues and ensure no severe adverse effects would emerge and impact the patient. The regular meetings and evaluation of the client’s state helped to monitor the progress and introduce changes when it was required.
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet, 391(10128), 1357–1366.
Kowalska, M., Nowaczyk, J., Fijałkowski, Ł., & Nowaczyk, A. (2021). Paroxetine-overview of the molecular mechanisms of action. International Journal of Molecular Sciences, 22(4), 1662.
Marks, J., Rosenblatt, S., & Knoll, J. (2021). Ethical challenges in the treatment of anxiety. Focus, 19(2), 212-216.
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070.