A forty five-year-old Caucasian man presents to your clinic with complaints of hysteria, which he describes as “fixed fear and nervousness.” He experiences that his signs have been current for a number of months and are impacting his means to work and luxuriate in his hobbies. He denies any historical past of substance abuse or important medical issues.
After finishing a complete analysis, you diagnose the affected person with generalized anxiousness dysfunction (GAD) and determine to prescribe treatment to handle his signs.
Determination 1: What class of treatment needs to be prescribed for this affected person’s anxiousness?
The category of treatment that’s generally prescribed for anxiousness is selective serotonin reuptake inhibitors (SSRIs). These medicines are most well-liked over benzodiazepines resulting from their decrease potential for dependence and abuse. SSRIs are additionally efficient in treating the signs of GAD.
Determination 2: Which particular SSRI needs to be prescribed for this affected person?
The selection of SSRI is determined by a number of elements, together with the affected person’s medical historical past, potential drug interactions, and particular person response to treatment. On this case, the affected person denies any important medical issues or present medicines, so there aren’t any contraindications for using any particular SSRI.
Nonetheless, it is very important take into account the affected person’s pharmacokinetic and pharmacodynamic processes. For the reason that affected person is a middle-aged Caucasian man, there aren’t any important variations within the pharmacokinetic and pharmacodynamic processes in comparison with the overall inhabitants. Nonetheless, particular person variations could exist and needs to be taken into consideration. Basically, SSRIs are well-tolerated, however some sufferers could expertise unwanted side effects similar to nausea, vomiting, and sexual dysfunction. Due to this fact, the selection of treatment ought to take into accounts the potential for unwanted side effects and the affected person’s preferences.
Determination 3: What’s the applicable beginning dose for the chosen treatment?
The suitable beginning dose for the chosen treatment is determined by a number of elements, together with the affected person’s age, weight, medical historical past, and potential drug interactions. Basically, SSRIs have a low threat of overdose, and a typical beginning dose can be utilized for many sufferers.
For this affected person, a beginning dose of 10-20mg of escitalopram (Lexapro) or sertraline (Zoloft) every day can be applicable. These doses will be elevated progressively as wanted to realize the specified impact, however no more ceaselessly than each 1-2 weeks. Shut monitoring of the affected person’s response and any potential unwanted side effects needs to be performed throughout dose titration.
In conclusion, the selection of treatment for the remedy of hysteria ought to take note of the affected person’s medical historical past, potential drug interactions, and particular person response to treatment. A selective serotonin reuptake inhibitor is the popular class of treatment for anxiousness, and the selection of treatment inside this class needs to be made based mostly on the affected person’s particular person wants and preferences. The suitable beginning dose needs to be decided based mostly on the affected person’s particular person traits and shut monitoring needs to be performed throughout dose titration.