Jul 23 7:15pm
Reply from Kirsis Perez
NRNP 6675 Week 9 Discussion for July 24
Prescription for Older Adults
Generalized anxiety disorder (GAD) is a mental health disorder that is associated with uncontrollable and excessive worry over various aspects of daily life. Individuals with chronic anxiety tend to have physical stress, especially in their cardiovascular, nervous, and respiratory systems. Therefore, without proper management, GAD can affect the quality of a patient’s life (Sapra et al., 2019). The prevalence of the condition among older adults is about 11.2%. When prescribing for older adults, practitioners need to consider different age-related characteristics of the patients. For instance, they need to consider the patients have altered drug metabolism and a relatively higher sensitivity to the drugs (Showraki, Showraki, & Brown, 2020). The paper discusses the treatment of GAD, the risks associated with the treatment decision-making, and the existing clinical guidelines and recommendations for older patients.
FDA-Approved Drug, Off-Label Drug, and Non-Pharmacological Intervention for GAD
Escitalopram is an FDA-approved medication for the management of GAD. It belongs to a group of drugs known as selective serotonin reuptake inhibitors (SSRIs). It functions by enhancing the balance of serotonin in the brain (Afridi et al., 2020). An example of a suitable off-label drug for the management of GAD is quetiapine. It belongs to a class of drugs known as atypical antipsychotics. Like escitalopram, quetiapine functions by restoring the balance of neurotransmitters in the brain. As a result, it improves the level of concentration in a patient and decreases their anxiety symptoms (Shelton et al., 2024). On the other hand, cognitive behavioral therapy (CBT) is an effective non-pharmacological treatment for GAD. It works by enabling patients to identify and challenge negative thoughts that lead to the development of anxiety. By identifying the thought patterns, individuals are able to change their thinking to be realistic (Newman, Zainal, & Hoyer, 2020).
The Risk Assessment for the Treatment Decision-Making
The use of the FDA-approved drug is beneficial to a patient with GAD as it is an SSRI; hence it has relatively fewer side effects to an older patient. It is also effective in managing anxiety symptoms, thus reducing the need for the patient to use another drug for managing the condition. It can also be combined with CBT to improve the management of GAD. On the other hand, the drug can lead to side effects such as insomnia, fatigue, and sexual dysfunction. Older patients may also be susceptible to weight gain and serotonin syndrome (Afridi et al., 2020). Quetiapine is useful as it improves anxiety symptoms. It also helps in managing a patient’s mood and their sleep. It is likely that a patient using the drug will experience a relatively quicker control of anxiety. However, older patients may also experience side effects such as increased appetite, weight gain, and dizziness (Shelton et al., 2024).
Existing Clinical Guidelines and Recommendations for GAD
Gray et al. (2024) provide a clinical guideline for the management of GAD in general care settings. The guideline recommends the use of CBT in managing GAD. It reveals that patients should engage in guided self-help and also focus on interventions that are delivered by a specialist. Moreover, the guideline recommends the use of SSRIs in the management of GAD. On the other hand, atypical antipsychotics are recommended if the patient’s symptoms are persistent. Stress management techniques are also recommended for older adults with GAD. Practitioners are also discouraged from prescribing benzodiazepines in managing GAD in older patients (Gray et al., 2024).
References
Afridi, M. I., Dogar, I. A., Nizami, A. T., Aslam, R., Mustafa, A. B., Muhammad, S. S., & Maheshwary, N. (2020). Efficacy and safety of escitalopram oral drops to treat major depressive disorder and generalized anxiety disorder in adolescent, adult and geriatric patients: A prospective multicenter observational study in Pakistan. Cureus, 12(1). e6792. https://doi.org/10.7759/cureus.6792
Gray, B., Asrat, B., Brohan, E., Chowdhury, N., Dua, T., & van Ommeren, M. (2024). Management of generalized anxiety disorder and panic disorder in general health care settings: new WHO recommendations. World Psychiatry, 23(1), 160. https://doi.org/ 10.1002/wps.21172
Newman, M. G., Zainal, N. H., & Hoyer, J. (2020). Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder (GAD). Generalized Anxiety Disorder and Worrying: A Comprehensive Handbook For Clinicians And Researchers, 203-230. https://doi.org/10.1002/9781119189909.ch10
Sapra, A., Bhandari, P., Sharma, S., Chanpura, T., & Lopp, L. (2020). Using generalized anxiety disorder-2 (GAD-2) and GAD-7 in a primary care setting. Cureus, 12(5). https://doi.org/10.7759/cureus.8224
Shelton, S., Chang, R., Elgharbawy, S., Hunter-Reach, P., & Richard, M. (2024). Is quetiapine an effective treatment for generalized anxiety disorder? Evidence-Based Practice, 27(5), 35-36. https://doi.org/10.1097/EBP.0000000000002091
Showraki, M., Showraki, T., & Brown, K. (2020). Generalized anxiety disorder: Revisited. Psychiatric Quarterly, 91, 905-914. https://doi.org/10.1007/s11126-020-09747-0
