Question

Today you met with a new patient named Brian. You have received consent from him to coordinate care with his personal physician and must write a letter with your thoughts on continued treatment and medication options. Based on your meetings and evaluation, you have determined that Brian has generalized anxiety disorder (GAD) and would benefit from a non-benzodiazepine medication. Brian believes only benzodiazepine drugs will work.

Read Case Study: Brian to learn more about your new patient. Prepare a patient profile and write a letter to his primary care physician that explains the rationale behind your medication and treatment recommendations.

The numbered assignment instructions outlined below correspond to the grading criteria in the Medication Selection and Ethical Issues rubric, so be sure to address each point.

Differentiate types of benzodiazepine drugs based on their effect on neurotransmission.
Choose any of the benzodiazepine drugs—Valium (diazepam), Librium (chlordiazepoxide), Klonopin (clonazepam), Restoril (temazepam), Ativan (lorazepam), Xanax (alprazolam), or Halcion (triazolam).
Differentiate types of benzodiazepine drugs based on their effect on the hormonal system.
Create a profile of a client who would benefit from a benzodiazepine drug.
Create a profile for Brian.
Explain why he would benefit from this type of medication, based on its effect on neurotransmission and the hormonal system.
Explain the rationale for the selection of a benzodiazepine drug for use with a client.
The profile should contain enough information about the client's GAD that you could perform a diagnosis to determine the disorder.
You do not need to address any treatment issues; however, do include any significant demographic or background factors that may inform clinical decision-making related to the medication choice.
Communicate in a manner that is consistent with expectations for professional communities.
Write a brief letter to a primary care physician that explains your rationale for the use of this medication with this client.
Assume the physician does not know you and include properly cited references to support your assertion so he or she is convinced to accept your referral.

Brian is a 35-year-old male whom is seeking counseling for what he believes are anxiety symptoms. Brian reports worrying a lot about different issues in his life including the health of his parents and his job as a sales manager.

Brian said he has trouble relaxing when he gets home from work, finds it difficult to fall and stay asleep, and has been very irritable. Brian reports that sometimes his anxiety becomes overwhelming and he starts to sweat and have heart palpitations.

Brian resides alone and is single, never married. Brian reports his support system is comprised of his parents, his sister, and a few friends. Brian discloses that he is in recovery from substance abuse for alcohol and cocaine dependence and has 7 years of sobriety.

Brian shared that he completed inpatient treatment but is not active in any 12 step groups.

Answer 1

[Your Name]

[Your Title]

[Your Address]

[City, State, ZIP]

[Date]

[Primary Care Physician's Name]

[Physician's Practice]

[Address]

[City, State, ZIP]

Dear Dr. [Physician's Last Name],

I hope this letter finds you well. I recently had the opportunity to meet with your patient, Brian, who presented with symptoms consistent with generalized anxiety disorder (GAD). After conducting a thorough evaluation and considering Brian's medical history, I would like to discuss my thoughts on continued treatment and medication options.

Based on our meetings and assessment, it is evident that Brian is experiencing significant anxiety symptoms, including excessive worry, difficulty relaxing, sleep disturbances, irritability, and physical manifestations such as sweating and heart palpitations. These symptoms are consistent with the diagnostic criteria for GAD outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Considering Brian's history of substance abuse and his desire to avoid benzodiazepine drugs, I believe it is crucial to explore non-benzodiazepine medication options for his anxiety management. While benzodiazepines have traditionally been used to treat anxiety disorders, they carry a risk of dependence and potential for abuse, particularly in individuals with a history of substance use disorders.

Nonetheless, it is important to address Brian's concerns and provide him with an effective treatment plan. Therefore, I propose considering the use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line pharmacological interventions for his GAD. These medications have demonstrated efficacy in treating anxiety disorders and are generally well-tolerated with a lower risk of dependence compared to benzodiazepines.

SSRIs, such as sertraline or escitalopram, work by increasing the availability of serotonin in the brain, which helps regulate mood and anxiety. SNRIs, such as venlafaxine or duloxetine, additionally target norepinephrine, which plays a role in the stress response. Both classes of medications have shown effectiveness in reducing anxiety symptoms and improving overall functioning in individuals with GAD.

Considering Brian's specific symptoms and his desire for effective treatment, I believe that a non-benzodiazepine medication, such as an SSRI or SNRI, would be a suitable choice. These medications can provide long-term relief from anxiety symptoms without the risk of dependence or potential for abuse associated with benzodiazepines.

I understand that each patient is unique, and individual factors should be considered when making treatment decisions. Therefore, I encourage you to review the literature on the efficacy and safety of SSRIs and SNRIs in the treatment of GAD. I have included a list of references at the end of this letter to support my recommendation.

I appreciate your attention to this matter and would be grateful for your collaboration in providing the best possible care for Brian. If you have any questions or require further information, please do not hesitate to contact me. I look forward to working together to support Brian's well-being.

Thank you for your time and consideration.

Sincerely,

[Your Name]

[Your Title]

[Your Contact Information]

References:

1. Baldwin DS, Anderson IM, Nutt DJ, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder, and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014;28(5):403-439.

2. Bandelow B, Zohar J, Hollander E, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision. World J Biol Psychiatry. 2008;9(4):248-312.

3. National Institute for Health and Care Excellence (NICE). Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline [CG113]. Published January 2011. Accessed [Date]. Available from: [URL].