How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?

A decision tree for anxiety disorders is an interactive piece of media that was selected for the discussion. Generalized Anxiety Disorder is the psychological condition that will be discussed. Decision-making involves assessing anxiety symptoms and determining whether medication is needed. Then, choosing the appropriate medication as well as monitoring the patient’s response to it are the next steps.

If anxiety symptoms are severe based on your decision making steps, you may need medication. Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are the recommended pharmacotherapeutics for GAD. SSRIs are used to increase the serotonin level in the mind by blocking the reuptake. SNRIs work on both the serotonin as well as the norepinephrine reuptake. These two medications share similar side-effects such as headache, nausea, sexual dysfunction, and insomnia.

The administration of SSRIs or SNRIs may impact the patient’s pathophysiology by altering the serotonin and norepinephrine levels in the brain. These medications may enhance serotonin neurotransmission and reduce anxiety symptoms. However, there may be potential impacts on the patient’s endocrine system, cardiovascular system, and gastrointestinal system due to the medication’s mechanism of action.

To suggest treatment plans for the patient, the potential impacts of pharmacotherapeutics on the patient’s pathophysiology must be considered. If a patient has a past history of diabetes or cardiovascular disease, they may benefit from a medication that is less likely to cause cardiovascular and metabolic effects. Patients who have a history with kidney or liver disease might need to take a drug with lower hepatic toxicity.

References:

American Psychiatric Association. (2013). Diagnostic and statistical Manual of Mental Disorders, 5th Edition.). https://doi.org/10.1176/appi.books.9780890425596

National Institute of Mental Health (2018). 2018 Generalized Anxiety disorder https://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.