Generalized Anxiety Disorder Middle-Aged White Male With Anxiety

Decision Point One

Begin Paxil 10 mg po daily

RESULTS OF DECISION POINT ONE � Client returns to clinic in four weeks

� Client informs you that he has no tightness in chest, or shortness of breath

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� Client states that he noticed decreased worries about work over the past 4 or 5 days

� HAM-A score has decreased to 18 (partial response)

Decision Point Two

Increase dose to 20 mg po daily

RESULTS OF DECISION POINT TWO � Client returns to clinic in four weeks

� Client reports an even further reduction in his symptoms

� HAM-A score has now decreased to 10. At this point- continue current dose (61% reduction in symptoms)

Decision Point Three

Maintain current dose

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Guidance to Student

At this point, it may be appropriate to continue client at the current

dose. It is clear that the client is having a good response (as

evidenced by greater than a 50% reduction in symptoms) and the

client is currently not experiencing any side e�ects, the current

dose can be maintained for 12 weeks to evaluate full e�ect of drug.

Increasing drug at this point may yield a further decrease in

symptoms, but may also increase the risk of side e�ects. This is a

decision that you should discuss with the client. Nothing in the

client’s case tells us that we should consider adding an

augmentation agent at this point as the client is demonstrating

response to the drug. Avoid polypharmacy unless symptoms

cannot be managed by a single drug.

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