The exact cause for GAD is unknown. However, studies have shown that patients with GAD have shown more significant activity in parts of the brain related to mental activity and introspective thinking after anxiety episodes. Additional studies involving twins have shown that a person’s environment and genetic make-up affect whether or not an individual will be diagnosed with GAD (Locke et al., 2015).
In the patient diagnosed with GAD, I first chose Zoloft 50 mg oral daily for treatment. I decided on this medication because Zoloft is a selective serotonin reuptake inhibitor (SSRI), and SSRIs are the preferred treatment choice for patients with GAD (Locke et al., 2015). After four weeks of taking Zoloft, the patient had a HAM-A score of 18.
The HAM-A or Hamilton Anxiety Rating Scale was first used in 1959 and is a survey of 14 questions. Both psychological and somatic symptoms relating to anxiety are assessed in the HAM-A questionnaire. If patients score greater than 17, then symptoms considered are mild. However, a score of 25-30 indicates moderate to severe anxiety (Thompson, 2015). The patient in the scenario originally had a HAM-A score of 26 that decreased to 18 after one month of taking Zoloft. This was a significant improvement.
At the first follow-up visit, I would increase the Zoloft to 75 mg. With a HAM-A score of 10 on the follow-up visit, I would not change the dosage of Zoloft at that time and continue to schedule follow-up visits with the patient. Since GAD is a chronic disorder, it is recommended that medication therapy continues for twelve months before considering a slow wean off Zoloft (Rosenthal & Burchum, 2018). I would also highly suggest that the patient undergo psychotherapy treatment. It has been shown that patients with moderate to severe GAD show more significant improvements when medication and psychotherapy are combined (Locke et al., 2015).
Locke, A. B., Nell, K., & Schultz, C. D. (2015). Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. American Family Physician, 91(9), 617–623.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s Pharmacotherapeutics for Nurse Practitioners and Physician Assistants (1st ed.). Elsevier .
Thompson, E. (2015). Hamilton rating scale for anxiety (ham-a). Occupational Medicine, 65(7), 601–601. https://doi.org/10.1093/occmed/kqv054