Assessing and Treating Patients With Anxiety Disorders

Decision Point One

Begin Zoloft 50 mg orally dailyBegin Zoloft 50 mg orally 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

·  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 75 mg orally 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

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 effects, the current dose can be maintained for 12 weeks to evaluate full effect of drug. Increasing drug at this point may yield a further decrease in symptoms, but may also increase the risk of side effects. 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.