NURS 6630 Week 8 Assignment 1: Short Answer Assessment

NURS 6630 Week 8 Assignment 1: Short Answer Assessment

As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.

To Prepare:

• Review the Learning Resources for this week.
• Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders.
• Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.

To complete:

Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
2. List 4 predictors of late onset generalized anxiety disorder.
3. List 4 potential neurobiology causes of psychotic major depression.
4. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.
5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.

 

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Learning Resources

Required Readings

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf

Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf

Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740

 

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Assignment 1: Short Answer Assessment

 

Appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse.

To provide the best possible therapy for individuals suffering from Major Depressive Disorder, it is necessary to be informed of their concomitant alcohol use record. Zoloft 50 mg orally daily administered in the morning and Naltrexone 50 mg orally daily for 12 weeks is an ideal therapy for people suffering from MDD and alcohol dependency. Zoloft raises serotonin concentrations in the nervous system, which is important for boosting emotions and reducing symptoms of depression (McHugh, 2019). Naltrexone, on the contrary, prevents the pleasurable and relaxing impacts of substances by inhibiting their receptors.

Buprenorphine  and Methadone are medicines that should not be used in conjunction with concomitant alcohol use management in MDD. They function by stimulating the opioid receptors in the brain, which reduces the need to seek out substances. When Zoloft and methadone are combined, the chance of an irregular heartbeat rises significantly. Sertraline and Buprenorphine may produce a disorder known as serotonin syndrome when used together. When this happens, it may lead to a variety of unpleasant side effects, such as disorientation and dizziness, as well as elevated blood pressure and heart rate (APA, 2013). Individuals who are taking or have ceased using MAOIs, pimozide, or who have a history of Zoloft intolerance should not use Zoloft. It is expected that the patient would experience improvements by the fourth week after starting the treatment.

4 predictors of late-onset generalized anxiety disorder

The following are the most important factors in predicting the late development of generalized anxiety:

• History of generalized anxiety disorder
• History of cognitive dysfunction
• History of phobia and depression
• History of severe physical illnesses, such as pulmonary illnesses, cardiovascular problems, arrhythmias, and high cholesterol

(Hellwig & Domschke, 2019).

4 potential neurobiology causes of psychotic major depression

• Malformations and dysfunctions of the prefrontal cortex and its associated circuitry
• Hypothalamic-pituitary-adrenal axis dysfunction
• Decreased connection in the default mode network and other parts of the brain
• Childhood trauma or abuse, as well as other past distressing events

(Croarkin, 2018).

Five symptoms required for a major depression episode to occur.

• The majority of the day is spent in a depressed state, as evidenced by emotions of sadness, hopelessness, or emptiness.
• Tasks that were once delightful to participate in become less appealing to the patient.
• Hypersomnia or sleep deprivation becomes a common occurrence.
• Constant thoughts of insignificance and unwarranted guilt.
• Suicidal attempts, suicidal thoughts, or intrusive thoughts on a regular basis

(American Psychiatric Association, 2013)

3 classes of drugs, with a corresponding example for each class that precipitate insomnia

·         Selective serotonin reuptake inhibitors (SSRIs): For example Prozac and Zoloft

• Monoamine oxidase inhibitors (MAOIs): for example phenelzine and selegiline
• Benzodiazepines: for example Xanax and Valium

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Croarkin P. E. (2018). Indexing the neurobiology of psychotic depression with resting-state connectivity: Insights from the STOP-PD study. EBioMedicine, 37, 32–33. https://doi.org/10.1016/j.ebiom.2018.10.010

Hellwig, S., & Domschke, K. (2019). Anxiety in late life: An update on Pathomechanisms. Gerontology, 65(5), 465-473. https://doi.org/10.1159/000500306

McHugh, R. (2019). Alcohol use disorder and depressive disorders. Alcohol Research: Current Reviews, 40(1). https://doi.org/10.35946/arcr.v40.1.01