Walden – NURS 6521 – Decision Making When Treating Psychological Disorders

Module 6: Psychological Disorders

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act…mental health is important at every stage of life, from childhood and adolescence through adulthood.

—Centers for Disease Control and Prevention, 2018

As an advanced practice nurse, treating patients who may present with psychological disorders requires critical clinical decision making. It is your expertise in clinical decision making that will ensure that the pharmacotherapeutics and other suggested treatments prescribed to your patients will not only promote positive patient health outcomes but will lead to sustained health and well-being.

Reference: Centers for Disease Control and Prevention. (2018). Mental health. Retrieved from https://www.cdc.gov/mentalhealth/index.htm

What’s Happening In This Module?

Module 6: Psychological Disorders is a 1-week module, Week 8 of the course. In this module, you will examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

Go to the Week’s Content

Week 8: Pharmacology for Psychological Disorders

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

Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care.

This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

Learning Objectives

Students will:

• Evaluate patients for treatment of psychological disorders
• Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders
• Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology
• Evaluate patients for treatment of neurological and musculoskeletal disorders
• Analyze decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders
• Justify decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders

Learning Resources

Required Readings

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2^nd) St. Louis, MO: Elsevier.
• Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
• Chapter 27, “Antidepressants” (pp. 214–226)
• Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
• Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
• Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
• Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)

Required Media

Laureate Education (Producer). (2019a). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.

Laureate Education (Producer). (2019c). Attention deficit hyperactivity disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.

Laureate Education (Producer). (2019d). Bipolar therapy [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.

Laureate Education (Producer). (2019g). Generalized anxiety disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder.

Discussion: Decision Making When Treating Psychological Disorders

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

• Review this week’s interactive media pieces and select one to focus on for this Discussion.
• Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

By Day 3 of Week 8

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

By Day 6 of Week 8

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Assignment: Decision Tree for Neurological and Musculoskeletal

By Day 7 of Week 8

Submit your Assignment, started in Week 6.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
• Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 8 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

            Sample Paper Week 8

Walden NURS 6521 – Decision Making When Treating Psychological Disorders

Treating Psychological Disorders

Student’s Name:

Institutional Affiliation:

Mental health issues are serious and do have debilitating outcomes, affecting normal functioning, increasing dependency levels, and not only affects the diagnosed person but also their loved ones. Mental health illness symptoms may occur temporarily or chronic and can range from mild, moderate, and severe. The mild symptoms of mental illness can be managed through life adjustment and psychotherapy, but when they are severe, a combination with medication/ pharmacotherapy is recommended. The majority of mental health experts do agree that a combination of pharmacotherapy and psychotherapy is more effective compared to implementing the individual approaches in the treatment of severe mental health issues (Pedrelli et al., 2015). This paper aims to review a case study of a Hispanic male with a major depressive disorder to assess some of the three medications proposed: Zoloft 25 mg orally daily, Effexor XR 37.5 MG orally daily, and Phenelzine 15 mg orally TID to recommend the most appropriate.

Before recommending any medications to a patient, it is best to collect sufficient information such as the patient characteristics such as age and health condition, current medication, past medical history, psychiatric history of the family, and generally the patient’s functional status. The caregiver also has to collect the patient’s objective data. After assessing the patient’s cognitive and emotional state, as in the case study, the caregiver can plan for the prescription such as patient and support education, dosage, frequency, route, and the span based on information collected (Mayo-Wilson et al., 2014). It is also best to review the medications for effectiveness, interactions, and side effects based on the patient’s condition.

Zoloft 25 Mg Orally Daily

Zoloft is a selective serotonin reuptake inhibitor (SSRI) and works by restoring serotonin in the brain. The medication is used in treating depression, post-traumatic stress disorder, panic attacks, obsessive-compulsive disorder, and social phobia. Zoloft may mend sleep disorders, appetite, mood, energy levels, and increase interest in activities which one loves (Milgrom et al., 2015). The medication may also interfere with the urge to partake in repetitive tasks that one faces in daily living, such as counting. The appropriate dosage for persons with MDD is 50mg, with a maximum upper range of 200mg for unresponsive patients.

Effexor XR 37.5 Mg Oral Daily

Also known as Venlafaxine, Effexor XR is used as a mood and energy enhancer to rejuvenate interest (Dahale e al., 2014). The antidepressant is used to treat social anxiety disorder, depression panic attacks, and anxiety. Effexor XR is a serotonin-norepinephrine reuptake inhibitor and works by restoring and balancing norepinephrine and serotonin in the brain. The oral medication is taken once daily, either in the morning or evening, and is not to be chewed as it may increase the chances of side effects. The medication is not stopped unless the caregiver orders so, and the benefits are gradual to note and may take several weeks for positive results. The 37.5 mg dosage is best at the beginning for the patient to adjust; then, it can be raised to 75mg, which is the recommended dose.

Phenelzine 15 Mg Oral TID

Phenelzine is a usual dose for depression and mostly administered to adults. The initial dose for depression is 15mg tid but can be increased to 90 mg for patients who require high monoamine oxidase inhibition. The results of Phenelzine may be noted after at least a month at 60mg daily dosing. The 15 mg dose can only be used for maintenance purposes after benefits are attained. Phenelzine is not recommended as the initial depressant to use in patient treatment, but as the last option after other medications are unresponsive on the patient (Willaert et al., 2014).

Appropriate Choice

The three medications are antidepressants and seem to have almost similar side effects such as suicidal thoughts and behavior; hence caregivers need to balance between the clinical benefits to the patient and the risks involved (Mayo-Wilson et al., 2014). From assessing the above medication in treating MDD, the first to exclude is the Phenelzine 15 mg oral TID dosage as it should be used as an alternative treatment after all other options have failed. Zoloft 25 mg orally daily is also a better prescription, but the problem is that that dosage is way below for the 50mg appropriate for treatment of MDD; hence, it may take time to restore the patient’s wellbeing. Zoloft does also have the risk of interfering with repeated tasks; thus, the patient’s job may be at stake, which may affect the patient’s wellbeing further and worsen the situation.

The recommendable medication, in this case, is Effexor XR 37.5 mg oral daily as it begins with the lowest dosage, which can be controlled based on the patient’s response. Since the medication is taken once a day, it can be prescribed in a period where the patient is off work hence cannot interfere with their daily activities. The caregivers need to monitor the patient carefully as they use antidepressants, and so should the family of the patient keeping close contact with the prescriber in case of any negative observations.

References

Dahale, A. B., Narayanaswamy, J. C., Venkatasubramanian, G., & Bagewadi, V. I. (2014). Successful use of agomelatine and venlafaxine combination in major depression. General hospital psychiatry, 36(1), e3.

Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376.

Milgrom, J., Gemmill, A. W., Ericksen, J., Burrows, G., Buist, A., & Reece, J. (2015). Treatment of postnatal depression with cognitive behavioural therapy, sertraline and combination therapy: a randomised controlled trial. Australian & New Zealand Journal of Psychiatry, 49(3), 236-245.

Pedrelli, P., Nyer, M., Yeung, A., Zulauf, C., & Wilens, T. (2015). College students: mental health problems and treatment considerations. Academic Psychiatry, 39(5), 503-511.

Willaert, L., Verbeke, P., Sienaert, P., & De, J. F. (2014). Irreversible monoamine oxidase inhibitors (IMAOI) to treat depressive disorders-limited use at present in Flanders. Tijdschrift voor psychiatrie, 56(10), 651-659.

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