Nursing Papers Market

At times, psychotherapy is not enough to alleviate the emotional difficulties that some patients face. To that end, psychopharmacologic approaches are needed. Psychiatric nurse practitioners (PNPs) must have a strong basis in psychopharmacology, extending from a prior education in pharmacology, to make appropriate medication choices for their patients. Learners in this course consider psychopharmacologic approaches to major behavioral health disorders including but not limited to major depressive disorders, bipolar disorder, anxiety disorders, as well as psychotic disorders. Learners explore key considerations associated with medication selection, monitoring efficacy, and long-term management.

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Week 1 discussion

Discussion: Foundational Neuroscience

As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 1, “Chemical Neurotransmission”

Chapter 2, “Transporters, Receptors, and Enzymes as Targets of Psychopharmacologic Drug Action”

Chapter 3, “Ion Channels as Targets of Psychopharmacologic Drug Action”

Document: Midterm Exam Study Guide (PDF)

Document: Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2016i). Introduction to psychopharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 3 minutes.

Accessible player

Optional Resources

Laureate Education (Producer). (2009). Pathopharmacology: Disorders of the nervous system: Exploring the human brain [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 15 minutes.

Dr. Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain.

Accessible player

Laureate Education (Producer). (2012). Introduction to advanced pharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 8 minutes.

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse.

Accessible player

To prepare for this Discussion:

Review this week’s Learning Resources.

Reflect on concepts of foundational neuroscience.

Walden NURS 6630 Week 1 Sample Paper
(Psychopharmacologic Approaches to Treatment of Psychopathology)

Psychopharmacologic Approaches

Student’s Name:

Institutional Affiliation:

Psychopharmacologic Approaches

Post 1

To apprehend the agonist-to-antagonist action spectrum of psychopharmacologic agents, it is at first vital to comprehend what the terms agonist and antagonist stands for. An agonist is a chemical that binds to the receptor, receptor initiates, and biological reactions produced (Wang, Su, Morin, Jones, Whitby, Surakattula & Moresco 2016). In contrast, an antagonist blocks the agonist action, and a reverse agonist cause actions opposite to the one for agonist (Monti, Perumal, Spence & Torterolo 2018). The agonist spectrum may be categorized by four types known as agonist, antagonist, partial agonist, an inverse agonist. The agonist unlocks the channel, maximal extent, and frequency permitted by the binding site.

In contrast, antagonists that are lying in the middle of the spectrum preserves the latent state with irregular channel opening. The inverse agonist puts the ion channel to an inactive and closed state. Antagonists can block whatever is in the agonist spectrum, and the ions are reverted to their latent state in all instances. Agonist ties to the receptor site, causing a response whereas the antagonist works contrary to the drug blocking the receptor. Agonist motivates the action, whereas antagonist sits idle, doing nothing. For the ideal therapeutic drug act, ion signal and flow transduction is necessary not too much hot, nor too cold and having the correct balance. Such a model state differs from clinical case to another depending on the balance among agonism and still antagonism.

Post 2

Two expansive families of the receptor proteins do their operational in closing and opening of postsynaptic ion passages (Fux, Mehta, Quan & Spafford 2018). Receptors in one of the families known as the inotropic receptor connected directly to the ion channels. These particular receptors comprise of two efficient domains, an extracellular site binding neurotransmitters, and secondly membrane-spanning area that forms ion channel. Thus, inotropic receptors combine the transmitter-binding channeling roles to a single molecular unit known as ligand-gated ion channels. Receptors of such are multimers comprising four or five individual proteins subunits. All of these units play parts in the ion channel pore.
The metabotropic receptor is the second family of neurotransmitters. Here, the ion movement depends on lone or more metabolic phases. In the receptors, there is the absence of ion channels but are affected by intermediate instigation molecules known as G-proteins.

For this reason, the metabotropic receptors are likewise known as G-protein-coupled receptors. The metabotropic receptors are monomeric proteins with an extracellular dominion for neurotransmitter obligatory and intracellular dominion for required G-proteins. Neurotransmitter required to metabotropic receptors initiates the G-proteins and dissociates from receptor-interacting straight with the ion channels to make the intracellular envoys close and open ion channels. Thus, the G-proteins work as transducers coupling the neurotransmitter binding to the guideline of the postsynaptic ion channels.

Post 3

Epigenetics is the changes study influencing phenotype, causing no changes in the genotype (Verhoeven, Vonholdt & Sork 2016). It is as well the study of heritable but reversible variations in gene countenance deprived of any adjustments of the primary DNA system. Epigenetic appliances, mainly circulating RNAs, are seriously in use for investigative biomarkers presently. Epigenetic guideline of gene action is significant in upholding usual phenotypic cells activity, as well as in the management of illness as cancer counting neurodegenerative diseases such as schizophrenia and dementia. New drug classes are presently used to control epigenetic appliances to cope with disorders in individuals

Post 4

The pharmacology of drug knowledge is very significant for psychiatric, psychological health nurse physicians since she should be aware of how the drug action might be valuable for a particular patient (Arnold Gebke & Choy 2016). The practice concerning the prescription of medicine is especially severe for mental and psychiatric health patients since changes created by neurocognitive mechanisms might lead to an adjustment of drugs. The Psychiatric mental health nurse-physician should be alert of medication’s action when occupied with Alzheimer’s patients. Alzheimer’s illness is an enduring neurodegenerative illness that generally gets worse as time progresses. The disease cannot be managed fully, but its deteriorating indications may be controlled. The scientists and researchers currently are finding ways to complete the cure of this illness by epigenetic alterations that may reverse mechanism triggering the neurocognitive weakening through pharmacologic means. Thus, the information on drug pharmacology remains vital for psychiatric mental health nurse specialists while managing patients with Alzheimer’s illness so that she may define whether the treatment emphasis is based on preventing symptoms from being worse or trying hard to inverse the illness process.

References

Arnold, L. M., Gebke, K. B., & Choy, E. H. S. (2016). Fibromyalgia: management strategies for primary care providers. International journal of clinical practice, 70(2), 99-112.

Fux, J., Mehta, A., Quan, C., & Spafford, J. D. (2018). Origins, diversity, and adaptations of voltage-gated sodium channels and their accessory beta subunits. Frontiers in Physiology, 9, 1406.

Monti, J. M., Perumal, S. R. P., Spence, D. W., & Torterolo, P. (2018). The involvement of 5-HT 2A receptor in the regulation of sleep and wakefulness, and the potential therapeutic use of selective 5-HT 2A receptor antagonists and inverse agonists for the treatment of an insomnia disorder. In 5-HT2A Receptors in the Central Nervous System (pp. 311-337). Humana Press, Cham.

Verhoeven, K. J., Vonholdt, B. M., & Sork, V. L. (2016). Epigenetics in ecology and evolution: what we know and what we need to know. Molecular Ecology, 25(8), 1631-1638.

Wang, Y., Su, L., Morin, M. D., Jones, B. T., Whitby, L. R., Surakattula, M. M., … & Moresco, E. M. Y. (2016). TLR4/MD-2 activation by a synthetic agonist with no similarity to LPS. Proceedings of the National Academy of Sciences, 113(7), E884-E893.

Week 2 discussion

Assignment: Assessing and Treating Pediatric Clients With Mood Disorders

When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.

Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

Learning Objectives

Students will:

Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.

The Assignment

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

(Please see attached case study: An African American Child Suffering From Depression)

Required Readings

Note: All Stahl resources can be accessed through this link provided.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 6, “Mood Disorders”
Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Review the following medications:

amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine

Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf

Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Note: Retrieved from Walden Library databases.

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787-791. doi:10.1002/da.22171

Required Media

Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655

Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497

Walden NURS 6630 Week 2 Sample Paper
(Assessing and Treating Pediatric Clients With Mood Disorders)

Treating Pediatric Patients with Mood Disorders

Student’s Name:

Institutional Affiliation:

Treating Pediatric Patients with Mood Disorders

Diagnosing and treating pediatric patients with mood disorders can be complicated and difficult. Mood disorders refer to feelings and thoughts that are difficult to manage, intense, and persistent. According to researchers and clinicians, one of the most underdiagnosed health problems in children is a mood disorder. Failure to diagnose mood disorders on time can put pediatrics at risk of developing other health complications. Some of the mood disorders that affect pediatrics include bipolar disorder, persistent depressive disorder, and major depression (Kumar, 2016). This paper discusses some of the decisions made concerning the medications to prescribe to a client who is an African American child suffering from depression.

Decision One

The first decision that I made regarding the medication that should be administered to the client is to prescribe the 8-year old with 25mg Zoloft daily. The reason for making this decision is because the medication is used for the treatment of depression, which is beneficial in this case, considering that the client is exhibiting signs of depression. The medicine has been approved by the Food and Drug Administration to treat depressive disorders. Another reason for making this decision is that after only a few weeks, the medication usually produces its full effects when treated for a mood disorder, and it will, therefore, be important to use it in this case since the self-reported mood for the child is “sad.” I also selected this decision because the Zoloft 25mg capsule is usually administered once a day; therefore, the risk of medication error occurring is minimal, unlike when a medication is to be taken several times a day since the patient or caregiver can easily forget (Kolomeyer, & Renk, 2016). The medicine can be taken with or without food, and therefore if the patient is not in a position of eating, he can still take Zoloft 25mg medicine. The reason for making the decision to administer the 25mg Zoloft was also to monitor whether the medicine will have an adverse effect on the client.

By making this decision, I was hoping to improve the mood of the child and also reduce any form of anxiety that the child could be having, considering that he is endorsing active suicidal ideation, although he does not admit that he often thinks about himself being dead. Zoloft can help improve the mood of the child and treat any serious mental health problem that the child is suffering from by slowing reabsorption of the serotonin chemical in the brain (Kumar, 2016). I was hoping after taking the medication; the child will be in a better position of socializing with his peers. There was no difference between what I expected to achieve after making the decision.

Decision Two

The second decision that I made, in this case, was to increase the Zoloft dosage from 25mg to 50 mg. The reason for making this decision is because the patient was responding well to it, and no adverse effect was reported. The decision was also appropriate for the child because children usually have more water body with less plasma albumin. Zoloft is the most prescribed type of antidepressant in the United States that is considered to have fewer side effects as compared to other antidepressants, and also it is a non-addictive drug, and therefore, it is suitable for the patient in this case. Another reason for maintaining the same drug without changing it is because the patient can develop resistance and refuse to take another medication, and hence, it was appropriate to increase the dosage instead. Change of medication can also cause an increase in the patient’s level of anxiety, which affects the health outcome of the patient negatively (Neal, 2019). Zoloft dosage starts at 25 mg and can be increased to 50mg after one week. Depending on the tolerability of the patient, the medicine can be increased up to a maximum of 200 mg per day. According to past research, it is not appropriate to discontinue the use of ZOLOFT abruptly since adverse reactions may occur upon discontinuation (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015).

By making this decision, I was hoping to increase the appetite of the patient, reduce periods of irritation, and improve the overall health outcome of the patient. After making this decision, there was no difference between what I expected and the actual results since the patient was improving as expected.

Decision Three

The third decision that I selected was the client to continue using Zoloft 50 mg. The reason for selecting this decision is to ensure that the symptoms of severe depression are all cleared up. It was important to continue using the medication to control the serotonin levels in the brain. Serotonin is a neurotransmitter chemical that helps in carrying signals between brain cells that help in controlling the mood of a patient (Aggarwal, Jethani, Rohatgi, & Kalra, 2016). I was hoping to increase the energy level of the client, improve his overall mood, and help him gain interest in daily life. There was no difference between what was expected to be achieved with decision three and the actual results of the decision. The health of the patient had improved significantly. He has started to socialize with his peers, and his mood had begun to change to being “happy”. In addition to that, his appetite increased.

Ethical Considerations

One of the ethical considerations that might impact the treatment plan with the client is the ethical principle of autonomy whereby, as a health provider, I am required to respect the decision of the patients or their caregiver. Another ethical consideration that might impact the treatment plan and communication with the client is ensuring that their privacy is enhanced and that third parties do not have access to any information that they provide (American College of Clinical Pharmacy, 2014). .

References

Aggarwal, A., Jethani, S. L., Rohatgi, R. K., & Kalra, J. (2016). Selective serotonin re-uptake inhibitors (SSRIs) induced weight changes: a dose and duration dependent study on albino rats. Journal of clinical and diagnostic research: JCDR, 10(3), AF01.

American College of Clinical Pharmacy. (2014). Standards of practice for clinical

pharmacists. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34(8), 794-797.

Kolomeyer, E., & Renk, K. (2016). Family-Based Cognitive–behavioral Therapy for an Intelligent, Elementary School-Aged Child With Generalized Anxiety Disorder. Clinical Case Studies, 15(6), 443-458.

Kumar, S. (2016). Comparative bioavailability study comparing single tablet of SERLIFT 100 mg contains Sertraline hydrochloride equivalent to 100 mg sertraline of Ranbaxy M SDN BHD with two tablets of ZOLOFT contains sertraline hydrochloride equivalent to 50 mg sertraline total dose 100 mg of Pfizer Malaysia SDN BHD in healthy adult human subjects under fasting condition.

Neal, P. (2019). Pediatric anxiety disorder: When to worry about the “worrier.”. In 40th National Conference on Pediatric Health Care (pp. 7-10).

Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual

Research Review: A meta‐analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345-365.

Week 3 discussion

Discussion: The Impact of Ethnicity on Antidepressant Therapy

Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amitriptyline
bupropion
citalopram
clomipramine
desipramine

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 1, Case #1: The man whose antidepressants stopped working

Case 2: Volume 1, Case #7: The case of physician do not heal thyself

Case 3: Volume 1, Case #29: The depressed man who thought he was out of options

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Walden NURS 6630 Week 3 Sample Paper
(Impact of Ethnicity on Antidepressant Therapy)

Impact of Ethnicity on Antidepressant Therapy

Student’s Name:

Institutional Affiliation:

Impact of Ethnicity on Antidepressant Therapy

Case #7: The Case of Physicians Do Not Heal Thyself

The patient is a 60-year-old man physician who presents with chief complaint of being unstable. He states that he spend two-thirds of his previous year in a mixed dysphoric state and one-third depressed. He has a psychiatric childhood, adolescent, and adult history. The family members and maternal relatives have an account of mental health. His medical history is Crohn disease, and current medication is methylphenidate, remiacid for Crohn, and Azothiaprine.

Questions and Rationale

The patient will be asked the following questions to assess his mental state. The first question is to understand more about the patient’s background and specifically his relationship with divorced wife. This question will help to determine if the patient has a personality disorder or mental. A follow-up discussion with the former wife will be essential in highlighting her experience with the patient. The second questions on his relationship with his patients, how does he manage to attend to them.Since he stated that he spend two-thirds of his time in a mixed dysphonic state and one-third depressed. The third question is on his experiences and perceptions of the medication that is prescribed to him. This is because it is evident that, in most instances, he is unable to follow the dosage prescribed.

Physical Examination and Diagnosis

The patients need to have a comprehensive physical examination. This will include assessing all physical elements that have an impact on his mental health. This physical examination is crucial since it helps to exclude conditions that may present with similar signs and symptoms. In physical examination helps in narrowing down to specific diagnoses. Since the patient has suggested that they have mental concerns, it will be appropriate to use the bipolar spectrum diagnostics scale (Shabani, Khoshalani, Mahdavi & Ahmadzad-Asl, 2019). This tool is essential in accessing patient’s ideas and emotional concerns on the things that are happening to him. Moreover, the bipolar spectrum diagnostics scale will help to evaluate the presence of bipolar disorder in the patient. Due to the mood swings that the patient experiences, a mood disorder questionnaire will be administered to the patient (Shabani et al., 2019). This tool will offer an overview of the patient’s feelings and will be analyzed to mental depict the status of the patients.

Differential Diagnosis

Based on the patient’s previous and current medical status, the following diagnosis for the following disorders will be conducted: Cyclothymic, unspecified depressive disorder, and bipolar 11 depression. The cyclothymic disease is a condition that is difficult to diagnose due to the different signs and symptoms (Amare, 2018). A patient is usually hard to diagnosis, although episodes of hypomanic systems characterize it. Signs and symptoms such as racing thoughts, pressured speech, decreased need for sleep, depression for more than two weeks, and engagement in risky behaviors suggest that the patient may be suffering from unspecified depressive disorder(Amare,2018). Moreover, a reduced need for sleep, feeling of unworthiness, over-talkative, irritability, shifts in energy, racing thoughts may indicate that the patient has bipolar two depression (Grande, Berk, Birmaher & Vieta,2016).

Patient’s Most Likely Condition

Based on the diagnosis, the patient is most likely to be suffering from cyclothymic disorder disease. This is because his conditions have been hard to diagnosis, although the patient has been experiencing episodic mental health issues since he was a child, it was not diagnosed until he was 23 years. Moreover, the family has an extensive history of mental disorders.

Pharmacologic Agents

Cyclothymic disorder is treated using medications such as ant seizure, anti-depressants, and mood stabilizers medication. In the treatment of this condition, pharmacologic agents such as valproate, lamotrigine, and lithium are recommended. They are found to have significant results as compared to other medications (Alda, 2015). Moreover, these agents can be altered to ensure that the patient can heal completely. The patient is also suffering from Chron disease; thus, the dosage of lithium can be increased gradually to avert conditions such as diarrhea. The dosage can be started low and adjusted to reach the therapeutic levels. The dosage for the patients can be started as low as 300 mg and increased gradually to 1.0mEq/L. In case, the patient is unable to cope with lithium, valproate lamotrigine are recommended. These dosages can also be increased steadily, to be effective. The pharmacokinetics and pharmacodynamics process of drug therapy for this patient is affected due to the aging factor. There is reduced metabolic, distribution, and excretion process. Therefore, these agents will be more applicable, and their dosage should be increased gradually to prevent diarrhea, which might have severe consequences on the pharmacodynamics. Evidence-based practice highlights lithium as the most effective antidepressant in the treatment of the cyclothymic disorder (Alda, 2015).

How Ethnicity Affect Drug Therapy

The ethnicity of a patient is a risk factor in the drug therapy of a patient. Some drugs are likely to do well among some ethnic groups and fail to be effective in others. The anti-depressant that is recommended for the patient is lithium. This drug may be required to be changed to either lamotrigine or lithium is the patient is of African American descent. The risk of lithium among African Americans is contributed by the high levels of red blood cells to plasma ratio (Arnold et al., 2015). Although it is rearly used, African American patients can sustain a low dosage of lithium.

Check Points

In week 12, the patient had stopped taking methylphenidate, and started lamotrigine at a higher dose than what is recommended. This is health risk behavior, and the patient is required to remain within the stipulated dosage. Alternatively, he could have continued with the lithium dosage that was recommended previously. The moods of the patient had stabilized, although there was a decrease in libido and sexual dysfunction. From the start, the patient should have kept a record of his pathological changes. However, for patients with mental disorders, it is hard to keep such records. Thus the need to be helped to keep records, and this will ensure that they keep track of their mood changes.

Lessons Learned

Completing this task has shaped my understanding of dealing with a patient with a mental disorder who is also a medical practitioner. Due to their knowledge in medicine, the patient is not likely to follow drug therapy that is prescribed to them. Moreover, when attending to such a patient, it is essential to have clear health practitioners’ patient roles. This will ensure that they can respect the medication, and if they are not cooperative, it is advised to have a debrief. However, it is crucial to educate them on the importance of following drug therapy. Mental disorders require a comprehensive approach to address and may occasionally review of the medication.

References

Alda, M. (2015). Lithium in the treatment of bipolar disorder: pharmacology and pharmacogenetics. Molecular psychiatry, 20(6), 661.Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125816/

Amare, A. T. (2018). Genetic predictors of response to pharmacotherapy in patients with mood disorders: steps on the path to personalized psychiatry (Doctoral dissertation).

Arnold, J. G., Salcedo, S., Ketter, T. A., Calabrese, J. R., Rabideau, D. J., Nierenberg, A. A., … & Sylvia, L. G. (2015). An exploratory study of responses to low-dose lithium in African Americans and Hispanics. Journal of affective disorders, 178, 224-228. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397978/

Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561-1572. Retrieved from https://www.sciencedirect.com/science/article/pii/S014067361500241X

Shabani, A., Khoshalani, M. M., Mahdavi, S., & Ahmadzad-Asl, M. (2019). Screening bipolar disorders in a general hospital: Psychometric findings for the Persian version of mood disorder questionnaire and bipolar spectrum diagnostic scale. Medical journal of the Islamic Republic of Iran, 33, 48. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708087/

Week 3 assignment

Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Advances in genetics and epigenetics have changed the traditional understanding of mood disorders, resulting in new evidence-based practices. In your role as a psychiatric mental health nurse practitioner, it is essential for you to continually educate yourself on new findings and best practices in the field. For this Assignment, you consider best practices for assessing and treating adult and geriatric clients presenting with mood disorders.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 6, “Mood Disorders”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amitriptyline
bupropion
citalopram

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Retrieved from https://www.researchgate.net/profile/Marie_Asberg/publication/22697065_A_New_Depression_Scale_Designed_to_be_Sensitive_to_Change/links/09e41513f85c708fee000000.pdf

Required Media

Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment

Review this week’s Learning Resources. Consider how to assess and treat adult and geriatric clients requiring antidepressant therapy.

The Assignment

Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Walden NURS 6630 Week 3 Sample Paper
(Assessing and Treating Adult and Geriatric Clients With Mood Disorders)

Mood Disorders

Student’s Name:

Institutional Affiliation:

Mood Disorders

In a mental health class, mood disorder is a term that is used by health providers to describe all types of bipolar and depression disorders broadly. A mood disorder can affect people of all ages that is adults, teens, and children. A major depressive disorder is a mood disorder that usually interferes with a person’s daily life. It is characterized by a lack of interest in outside stimuli or a persistent feeling of sadness. Mood disorders represent the most common psychiatric morbidity in older adults, which includes bipolar and unipolar with varying levels of severity. Mood disorders are usually intense and harder to manage as compared to normal feelings of sadness. Several factors can lead to mood disorders, including life events. This paper discusses three decisions that can be included in the treatment plan of an elderly Hispanic man with major depressive disorder.

Decision One

The first decision that I selected, in this case, is to administer the patient with Effexor XR 37.5 orally daily. The reason for selecting this decision is because it has been approved for use in adults in the treatment of major depressive disorders, social anxiety disorder, generalized anxiety disorder, and panic disorder. Effexor XR is a medication that belongs to a class of drugs that is referred to as serotonin-norepinephrine reuptake inhibitors.it was important to start the dosage at 37.5 mg per day to give the patient time to adjust to it and monitor if there is any form of side effect that the patient will experience. Effexor XR works by increasing and regulating the levels of serotonin and norepinephrine, which are neurotransmitters in the brain. According to Clevenger, Malhotra, Dang, Vanle, & IsHak, 2018) serotonin is a hormone that helps in controlling several processes within the brain. Some of these processes include sleep, aggression, perceptions, mood, and emotions. Norepinephrine, on the other hand, is a hormone that tends to affect parts of the brain that relates to response and attention. Another reason for making this decision is because Effexor XR is usually taken once daily, and therefore it is crucial in this case considering the condition to help prevent the occurrence of medication errors. I also selected this decision because Effexor XR is extensively metabolized and well absorbed in the liver (Barhate, & Husain, 2016). According to past studies, approximately 92% of a single oral dose of this medicine is absorbed. When selecting the decision, I also considered the half-life of the drug, which is five hours, and therefore it was less likely to have a clinical effect on the patient. Although there were other options, I did not choose them because I considered them as being less suitable in this case. The reason I did not select Zoloft 25mg orally daily as my first option is because Zoloft is a selective serotonin reuptake inhibitor, unlike Effexor XR, which is a reuptake inhibitor for both norepinephrine and serotonin. Another reason for not selecting Zoloft is because of its effects in the liver. Zoloft also cause allergic reactions to some patients (Citrome, 2016). Also, I did not select the decision of beginning with phenelzine 15mg orally TID because the medication is mostly used in persons who have not responded to treatment with other drugs, which is not the case for the Hispanic patient (Chiuccariello et al.,2016).

By making this decision, I was hoping to improve the mood and the client’s energy level, which would in turn help in restoring his interests in daily living since he reported to have a remarkably diminished interest in engaging in usual activities. I was also hoping to reduce any form of unwanted thoughts, fear, and anxiety that the client could be having and improve his concentration since he reports to have poor concentration, which was impacting his work life negatively. I was also hoping to reduce the side effects that the patient could probably experience since Effexor XR have fewer side effects as compared to other antidepressants.

There was no difference between what I expected to achieve and the actual results of the decision because the client had improved as expected and had not experienced any severe side effects after using the medicine.

Decision Two

The second decision that I selected was to increase Effexor XR to 75 mg orally daily. The reason I selected this decision was because the patient had shown signs of improvement after using the drug. Therefore there was no cause of alarm to change the medication and start using another one; instead, it was better to increase the dosage. According to past research, it is vital to begin by administering a small amount of dosage when using antidepressants and increase the dosage later after the patient is used to the medication and after establishing that there are no major side effects of using the medication (Stahl, 2014b). Another reason for selecting this decision is to avoid changing the medication since it could affect the health outcome of the patient negatively. A gradual change of medication can cause resistance form the patient. A gradual reduction of Effexor is recommended rather than abrupt cessation. I also selected this decision because increasing the amount of dosage would, in turn, help increase the amount of natural substances, serotonin, and norepinephrine in the brain of the patient (Barhate, & Husain, 2016).

By making this decision, I was hoping to manage the depression symptoms further and improve the health outcome of the patient. I was hoping to do away with the feelings of depression that the patient was endorsing and also help him to carry on with his daily activities smoothly and gain interest in usual activities. There was no difference between what I expected to achieve with decision two and the results of the decision because the patient had started improving as expected. The patient had stopped getting troubled with insomnia, had begun to gain interest in engaging in usual activities, and his level of concentration was also improving.

Decision Three

The third decision that I selected was to increase Effexor XR from 75 mg to 112.5 mg orally. The reason for choosing this decision was because the medication had proved to be effective in the management of the client’s symptoms. By making this decision, I was hoping to help manage the symptoms fully and restore the client’s optimal health. I was hoping to clear all the symptoms of depression. There was no difference between what I expected to achieve with decision three and the actual results. The patient’s Montgomery- Asberg Depression Rating Scale had improved since, by the end of this decision, his score was ten, which indicated mild depression and was close to normal or no symptoms for depression.

Ethical Considerations

One of the ethical considerations that might impact the treatment plan and communication with clients is ensuring that the principle of autonomy is respected. A health provider is expected to respect the decisions made by patients concerning their own lives and health. Ensuring that the treatment plan does not pose any form of harm to the patient is another ethical consideration that could impact the treatment plan since some medications tend to have severe side effects on a patient. Causing harm to a patient is against the principle of beneficence, which requires a health provider to do what is best for a client. The patient should be administered with the right medication at the right time to prevent any type of medical error from occurring (Carpenter, & Gonzalez, Retsch-Bogart, Sleath, & Wilfond, 2017).

Conclusion

Mood disorders are usually intense and harder to manage as compared to normal feelings of sadness. A health provider needs to weigh the benefit of using different medications before administering it to a patient. Effexor XR is one of the medications that can help in managing the symptoms of severe depression effectively.

References

Barhate, S., & Husain, M. (2016). Comparative in vitro dissolution testing of hydrophilic controlled-release venlafaxine matrix tablets and Effexor XR using QbD. Dissolution Technologies, 23(3), 40-44.

Citrome, L. (2016). Vortioxetine for major depressive disorder: an indirect comparison with duloxetine, escitalopram, levomilnacipran, sertraline, venlafaxine, and vilazodone, using number needed to treat, number needed to harm, and likelihood to be helped or harmed. Journal of affective disorders, 196, 225-233.

Carpenter, D., & Gonzalez, D., Retsch-Bogart, G., Sleath, B., & Wilfond, B. (2017).

Methodological and Ethical Issues in Pediatric Medication Safety Research

Pediatrics. 140 (3) e20170195; DOI: 10.1542/peds.2017-0195.

Chiuccariello, L., Cooke, R. G., Miler, L., Levitan, R. D., Baker, G. B., Kish, S. J., … & Meyer, J. H. (2016). Monoamine oxidase-A occupancy by moclobemide and phenelzine: implications for the development of monoamine oxidase inhibitors. International Journal of Neuropsychopharmacology, 19(1).

Clevenger, S. S., Malhotra, D., Dang, J., Vanle, B., & IsHak, W. W. (2018). The role of selective

serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Therapeutic advances in psychopharmacology, 8(1), 49–58. DOI:10.1177/2045125317737264.

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Week 4 assignment

Assignment: Assessing and Treating Clients with With Bipolar Disorder

Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for clients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) clients often present as depressive or manic, but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with bipolar disorder.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 6, “Mood Disorders”

Chapter 8, “Mood Stabilizers”

Stahl, S. M., & Ball, S. (2009b). Stahl’s illustrated mood stabilizers. New York, NY: Cambridge University Press.

To access the following chapters, click on the Illustrated Guides tab and then the Mood Stabilizers tab.

Chapter 4, “Lithium and Various Anticonvulsants as Mood Stabilizers for Bipolar Disorder”

Chapter 5, “Atypical Antipsychotics as Mood Stabilizers for Bipolar Disorder”

Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-0060-3

Note: Retrieved from Walden Library databases.

Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

Mostafavi, A., Solhi, M., Mohammadi, M., Hamedi, M., Keshavarzi, M., & Akhondzadeh, S. (2014). Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Acta Medica Iranica, 52(10), 734-739.

Retrieved from http://acta.tums.ac.ir/index.php/acta

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy.

The Assignment

Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Walden NURS 6630 Week 4 Sample Paper
(Assessing and Treating Adult and Geriatric Clients With Mood Disorders)

Bipolar Disorder

Student’s Name:

Institutional Affiliation:

Bipolar Disorder

Bipolar disorder refers to a mental health condition that normally causes a person to experience extreme mood swings, such as emotional highs and lows. When depressed, people tend to feel hopeless or sad and may also lose pleasure and interest in their daily activities. On the other hand, the moods of a person can shift to hypomania or mania, which causes a person to start feeling euphoric. Some people suffering from this condition may experience emotional symptoms between episodes, while other people may fail to experience any symptoms (Grande, Berk, Birmaher, & Vieta, 2016). A treatment plan can help in the management of mood swings and other symptoms despite the bipolar disorder being a lifelong condition. Men and women are equally likely to suffer from bipolar disorder. This paper discusses three decisions made concerning the medication that should be prescribed to an Asian American woman with bipolar 1 disorder.

Decision One

The first decision that I selected, in this case, was to prescribe Begin Risperdal 1 mg orally BID. The reason I selected this decision is that this medicine is used to treat certain moods/mental disorders such as bipolar disorder, schizophrenia, and irritability associated with autistic disorder. Risperidone is a medicine that belongs to a class of drugs that is referred to as atypical antipsychotics, which has been approved by the U.S Food and Drug Administration. It helps in restoring the balance of certain. The effects of dopamine in the brain are usually blocked by Risperidone, which helps in reducing the symptoms of bipolar disorder (Corena-McLeod, 2015). Dopamine is a chemical messenger in the brain that occurs naturally. The chemical is involved in emotions, thinking, perception, and behavior. Another reason for selecting this decision is because Risperidone also affects other neurotransmitters in the brain such as serotonin. This is beneficial in the management of the symptoms (Wu, Hsieh, Tang, & Chang, 2016). I also selected the decision because the medicine can be taken with or without food, and this is an essential factor in ensuring that the patient adheres to the prescribed medication. Food does not affect the extent and rate of absorption of Risperidone. I also selected this decision because the medicine is extensively metabolized in the liver. According to past research the medicine is relatively well tolerated in bipolar manic patients and metabolic and weight gain concerns may be less when using this medicine in a clinical setting (Corena-McLeod, 2015). Although there were other options of medications that could be used in this case I considered them as being less effective. The reason I did not opt to start the treatment plan with Lithium 300 mg orally BID is because Risperidone is considered to be significantly superior to Lithium (Kowatch et al., 2015). Also, there is greater tolerability for Risperidone compared to Lithium. I did also not select the use of Begin Seroquel XR 100mg in this case because of its potential long-term side effects such as weight gain, which will not be healthy considering that the patient already weighs 110lbs. Other side effects of this drug include increased blood sugar, cataracts, and tardive dyskinesia. The medicine can also cause an increase in suicidal thoughts and behaviors (Roberts, Lohano, & El‐Mallakh, 2016). Another reason why I did not select Lithium is that it had been prescribed in the hospital, but it had not worked.

By selecting this decision, I was hoping to help the patient to start thinking clearly and start taking part in everyday life. I was hoping the patient will experience a positive change in her state of mind and develop some positive attitude, such as stopping to hate sleep. There was no major difference between what I expected to achieve and the actual results of the decision. The patient’s health condition was improving as expected. The only difference was that some of the side effects of the medication were affecting the treatment plan. After taking the medication, the patient was experiencing some form of drowsiness and sedation. The race of the patient was one of the factors that contributed to this side effect.

Decision Two

The second decision that I selected, in this case, was to decrease Risperdal to 1 mg at bedtime due to an increase in sedation and lethargy. The reason for making this decision was to avoid administering the patient with a new prescription, considering that her health had started to improve. This was an indication that the drug was helping manage the symptoms of the bipolar 1 disorder. By making this decision, I Was hoping to reduce the episodes of sedation and drowsiness, which would, in turn, help improve the health outcome of the patient as expected. Sedation can be troublesome to patients who are trying to be reintegrated into society, and it can also interfere with the treatment plan (Jann, 2014). By making this decision, I was hoping to achieve the maximum benefit from administering the medication. I was hoping to manage the manic episodes associated with bipolar 1 disorder that the patient was experiencing. I was also hoping to reduce sedation and lethargy that the patient was experiencing. There was no difference between what was expected to be achieved, and the actual results since the symptoms of bipolar 1 disorder had reduced significantly, which led to the improvement of the patient’s health outcome.

Decision Three

The third decision that I selected was to continue using Risperdal 1 mg at bedtime. The reason I selected this decision was because the health of the patient had improved, which was an indication that the medication was effective. Another reason for selecting this decision was to prevent a situation whereby a new medication is administered to the patient. This can lead to resistance from the patient, which can affect the treatment plan and lead to negative health outcomes. By making this decision, I was hoping to restore the mood of the patient to normal and manage the symptoms of bipolar 1 disorder that the patient was experiencing. I was also hoping to improve the mental stability of the patient. There was no difference between what I expected to achieve, and the results of the decision. The health of the patient had improved.

Ethical Considerations

It is essential to respect the decisions of the patient about the treatment plan. It is crucial to educate the patient about the advantages and disadvantages of the medications that will be used in the treatment plan. This is important as it helps a patient to make an informed decision. This can affect the treatment plan and communication because the decision of the patient and that of the health provider can, at times, differ. Another ethical consideration is ensuring that the treatment does not cause any harm to the patient and that medication is administered correctly.

In conclusion, bipolar disorder is a brain problem that causes unusual shifts in energy, mood, and activity levels in a person. The condition also affects a person’s ability to conduct their daily activities. One of the medications that can be used to manage the symptoms associated with bipolar 1 disorder.

References

Corena-McLeod, M. (2015). Comparative pharmacology of risperidone and paliperidone. Drugs in R&D, 15(2), 163-174.

Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561-1572.

Jann, M. W. (2014). Diagnosis and treatment of bipolar disorders in adults: a review of the evidence on pharmacologic treatments. American health & drug benefits, 7(9), 489.

Kowatch, R. A., Scheffer, R. E., Monroe, E., Delgado, S., Altaye, M., & Lagory, D. (2015). Placebo-controlled trial of valproic acid versus risperidone in children 3–7 years of age with bipolar I disorder. Journal of child and adolescent psychopharmacology, 25(4), 306-313.

Roberts, R. J., Lohano, K. K., & El‐Mallakh, R. S. (2016). Antipsychotics as antidepressants. Asia‐Pacific Psychiatry, 8(3), 179-188.

Wu, C. S., Hsieh, M. H., Tang, C. H., & Chang, C. J. (2016). Comparative effectiveness of long-acting injectable risperidone vs. long-acting injectable first-generation antipsychotics in bipolar disorder. Journal of affective disorders, 197, 189-195.

Week 5 assignment

Assignment: Assessing and Treating Clients With Anxiety Disorders

Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 9, “Anxiety Disorder and Anxiolytics”

Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD. New York, NY: Cambridge University Press.

To access the following chapters, click on the Illustrated Guides tab and then the Anxiety, Stress, and PTSD tab.

Chapter 4, “First-Line Medications for PTSD”

Chapter 5, “Second-Line, Adjunct, and Investigational Medications for PTSD”

Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety, 29(4), 328–-339. doi:10.1002/da.21913

Note: Retrieved from Walden Library databases.

Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., & … Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. doi:10.1155/2014/537306

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Walden NURS 6630 Week 5 Sample Paper
(Assessing and Treating Clients With Anxiety Disorders)

Anxiety Disorders

Student’s Name:

Institutional Affiliation:

Anxiety Disorders

Anxiety disorders refer to a group of mental disorders that are usually characterized by feelings of fear and anxiety. Several factors can cause anxiety disorder, which includes other mental disorders, stress buildup, trauma, drugs, or alcohol. These disorders can prevent one from carrying on with their daily lives. Symptoms of anxiety disorder include dizziness, nausea, breath shortness, sleep difficulties, inability to stay still and calm, panic, and fear. This paper discusses the decisions of the pharmacologic interventions that are the most effective in the treatment of a 46-year old white male who has been diagnosed with generalized anxiety disorder.

Decision One

The first decision that I selected was, to begin with, Zoloft 50 mg PO daily. The reason for choosing this decision is because Zoloft is used to treat mental illnesses like obsessive-compulsive disorder, depression, social anxiety disorder, and post-traumatic stress disorder. Zoloft 25-50 mg daily is the standard dosage that is usually prescribed to adults. Starting at a dose that is too high can cause vomiting and nausea. The Food and Drug Administration has approved Zoloft for the treatment of social anxiety disorder (ER, 2015). Zoloft belongs to the selective serotonin reuptake inhibitors class of medications. These medications increase the amount of serotonin in the brain. They prevent the uptake or reabsorption of serotonin in the brain, which helps in increasing the amount of the chemical in the nerve synapse. Serotonin is a neurotransmitter chemical that helps in the transfer of signals between brain cells, which helps in regulating anxiety and mood (Driot et al.,2017). Another reason as to why I selected this decision is because Zoloft is usually associated with positive emotions. Another reason for choosing this decision is because Zoloft 50 mg can be taken with or without food and is taken once daily. This reduces the occurrence of medical errors (Clifford, Duncan, Heinrich, K., & Shaw, 2015). Although there were other options, it was not appropriate to use those decisions. The reason as to why I did not select Imipramine 25 mg PO BID is because this medicine takes time before its full effects are experienced. It can take weeks or months. The symptoms of a patient can also relapse after tapering from the drug, which is not the case when Zoloft is used. Another reason for not selecting Imipramine is that one of its side effects is that it causes an increase in anxiety, which is not appropriate in this case, considering that the patient has a generalized anxiety disorder. The reason for not selecting Begin Buspirone 10 mg PO BID is that it also takes time before its full effects are experienced. The medicine can take four to six weeks for one to experience its full clinical effects (Reinhold, & Rickels, 2015).

By making this decision, I was hoping to reduce the unwanted thoughts that the patient was having. Decrease unwanted fears. For example, the patient fears for his job. I was also hoping to reduce the patient’s level of anxiety.

There was no difference between what was expected to be achieved by making the decision and the actual results since the patient reported that the problems with tightness in the chest and episodes of breath shortness had reduced significantly. The patient also reported that worries about work had also reduced, which was also an indication that the goals for administering the medication were being achieved. The HAM-A score had also decreased partially but needed to be reduced more.

Decision Two

The second decision that I selected was to increase Zoloft from 50 mg to 75 mg orally. The reason I selected this decision is that the medication was working as expected, and the patient had not experienced any major side effects. Therefore it was appropriate to increase the dosage rather than introducing a new medication since the body of the patient had gotten used to the medication. Another reason for selecting this decision is that medications should not be considered as being ineffective until the highest amount of dosage has been administered (Lader, 2015).

By making this decision, I was hoping to manage the symptoms of generalized anxiety disorder that the patient was experiencing further. I was also hoping to reduce the HAM-A score further to a suitable score. I was hoping to increase the daily functioning of the patient and manage the occasional feelings of impending doom and the need to escape or run from wherever he is at.

There was no difference between what I expected to achieve with decision two and the actual results. The HAM-A score had reduced to 8, which was a sign of significant improvement. Most of the symptoms that the patient was experiencing also been managed and only experienced a few symptoms that were not severe. This was an indication that the patient was progressing well as expected.

Decision Three

The third decision that I selected was to maintain the current dosage. The reason for selecting this decision is positive health outcomes had been recorded. It is, therefore, appropriate to measure the effectiveness of the treatment by maintaining the same dosage for approximately 12 weeks. Another reason for selecting this decision is to avoid changing the medication or increasing the dosage, which could lead to adverse health outcomes.

By making this decision, I was hoping to reduce the HAM-A score further and ensure that all the symptoms are fully managed. There was no difference between what I expected to achieve and the actual results because the HAM-A score of the patient reduced to 4, which was an indication that the anxiety level was minimal as expected.

Ethical Considerations

In this case, considering that the patient was suffering from anxiety disorder, it was necessary to educate him about medication adherence and how it can affect his health outcome. As a health provider, it is also important to ensure that the ethical principle of autonomy is respected. It is the right of the patient to decide whether to undertake the treatment or not. Also, when administering the treatment regimen, the ethical principle of beneficence should be considered. This principle addresses the idea that the actions of a health provider should promote good by doing what is best for the patient. The right amount of dosage should be prescribed to avoid the occurrence of medical errors, which can cause harm to the patient.

References

Clifford, K. M., Duncan, N. A., Heinrich, K., & Shaw, J. (2015). Update on managing generalized anxiety disorder in older adults. Journal of gerontological nursing, 41(4), 10-20.

Driot, D., Bismuth, M., Maurel, A., Soulie-Albouy, J., Birebent, J., Oustric, S., & Dupouy, J. (2017). Management of first depression or generalized anxiety disorder episode in adults in primary care: A systematic metareview. La Presse Médicale, 46(12), 1124-1138.

ER, I. (2015). Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician, 91(9), 617-624.

Lader, M. (2015). Generalized anxiety disorder. Encyclopedia of psychopharmacology, 699-702.

Reinhold, J. A., & Rickels, K. (2015). Pharmacological treatment for generalized anxiety disorder in adults: an update. Expert opinion on pharmacotherapy, 16(11), 1669-1681.

Week 6 midterm

Question 1

A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP).

Question 2

Which statement about neurotransmitters and medications is true?

Question 3

When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be:

Question 4

During gene expression, what must occur prior to a gene being expressed?

Question 5

While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

Week 6 assignment

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 4, “Psychosis and Schizophrenia”

Chapter 5, “Antipsychotic Agents”

Stahl, S. M. (2014b)

The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amisulpride
aripiprazole
asenapine
chlorpromazine
clozapine
flupenthixol
fluphenazine
haloperidol
iloperidone
loxapine
lurasidone
olanzapine
paliperidone
perphenazine
quetiapine
risperidone
sulpiride
thioridazine
thiothixene
trifluoperazine
ziprasidone

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659. doi:10.2165/00023210-200923080-00002

Note: Retrieved from Walden Library databases.

Document: Midterm Exam Study Guide (PDF)

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

Note: Retrieved from Walden Library databases.

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

Required Media

Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

Walden NURS 6630 Week 6 Sample Paper
(Assessing and Treating Clients With Psychosis and Schizophrenia)

Assessing And Treating Clients With Psychosis And Schizophrenia Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Psychosis and Schizophrenia

In treating patients with mental disorders, it will be vital to evaluate the pharmacodynamics and the pharmacokinetics process of such drugs and their effects on the patients. This paper explores the decisions that will be made in treating a Pakistani woman with delusional thought processes.

Decision #1

For the first decision, I selected the Pakistani Woman to start by taking Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day four and monthly after that. The administration of this medication seemed to be effective. After the client returned to the clinic after four weeks, they displayed a decrease in PANSS score by about 25% and a good way of tolerating medications. I selected the decision to administer Invega Sustenna to the patients as numerous evidence-based scholarly studies have shown that the drug effectively treats schizoaffective disorders when administered as a monotherapy (Li, Turkoz, & Zhang, 2015). The drug is effective, acting as a mood stabilizer, which is an important element in treating the Pakistani Woman. In the first decision I did not choose administer Zyprexa 10 mg orally as the drug is known to cause a lot of adverse side effects including weight gain, headaches, changes in personality and problems with memory and speech. I also did not choose to administer Abilify 10 mg orally as the drug is also known to cause adverse side effects including insomnia, weight gain, drooling, headache and dizziness and anxiety and restlessness among many others (Wani, Dar, Chandel, et al., 2015).

In deciding to administer Invega Sustenna 234 mg to the Pakistani Woman, I was hoping that I would tone down her delusions, which have made it difficult for her to live with her husband and children. Therefore, I was hoping that the client would stop having delusions such as the TV talking to her and viewing herself as Prophet Muhamad. I was also hoping to decrease the patient’s PANSS score. What I was hoping to achieve by making the first decision was similar to what I achieved because by administering Invega Sustenna, I was able to decrease the patient’s PANSS score by nearly 25%. This showed an improvement in the patient’s condition and having fewer delusions. By administering Invega Sustenna, I expected some side effects on the patient, such as weight gain and pain in the injection area.

Decision #2

For the second decision, I choose to continue the administration of Invega Sustenna to the patient but asked the nurses to change the injection sites to the deltoid muscle for the subsequent visits. I selected this decision as Invega Sustenna was effective in reducing the patient’s delusional symptoms. According to Morris and Tarpada (2017), the dosage of Invega Sustenna should be continued if no major side effects were experienced in the patients. After the first month of the administration of Invega Sustenna to the Pakistani Woman, no major side effects expected weight gain and pain in the injection site were witnessed. According to Emsley and Kilian (2018), to deal with pain in the injection areas, the injection in the patients would have to be performed on the deltoid muscles with adequate alternation of the injection. By making the second decision to continue the administration of Invega Sustenna but on the patient’s alternating deltoid muscles, I was hoping to keep lowering the incidences of delusions on the Pakistani Woman and to reduce the complaints of pain in the injection area.

What I was hoping to achieve by electing to continue the administration of Invega Sustenna to the Pakistani Woman and what I achieved was similar. This is because the drug managed to reduce most of the patient’s delusional symptoms, with a PANNS score of the patient reducing by 50%. The patient also stated that they experienced less pain in the injection areas. However, in continuing the administration of Invega Sustenna to the patients, I was also hoping that the clients would gain some weight. According to Emsley & Kilian (2018), weight gain among patients is one of the common side effects of Invega Sustenna. The patient gaining only 4.5 pounds during a whole treatment period of two months was therefore not abnormal in any way.

Decision #3

For the third decision, I decided to continue the administration of Invega Sustenna to the Pakistani Woman. According to Savitz, Xu, Gopal, et al. (2016), if Invega Sustenna effectively alleviates delusional symptoms among patients and does not cause any significant negative side effects on the patients, it should be continued till the client completely recovers. I also choose to counsel the patient on her weight gain as the weight gain caused by Invega Sustenna was the least the patient could encounter than other drugs that had similar efficacy. I made the decisions to make appointments with the dieticians and exercise psychologists.

By deciding to continue the treatment of Invega Sustenna on the patients, I was hoping that all the client’s delusional symptoms would disappear, and the patient would return to their normal life. I was also hoping that the client could control her weight gain through a quality diet and exercise. What I expected to achieve in making the decision to continue Invega Sustenna administration in the patient and what I achieved were similar. This is because the patient’s delusions were alleviated so that they would perform daily living activities. The patient was also able to perform manage her weight by taking a healthy diet and exercising.

Ethical Considerations

The ethical consideration that would impact the patients’ treatment plan would include beneficence, non-maleficence, and confidentiality (Howe, 2018). All the decisions made relating to the patient would thus be made for their benefits with any intentional harm to patients being avoided. The treatment process of the patient would also be kept confidential.

References

Emsley, R., & Kilian, S. (2018). Efficacy and safety profile of paliperidone palmitate injections

in the management of patients with schizophrenia: an evidence-based review. Neuropsychiatric disease and treatment, 14, 205–223. https://doi.org/10.2147/NDT.S139633.

Howe E. (2018). Ethical considerations when treating patients with schizophrenia. Psychiatry

(Edgmont (Pa. : Township)), 5(4), 59–64.

Li, H., Turkoz, I., & Zhang, F. (2015). Efficacy and safety of once-monthly injection of

paliperidone palmitate in hospitalized Asian patients with acute exacerbated schizophrenia: an open-label, prospective, noncomparative study. Neuropsychiatric disease and treatment, 12, 15–24. https://doi.org/10.2147/NDT.S83651.

Morris, M. T., & Tarpada, S. P. (2017). Long-Acting Injectable Paliperidone Palmitate: A

Review of Efficacy and Safety. Psychopharmacology bulletin, 47(2), 42–52.

Savitz A ,J., Xu, H., Gopal, S, Nuamah, I., Ravenstijn, P., Janik, A., Schotte, A., Hough, D.,

Fleischhacker, W. (2016). Efficacy and Safety of Paliperidone Palmitate 3-Month Formulation for Patients with Schizophrenia: A Randomized, Multicenter, Double-Blind, Noninferiority Study, International Journal of Neuropsychopharmacology, Vol. 19, Iss. 7.

Wani, R. A., Dar, M. A., Chandel, R. K., Rather, Y. H., Haq, I., Hussain, A., & Malla, A. A.

(2015). Effects of switching from olanzapine to aripiprazole on the metabolic profiles of patients with schizophrenia and metabolic syndrome: a double-blind, randomized, open-label study. Neuropsychiatric disease and treatment, 11, 685–693. https://doi.org/10.2147/NDT.S80925

Week 7 discussion

Discussion: Sleep/Wake Disorders

It is not uncommon to experience a night or two of disrupted sleep when there is something major going on in your life. However, sleep/wake disorders are much more than an occasional night of disrupted sleep. A recent report from the Centers for Disease Control and Prevention estimated that between 50 and 70 million American have problems with sleep/wake disorders (CDC, 2015). Although the vast majority of Americans will visit their primary care provider for treatment of these disorders, many providers will refer patients for further evaluation. For this Discussion, you consider how you might assess and treat the individuals based on the provided client factors.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia
alprazolam
amitriptyline
amoxapine
clomipramine

Case 1: Volume 2, Case #16: The woman who liked late-night TV

Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

Case 3: Volume 1, Case #5: The sleepy woman with anxiety

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Week 7 assignment

Assignment: Assessing and Treating Clients With Pain

Pain can greatly influence an individual’s quality of life, as uncontrolled pain negatively impacts mood, concentration, and the overall physical and mental well-being of clients. Although pain can often be controlled with medications, the process of assessing and treating clients can be challenging because pain is such a subjective experience. Only the person experiencing the pain truly knows the intensity of the pain and whether there is a need for medication therapies. Sometimes, beliefs about pain and treatments for pain can have an adverse effect on the provider-client relationship. For this Assignment, as you examine the interactive case study consider how you might assess and treat clients presenting with pain.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 10, “Chronic Pain and Its Treatment”

Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the Chronic Pain and Fibromyalgia tab.

Chapter 5, “Pain Drugs”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia
amitriptyline
amoxapine
carbamazepine
clomipramine
clonidine (adjunct)
desipramine
dothiepin
doxepin
duloxetine
gabapentin
imipramine
lamotrigine
levetiracetam
lofepramine
maprotiline
memantine
milnacipran
nortriptyline
pregabalin
tiagabine
topiramate
trimipramine
valproate (divalproex)
zonisamide

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

National Institute of Neurological Disorders and Stroke. (2016). Pain: Hope through research. Retrieved from http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#3084_2

Required Media

Laureate Education (2016a). Case study: A Caucasian man with hip pain [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for pain and sleep/wake disorders.

The Assignment

Examine Case Study: A Caucasian Man With Hip Pain. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Walden NURS 6630 Week 7 Sample Paper
(Assessing and Treating Clients With Pain)

Assessing and Treating Clients with Pain

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Pain

Mental disorders relating to pain can be quite challenging to treat as the PMHNP walks the tight rope to alleviate the patient’s pain and administer medications with the least severe side effects. Evaluating the pharmacodynamics and pharmacokinetics of a group of preferred drugs and their effects on patients can help make decisions of the most appropriate prescription. This paper explores the decisions that will be made in treating a White male with complex regional pain disorder.

Decision #1

I choose to administer Amitriptyline 25 mg PO QHS to the white male patient with hip pain for the first decision. I selected the decision to administer Amitriptyline 25 mg PO to the patient as he seemed to be experiencing pain due to depression. When administered in low doses such as 25 mg, Amitriptyline effectively alleviates depression and the disorders that it causes, such as complex regional pain disorders among patients. According to Lawson (2017), the daily recommend dose of Amitriptyline among outpatients is a maximum of 150 mg/day. Starting with a low dose and increasing the dosage as the treatment progresses is recommended to reduce the incidences of adverse effects caused by the drug. These negative side effects include agitation, anxiety, constipation, diarrhea, lethargy, sexual dysfunction, and weight gain, among others (Brueckle, Thomas, Seide, et al., 2020).

The other two decisions, which included administering Savella 12.5 mg to the patients or Neurontin (gabapentin) 300 mg, were less advantageous. The administration of Savella 12.5 mg was therefore ruled out because though the drug would effectively reduce the patient’s pain, it could cause adverse side effects that would be a huge health challenge to the patient. According to Derry, Phillips, Moore, & Wiffen (2015), the most adverse side effects of Savella include elevated blood pressure, nausea, insomnia, nausea, and sweating. The benefits of the drug to patients should be weighed against the side effects. In the case of the white male patient with hip pains, Savella’s adverse effects would exceed the benefits of the drug in reducing pain. The drug would thus be less beneficial. The administration of Neurontin (gabapentin) 300 mg would also be less beneficial to the patient. According to Peckham, Evoy et al. (2018), Neurontin (gabapentin) is mainly preferred as a form of antiepileptic drug and anticonvulsant. The patient did not seem to have any significant convulsing episodes that could warrant the use of Neurontin (gabapentin). The drug would also be less preferred due to its low effect on reducing pain and the adverse effect of drowsiness and feeling foggy, which could affect the patients’ quality of life.

In deciding to administer Amitriptyline 25 mg to the patient, I was hoping to reduce the patient’s pain levels to a level of about five out of teen on his scale and avoid any adverse effects. According to Brueckle et al. (2020), a low dosage of Amitriptyline is effective in alleviating pain among patients with complex regional pain disorder while not causing major side effects.

What I expected to achieve and what I achieved in deciding to administer Amitriptyline 25 mg to the patient was similar. After a month, the client reported that his pain level was six out of ten. Simultaneously, he also had no major adverse effects, with the only side effect being groggy in the morning.

Decision #2

For the second decision, I selected the option of increasing the administration of Amitriptyline from the current 25mg to 125mg before bed time. According to Lawson (2017), a maximum dosage of 150mg of Amitriptyline per day will be safe for outpatients. By increasing the dosage of Amitriptyline from 25mg per day to 125 mg taken before bedtime, I was hoping to reduce the patient’s pain levels to lower than 4 out of 10. I was also hoping to reduce the side effects of grogginess in the morning by asking the client to take the full dose before going to bed. My expectations in increasing the dosage of Amitriptyline from 25 mg to 125 mg on the client and the result of my decision were similar in that’s the patient reported having a pain level of four out of ten and not being groggy in the morning. His only complaint was a little weight gain.

Decision #3

I choose to continue administering Amitriptyline 125 mg daily dose to the patients during bed time for the third decision. I also chose to refer the patient to a life coach who would help him control his weight gain through healthy diets and effective exercise habits. According to Plodkowski, McGarvey, Reisinger-Kindle, et al. (2016), Qysmia should only be prescribed to morbidly obese patients with a BMI of more than 30kg/m2. Patients with a BMI of less than 30 should explore other options to manage their weight. By making this decision, I was hoping to achieve the client’s pain goals of three out of ten and help him control his weight gain. According to Lawson (2017), the appropriate dosage of Amitriptyline can play a significant role in treating patients with complex regional pain disorders.

My expectations for taking the third decision to continue administering Amitriptyline 12mg to the patient were similar to the results. The patient’s pain goal of three was achieved with non-adverse side effects being witnessed.

Ethical Considerations

The three ethical considerations that would need to be considered in the patient’s treatment would include confidentiality and beneficence. All the decisions made to treat the patients would thus need to be made to benefit the patient. All the information relating to the patient’s identification and treatment details would also need to be kept in confidence (Stein & van Niekerk, 2015).

References

Brueckle, M., Thomas, E.T., Seide, S.E., et al. (2020). Adverse drug reactions associated with

Amitriptyline — protocol for a systematic multiple-indication review and meta-analysis. Syst Rev 9, 59 https://doi.org/10.1186/s13643-020-01296-8.

Derry, S., Phillips, T., Moore, R. A., & Wiffen, P. J. (2015). Milnacipran (Savella) for

neuropathic pain in adults. The Cochrane database of systematic reviews, 2015(7), CD011789. https://doi.org/10.1002/14651858.CD011789.

Lawson K. (2017). A Brief Review of the Pharmacology of Amitriptyline and Clinical Outcomes

in Treating Fibromyalgia. Biomedicines, 5(2), 24. https://doi.org/10.3390/biomedicines5020024.

Peckham, A. M., Evoy, K. E., Ochs, L., & Covvey, J. R. (2018). Gabapentin for Off-Label Use:

Evidence-Based or Cause for Concern?. Substance abuse : research and treatment, 12, 1178221818801311. https://doi.org/10.1177/1178221818801311.

Plodkowski, R. A., McGarvey, M. E., Reisinger-Kindle, K., Kramer, B., Nelson, E., Lee, J., &

Nguyen, Q. T. (2016). Obesity Management: Clinical Review and Update of the Pharmacologic Treatment Options. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 33(1), 6–16.

Stein, D. J., & van Niekerk, A. A. (2015). Ethics of psychopharmacology. International

perspectives in philosophy and psychiatry. The Oxford handbook of psychiatric ethics (p. 1175–1190). Oxford University Press.

Week 8 assignment

Assignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction

Impulsivity, compulsivity, and addiction are challenging disorders for clients across the lifespan. These disorders often manifest as negative behaviors, resulting in adverse outcomes for clients. In your role as the psychiatric mental health nurse practitioner, you have the opportunity to help clients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 14, “Impulsivity, Compulsivity, and Addiction”

Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the Substance Use and Impulsive Disorders tab.

Chapter 10, “Disorders of Impulsivity and Compulsivity”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia
For obsessive-compulsive disorder
Citalopram
clomipramine
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine
vilazodone
For alcohol withdrawal
chlordiazepoxide
clonidine
clorazepate
diazepam
lorazepam
oxazepam
For bulimia nervosa and binge eating
fluoxetine
topiramate
zonisamide
For alcohol abstinence
acamprosate
disulfiram
For alcohol dependence
nalmefene
naltrexone
For opioid dependence
buprenorphine
naltrexone
For nicotine addiction
bupropion
varenicline

Book Excerpt: S.ubstance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders. Treatment Improvement Protocol Series, No. 32. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64350/

Chapter 1, “Substance Use Among Adolescents”

Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”

Chapter 7, “Youths with Distinctive Treatment Needs”

University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control in adulthood, study finds. Retrieved from https://www.sciencedaily.com/releases/2016/01/160120201324.htm

Note: Retrieved from Walden Library databases.

Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. doi:10.1111/j.1365-2125.2012.04457.x

Note: Retrieved from Walden Library databases.

Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. doi:10.3928/00989134-20160314-04

Note: Retrieved from Walden Library databases.

Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis, 8(1), 74–84. doi:10.1080/15504263.2012.648439

Note: Retrieved from Walden Library databases.

Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., & … Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337–1341. doi:10.1016/j.comppsych.2014.04.018

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016c). Case study: A Puerto Rican woman with comorbid addiction [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat adolescent clients requiring therapy for impulsivity, compulsivity, and addiction.

The Assignment

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Walden NURS 6630 Week 8 Sample Paper
(Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction)

Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

In the treatment of alcohol use disorder, gambling, and other addiction disorders, a PMHNP must take time to consider the effects of the chosen treatment and its effectiveness. This will be essential in ensuring that only the right medication is administered to avoid adverse effects on the patients and the chances of picking another addiction. The evaluation of pharmacokinetics and pharmacodynamics of different preferred drugs and their effects on patients is critical in making decisions of the most appropriate prescription for addiction patients. This paper explores the decisions that will be made in treating a 53-year-old Puertorican female with gambling and alcohol use disorder.

Decision #1

For the first decision, I choose to administer Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every four weeks to the patient. I selected the decision to administer Naltrexone to the patient as the drug would be effective in alleviating the alcoholism problems in the patient, which was their main challenge that fueled their gambling problems. According to Swiatek, Bosso, & Hughes (2018), Naltrexone (Vivitrol) injection is effective in treating alcoholism as it reduces the urge to drink. This helps patients to drink less or to stop drinking altogether.

I opted against the other two decisions, including administering Antabuse (Disulfiram) 250 mg orally every morning and administering Campral (acamprosate) 666 mg orally TID due to the adverse side effects that both the drugs would have on the patient and the less efficacy in resolving the patient’s alcohol abuse disorder. According to Skinner, Lahmek, Pham, & Aubin (2014), Antabuse (Disulfiram) may cause psychotic reactions among patients when it is administered in large doses. The administration of 250mg on the patient would be expected to have adverse side effects on the patients and thus was not chosen. According to Maisel, Blodgett, Wilbourne, et al. (2015), Campral (acamprosate) may have adverse side effects on patients, including fear, severe depression, and an extreme feeling of emptiness and sadness when administered in larger dosages. I ruled against the administration of Campral 666 mg orally was due to the anticipated adverse effects.

By administering Naltrexone (Vivitrol) injection, 380 mg intramuscularly, I was hoping to address the patient’s alcohol abuse disorder by reducing the amount of alcohol she took. Naltrexone (Vivitrol) injection is effective in treating alcoholism as it reduces the urge to drink among patients (Swiatek et al., 2018).

What I was hoping to achieve by administering Naltrexone (Vivitrol) injection was similar to what I achieved in that after a month, the client reported to the clinician and highlighted she had not taken alcohol in the past month and that she felt great. This showed that the naltrexone (Vivitrol) injection had worked as expected in stopping the patient from abusing alcohol.

Decision #2

For the second decision, I choose to refer the client to the counselor to address her gambling issues. According to Choi, Shin, & Kim, et al. (2017), psychotherapy is the most effective method of treating pathological gambling, such as in the case of Mrs. Perez. Referring the client to the counselor would therefore put her up to receive evidence-based therapies, including cognitive-behavioral therapy, Gambler’s Anonymous, psychodynamic therapy, behavioral therapy, and family therapy (Choi et al. 2017). These therapies would be effective in treating the client’s gambling disorders.

By making the decision to refer the client to a counselor to address her gambling issues, I was hoping to help the clients deal with her gambling addictions. I was also hoping that the anxiety side effects that the client experienced after the first month of treatment with naltrexone (Vivitrol) injection would subside with no need for treatment.

What I was hoping to achieve in making decision #2 was similar to what I achieved in that though the patient stated that she did not like her counselor, she started some session and enrolled in gamblers anonymous, where she felt supported. The patient’s anxiety also dissipated with no need for treatment, which was expected.

Decision #3

For the third decision, I choose to explore the issues Mrs. Perez was having with her counselors and encouraged her to keep attending her gamblers anonymous meetings where she was receiving a lot of support. According to Menchon, Mestre-Bach, Steward, et al. (2018), there will be no FDA approved pharmacological treatments for gambling, with counseling being the only effective option for treatment.

In making the decision to explore the issues between Mrs. Perez and her counselor and encourage her to keep attending the gamblers anonymous session, I was therefore hoping to help her kick her gambling habit through evidence-based psychotherapeutic measures. According to Ngepa Menchon et al. (2018), psychotherapeutic measures are effective in treating pathological gambling.

What is expected to achieve in encouraging Mrs. Perez to keep seeing her counselor and attending gambler anonymous decisions were similar to what I achieved in that the client reduced her gambling habit after a month of attending the sessions with a clear indication that the client would be able to quit completely after a time.

Ethical Considerations

Confidentiality and beneficence will include the two ethical considerations that would need to be included in the care of the patient. All the treatment decisions taken would, therefore, be for the benefit of the patients. The decisions would also be kept confidential and never revealed to any third parties (Stein & van Niekerk, 2015).

References

Choi, S., Shin, Y., & Kim, D. et al. (2017). Treatment modalities for patients with gambling

disorder. Ann Gen Psychiatry 16, 23. https://doi.org/10.1186/s12991-017-0146-2.

Maisel, N. C., Blodgett, J. C., Wilbourne, P. L., Humphreys, K., & Finney, J. W. (2015). Meta-

analysis of Naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?. Addiction (Abingdon, England), 108(2), 275–293. https://doi.org/10.1111/j.1360-0443.2012.04054.x.

Menchon, J. M., Mestre-Bach, G., Steward, T., Fernández-Aranda, F., & Jiménez-Murcia, S.

(, 2018). An overview of gambling disorder: from treatment approaches to risk factors. F1000Research, 7, 434. https://doi.org/10.12688/f1000research.12784.1.

Stein, D. J., & van Niekerk, A. A. (2015). Ethics of psychopharmacology. International

perspectives in philosophy and psychiatry. The Oxford handbook of psychiatric ethics (p. 1175–1190). Oxford University Press.

Swiatek, D., Bosso, N.A., & Hughes, L.P (2018). Naltrexone for the Treatment of Alcohol Use

Disorder in the Primary Care Setting. US Pharm. 2018; 43(8)26-33.

Skinner, M. D., Lahmek, P., Pham, H., & Aubin, H. J. (2014). Disulfiram efficacy in the

treatment of alcohol dependence: a meta-analysis. PloS one, 9(2), e87366. https://doi.org/10.1371/journal.pone.0087366.

Week 9 discussion

Discussion: Presentations of ADHD

Although ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this Discussion, you consider how you might assess and treat individuals presenting with ADHD.

Required Readings

Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”

Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab.

Chapter 4, “ADHD Treatments”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For ADHD
armodafinil
amphetamine (d)
amphetamine (d,l)
atomoxetine

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty

Case 2: Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughter

Case 3: Volume 2, Case #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Week 9 assignment

Assignment: Assessing and Treating Clients With ADHD

Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. They may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: Review all materials from the Discussion.

Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

This case study will serve as the foundation for this week’s Assignment.

The Assignment

Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Walden NURS 6630 Week 9 Sample Paper
(Assessing and Treating Clients With ADHD)

Assessing and Treating Clients with ADHD

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with ADHD

ADHD is a condition that makes it difficult for the individual affected to pay attention or control impulsive behavior. Patients suffering from ADHD might appear to be restless and continuously active. ADHD symptoms will begin in childhood among many patients and can continue as the child matures. Adults and children will show different ADHD presentations, while gender will also affect how ADHD progresses (Keilow, Holm, & Fallesen, 2018). In the treatment of ADHD patients, it will be important to consider the pharmacodynamics and pharmacokinetics of different medication therapies. PMHNPs need to perform careful evaluations and assessments to determine the risks and benefits of medication therapies they administer to ADHD patients. This paper reviews and supports the decisions that would be made in the treatment of a young girl with ADHD.

Decision #1

For the first decision, I selected administering Ritalin (methylphenidate) chewable tablets 10 mg to the patient. The patient was to take the medication orally every morning for a month until their next appointment. My decision to administer Ritalin was based on scholarly evidence that supported the effectiveness of the drug in treating ADHD among children while having less adverse side effects. According to Van der Schans, Çiçek, Vardar, et al. (2017). Ritalin will be effective in reducing ADHD among children. It will increase the production of chemicals in the brain that is responsible for increasing concentration, controlling behavior problems, and helping one pay attention.

The other decision of administering Intuniv or Wellbutrin would be less advantageous to the patient because of the adverse effects that the drugs are known to cause on children. According to Patel, Allen, Haque, et al. (2016), Wellbutrin may cause severe mood changes among patients that can drive them to want to hurt themselves. According to Martinez-Raga, Knecht, & de Alvaro (2015), Intuniv may cause severe dizziness and sluggishness in a patient, which may affect their productivity. Therefore, the decision to administer the two drugs would be avoided to avoid the adverse side effects.

By deciding to administer Ritalin to the young ADHD patients, I was hoping to help her improve her concentration in school while nursing the least side effects. What I was hoping to achieve with making the decision was different from the results in that the patient’s concentration in school increased only in the morning sessions. My expectations of side effects were similar to the results in that though the patients had an elevated heartbeat, it was within normal ranges, which was not dangerous for her health.

Decision #2

On the second decision, I choose to increase the dosage of the patient to Ritalin LA 20 mg orally taken daily in the morning. According to Storebø, Pedersen, Ramstad, et al. (2018), increasing the dosage of Ritalin can help a patient with ADHD to remain focused throughout the day if no adverse side effects had been observed previously. By making the decision to change the ADHD patient’s dosage to Ritalin LA 20 mg, I was hoping to improve the patient’s concentration throughout the day. I was also hoping that the patient would stop experiencing an elevated heartbeat. What I expected to achieve by increasing the dosage of Ritalin for the patient was similar to what I achieved in that the patient’s academic performance improved throughout the day while they stopped having an elevated heartbeat. According to Van der Schans et al. (2017), increasing the dosage of Ritalin among patients can help improve their concertation throughout the day. What I expected to achieve in making the decision to increase the dosage of Ritalin to the patient was similar to what I achieved.

Decision #3

For the third decision, I choose to maintain the dosage of Ritalin LA 20 mg to the young girl with ADHD and evaluate the patient’s performance after a month. According to Storebø et al. (2018), it is always advisable to maintain the lowest effective dose of a stimulant, especially among young patients. In making the decision, I was hoping that the concentration of the patient would be present throughout the day and that the patient would experience no side effects. What I expected to achieve in making the decision to maintain a dosage of Ritalin LA 20 mg to the patient was similar to what I achieved in that the patient’s concentration was maintained while they experienced no side effects.

Ethical Considerations

The two ethical considerations that would impact the treatment plans for the eight-year patient with ADHD would be the consideration of beneficence and informed consent (Howe, 2018). All the treatment plans would have to be approved by the patient’s parents as she is a minor, with parents being provided with necessary information relating to benefits and side effects to make the right decision. All the treatment decisions made would also be to benefit the patients.

References

Howe, E. (2018). Ethical considerations when treating patients with schizophrenia. Psychiatry

(Edgmont (Pa. : Township)), 5(4), 59–64.

Keilow, M., Holm, A., & Fallesen, P. (2018). Medical treatment of attention

Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance. PloS one, 13(11), e0207905. https://doi.org/10.1371/journal.pone.0207905.

Martinez-Raga, J., Knecht, C., & de Alvaro, R. (2015). Profile of guanfacine extended release

and its potential in the treatment of attention-deficit hyperactivity disorder. Neuropsychiatric disease and treatment, 11, 1359–1370. https://doi.org/10.2147/NDT.S65735.

Patel, K., Allen, S., Haque, M. N., Angelescu, I., Baumeister, D., & Tracy, D. K. (2016).

Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Therapeutic advances in psychopharmacology, 6(2), 99–144. https://doi.org/10.1177/2045125316629071.

Storebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B.,

Moreira-Maia, C. R., Magnusson, F. L., Holmskov, M., Gerner, T., Skoog, M., Rosendal, S., Groth, C., Gillies, D., Buch Rasmussen, K., Gauci, D., Zwi, M., Kirubakaran, R., Håkonsen, S. J., Aagaard, L., … Gluud, C. (2018). Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents – assessment of adverse events in non-randomised studies. The Cochrane database of systematic reviews, 5(5), CD012069. https://doi.org/10.1002/14651858.CD012069.pub2.

Van der Schans, J., Çiçek, R., Vardar, S. et al. (2017). Methylphenidate use and school

performance among primary school children: a descriptive study. BMC Psychiatry 17, 116 https://doi.org/10.1186/s12888-017-1279-1.

Week 10 discussion

Discussion: Influencing Social Change

Individuals with psychiatric mental health disorders are frequently stigmatized not only by society as a whole, but also by their friends, family, and sometimes healthcare providers. In your role, however, you have the opportunity to become a social change agent for these individuals. For this Discussion, consider how you might make a positive impact for your clients and advocate for social change within your own community.

Learning Objectives

Students will:

Apply strategies to become a social change agent for psychiatric mental health

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Angermeyer, M. C., Matschinger, H., & Schomerus, G. (2013). Attitudes towards psychiatric treatment and people with mental illness: Changes over two decades. The British Journal of Psychiatry, 203(2), 146–151. Retrieved from http://bjp.rcpsych.org/content/203/2/146.full

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

Dingfelder, S. F. (2009). Stigma: Alive and well. American Psychological Association, 40(6), 56. Retrieved from http://www.apa.org/monitor/2009/06/stigma.aspx

Jenkins, J. H. (2012). The anthropology of psychopharmacology: Commentary on contributions to the analysis of pharmaceutical self and imaginary. Culture, Medicine and Psychiatry, 36(1), 78–79. doi:10.1007/s11013-012-9248-0

Note: Retrieved from from the Walden Library databases.

Price, L. H. (2010). Violence in America: Is psychopharmacology the answer? Brown University Psychopharmacology Update, 21(5), 5. Retrieved from http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1556-7532

Note: Retrieved from from the Walden Library databases.

Optional Resources

Bennett, T. (2015). Changing the way society understands mental health. National Alliance on Mental Illness. Retrieved from http://www.nami.org/Blogs/NAMI-Blog/April-2015/Changing-The-Way-Society-Understands-Mental-Health

Mechanic, D. (2007). Mental health services then and now. Health Affairs, 26(6), 1548–1550. Retrieved from https://web.archive.org/web/20170605094514/http://content.healthaffairs.org/content/26/6/1548.full

Rothman, D. J. (1994). Shiny, happy people: The problem with “cosmetic psychopharmacology.” New Republic, 210(7), 34–38.

To prepare for this Discussion:

Reflect on how you might influence social change for psychiatric mental health.

Week 10 assignment

Assignment: Assessing and Treating Clients With Dementia

The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia.

Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

Required Readings

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia
donepezil
galantamine
memantine
rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf

Required Media

Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.

The Assignment

Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also, include how ethical considerations might impact your treatment plan and communication with clients.

Walden NURS 6630 Week 10 Sample Paper
(Assessing and Treating Clients with Dementia)

Assessing and Treating Clients with Dementia

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Dementia

The treatment of brain degeneration illnesses such as Alzheimer’s will require the PMHNP to consider the benefits and side effects of such treatments. The PMHNP will recognize that though the brain degeneration caused by conditions such as Alzheimer’s is not reversible, it can be controlled when the right medication and dosage are administered to patients. This paper explores the pharmacokinetics and pharmacodynamics of the medications administered to control Alzheimer’s in a 76-year-old Iranian male.

Decision #1

For the first decision, I decided to administer Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID after two weeks. I made the decision to administer Exelon (rivastigmine) 1.5 mg to the patient and increase the dosage to 3 mg after two weeks as the drug is known to be effective in limiting the symptoms of degenerative brain disease as a cholinesterase inhibitor (Khoury, Rajamanickam, & Grossberg, 2018). I also made the decision, to begin with, a 1.5 mg dosage and increase to 3mg after two weeks as this would help to avoid severe side effects on the patients a such as the loss of appetite, nausea, and upset stomach (Khoury et al., 2018). The medication would benefit the patients and cause less harm.

The other two decisions, which would be to administer Aricept (donepezil) 5 mg orally or Razadyne (galantamine) 4 mg orally BID, would be less advantageous and would not be considered. The central reason for not administering Aricept (donepezil) 5 mg to the 76-year-old Iranian male would be because of the severe side effects associated with the drug. According to Agboton, Mahdavian, Singh, et al. (2014), Aricept has been shown to cause a slow and irregular heartbeat in some patients, which can result in fainting. On the other hand, the decision to administer Razadyne would be less advantageous as it can cause severe side effects such as fast, slow, and irregular breathing, which would be detrimental to the elderly patient’s health. Razadyne would also have a higher probability of contributing to severe side effects such as slow or irregular heartbeats in a patient and would not be considered (Nakagawa, Ohnishi, Kobayashi, et al., 2017).

By making the decision to administer Exelon (rivastigmine) 1.5 mg orally and increase to 3 mg orally BID in 2 weeks, I was hoping to help limit the symptoms of Alzheimer’s on the patient, including loss of interest in important activities, and increasing the patients Mini-Mental State Exam (MMSE) score. According to Kandiah, Pai, Senanarong, et al. (2017), Exelon will be effective in treating most symptoms of Alzheimer’s and will boost the brain’s activity of patients.

What I was hoping to achieve after administering Exelon 1.5 mg orally and increasing the dose to 3 mg orally after two weeks and the results of the decision were different because no improvements were noted in the patient’s MMSE score. The patient was also quite disinterested in important activities in their life, such as religious activities. From the results, it was evident that the medication had not yet been effective on the patient. According to Khoury et al. (2018), cholinesterase inhibitors will not be effective from the onset, with effects likely to be observed in the second month of administration.

Decision #2

For the second decision, I choose to increase the dosage of Exelon to 4.5 mg orally. I selected this decision because the patient had not displayed any severe side effects with the administration of 3mg of Exelon in the past month. Increasing the dosage of Exelon to 4.5 mg was also needed to bring about the preferred results of limiting the symptom of Alzheimer’s on the patient. According to Kandiah et al. (2017), increasing the dosage of Exelon is recommended among patients who do not experience severe side effects so as to limit the symptoms of Alzheimer’s.

By making the decision to increase the dosage of Exelon to 4.5 mg, I was hoping to improve the patient’s brain functionality and interest in activities which they liked. What I expected to achieve in increasing the dosage of Exelon to 4.5 mg was similar to what I achieved in that after a month, the patients showed increased functionality by attending religious activities and showing interest. This showed the dosage was effective in limiting the symptoms of Alzheimer’s on the patient.

Decision #3

For the third decision, I choose to increase Exelon dosage to 6mg orally. According to Khoury et al. (2018), increasing the dosage of Exelon is recommended in cases where the patient does not show any severe side effects. The increased dosage will be more effective in limiting Alzheimer’s symptoms.

By making the decision to increase the Exelon dosage of the 76-year-old Iranian patient to 6mg, I was hoping to sustain the patient’s interests in activities which they liked and improve the brain functionality. Cholinesterase inhibitors help to stabilize the symptoms of Alzheimer’s and help patients to regain interest in activities they consider important while functioning better (Kandiah et al., 2017). What I was hoping to accomplish by increasing the dosage was similar to what I achieved in that the patient showed an increased interest in religious activities and general improvement in brain function. This showed that the increased dosage was effective in limiting Alzheimer’s symptoms in the patients.

Ethical Considerations

In treating the 76-year-old Iranian male, the ethical principles of confidentiality and beneficence would be followed. Only the medication that provides the benefits to the patients would be considered, with all the information related to the treatment being held in confidence by all involved parties.

References

Agboton, C Mahdavian, S., Singh, A., Ghazvini, P., Hill, A., & Sweet, R. (2014). Impact of

nighttime donepezil administration on sleep in the older adult population: A retrospective study. Mental Health Clinician 1; 4 (5): 257–259. doi: https://doi.org/10.9740/mhc.n222761.

Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current

therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic advances in drug safety, 9(3), 171–178. https://doi.org/10.1177/2042098617750555.

Kandiah N, Pai MC, Senanarong V, Looi I, Ampil E, Park KW, Karanam AK, & Christopher S.

(, 2017). Rivastigmine: the advantages of dual inhibition of acetylcholinesterase and butyrylcholinesterase and its role in subcortical vascular dementia and Parkinson’s disease dementia. Clin Interv Aging. 12:697-707 https://doi.org/10.2147/CIA.S129145.

Nakagawa, R., Ohnishi, T., Kobayashi, H., Yamaoka, T., Yajima, T., Tanimura, A., Kato, T., &

Yoshizawa, K. (2017). Long-term effect of galantamine on cognitive function in patients with Alzheimer’s disease versus a simulated disease trajectory: an observational study in the clinical setting. Neuropsychiatric disease and treatment, 13, 1115–1124. https://doi.org/10.2147/NDT.S133145.

PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING PAPERS MARKET TODAY AND GET AN AMAZING DISCOUNT

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Week 1 discussion

Discussion: Foundational Neuroscience

Required Readings

Walden NURS 6630 Week 1 Sample Paper (Psychopharmacologic Approaches to Treatment of Psychopathology)

Post 1

Post 2

Post 3

Post 4

References

Week 2 discussion

Assignment: Assessing and Treating Pediatric Clients With Mood Disorders

The Assignment

Decision #1

Decision #2

Decision #3

Required Readings

Review the following medications:

Required Media

Walden NURS 6630 Week 2 Sample Paper (Assessing and Treating Pediatric Clients With Mood Disorders)

Treating Pediatric Patients with Mood Disorders

Decision One

Decision Two

Decision Three

Ethical Considerations

References

Week 3 discussion

Discussion: The Impact of Ethnicity on Antidepressant Therapy

Required Readings

Review the following medications:

Walden NURS 6630 Week 3 Sample Paper (Impact of Ethnicity on Antidepressant Therapy)

Impact of Ethnicity on Antidepressant Therapy

Case #7: The Case of Physicians Do Not Heal Thyself

Questions and Rationale

Physical Examination and Diagnosis

Differential Diagnosis

Patient’s Most Likely Condition

Pharmacologic Agents

How Ethnicity Affect Drug Therapy

Check Points

Lessons Learned

References

Week 3 assignment

Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Required Readings

The Assignment

Decision #1

Decision #2

Decision #3

Walden NURS 6630 Week 3 Sample Paper (Assessing and Treating Adult and Geriatric Clients With Mood Disorders)

Mood Disorders

Decision One

Decision Two

Decision Three

Ethical Considerations

Conclusion

References

Week 4 assignment

Assignment: Assessing and Treating Clients with With Bipolar Disorder

Required Readings

The Assignment

Decision #1

Decision #2

Decision #3

Walden NURS 6630 Week 4 Sample Paper (Assessing and Treating Adult and Geriatric Clients With Mood Disorders)

Bipolar Disorder

Decision One

Decision Two

Decision Three

Ethical Considerations

References

Week 5 assignment

Assignment: Assessing and Treating Clients With Anxiety Disorders

Required Readings

The Assignment

Decision #1

Decision #2

Decision #3

Walden NURS 6630 Week 5 Sample Paper (Assessing and Treating Clients With Anxiety Disorders)

Anxiety Disorders

Walden NURS 6630 Week 1 Sample Paper
(Psychopharmacologic Approaches to Treatment of Psychopathology)

Walden NURS 6630 Week 2 Sample Paper
(Assessing and Treating Pediatric Clients With Mood Disorders)

Walden NURS 6630 Week 3 Sample Paper
(Impact of Ethnicity on Antidepressant Therapy)

Walden NURS 6630 Week 3 Sample Paper
(Assessing and Treating Adult and Geriatric Clients With Mood Disorders)

Walden NURS 6630 Week 4 Sample Paper
(Assessing and Treating Adult and Geriatric Clients With Mood Disorders)

Walden NURS 6630 Week 5 Sample Paper
(Assessing and Treating Clients With Anxiety Disorders)

Walden NURS 6630 Week 6 Sample Paper
(Assessing and Treating Clients With Psychosis and Schizophrenia)

Walden NURS 6630 Week 7 Sample Paper
(Assessing and Treating Clients With Pain)

Walden NURS 6630 Week 8 Sample Paper
(Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction)