Assignment: Treating Psychological Disorders - Response to Classmate's Post

Assignment: Treating Psychological Disorders – Response to Classmate’s Post

Instructions and formatting

Read a colleague’s responses and respond to one of your colleague who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

This is a 2-3 paragraph essay responds
The colleague’s post to responds to is below
This responds should cite 2 resources and referenced on a reference page.
Writer can cite from one of the resources below. Writer can use own 1 or 2 scholarly articles as well
Write paragraphs in APA Format
Writer should use basic vocabulary

Resources

Required Readings

URL for the Book and chapters listed above

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Chapter 24, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 231–246)
Chapter 25, “Antidepressants” (pp. 247–265)
Chapter 26, “Drugs for Bipolar Disorder” (pp. 267–274)
Chapter 27, “Sedative-Hypnotic Drugs” (pp. 275–285)
Chapter 28, “Management of Anxiety Disorders” (pp. 287–292)
Chapter 29, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 293–299)

Bipolar disorder is a brain condition characterized by dramatic shifts in mood, energy, activity levels, and the ability to meet the demands of day to day tasks. There are four types of bipolar disorder, Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, and Other Specified and Unspecified Bipolar and Related Disorders. These moods will range from mania, which is defined as extraordinarily elated and energized behaviors to depressive episodes characterized by intense sadness and hopelessness, and hypomania, defined as less severe manic episodes (NIMH, 2016).

For this discussion, I chose the interactive media piece where I engaged in a set of decisions for prescribing and recommending pharmacotherapy for bipolar disorder. A 26-year-old Korean female presents to her follow up appointment following a 21-day inpatient hospital stay for the onset of acute mania. While hospitalized, lithium was initiated to manage her mood. She presents with a broad affect. Her speech is rapid, tangential, and pressured. She denies suicidal thoughts, homicidal thoughts, delusions, and paranoia. Her Young Mania Rating Scale score is 22, and she admits that she has stopped taking lithium (Laureate Education, 2019).

My first point of action is to restart the lithium as lithium is the drug of choice in controlling acute manic episode (Rosenthal & Burchum, 2018, p. 269). She was recently hospitalized and discharged with orders to continue lithium; my assumption is that she responded well to the therapy, which is how she reached the point of discharge readiness. Therefore, Lithium 300 mg twice daily was ordered. While bipolar disorder is treated with mood stabilizers, antipsychotics, and antidepressants (Rosenthal & Burchum, 2018, p. 268), she did not display or report any psychotic features, which is why I did not start Risperdal or Seroquel.

Four weeks later, she presents similar to her first visit and again admits to non-adherence to the medication regimen. At this point, I decided to assess her reasoning for not taking the medication as prescribed. She advised that she experience nausea and diarrhea while taking the medication and will stop self-administering the drug until the symptoms subside and then begin retaking the medicine. It is important to provide patient education, being that such responses to treatment are common and usually last for a short period (Rosenthal & Burchum, 2018, p. 271).

Last, I would have an immediate lithium level drawn to assess for toxicity as some GI issues are signs of toxicity (Rosenthal & Burchum, 2018, p. 270). Upon receipt of normal results, I would then change lithium to a sustained release preparation while maintaining the dose and frequency of 300 mg twice daily. According to Girardi, Brugnoli, Manfredi, & Sani (2016), some lithium related adverse events has shown to be related to the rate of increase in serum lithium concentrations; suggesting that slower rates of increase through the use of sustained-release preparations over immediate-release formulas provide a tolerability advantage.

Assignment: Treating Psychological Disorders – Response to Classmate’s Post

Instructions and formatting

This is a 2-3 paragraph essay responds
The colleague’s post to responds to is below
This responds should cite 2 resources and referenced on a reference page.
Writer can cite from one of the resources below. Writer can use own 1 or 2 scholarly articles as well
Write paragraphs in APA Format
Writer should use basic vocabulary

Resources

URL for the Book and chapters listed below

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Chapter 24, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 231–246)
Chapter 25, “Antidepressants” (pp. 247–265)
Chapter 26, “Drugs for Bipolar Disorder” (pp. 267–274)
Chapter 27, “Sedative-Hypnotic Drugs” (pp. 275–285)
Chapter 28, “Management of Anxiety Disorders” (pp. 287–292)
Chapter 29, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 293–299)

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Geriatric Depression

Geriatric depression is a critical health issue that is continuing to increase in the elderly population. It is estimated that it affects around 15-20% of the geriatric population worldwide. In a study by BS, Vijayakumar, Senan, and Paul 2018 found the prevalence at 53.2%. They also found predisposing factors connected with depression for geriatrics to be unemployed or retired life, female gender, low level of education, polypharmacy, multiple comorbid diagnosis, functional impairment, and crisis in the family. Major depressive disorder (MDD) is put in the mood disorder category of mental illness due to changes in patient’s perception, belief systems, behaviors, and physical function. Depression is linked to several symptoms that impair normal functioning, making it difficult for a patient to execute at their baseline levels psychologically, emotionally, and cognitively (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 681).

While it is difficult to narrow down a single cause of depression, there are a number of factors such as genetics, environmental, immunologic, biogenic amine deficiency, endocrine factors and neurogenesis that have been recognized tools to explain the pathophysiology of depression. Combinations of these factors rather than a single factor have been found to be the culprit for cause of depression. Structural changes in several of brain regions result from immunologic and endocrine responses to environmental stressors and inherited genetic factors. These changes cause dysfunctional changes in the brain and neurotransmission that unfolds as a collection of symptoms presenting as depression (Jesulola, Micalos, and Baguley, 2018).

Patient Scenario

The scenario I chose was the 70-year-old patient that presented with depression. I began the decision tree with starting the patient on Zoloft 25mg orally daily, after looking through the patient’s subjective data and mental health status exam. I chose Zoloft because selective serotonin reuptake inhibitors (SSRIs) are less likely to have inconvenient side effects and tend to cause less issues at higher therapeutic doses than several other antidepressants (Mayo Clinic, 2017). The patient reported a 25% decrease in depressive symptoms after 4 weeks which was an expected result but was concerned about a new onset erectile dysfunction problem, an unexpected result. At this decision point I chose to add Wellbutrin IR 150mg orally in the morning. I chose this for two reasons. The first being that many times adding a second antidepressant may work better than a single antidepressant. The second reason is that Wellbutrin has been found to have the potential for counteracting SSRI caused erectile dysfunction or increase sexual response. The patient came back 4 weeks later with a greater decrease in depression and the erectile dysfunction had subsided, both expected results. The patient did report having a nervousness or jitteriness, an unexpected result. This led me to the last decision to change the Wellbutrin to extended release 150mg orally in the am. The last decision was because when first starting antidepressants patients can have feelings of jitteriness that many times will subside. I felt that using the extended release could possibly decrease this side effect as the medication would be dispersed in the body at a slower rate (Drugs.Com, 2019).

Depression in the geriatric population is an issue that continues to grow and needs to be addressed. It is important to notice the symptoms of depression with our elderly patients who sometimes won’t be as forthright with us. Careful consideration needs to be taken in prescribing medications to help alleviate the depression symptoms for this population including for sexual dysfunction. As future providers this is an issue that we pay close attention to.

Assignment: Treating Psychological Disorders – Response to Classmate’s Post

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4 ed.). Retrieved from www.vitalsource.com

BS, D. B., Vijayakumar, D. P., Senan, D. S. K., & Paul, D. G. (2018). A Study of the prevalence of depression in geriatric outpatients and associated predisposing factors. International Journal of Medical Science and Clinical Invention, 5(1), 3454-3459. https://doi.org/10.18535/ijmsci/v5i1.17

Drugs.com (2019). Wellbutrin XL. Retrieved from https://www.drugs.com/cdi/wellbutrin-xl.html

Jesulola, E., Micalos, P., and Baguley, I.J. (2018). Understanding the pathophysiology of depression: From monoamines to the neurogenesis hypothesis model-are we there yet? Behavioural Brain Research, 341, 79-90. Elsevier. Retrieved from https://www.sciencedirect.com/science/article/pii/S0166432817318521

Mayo Clinic.(2017). Antidepressants: Selecting one that is right for you. Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273