Case Study: An Elderly Hispanic Man With Major Depressive Disorder

Progress is now being made in identifying specific genetic factors that predispose people to major depressive disorder (MDD), using the genome-wide association study (GWAS) method to study common DNA sequence variants. This chapter summarizes epidemiological findings relevant to genetics of MDD and its overlap with other psychiatric disorders.

NURS6630 Week 3 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.

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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.

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 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.

Abstract

Progress is now being made in identifying specific genetic factors that predispose people to major depressive disorder (MDD), using the genome-wide association study (GWAS) method to study common DNA sequence variants. This chapter summarizes epidemiological findings relevant to genetics of MDD and its overlap with other psychiatric disorders. The principles of GWAS and other genetic approaches are described, along with current analytic strategies to detect association to single genetic variants, and to use genome-wide data to evaluate heritability, overlap of genetic factors with other disorders, and genetic pathways (sets of genes with known functional relationships) that may be involved in risk. We then review findings of recent GWAS meta-analyses of multiple cohorts, resulting in samples exceeding 100,000 cases in the largest analyses, for example, the Psychiatric Genomics Consortium analysis that detected 44 independent significantly-associated genetic loci. Genes with roles in brain function predominate the list of individual associations and of significant pathways, but there is also representation of the immune system. Genome-wide, common variants explain 8%–30% of the risk of MDD (compared with 35%–40% according to twin studies), with a tendency for studies of more severely ill, “clinical” cases to have a higher common-variant heritability. Genetic risk factors for MDD overlap substantially with those for anxiety disorders and trait neuroticism, and significantly with ADHD, autism schizophrenia, bipolar disorder, and obesity. Based on current knowledge and studies of other disorders, it is likely that GWAS analyses of even larger samples will greatly increase the number of specific associations and enhance our knowledge of relevant genetic mechanisms. The evidence for genetic overlap among current diagnostic categories suggests that genetic data may ultimately contribute to a reformulation of diagnostic approaches, but given how little we know about which genetic factors underlie the important differences among these disorders, genetic data do not yet support a radical restructuring of diagnostic methods for clinical practice and research.