NURS-6630N Week 7: Therapy for Patients With Schizophrenia Treatment for a Patient With a Common Condition Paper

NURS-6630N Week 7: Therapy for Patients With Schizophrenia Treatment for a Patient With a Common Condition Paper

NURS-6630N Week 7: Therapy for Patients With Schizophrenia Treatment for a Patient With a Common Condition Paper

The case scenario concerns a 75-year-old female with a complaint of insomnia. Her medical is positive for DM, HTN, and MDD. Since the patient’s husband died ten months ago, her depression and sleeping difficulties have worsened. However, she had no history of depression before her husband’s death. The patient is awake, alert, and oriented and denies having suicidal ideations. She is currently on Metformin, Januvia, Losartan, HCTZ, and Sertraline. She currently weighs 88 kg, her height is 64 inches, and her BP is 132/86. The purpose of this paper is to explain the questions to ask the patient, outline appropriate physical exams and diagnostic tests, and discuss the differential diagnosis and pharmacologic treatment.

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Questions To Ask the Patient If She Were In Your Office

1. What symptoms are associated with depression and insomnia? To establish other symptoms the patient has, which are consistent with depression.
2. How have depression and insomnia affected your social and occupational functioning? To determine how the patient’s symptoms have impacted her overall functioning (Park & Zarate, 2019).
3. How often do you take the prescribed Sertraline medication? To establish if the patient adheres to the antidepressant medication and determine if she is resistant to Sertraline therapy (Park & Zarate, 2019).

People in the Patient’s Life I Would Need to Speak To

The clinician would need to speak to the primary caregiver and ask them the following:

1. How would you describe the patient’s general mood in the past two weeks? The question will help identify the mood disorder that the patient has.
2. What challenges does the patient experience in her day-to-day activities? This will help establish how the patient’s symptoms affect her performance in daily living activities (Park & Zarate, 2019).
3. Who else currently lives or interacts more often with the patient? To identify the patient’s support system.

Physical Exams and Diagnostic Tests Appropriate For the Patient

A head-to-toe physical exam will be appropriate for this patient to assess for any underlying abnormalities owing to her history of diabetes and hypertension. Blood pressure screening will be appropriate to assess the patient’s BP and determine if the medication has effectively promoted optimal blood pressure. Diagnostic tests will include Thyroid-stimulating Hormone (TSH) test and Hemoglobin A1c. The TSH test will be needed to rule out hypothyroidism since it is also characterized by a depressed mood (Maurer et al., 2018). Besides, the hemoglobin A1C will be essential in assessing the patient’s mean glycemic level to establish if she has achieved adequate glycemic control. In addition, depression screening with the Patient Health Questionnaire (PHQ)-9 will be appropriate to assess the severity of the patient’s depressive symptoms and guide in selecting the treatment intervention (Maurer et al., 2018).

Differential Diagnosis

Major Depressive Disorder (MDD): MDD is a mood disorder characterized by a depressed/sad mood, diminished interest in activities, or both. The DSM-V diagnostic criteria for MDD require the presence of a depressed mood or diminished interest in addition to at least other four of the following symptoms: Low energy levels/ fatigue, Appetite disturbances, weight gain/loss, sleep disturbances, reduced ability to think and concentrate psychomotor agitation, indecisiveness, feelings of guilt, and suicidal thoughts, ideations, or attempt (APA, 2013; Maurer et al., 2018). MDD is a differential diagnosis based on pertinent positive symptoms of depressed mood and insomnia and the patient’s history of MDD.

Pharmacologic Agents

1. Venlafaxine (Effexor XR) 37.5 mg per oral once daily.

Venlafaxine is an antidepressant under serotonin-norepinephrine reuptake inhibitors (SNRI) and is indicated to treat MDD. It acts by inhibiting the neuronal reuptake of serotonin and norepinephrine. SNRIs are recommended as second-line agents when the first-line agents (SSRIs) are ineffective. Venlafaxine has modest side effects making it tolerable (Avasthi & Grover, 2018).

2. Wellbutrin SR 150 mg orally OD. Wellbutrin is an antidepressant indicated for treatment-resistant depression. The patient seems to have treatment-resistant depression due to the worsening depression despite being on Sertraline. Wellbutrin acts by inhibiting neuronal reuptake of dopamine and minimizing the rate of norepinephrine activity (Avasthi & Grover, 2018).

Selected drug therapy: Venlafaxine is the selected pharmacological agent for this patient since it is more effective and tolerable than Wellbutrin. However, it is contraindicated in patients with hypersensitivity to the drug and those on antidepressant therapy with monoamine oxidase inhibitors (MAOIs) (Avasthi & Grover, 2018). Dose reduction is recommended in patients with renal and hepatic impairment.

Check-Points: The patient will be followed-up after four weeks. The depressive symptoms will be assessed to determine if any alterations will be made to the treatment plan.

Conclusion

Additional questions for this patient will help to identify other symptoms of depression and the impact of depression on the patient’s functioning. MDD is the differential diagnosis based on the patient’s symptoms of depressed mood and insomnia and her history of MDD. Venlafaxine is an appropriate medication for the patient since it is indicated in patients who do not respond adequately to SSRIs.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Avasthi, A., & Grover, S. (2018). Clinical Practice Guidelines for Management of Depression in Elderly. Indian journal of psychiatry, 60(Suppl 3), S341–S362. https://doi.org/10.4103/0019-5545.224474

Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018). Depression: screening and diagnosis. American family physician, 98(8), 508-515.

Park, L. T., & Zarate, C. A., Jr (2019). Depression in the Primary Care Setting. The New England journal of medicine, 380(6), 559–568. https://doi.org/10.1056/NEJMcp1712493

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NURS-6630N: Week 7: Therapy for Patients With Schizophrenia
Discussion: Treatment for a Patient With a Common Condition. Due 7/13/22. 2 peers response
Insomnia is one of the most common medical conditions you will encounter as a PMHNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PMHNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.
Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
• Metformin 500mg BID
• Januvia 100mg daily
• Losartan 100mg daily
• HCTZ 25mg daily
• Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post a response to each of the following:
• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Read a selection of your colleagues’ responses.
By Day 6 of Week 7
Respond to at least two of your colleagues on two different days in one of the following ways:
• If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
• If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days and
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!