NURS 6630 Week 8 Assignment 1 Psychopharmacologic Treatment for Patients with Multiple Mental Health Disorders Essay

NURS 6630 Week 8 Assignment 1 Psychopharmacologic Treatment for Patients with Multiple Mental Health Disorders Essay

NURS 6630 Week 8 Assignment 1 Psychopharmacologic Treatment for Patients with Multiple Mental Health Disorders Essay

A psychiatric nurse practitioner will likely come across patients with multiple mental health disorders. It is therefore essential for psychiatric nurses to equip themselves with knowledge of various mental health disorders to accurately evaluate and treat these patients. Similarly, treatment of these conditions necessitates nurses to acquaint themselves with information on various psychopharmacologic agents including their mechanism of action, side effects, and potential drug-drug interactions. In the subsequent paragraphs, the knowledge of psychopharmacologic treatments for patients with multiple mental health disorders shall be utilized to respond to the subsequent questions.

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1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated if any, and why? Be specific. What is the timeframe that the patient should see the resolution of symptoms?

Alcohol is a common comorbidity in major depression. This presents a challenge when it comes to the selection of appropriate pharmacotherapy for depression. For instance, evidence supporting the use of selective serotonin reuptake inhibitors in the treatment of depression and comorbid alcohol use is limited or rather controversial. While SSRIs remain the first line for major depression, tricyclic antidepressants such as imipramine and desipramine have shown greater efficacy in managing depression in alcohol use disorder and are therefore preferred (Ballesta et al., 2019). Several drugs are contraindicated for simultaneous use with alcohol. For instance, NSAIDs are contraindicated in individuals with alcohol use disorder due to the enormous risk of peptic ulcer and bleeding. Likewise, alcohol has depressant effects hence concurrent use with selective serotonin reuptake inhibitors, benzodiazepines, and opioids are unadvisable due to the significant risk of severe CNS depression.  Most antidepressants take an estimated two to 6 weeks for an initial improvement in symptoms to be seen. However, it takes approximately three to six months for complete resolution of symptoms of depression.

2. List 4 predictors of late-onset generalized anxiety disorder.

Generalized anxiety disorder is a chronic disorder characterized by excessive anxiety that is not focused on a distinct fear. The lifetime prevalence rate of generalized anxiety disorder is estimated to be 5 to 10% (Munir & Takov, 2022). The predictors of late-onset anxiety include the following;

• Female gender- anxiety is more common among females than males (Munir & Takov, 2022)
• Recent adverse life events
• Mental health disorders including phobias, depression, and past generalized anxiety disorder (Munir & Takov, 2022)
• Chronic physical illnesses such as heart failure, arrhythmia, and respiratory disorders.

3. List 4 potential neurobiology causes of psychotic major depression.

Major depression causes significant impairment in social, occupational, and personal functioning. Major depression is considered a manifestation of stress to the neurobiological mechanisms by several factors including genes, psychosocial adversity in childhood, and ongoing psychosocial stress (Li et al., 2021). These neurobiological causes of major depression include the following;

• Monoamine hypothesis- diminished levels of serotonin and noradrenaline.
• Dysfunction of the hypothalamic-pituitary-adrenal axis- leads to increased production of stress hormones such as cortisol and corticotropin-releasing hormone.
• Stress-induced alterations in the dopamine system- increased levels of dopamine in the prefrontal cortex and ventral striatum.
• Polymorphisms in the gene that code for brain-derived neurotrophic factor. This factor is important in brain cell growth and synaptic plasticity.

4. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.

According to DSM-5, major depression is diagnosed when five or more of the following nine symptoms are present for a minimum of two weeks, with at least one of the symptoms being anhedonia or depressed mood (American Psychiatric Association, 2013).

• Depressed mood
• Insomnia/hypersomnia
• Anhedonia
• Fatigue
• Feeling of disproportionate guilt
• Diminished cognition, concentration, and ability to make decisions
• Weight change due to change in appetite
• Psychomotor agitation or retardation
• Suicidal ideation

5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.

Insomnia is a sleep disorder characterized by either difficulty falling or staying asleep. It can be acute or chronic. It is the most common sleep-wake disorder. Its etiology is complex and not fully understood although predisposing, precipitating, and perpetuating factors have all been identified (Levenson et al., 2015). For instance, the following classes of drugs can precipitate insomnia;

• Selective serotonin reuptake inhibitors (SSRIs) antidepressants such as escitalopram (Van Gastel, 2018). The mechanism of causation of insomnia is still unknown.
• Beta blockers such as atenolol. Inhibit the nighttime secretion of melatonin, a hormone involved in the regulation of both sleep and the body’s circadian clock (Van Gastel, 2018).
• Cholinesterase inhibitors such as donepezil. Cause insomnia by inhibiting acetylcholinesterase the enzyme responsible for acetylcholine breakdown. Consequently, high levels of acetylcholine keep the patient alert.

Conclusion

Alcohol abuse is a common comorbidity in depression. Tricyclic antidepressants are more effective than the usual selective serotonin reuptake inhibitors in treating depression in individuals with concurrent alcohol abuse. Major depression has a neurobiological origin although it is diagnosed using the DSM-5 criteria. Finally, insomnia can be precipitated by an array of pharmacological agents.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596

Ballesta, A., Alén, F., Rodríguez de Fonseca, F., Gómez de Heras, R., & Orio, L. (2019). Rethinking the use of antidepressants to treat alcohol use disorders and depression comorbidity: The role of neurogenesis. In Antidepressants – Preclinical, Clinical and Translational Aspects. IntechOpen. https://doi.org/10.5772/intechopen.83743

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://doi.org/10.1378/chest.14-1617

Li, Z., Ruan, M., Chen, J., & Fang, Y. (2021). Major depressive disorder: Advances in neuroscience research and translational applications. Neuroscience Bulletin, 37(6), 863–880. https://doi.org/10.1007/s12264-021-00638-3

Munir, S., & Takov, V. (2022). Generalized anxiety disorder. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441870/

Van Gastel, A. (2018). Drug-induced insomnia and excessive sleepiness. Sleep Medicine Clinics, 13(2), 147–159. https://doi.org/10.1016/j.jsmc.2018.02.001

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Assignment 1: Short Answer Assessment
As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.

To Prepare
Review the Learning Resources for this week.
Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders.
Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.
To complete:
Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

In 3 or 4 sentences,
explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse.
Which drugs are contraindicated, if any, and why? Be specific.
What is the timeframe that the patient should see resolution of symptoms?
List 4 predictors of late onset generalized anxiety disorder.
List 4 potential neurobiology causes of psychotic major depression.
An episode of major depression is defined as a period of time lasting at least 2 weeks.
List at least 5 symptoms required for the episode to occur. Be specific.
List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.

Learning Resources Required
Required Readings

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf

Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf

Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740

Rubric Detail
Name: NURS_6630_Week8_Assignment1_Rubric
In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse.
Which drugs are contraindicated, if any, and why. Be specific.
What it is the timeframe that the patient should see resolution of symptoms?–
Excellent
Point range: 90–100 12 (16%) – 13 (17.33%)
The response accurately and clearly explains in detail the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse.
The response accurately and clearly details which drugs are contraindicated with specific examples.
The response accurately and clearly explains in detail the timeframe that the patient should see resolution of symptoms.
Good
Point range: 80–89 11 (14.67%) – 11 (14.67%)
The response accurately explains the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse.
The response accurately identifies which drugs are contraindicated with specific examples.
The response accurately explains the timeframe that the patient should see resolution of symptoms.
Fair
Point range: 70–79 10 (13.33%) – 10 (13.33%)
The response inaccurately or vaguely explains the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse.
The response inaccurately or vaguely identifies which drugs are contraindicated with inaccurate or vague examples.
The response inaccurately or vaguely explains the timeframe that the patient should see resolution of symptoms.
Poor
Point range: 0–69 0 (0%) – 9 (12%)
The response inaccurately and vaguely explains the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse, or is missing.
The response inaccurately and vaguely identifies which drugs are contraindicated with inaccurate examples, or is missing.

The response inaccurately and vaguely explains the timeframe that the patient should see resolution of symptoms, or is missing.
List four predictors of late onset generalized anxiety disorder.–
Excellent
Point range: 90–100 12 (16%) – 13 (17.33%)
The response accurately and clearly lists in detail four predictors of late-onset generalized anxiety disorder.
Good
Point range: 80–89 11 (14.67%) – 11 (14.67%)
The response accurately lists four predictors of late-onset generalized anxiety disorder.
Fair
Point range: 70–79 10 (13.33%) – 10 (13.33%)
The response inaccurately or vaguely lists four predictors of late-onset generalized anxiety disorder.
Poor
Point range: 0–69 0 (0%) – 9 (12%)
The response inaccurately and vaguely lists four predictors of late-onset generalized anxiety disorder, or is missing.

List four potential neurobiology causes of psychotic major depression.–
Excellent
Point range: 90–100 12 (16%) – 13 (17.33%)
The response accurately and clearly lists in detail four potential neurobiology causes of psychotic major depression.
Good
Point range: 80–89 11 (14.67%) – 11 (14.67%)
The response accurately lists four potential neurobiology causes of psychotic major depression.
Fair
Point range: 70–79 10 (13.33%) – 10 (13.33%)
The response inaccurately or vaguely lists four potential neurobiology causes of psychotic major depression.
Poor
Point range: 0–69 0 (0%) – 9 (12%)
The response inaccurately and vaguely lists four potential neurobiology causes of psychotic major depression.

An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least five symptoms required for the episode to occur. Be specific.–
Excellent
Point range: 90–100 12 (16%) – 13 (17.33%)
The response accurately and clearly explains in detail at least five symptoms for the episode of major depression to occur.
Specific examples provided fully support the response.
Good
Point range: 80–89 11 (14.67%) – 11 (14.67%)
The response accurately explains at least five symptoms for the episode of major depression to occur.
Specific examples provided support the response.
Fair
Point range: 70–79 10 (13.33%) – 10 (13.33%)
The response inaccurately or vaguely explains at least five symptoms for the episode of major depression to occur.
Specific examples provided inaccurately or vaguely support the response.
Poor
Point range: 0–69 0 (0%) – 9 (12%)
The response inaccurately and vaguely explains at least five symptoms for the episode of major depression to occur, or is missing.
Specific examples provided do not support the response, or is missing.

List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.–
Excellent
Point range: 90–100 12 (16%) – 13 (17.33%)
The response accurately and clearly lists in detail 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia.
Examples provided fully support the response provided.
Good
Point range: 80–89 11 (14.67%) – 11 (14.67%)
The response accurately lists 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia.
Examples provided support the response provided.
Fair
Point range: 70–79 10 (13.33%) – 10 (13.33%)
The response inaccurately or vaguely lists 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia.
Examples provided inaccurately or vaguely support the response provided.
Poor
Point range: 0–69 0 (0%) – 9 (12%)
The response inaccurately and vaguely lists 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia, or is missing.

Examples provided do not support the response provided, or is missing.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation–
Excellent
Point range: 90–100 5 (6.67%) – 5 (6.67%)
Uses correct grammar, spelling, and punctuation with no errors.
Good
Point range: 80–89 4 (5.33%) – 4 (5.33%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
Fair
Point range: 70–79 3.5 (4.67%) – 3.5 (4.67%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
Poor
Point range: 0–69 0 (0%) – 2 (2.67%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.–
Excellent
Point range: 90–100 5 (6.67%) – 5 (6.67%)
Uses correct APA format with no errors.
Good
Point range: 80–89 4 (5.33%) – 4 (5.33%)
Contains a few (1 or 2) APA format errors.
Fair
Point range: 70–79 3.5 (4.67%) – 3.5 (4.67%)
Contains several (3 or 4) APA format errors.
Poor
Point range: 0–69 0 (0%) – 2 (2.67%)
Contains many (≥ 5) APA format errors.
Total Points: 75
Name: NURS_6630_Week8_Assignment1_Rubric