Week 9: Special Considerations Related to Vulnerable Populations
Week 9: Special Considerations Related to Vulnerable Populations
The psychiatric mental health nurse practitioner assumes probably no greater responsibility than the responsibility of prescribing medications. While someone can be harmed by psychotherapy, the level and intensity of the harm generally does not come to the same level of harm that can occur from improper prescribing. The PMHNP must understand his/her responsibility both at a state and federal level when it comes to prescribing medications. It is of critical importance to understand the risks and benefits of the medications prescribed and their varying potential effects on special populations such as children/adolescents, pregnant women, or older adults.
This week, you examine the special considerations when prescribing for pregnant women and older adults. 
Learning Objectives
Students will:
Recommend psychopharmacological and nonpharmacological interventions for older adults and pregnant women in mental health settings
Evaluate the risks and benefits of pharmacological treatment for older adults and pregnant womeJustify clinical decision making related to pharmacological treatment of older adults and pregnant women in mental health settings
Learning Resources
Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
Discussion: Prescribing for Older Adults and Pregnant Women.
After assessing and diagnosing a patient, PMHNPs must take into consideration special characteristics of the patient before determining an appropriate course of treatment. For pharmacological treatments that are not FDA-approved for a particular use or population, off-label use may be considered when the potential benefits could outweigh the risks.
In this Discussion, you will investigate a specific disorder and determine potential appropriate treatments for when it occurs in an older adult or pregnant woman. 
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To Prepare:\r\nChoose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the DSM-5-TR to use.
Use the Walden Library to research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one nonpharmacological intervention for treating the disorder in that population.\r\nBy Day 3 of Week 9
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.
Read a selection of your colleagues’ responses.
By Day 6 of Week 9
Respond to at least two of your colleagues on 2 different days who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature. 
Note: For this Discussion, you are required to complete your initial post before you can 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!\r\nSubmission and Grading Information
Grading Criteria
 To access your rubric:
Week 9 Discussion Rubric
Post by Day 3 of Week 9 and Respond by Day 6 of Week 9
                               BUY  AN ORIGINAL PAPER HERE

Depression in EWeek 9: Special Considerations Related to Vulnerable Populations 

According to the findings of certain studies, around 7 percent of pregnant women suffer from clinical depression at some point during their pregnancies. Rates may be greater in low- and middle-income nations. The manifestations and indicators of depression that might arise during pregnancy are identical to those that can be seen in the overall population when depression is prevalent. Nevertheless, the following are some other warning signs that may point to depression during pregnancy: excessive worry about the impending arrival of the new baby; low self-esteem; inability to get pleasure from activities that are often considered to be pleasurable; poor response to encouragement; lack of compliance with prenatal care; engaging in risky behaviors such as smoking, drinking alcohol, or using illegal substances; unsatisfactory progress in terms of weight gain as a result of an insufficient diet; and suicidal ideas or tendencies.

FDA-Approved Drug

Bupropion is the medication approved by the FDA for treating depression. It is an antidepressant categorized under norepinephrine-dopamine reuptake inhibitors. Bupropion stabilizes the patient’s mood by weakly inhibiting the enzymes involved in the uptake of the neurotransmitters norepinephrine and dopamine from the synaptic cleft. This prolongs their duration of action within the neuronal synapse and the downstream effects of these neurotransmitters (Creeley & Denton, 2019). Bupropion may be a reasonable option for the treatment of depression among pregnant women as it has no adverse effects. Bupropion can be especially helpful for pregnant women who need help with smoking cessation in addition to depression.

Off-Label Drug

Duloxetine is a medication that is often prescribed off-label to treat depression in adults. This medicine has been given the go-ahead to treat patients who suffer from persistent musculoskeletal discomfort. Unconventionally, it is utilized as a treatment for depression since a large number of studies have shown that it is useful in elevating mood (Rodrigues-Amorim et al., 2020). Duloxetine is classified as a selective serotonin and norepinephrine reuptake inhibitor. It works by enhancing brain activity by elevating levels of noradrenaline and serotonin already present in the brain. It is a class C medicine, which means that although there are possible complications linked with the medicine, the advantages of taking it exceed the risks (Rodrigues-Amorim et al., 2020).

Non-pharmacological Intervention

Treatment for psychiatric problems most often involves Cognitive-Behavioral Therapy (CBT). The idea behind it is that the emotions one has has an effect on their mood, which in turn has an effect on the actions one engages in. Individuals undergoing CBT learn to recognize their self-defeating thinking patterns and how to replace them with ones that are more positive (Gautam et al., 2020). As a direct consequence of this, the individual may now enjoy an improved state of mental well-being. In addition to this, it assists the patient in developing improved coping mechanisms. According to numerous studies, cognitive behavioral therapy is more effective than medicine at treating mental health issues (Gautam et al., 2020). On the other hand, the use of combination treatment is strongly advocated.

Risk Assessment

Bupropion does not seem to have any negative impact on a developing baby when administered to expectant mothers. On the other hand, there have been reports that it may result in sleeplessness, headaches, vomiting, increased body weight, tachycardia, dry mouth, and constipation (Hendrick et al., 2017). Despite this, the likelihood of experiencing any of these adverse effects is rather remote. According to certain reports, Duloxetine may lead to non-teratogenic side effects such as hypertonia, hypoglycemia, vomiting, difficulties with feeding, seizures, sleep apnea, and cyanosis (Rodrigues-Amorim et al., 2020). Despite this, it has been assigned to group C, which indicates that the advantages of using it well exceed any potential risks.

Clinical Guidelines

Depression in pregnancy has become the subject of new consensual recommendations released by both the American College of Obstetricians and Gynecologists (ACOG) and the American Psychiatric Association. Professionals in the domains of prenatal psychiatry and obstetrics were consulted with the purpose of compiling a thorough evaluation of the relevant literature and making therapeutic suggestions. The majority of the recommendations made by the two organizations concern the administration of antidepressants to expectant mothers. They draw the conclusion that there is sufficient evidence to establish a link between the usage of selective serotonin reuptake inhibitors and the delivery of babies who are underweight. In addition to receiving therapy, the choice of whether or not to take antidepressants while one is pregnant, as recommended by the clinical guidelines, is determined by weighing the potential negative effects against the potential positive effects (Molenaar et al., 2018). In most cases, the possibility that antidepressant use would result in birth abnormalities is the source of the greatest worry. In general, there is a very minimal risk of birth abnormalities and other issues for children born to women who take antidepressants while pregnant.

 

 References

Creeley, & Denton. (2019). Use of Prescribed Psychotropics during Pregnancy: A Systematic Review of Pregnancy, Neonatal, and Childhood Outcomes. Brain Sciences, 9(9), 235. https://doi.org/10.3390/brainsci9090235.

Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive behavioral therapy for depression. Indian Journal of Psychiatry, 62(8), 223. https://doi.org/10.4103/psychiatry.indianjpsychiatry_772_19

Hendrick, V., Suri, R., Gitlin, M. J., & Ortiz-Portillo, E. (2017). Bupropion use during pregnancy. The Primary Care Companion For CNS Disorders, 19(5). https://doi.org/10.4088/pcc.17r02160

Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V. (2018). Guidelines on treatment of perinatal depression with antidepressants: An international review. Australian & New Zealand Journal of Psychiatry, 52(4), 320-327. https://doi.org/10.1177/0004867418762057

Rodrigues-Amorim, D., Olivares, J. M., Spuch, C., & Rivera-Baltanás, T. (2020). A systematic review of efficacy, safety, and tolerability of DuloxetineDuloxetine. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.554899