PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

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.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

Required Media (follow the link or just read the case study and the decisions below)
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.

Case Study: Hispanic Male w/Major Depressive Disorder (MDD)
BACKGROUND INFORMATION
The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after \"routine\" medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and \"stiff\" shoulders which he attributes to his current work as a laborer in a warehouse.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY
SUBJECTIVE
During today\'s clinical interview, client reports that he always felt like an outsider as he was \"teased\" a lot for being \"black\" in high school. States that he had few friends, and basically kept to himself. He describes his home life as \"good.\" Stating \"Dad did what he could for us, there were 8 of us.\" He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in \"trouble\" at work.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

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MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers the \"Montgomery- Asberg Depression Rating Scale (MADRS)\" and obtained a score of 51 (indicating severe depression).
RESOURCES
§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

Decisions Made and Outcomes (Needed to formulate the paper) You can follow my decision or choose yours if you are able to follow the link
Choices for Decision 1: Start Zoloft 25 mg orally daily, Effexor XR 37.5 mg orally daily, or Phenelzine 15 mg orally TID.
My decision: I chose to begin Effexor XR 37.5 mg orally daily.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY
Outcome: RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client reports that there is no change in depressive symptoms at all. Now choose what to do.

Choices for Decision 2: Increase Effexor XR to 75 mg orally daily, Change to Cymbalta 30 mg orally daily, or augment with an atypical antipsychotic.
My decision: I chose to increased dose of Effexor XR to 75 mg orally daily
Outcome: RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client reports an improvement in depressive symptoms
Montgomery- Asberg Depression Rating Scale (MADRS) decreased from 51 to 38 (25% reduction)

Choices for Decision 3: Increase Effexor XR dose to 112.5 mg orally daily, continue same dose of medication (Effexor XR 75 mg), or augment with Wellbutrin XL 150 mg orally daily
My decision: Increase Effexor XR dose to 112.5 mg orally daily
Outcome: Guidance to Student.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY
At this point, the PMHNP would have two choices to discuss with the client- the current dose of drug can be maintained if the client is feeling better and is not offering any complaints of side effects. The dose can also be increased at this point, but the PMHNP must counsel client regarding the possibility of side effects. The use of an augmenting agent is not appropriate at this time as we have not reached a maximum dose with Effexor (in fact, 75 mg is still a relatively small dose), displaying primarily SSRI properties only (recall that at lower doses, Effexor exerts a greater effect on serotonergic receptors than norepinephrine at low doses).
***Make sure that this paper has at least 5 References. Please use in-text citations. Don\'t forget the ethical considerations for this assignment. Can be included as a section by itself.***PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

To prepare for this Assignment:
• Review the Learning Resources. Consider how to assess and treat adult and geriatric clients requiring antidepressant therapy.

The Assignment
Examine Case Study above: 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:PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY
o 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?

o 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?PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

o 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.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

References/Resources
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.

Ø Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY
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”
Ø 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:PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY
• amitriptyline
• bupropion
• citalopram
• clomipramine
• desipramine
• desvenlafaxine
• doxepin
• duloxetine
• escitalopram
• fluoxetine
• fluvoxamine
• imipramine
• ketamine
• mirtazapine
• nortriptyline
• paroxetine
• selegiline
• sertraline
• trazodone
• venlafaxine
• vilazodone
• vortioxetine

Ø American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Ø 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 PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

Course Texts
These course texts are available through Stahl Online Resources
http://stahlonline.cambridge.org/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

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.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

 

Required Media (follow the link or just read the case study and the decisions below)

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.

 

Case Study: Hispanic Male w/Major Depressive Disorder (MDD)

BACKGROUND INFORMATION

The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after "routine" medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and "stiff" shoulders which he attributes to his current work as a laborer in a warehouse.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

SUBJECTIVE

During today's clinical interview, client reports that he always felt like an outsider as he was "teased" a lot for being "black" in high school. States that he had few friends, and basically kept to himself. He describes his home life as "good." Stating "Dad did what he could for us, there were 8 of us." He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in "trouble" at work.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers the "Montgomery- Asberg Depression Rating Scale (MADRS)" and obtained a score of 51 (indicating severe depression).PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

RESOURCES

  • Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

 

Decisions Made and Outcomes (Needed to formulate the paper) You can follow my decision or choose yours if you are able to follow the link

Choices for Decision 1: Start Zoloft 25 mg orally daily, Effexor XR 37.5 mg orally daily, or Phenelzine 15 mg orally TID.

My decision: I chose to begin Effexor XR 37.5 mg orally daily.

Outcome: RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks

Client reports that there is no change in depressive symptoms at all. Now choose what to do.

 

Choices for Decision 2: Increase Effexor XR to 75 mg orally daily, Change to Cymbalta 30 mg orally daily, or augment with an atypical antipsychotic.

My decision: I chose to increased dose of Effexor XR to 75 mg orally daily

Outcome: RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Client reports an improvement in depressive symptoms

Montgomery- Asberg Depression Rating Scale (MADRS) decreased from 51 to 38 (25% reduction)

 

Choices for Decision 3: Increase Effexor XR dose to 112.5 mg orally daily, continue same dose of medication (Effexor XR 75 mg), or augment with Wellbutrin XL 150 mg orally daily

My decision: Increase Effexor XR dose to 112.5 mg orally daily

Outcome: Guidance to Student

At this point, the PMHNP would have two choices to discuss with the client- the current dose of drug can be maintained if the client is feeling better and is not offering any complaints of side effects. The dose can also be increased at this point, but the PMHNP must counsel client regarding the possibility of side effects. The use of an augmenting agent is not appropriate at this time as we have not reached a maximum dose with Effexor (in fact, 75 mg is still a relatively small dose), displaying primarily SSRI properties only (recall that at lower doses, Effexor exerts a greater effect on serotonergic receptors than norepinephrine at low doses).PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

***Make sure that this paper has at least 5 References. Please use in-text citations. Don't forget the ethical considerations for this assignment. Can be included as a section by itself.***

 

 

To prepare for this Assignment:

  • Review the Learning Resources. Consider how to assess and treat adult and geriatric clients requiring antidepressant therapy.

 

The Assignment

Examine Case Study above: 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.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

  • 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?PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

 

    • 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.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

 

References/Resources

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: