Psychopharmalogical Approaches to Treat Psychopathology
FIRST POST
NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology-Week 7 Discussion
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
Ask about her social history- her social history will help be determine if there any social determinants that might influence her health.
Ask about the history of substance abuse- substance abuse history for this patient is vital to help find out if the patient is abusing any substances which might present as a psychiatric disorder. Also, the history of substance abuse in this patient is vital because people with depression have a higher risk of substance abuse problems
Ask about family psychiatry history- this patient’s family psychiatry history is important because people who have a first-degree relative with depression appear to have a two to three times greater risk of developing the condition than the general public.
Identify people in the patient’s life you would need to speak to or get feedback from to assess the patient’s situation further. Include specific questions you might ask these people and why.
The patient’s family members- ask the family members if the patient seems sad most of the time and if there are changes in her appetite and sleep patterns.
Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
Physical examination is important for this patient. This is a patient with MDD, hypertension, and diabetes therefore a comprehensive physical examination of all systems is vital.
Diagnostics tests:
Blood sugars- this is a diabetic patient and monitoring of sugars is vital
HBA1C- to check her glycemic control over the past three months
Urinalysis- to rule out urinary tract infections
Complete blood count- to rule out infections and anemia
Urea creatinine and electrolytes- to rule out kidney disease and electrolyte imbalance (Luo et al., 2020)
Liver function tests- to rule out liver disease
Thyroid function tests- to rule out thyroid disorders
EKG- to rule out any heart conduction disease
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
Major depressive disorder- MDD is the most likely diagnosis because the patient has been down with a change in sleep patterns. The loss of the partner occurred ten years ago.
Complex Bereavement Disorder- this is a differential diagnosis and not the major diagnosis because it has lasted for more than 6 months the patient lost a loved one ten years ago (Shinohara et al., 2022).
Two pharmacologic agents and their dosing 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.
Zoloft 50 mg PO OD- this is the be the best drug option for this patient because it has hypoglycemic effects. Zoloft can induce hypoglycemia by regulating liver receptors through 5-hydroxytryptamine activation and inhibition of potassium channels, resulting in increased insulin sensitivity and production and reduced gluconeogenesis (Malhi et al., 2020). Therefore, the oral hypoglycemic dose for this patient needs to be lowered and the patient needs to monitor their glucose. Contraindicated in patients taking MAOIs because of an increased risk of serotonin syndrome.
Prozac 20mg PO BD- contraindicated in diabetes, syndrome of inappropriate antidiuretic hormone, hyponatremia, and suicidal thoughts (Luo et al., 2020). Therefore, I would not prescribe Prozac to this patient because she is diabetic.
Include any “checkpoints” (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.
Follow up after 4 weeks to check the effectiveness of Zoloft and glycemic control
References
Luo, Y., Kataoka, Y., Ostinelli, E., Cipriani, A., & Furukawa, T. (2020). National Prescription Patterns of Antidepressants in the Treatment of Adults with Major Depression in the US Between 1996 and 2015: A Population Representative Survey Based Analysis. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00035
Malhi, G., Bell, E., Singh, A., Bassett, D., Berk, M., & Boyce, P. et al. (2020). The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary. Bipolar Disorders, 22(8), 788-804. https://doi.org/10.1111/bdi.13035
Shinohara, K., Efthimiou, O., Ostinelli, E., Tomlinson, A., Geddes, J., & Nierenberg, A. et al. (2022). Comparative efficacy and acceptability of antidepressants in the long-term treatment of major depression: protocol for a systematic review and network meta-analysis. Retrieved 11 July 2022, from.
SECOND POST
In this paper, an evaluation of a situation of a senior widow that has lost her partner is analyzed. The widow suffers sleeping disorders as well as clinical depression. The depression is because of her loss because she has never had incidences of anxiety before and that she is alert as well as knowledgeable about every little thing around her. This paper concentrates on evaluating, identifying the treatment of the patient. From the case study, if the client had actually approached me in my office, I would certainly initially ask her exactly how she really feels, how much time she has been experiencing the feeling, and also if she has someone close that has actually been helping her. The factor for asking these questions is to learn more about the person’s history and also establish just how serious it is.
To quickly evaluate this individual, it would certainly be handy if I could obtain a chance to talk to their oldest child, a close loved one, either a brother or sis, and a close friend. The reason for talking with the kid is being familiar with more regarding how the issue started, just how she has actually been taking care of the situation, and also learning more about regarding their home atmosphere. I would likewise ask the closest family member I will find about their family history as well as any mental illness in their family. For the pal, I wish to know from him how lately has she been behaving as well as the distinction between the current actions which before her loss.
Considering that the patient has been utilizing metformin 500 BID, it would be essential for me to perform analysis examinations because she may have some other underlying issues like kind two diabetics issues treated by her medication. She is additionally taking Losartan which is made use of for regulating high blood pressure. Having these examination outcomes will substantially assist detect and develop a correct therapy plan for the client. From the individual’s documents, she weighs 88kgs and has a height of 64 inches which, when calculated, results in a BMI of 33.3 kg/m2, that makes her overweight (McClellan et al., 2013). Consequently, a differential medical diagnosis of diabetes mellitus, hypertension, and also kidney illness may require to be conducted on the patient.
A differential medical diagnosis for diabetes will certainly be more than likely to be executed because of her BMI, which makes her obese, which she may be having some underlying problems that may require to be attended to. There are different categories of medicinal representatives that can be utilized to treat people dealing with anxiety. The various sorts of antidepressants are discerning serotonin reuptake inhibitors (SSRIs), serotonin and also norepinephrine reuptake preventions (SNRIs), irregular antidepressants, tricyclic antidepressants, among others.
Fluoxetine as well as lithium are some of the medicinal representatives that I may like to be made use of by the person. For Fluoxetine, a 20 to 60mg dosage will need to be taken a day substantially by the client to deal with clinical depression. As well as for lithium, 600-900 mg per day might be taken by the client, which may be split to be taken at periods or perhaps in a day, particularly throughout the evening. I prefer suggesting Fluoxetine (Prozac) to the client since it is one of the selective serotonin reuptake preventions as well as is famously used and also considered among the safest as well as efficient medicines for dealing with clinical depression and also other mental disorders.
Although Fluoxetine is taken into consideration one of the best medications for dealing with clinical depression, the drug can increase self-destructive ideas among the individuals of this drug, particularly those not more than 25 years old. Various other contradictions that come with this drug are lowered sex drive, abnormal dreams, sweating, looseness of the bowels, skin breakout, stress and anxiety, and uneasiness, among several opposite results. These adverse effects exist due to the fact that the medicine can boost SSRIs’ impact by promoting serotonin receptors in the mind (Levenson et al., 2015). It might cause suicidal thoughts for clients of another ethnic background apart from that of the widow in our instance. The individual will need to come for an examination after 4 weeks to undergo physiotherapy since the drug would certainly have helped reduce the disease’s signs and symptoms.
References
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015 ). The pathophysiology of sleeplessness. Upper body, 147( 4 ), 1179-1192.
McClellan, J., & Stock, S. (2013 ). Practice criterion for the evaluation and treatment of kids and also teens with schizophrenia. Journal of the American Academy of Kid & Teenager Psychiatry, 52( 9 ), 976-990.
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