Discuss: The Impact of Ethnicity on Antidepressant Therapy

Discuss: The Impact of Ethnicity on Antidepressant Therapy

Discuss  The Impact of Ethnicity on Antidepressant Therapy

‘The Case of Physician Do Not Heal Thyself’ concerns a 60-year-old patient suffering from a complex mood disorder. The case presents a very complex scenario given that the patient tries to treat himself as a result of his medical background. Self-medication has proven to be very troublesome even with the highest qualified medical practitioners. For effective diagnosis and management of this patient’s mental condition, this paper will examine crucial aspects necessary in developing the most efficacious care plan for such a complex mood disorder.

Three Questions

• Is there any point in your life where you were so irritated to the point that you started arguing and shouting at others, or even fighting with them for no particular reason?
• Have you ever been diagnosed with bipolar or a complex mood disorder previously by a qualified health practitioner?
• Are you aware of any of your relatives who have ever been diagnosed with a complex mental disorder such as bipolar?

The rationale behind the above questions is to get a subjective perspective of the patient’s presenting illness. The questions set a starting ground for the assigned nurse practitioner to be able to understand the background of the patients’ mental condition, and his knowledge of the disorder before conducting a thorough analysis (In Charney, In Buxbaum, In Sklar, & In Nestler, 2014). For instance, the first question allows the nurse to be aware of the effect of the patient’s mental condition to others. The second question gives the nurse an overview of the patient’s past medical history while the last question allows the nurse to understand the family medical history of the patient, given that the patient was unresponsive to previously prescribed antipsychotics.

People in the Patient’s Life

Based on the information provided concerning the patient’s social history, very few people seem to be aware or concerned with his mental condition. The only people who were close to the patient were his three divorced wives, who unfortunately are not part of his present life. In that case, only his friends and co-workers can be interviewed concerning his mental state and behavior. For instance, his workmates can be asked questions such as “How does he conduct himself around the workplace? Is he productive? How does he feel about his contribution?” Further, his friends will be able to provide information regarding his social behaviors and interpersonal relationships. They can be required to respond to questions such as: “How can you describe him as a friend, in terms of how his communication skills, and even general attitude?” Answers to these questions will help the nurse find out if the people around him have been able to notice presenting symptoms of a complex mood disorder in the patient, and how these symptoms are affecting both his social and professional life (Malgaroli, Maccallum, & Bonanno, 2018). With more questions, the nurse will be able to fully understand the level of mood instability that the patient has and come up with the most effective intervention.

Physical Examinations and Diagnostic Tests

            The diagnosis of a complex mood disorder cannot be affirmed or disputed purely by conducting a physical examination. Nonetheless, certain physical examinations can be used to assess related health conditions that might have contributed to the symptoms of mood instability that the patient is experiencing. The thyroid gland plays a significant role in stabilizing the mood of an individual (In Charney, In Buxbaum, In Sklar, & In Nestler, 2014). Hence, the nurse can conduct physical examinations that can enable her to check for hyperthyroidism or hypothyroidism to rule out some of the speculated causes of the patient’s mental disorder.

Other diagnostics tests, such as tests for vitamin disorders, may also be crucial for the diagnosis of the patient’s mental disorder. In as much as lab tests might not seem to be necessary in this case, they are important in ruling out some etiological factors related to the patient’s mental status such as drug-induced mood disorder (Suda, Tatsuzawa, Mogi, & Yoshino, 2017). Additional tests include complete blood count and urinalysis, especially in assessing any toxicities in the patient’s body that might have been caused by the previously used drugs. Imaging tests such as MRI are also crucial in ruling out anatomical aspects of the patient’s mental state.

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Differential Diagnosis

The symptoms presented by the patient are similar to several other health complications making the diagnosis very challenging.

However, with proper diagnosis, the patient’s symptoms and history point towards a complex mood disorder. Most of the mentioned patients’ symptoms are shared by several mood disorders and depression, which are very much identical to other medical causes. Mental complications such as dysthymia, adjustment disorder with depressed mood, bereavement, bipolar and mood disorder secondary to a medical cause all share the same symptoms (In Charney, In Buxbaum, In Sklar, & In Nestler, 2014). However, from the information provided concerning the patient’s family history, in addition to the DSM IV or even ICD 10 tools, the patient can be confirmed to be suffering from a complex mood disorder, given that the presence of irritability and mania episodes, which do not reach the thresholds of both hyper- and hypo-mania, rules out other differential diagnosis.

Pharmacologic Agents and their Dosing for the Patient

The manic levels of the patient can neither be related to hyper mania nor hypomania. Based on his past medical history, most of the previously prescribed antipsychotic agents were unresponsive to the patient’s mental condition. Most of the time, this is usually as a result of the patient being a defaulter or failing to take the medication as required. Unless a scientific reason is given, the patient should not be stopped from using SSRIs as mentioned. From the perspective of the present nurse in charge of the patient care plan, the options available are either sertraline (Zoloft) which is an SSRI or methylphenidate (Ritalin) which belongs to the broad class of monoamine oxidase inhibitor (MAOI), both of which are effective for the patient current mental condition. The patient will be stated on a 50mg daily dose of Zoloft. With time, the 50 mg Zoloft daily dose will be increased gradually to a maximum dose 200mg given the high sensitivity of the patient to other SSRIs probably due to his genetic make-up (Hough et al., 2017). Consequently, Ritalin can also be given in 20 mg daily dose. The main reason behind the choice of the two pharmacological agents is because of their relatively fast rates of absorption in addition to their rapid metabolic rate once in the body system, hence reduced toxicity.

The mode of action of Sertraline is by selectively inhibiting the reabsorption of serotonin in the brain. Thus, the levels of serotonin in the patient brain will be returned to normal levels hence enhancing mood stability (Hough et al., 2017). Methylphenidate, on the other hand, acts as a stimulant to the central nervous system (CNS) by blocking the catecholamine reuptake system, especially dopamine and norepinephrine, downgrading their high levels in the brain (Dolder et al., 2018). However, the norepinephrine concentration in the synaptic cleft will increase, helping in stabilizing the patient’s mood, hence making methylphenidate more effective.

Contraindications Based on Ethnicity

The mode of action of Methylphenidate is by modulating the levels of catecholamine in the brain through inhibiting their reuptake. In that case, the dosing regulations depend on the genetic composition responsible for synthesizing dopamine transporters (DART). Many studies confirmed that most patients with copies of the 10 repeat (10R) alleles tend to have poor responsiveness to methylphenidate as compared to those without the 10R alleles (Shora, Zarate, Park, & Afanador, 2018). As such, Pena et al. (2017) posit that individuals with the 10R alleles, who are mostly of Caucasians, Hispanics, and African-American origin, are contraindicated from using methylphenidate given its high plasma concentrations that can lead to toxic levels. Additionally, it has been observed that when patients form these ethnicities consume methylphenidate, they display symptoms such as extreme agitation, tension, and anxiety.

Lessons Learned from This Case Study

Nurses can learn several things from this case study of “Physician do not heal thyself.”’ For instance, it is very complicated to treat a patient who is your colleague member of staff, especially when you are working in the same field. Most of the time, they display some level of arrogance to prove their knowledge especially when it comes to drug prescription. To be able to manage such a patient properly, the nurse must be able to find a way of incorporating them in formulating appropriate interventions, so that they might not feel ignored or belittled. Additionally, several aspects of how to choose between SSRIs and MAOI has also been revealed from the case study. For instance, MOA inhibitors can only be used under strict considerations. Otherwise, SSRIs should be considered as the first line. Lastly, how one can differentiate between different mental disorders with identical symptoms have also been mentioned in the case study. Nurses should be able to use the experience gained from this case study to handle similar cases in the future to promote health.

Besides, the present has acquired adequate knowledge and skills required to handle ‘difficult clients’ based on her experience with this patient. Since the patient in this case study felt like the drugs that were prescribed by the physician was not working, he decided to alter the prescription by himself. The nurse is thus aware of the importance of this information in coming up with an appropriate intervention in case of such an encounter in the future.

see class rules
cite scholarly resources including peer-review journals and current practice guidelines
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The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

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Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

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Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource