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NURS 6501 Knowledge Check Psychological Disorders

NURS 6501 Knowledge Check Psychological Disorders

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The case study presented a 26-year-old female client with Bipolar I disorder. Bipolar disorder, also referred to as manic-depressive illness, is a prevalent and persistent psychiatric illness (Muneer, 2015). Its features include periods of deep, sustained and profound depression \alternating with periods of mania that present with excessively elevated or irritable mood. Bipolar disorder is classified into two, Bipolar I and Bipolar II (Muneer, 2015). Bipolar I is characterized by episodes of mania and major depression, while Bipolar II has episodes of hypomania and major depression.

My first decision was to Begin Seroquel XR 100 mg orally at HS. The client reported that she slept more, had a good mood, and the Mania score had improved from 22 to 18. However, Seroquel had the side effects of weight gain, constipation, and dry mouth. My second decision was to continue the same dose of Seroquel and counsel the client on the prevention of constipation. The client returned with previous complaints of weight gain and constipation. I decided to discontinue Seroquel and go back to Lithium but using an extended-release preparation.

Seroquel is an Atypical antipsychotic which acts by antagonizing multiple neurotransmitter receptors in the brain such as serotonin,

NURS 6501 Knowledge Check Psychological Disorders

NURS 6501 Knowledge Check Psychological Disorders

dopamine, and adrenergic receptors increasing concentration of the neurotransmitters (Rybakowski, 2017). However, antagonizing Muscarinic I receptors results in side effects of dry mouth, constipation, increased appetite, and weight gain (Muneer, 2015). I would include patient education in the treatment plan on the anticipated side effects and how to manage them. For instance, constipation can be managed by increasing fluid intake, high-fiber diet, and exercise (Rybakowski, 2017). Weight gain can be controlled by exercise and healthy dieting, while dry mouth can be managed by chewing gum.

Lithium is a Bipolar disorder agent that acts by altering the transportation of cation in muscle and nerve cells and promotes reuptake of norepinephrine and serotonin, thus increasing theory concentration in the brain (Tondo et al., 2019). However, Lithium is associated with an increased risk of hypothyroidism, weight gain, hyperparathyroidism, and diminished urinary concentration ability. When prescribing Lithium, I will include regular follow-ups for patient assessment and monitoring of serum levels biweekly in the acute phase (Tondo et al., 2019). I will also advise the client to adhere to the medication.

NURS 6501 Knowledge Check Psychological Disorders

 

References

Muneer A. (2015). Pharmacotherapy of bipolar disorder with quetiapine: a recent literature review and an update. Clinical psychopharmacology and neuroscience: the official scientific journal of the Korean College of Neuropsychopharmacology13(1), 25–35. https://doi.org/10.9758/cpn.2015.13.1.25

Rybakowski J. K. (2017). Recent advances in the understanding and management of bipolar disorder in adults. F1000Research6, 2033. https://doi.org/10.12688/f1000research.12329.1

Tondo, L., Alda, M., Bauer, M., Bergink, V., Grof, P., Hajek, T., Lewitka, U., Licht, R.W., Manchia, M., Müller-Oerlinghausen, B., & Nielsen, R. E. (2019). Clinical use of lithium salts: guide for users and prescribers. International journal of bipolar disorders7(1), 16.

  1. What are the known characteristics of schizophrenia and relate those to this patient?

Schizophrenia is a chronic mental disorder displayed in patients who interpreted reality abnormally just like the 22-year-old patient in the provided case study. It can lead to a combination of delusion. Hallucination and extremely disordered behaviour and thinking impair the patient normal functioning (Correll et al., 2019). The patient in the provided case study reported signs of auditory and visual hallucination, unexpected rage and crying, and delusion. Additional symptoms include disorganized speech and thinking as demonstrated by the results of the mental status examination. The patient also displayed negative symptoms such as inability to make eye contact and being socially withdrawn which are significant indications of schizophrenia disorder.

  1. Genetics are sometimes attached to schizophrenia explains this.

Pre-molecular and molecular genetic studies have reported that genetics play a significant role in the development of schizophrenia.  Consequently, the inheritance pattern of the disease demonstrates increased risk among first relatives. At the molecular level, several positional and functional genes associated with the development of schizophrenia have been identified, such as neuregulin (NRG-1, 8p12–21), proline dehydrogenase (PRODH-2, 22q11.21), dysbindin, (DTNBP1,6p22.3), catechol-O-methyltransferase (COMT, 22q11.21), G72 (13q34) / D-amino acid oxidase (DAAO,12q24),5HT2A and dopamine D3 receptor (DRD3) and regulator of G protein signaling (RGS-4) (Cleynen et al., 2021). Recent studies support schizophrenia candidate regions on chromosomes 1q, 2q, 5q, 6p, 8p, 10p, 13q,15q and 22q. Additional studies are however required to provide a precise association with the above-mentioned genetic factors concerning how they lead to the development of schizophrenia.

  1. What roles do neurotransmitters play in the development of schizophrenia?

Neurotransmitters are chemicals responsible for conveying messages between brain cells. Studies illustrate an association between changes in the levels of neurotransmitters in the brain to the development of schizophrenia. This is evident by the mechanism of antipsychotics in relieving symptoms of schizophrenia through altering the levels of certain neurotransmitters in the brain. Recent studies have reported several biochemical alterations in schizophrenia, concerningneurotransmitter dysfunction in different systems, with the most prominent being γ‎-aminobutyric acid (GABA), serotonin, glutamate, and dopamine (Müller, 2018). For instance, alterations in the signaling of dopamine and hyperactivity of the D2 receptor in the limbic and subcortical region of the brain have been associated with some of the schizophrenia symptoms including delusion and hallucination. Consequently, hypodopaminergic activity in the mesocortical system is also associated with negative symptoms of schizophrenia such as flattening, lack of pleasure, withdrawal, and inability to follow through.

  1. Explain what structural abnormalities are seen in people with schizophrenia.

Through imaging studies, several complex patterns of structural abnormalities have been reported among patients diagnosed with schizophrenia, in addition to those who are at high risk of the disorder (Zhao et al., 2018). For example, MRI studies have reported a reduced volume of grey matter in the prefrontal, superior temporal, and medial temporal areas of the brain. These regions of the brain are involved in several functions such as short-term memory/decision making, processing of auditory information, and episodic memory respectively. Postmortem studies on the other hand report that a reduction in the cortical grey matter does not indicate loss of cell bodies but instead, reflects a reduction in synaptic density and dendritic complexity which may impair intraneuronal integration and communication leading to cognitive changes among other associated symptoms. Disruptions in the integrity of the white matter have also been implicated in schizophrenia, given that it forms the structural connections between different regions of the brain.

Scenario 2: Bipolar Disorder

  1. How does genetics play in the development of bipolar 2 disorders?  

Bipolar disorder (BD) is characterized by extreme shifts in the patient’s mood, behaviour, and energy levels. The patient in the provided case study is however diagnosed with bipolar 2 disorder, which is characterized by hypomanic and depressive episodes. The inheritance pattern of bipolar 2 disorder is quite unclear. Studies however report greater risks among first-degree relatives, with genetic factors accounting for approximately 80% of the causes of this mental disorder (Gordovez& McMahon, 2020). Genome-wide association studies (GWASs) have associated increased risk of bipolar 2 disorder with several genetic factors such as alpha-1 subunit of the L-type voltage-gated calcium channel (CACNA1C), teneurin transmembrane protein 4 (ODZ4), ankyrin G node of Ranvier (ANK3), nesprin-1 (SYNE1) and diacylglycerol kinase eta (DGKH).For instance, the DGKH is involved in diacylglycerol (DAG) phosphorylation in the phosphoinositol pathway sensitive to lithium, which contributes to the development of the bipolar disorder.

References

Cleynen, I., Engchuan, W., Hestand, M. S., Heung, T., Holleman, A. M., Johnston, H. R., … & Bassett, A. S. (2021). Genetic contributors to the risk of schizophrenia in the presence of a 22q11. 2 deletion. Molecular psychiatry26(8), 4496-4510. https://doi.org/10.1038/s41380-020-0654-3

Correll, C. U., Brevig, T., & Brain, C. (2019). Patient characteristics, burden, and pharmacotherapy of treatment-resistant schizophrenia: results from a survey of 204 US psychiatrists. BMC psychiatry19(1), 1-12. https://doi.org/10.1186/s12888-019-2318-x

Gordovez, F. J. A., & McMahon, F. J. (2020). The genetics of bipolar disorder. Molecular psychiatry25(3), 544-559.https://doi.org/10.1038/s41380-019-0634-7

Müller, N. (2018). Inflammation in schizophrenia: pathogenetic aspects and therapeutic considerations. Schizophrenia bulletin44(5), 973-982. https://doi.org/10.1093/schbul/sby024

Zhao, C., Zhu, J., Liu, X., Pu, C., Lai, Y., Chen, L., … & Hong, N. (2018). Structural and functional brain abnormalities in schizophrenia: a cross-sectional study at different stages of the disease. Progress in Neuro-Psychopharmacology and Biological Psychiatry83, 27-32. https://doi.org/10.1016/j.pnpbp.2017.12.017.

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Generalized Anxiety Syndrome

Osmosis.org. (2016, February 29). Generalized anxiety disorder (GAD) – causes, symptoms, & treatment [Video file]. Retrieved from https://www.youtube.com/watch?v=9mPwQTiMSj8

Note: The approximate length of the media program is 5 minutes.

Knowledge Check: Psychological Disorders

In this exercise, you will complete a 10- to 20-essay type question Knowledge Check to gauge your understanding of this module’s content.

Possible topics covered in this Knowledge Check include:
Generalized anxiety disorder
Depression
Bipolar disorders
Schizophrenia
Delirium and dementia
Obsessive compulsive disease

NURS 6501 Knowledge Check Psychological Disorders

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Complete the Knowledge Check By Day 7 of Week 9

To complete this Knowledge Check:

Module 6 Knowledge Check

What’s Coming Up in Module 7?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 7, you will analyze processes related to women’s and men’s health, infections, and hematologic disorders through case study analysis. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, which may impact physiological functioning and altered physiology.

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