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NURS 6630 Week 1 Short Answer Assessment Assignment

NURS 6630 Week 1 Short Answer Assessment Assignment

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Appropriate Drug Therapy for a Patient with MDD and A History of Alcohol Abuse

The recommended pharmacological treatment for MDD and alcohol abuse includes antidepressants and drugs for use disorder (AUD). Antidepressants include SSRIs like Sertraline, Fluoxetine, Paroxetine, Citalopram, and Escitalopram. Drugs indicated for AUD Naltrexone or Acamprosate (McHugh & Weiss, 2019). Therefore, a patient can be administered Sertraline and Naltrexone or Escitalopram and Acamprosate. McHugh and Weiss (2019) established that the use of acamprosate in AUD has a similar effect in patients with and without MDD. It also promotes alcohol abstinence, which contributes to the remission of depressive symptoms.

Tricyclic antidepressants (TCAs) are contraindicated in individuals with AUD since it poses a risk of toxicity and enhances the depressant effect of alcohol on the central nervous system (McHugh & Weiss, 2019). Remission of symptoms is anticipated within 2-6 weeks after initiating antidepressant therapy if there is treatment compliance.

Predictors of Late Onset Generalized Anxiety Disorder

Chronic physical and psychiatric disorders are risk factors for late-onset generalized anxiety disorder (GAD). According to Hellwig and Domschke (2019), physical disorders that are risk factors for late-onset GAD include heart failure, arrhythmias, respiratory disorders, and hyperlipidemia. Psychiatric disorders include phobia, cognitive impairment, depression, and history of GAD. Other predictors include poverty, a history of parental separation or loss, and individuals with a childhood history of adverse events.

Potential Neurobiology Causes of Psychotic Major Depression

Neurobiology factors that can cause psychotic MDD include abnormalities in the production of neurotransmitters, including serotonin, dopamine, noradrenalin, and monoamine. MDD is attributed to reduced levels of serotonin and norepinephrine in the CNS. Defects in the hypothalamic–pituitary–adrenal (HPA) axis are also potential causes of MDD (Kaltenboeck & Harmer, 2018). Increased serum cortisol levels and reduced suppression of cortisol production are connected with MDD. In addition, immune system dysfunction with elevated levels of inflammatory biomarkers like C-reactive protein, tumor necrosis factor, and interleukins is a potential cause of depression. Lastly, Kaltenboeck and Harmer (2018) explain that structural and functional abnormalities in the limbic-cortico-striato-pallido-thalamic pathway can potentially cause major depression.

Symptoms Required For a Major Depression Episode to Occur

Major depression is diagnosed based on the presence of either a depressed/sad mood or diminished interest/pleasure in activities. Other symptoms include sleeping disturbances, weight changes, appetite changes, low energy levels, psychomotor retardation, feelings of worthlessness, reduced ability to think and concentrate, and the presence of suicidal thoughts or ideations (Christensen et al., 2020).

Classes of Drugs That Precipitate Insomnia

The drugs that cause insomnia include Cholinesterase Inhibitors like Rivastigmine and Donepezil; Beta Agonists like Carvedilol and Metoprolol; and SSRIs like Sertraline and Fluoxetine (Krystal et al., 2019).

References

Christensen, M. C., Wong, C. M. J., & Baune, B. T. (2020). Symptoms of major depressive disorder and their impact on psychosocial functioning in the different phases of the disease: do the perspectives of patients and healthcare providers differ?. Frontiers in Psychiatry11, 280.

Hellwig, S., & Domschke, K. (2019). Anxiety in late life: an update on pathomechanisms. Gerontology65(5), 465-473. https://doi.org/10.1159/000500306

Kaltenboeck, A., & Harmer, C. (2018). The neuroscience of depressive disorders: A brief review of the past and some considerations about the future. Brain and neuroscience advances2, 2398212818799269. https://doi.org/10.1177/2398212818799269

Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World psychiatry: official journal of the World Psychiatric Association (WPA)18(3), 337–352. https://doi.org/10.1002/wps.20674

McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol research: current reviews40(1), arcr.v40.1.01. https://doi.org/10.35946/arcr.v40.1.01

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS:NURS 6630 Week 1 Short Answer Assessment Assignment

Alcohol abuse and major depressive disorders occur commonly in the population. These disorders, from time to time occur together. When they occur together, they display a dreadful outcome (Baranyi et al., 2022). An integrated approach to the treatment of these patients is paramount. The purpose of this paper is to discuss the neurobiology, symptoms, and the appropriate drug therapy for patients with Major Depressive Disorder co-occurring with Alcohol Abuse.

Explain the Appropriate Drug therapy for Major Depressive Disorder co-occurring with Alcohol Abuse

A combination of naltrexone and sertraline has been proven ideal for the treatment of co-occurrence of alcohol abuse and major depressive disorder. This combination delays the reversion to alcohol abuse, is highly efficacious, marked improvement in mood in comparison to other drug therapies, and had fewer side effects (Stubbs et al., 2022).

Which Drugs are contraindicated

Benzodiazepines- such as diazepam- are contraindicated as they lower the seizure threshold hence the patient is at an increased risk of falls, intellectual impairment, increased risk aspiration, and low efficacy, in the long run, cross-tolerance of the benzodiazepines and alcohol hence propensity to abuse the drugs, and withdrawal effects after stoppage of the drug.

Bupropion lowers the seizure threshold. Mirtazapine and tricyclic antidepressants when used in the setting of alcohol abuse, they act synergistically to increase the sedative effects of alcohol. Duloxetine is hepatotoxic and may propel liver disease in the setting of chronic alcohol abuse.

NURS 6630 Week 1 Short Answer Assessment Assignment

What is the Timeframe that the Patient should see the Resolution of symptoms

  • With adherence to medication and abstinence from alcohol, symptoms abate starting from two weeks post initiation of therapy (Close, 2019).

List four Predictors of Late Onset Generalized Anxiety Disorder

  • They include chronic disease conditions like COPD, mental retardation, presence of other mental illnesses like depression, lack of support and affection during childhood, poverty, unpropitious events in life, and separation.

List four Potential Neurobiological causes of Psychotic Major Depression

  • They include hypersensitized response to stress, serotonin dysfunction, disrupted dopamine feedback system in the nigrostriatal pathway, and noradrenaline dysfunction.

List at least five Symptoms of Major Depression

  • The presence of all three of a low mood, anhedonia, and anergia plus at least any three of disturbed sleep, lack of appetite, ideations of self-harm, worthlessness, reduced self-esteem, reduced attention and pessimism about the future.

List three Classes of Drugs that Precipitate Insomnia with a corresponding example for each class, be specific

  • Selective Serotonin Reuptake Inhibitors such as fluoxetine.
  • Dopamine receptor agonists such as
  • Alpha-blockers such as alfuzosin.

References

Baranyi, G., Fazel, S., Langerfeldt, S. D., & Mundt, A. P. (2022). The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis. The Lancet Public Health, 7(6), e557–e568. https://doi.org/10.1016/s2468-2667(22)00093-7

Close, L. (2019). Depression & Substance Abuse Treatment Plans, Medication, Therapy. American Addiction Centers. https://americanaddictioncenters.org/treating-depression-substance-abuse

Stubbs, K. R., Van Bezooyen, J., & Tang, Y. (2022, January 1). Chapter 31 – Managing treatment-resistant depression with comorbid substance use disorders (J. Quevedo, P. Riva-Posse, & W. V. Bobo, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780128240670000311

Nervous System

  1. The nervous system is divided into two sections: the central nervous system, which is composed of the spinal cord and brain, and the peripheral nervous system, which is composed of nerves that branch off from the spinal cord and connect to different body parts. The neuron is the nervous system’s fundamental unit. The neuron is composed of several components, including nerves, the cell body, the nucleus, axons, and dendrites. Electrical impulse transmission, such as the sensation of pain, begins with the generation of an action potential in the brain or organ. The action potential is then transmitted to the neuron, axon, where it is converted to a chemical signal, followed by the release of neurotransmitters via the synapse to the next dendrite, where it is converted to an electrical signal. This process is repeated until the signal reaches the desired organ, at which point it is terminated.
  2. The major components of subcortical structures include the basal ganglia, cerebellum and thalamus. The parts of the subcortical structures that are involved in learning and memory include cerebellum, hippocampus, prefrontal cortex, and amygdala. The cerebellum plays a role inaddiction. The neurotransmitters that are located in the nigra striatal region of the brain and play the role in motor control include acetylcholine and dopamine.
  3. Glia cells play the role of maintaining homeostasis in the central nervous system. The cells form myelin and support the neurons. Glia cells also protect neurons by insulating them from one another. The other roles of glia cells include removing dead neurons and killing any pathogens that target neurons (Camprodon & Roffman, 2016). An example of homeostatic role played by glia cells in the central nervous system is buffering the chemicals and ions that are detrimental to the neurons and forming myelin sheath for the neuron that regulates the internal environment of the neuron. NURS 6630 Week 1 Short Answer Assessment Assignment
  4. Synapses are the part of the neurons that communicate with each other. Communication in neurons occurs in one direction. For example, when an action potential is generated in sensory muscle, the action potential moves from sensory neurons to the spinal cord where the information is relayed to the brain for processing. The direction of flow of information is terminated once the sensory information is acted upon in the brain through the initiation of a response.
  5. Neuroplasticity refers to the ability of the brain to change as well as adapt due to experience. Neuroplasticity exists in two types that include structural and functional neuroplasticity. Functional neuroplasticity is the ability of the brain to transfer its functions from a side of brain that is damaged to undamaged region while structural plasticity is the ability of the brain to transform its physical structure due to learning. Neuroplasticity is important because it enables learning, development of cognitive abilities, and recovery from conditions such as traumatic brain injuries (Camprodon & Roffman, 2016). An example of neuroplasticity is the restoration of motor functions that had been lost following traumatic brain injury or stroke.

References

Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 1–19). Elsevier.

The human brain is organized into the cerebral cortex, brainstem, subcortical structures, and the cerebellum. These anatomical structures are made of inter-connected elements that create distributed and highly inter-connected circuits. It is in these circuits where cognition, behavior, and affect are processed.

—Camprodon, J. A., & Roffman, J. L. (2016, p. 6)

By using a combination of psychotherapy and medication therapy, psychiatric nurse practitioners (PNP) are positioned to provide a very unique type of care to patients with psychiatric disorders. To be successful in this role, you must have a strong theoretical foundation in pathophysiology, psychopharmacology, and neuroscience. This foundation will help you assess, diagnose, and treat patients as you relate presenting symptoms to theoretical neuronal functioning.

This week, as you begin to study psychopharmacology, you will explore the basic functional unit of the nervous system, the neuron. You will review the structure of the neuron and you will examine the anatomy of the central nervous system and consider the functionality of the different structure and outward (phenotypic) expression of their activities. You will analyze these concepts as you complete your short answer assessment for this week.

NURS 6630 Week 1 Short Answer Assessment Assignment

Reference:
Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 1–19). Elsevier.

SAMPLE 2

Week 1 Assignment: Short Answer Assessment

  1. In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.

The human brain contains approximately 100 billion neurons. The anatomical structure of the neuron is made up of a cell body, that includes the cell nucleus and the axons, and the dendrites (Camina & Güell, 2017). The dendrites and the axons allow the neurons to communicate across any distance, long or short, through electrical conduction and chemical transmission. The electrical conduction involves a short electrical fluctuation that propagates down the dendrites, through the cell body, and out at the axon terminal. Chemical conduction on the other hand occurs in the synapse between two neurons, enabling the transmission of nerve impulses from one neuron to another.

  1. Answer the following (listing is acceptable for these questions):
    • What are the major components that make up the subcortical structures?
  • Basal ganglia (Javaid et al, 2020).
  • Limbic structures
  • Pituitary gland
  • Diencephalon
    • Which component plays a role in learning, memory, and addiction?

The limbic structures

    • What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?
  • Gamma-aminobutyricric acid (GABA)
  • Dopamine
  1. In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.

Glial cells mainly provide supporting functions to the central nervous system and peripheral nervous system. In the CNS, glial cells are made up of ependymal cells, rapid glial cells, oligodendrocytes, microglia, and astrocytes (Slominski et al., 2017). Microglial cells are responsible for the normal development of the brain in addition to the defense mechanisms, whereas oligodendrocytes are responsible for the production of the myelin sheath which promotes rapid transmission of electrical impulses. Astrocytes play a significant role in maintaining a balance in the chemical environment to control local blood flow and promote oxygenation in addition to maintaining the homeostasis of the brain.

  1. The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.

The synapse allows one neuron to send a message to the target neuron in another cell. Communication through the synapse normally occurs by the use of chemical messengers (Durkee & Araque, 2019). However, other synapses are normally electrical where ions flow directly between two cells. At the chemical synapse, the communication occurs by triggering an action potential at the presynaptic neuron releasing neurotransmitters that carry the message to the next neuron.

  1. In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples.

Neuroplasticity is the capacity of the nervous system to change its activity in response to either intrinsic or external stimuli. This is accomplished through the nervous system’s ability to recognize its function, connections, or structural makeup (Innocenti, 2022). Neurons in the brain are able to shift their activity and compensate for damage or sickness because to a phenomenon known as neuroplasticity. This allows the brain to adapt to new circumstances and environments. Neuroplasticity can occur in two main mechanisms, neuronal regeneration/collateral sprouting which is associated with concepts such as neurogenesis and synaptic plasticity, or through functional reorganization which is associated with concepts like diaschisis,  vicariation, and equipotentiality.

 

 

References

Camina, E., & Güell, F. (2017). The neuroanatomical, neurophysiological and psychological basis of memory: Current models and their origins. Frontiers in pharmacology8, 438. https://doi.org/10.3389/fphar.2017.00438

Durkee, C. A., & Araque, A. (2019). Diversity and specificity of astrocyte-neuron communication. Neuroscience396, 73-78. https://doi.org/10.1016/j.neuroscience.2018.11.010

Innocenti, G. M. (2022). Defining neuroplasticity. Handbook of clinical neurology184, 3-18. https://doi.org/10.1016/B978-0-12-819410-2.00001-1

Javaid, M. A., Schellekens, H., Cryan, J. F., & Toulouse, A. (2020). Evaluation of Neuroanatomy Web Resources for Undergraduate Education: Educators’ and Students’ Perspectives. Anatomical sciences education13(2), 237-249. https://doi.org/10.1002/ase.1896

Slominski, T. N., Momsen, J. L., & Montplaisir, L. M. (2017). Drawing on student knowledge of neuroanatomy and neurophysiology. Advances in physiology education41(2), 212-221. https://doi.org/10.1152/advan.00129.2016

Three possible questions meant for the client

  1. Are you really compliant with the medications prescribed to you?
  2. How often do you take caffeine drinks?
  3. Over the last one month, did you feel hopeless, helpless, depressed or even had reduced pleasure to your day-day activities?

Overly, in the case where a client is on medications, it is good to confirm whether the client is compliant to the prescribed medications. It also gives the reasons as to why the patient might present with a given chief complaint. In this case, the client complains about insomnia and is currently taking antihypertensive and even taking sertraline which is a selective serotonin reuptake inhibitor and it triggers insomnia as a side effect (Bickley et al., 2020). Additionally, it would be good to inquire whether the patient takes caffeinated drinks since they also cause insomnia. The last question is meant to assess the presence of depression and it is part of the mental health screening questions.

People who could offer feedback about the patient in the case presentation

The patient currently stays with her children and would be closest people to offer feedback on whether the patient is compliant with the prescribed medications. The question would be important in identifying the differential diagnosis for the patient. In this case, the question would be whether the patient is compliant to the prescribed medications (Bickley et al., 2020). Additionally, the patient’s guardian can be questioned about whether he or she noted any changes on the patient’s speech, mood or attention as well as changes in memory, insight or orientation.  Lastly, the question could deduce observations made on patient’s phobias, ritualistic behavior, anxiety and panic. Others would confirm if the patient has dementia or delirium (Carlo et al., 2021).

 

Diagnostics

The patient Health questionnaire which has got nine questions is used to screen the patient. Some of the questions include whether the patient is depressed and whether in the past one month the patient has been feeling hopeless, helpless or depressed. overly, the given questions could achieve a sensitivity of 97% and a specificity rated as 67%. Others include Zung Self –Rating depression scale and the last one which would be performed by a qualified professional include the Hamilton Depression rating scale where a score above 20 would be regarded as moderately severe (Bickley et al., 2020). A normal score would fall within 0 to 7.  Since she is an older patient, a geriatric depression scale would also be viable. It has got 30 items. However, it has got a complex interpretation of the results. Lastly, to assess dementia, a Cornell Scale for Depression in Dementia would be used and it determine both the category as well as the severity. There are other useful laboratory studies that are done in cases of major depressive disorder such as alcohol levels in blood. arterial blood gas, dexamethasone suppression test meant for Cushing disease and cosynthropin stimulation test meant for Addison disease.  Neuroimaging is also done to assess the nature of the neurological illnesses that the patient presents with (Kopel, 2021).

Differential diagnoses

Major Depressive disorder. This is the most possible condition in this case since the patient indicates that her depression worsened when her husband died.  Therefore, the assessment should be focused on identifying the symptoms of depression such as hopelessness, helplessness and having depressive episodes (Hogan-Quigley & Palm, 2021). The patient has altered sleep pattern or insomnia which might be as a result of major depression.

Schizophrenia: This is a possible diagnosis where the patient presents with compulsive behavior, delusions, slowness in activities, depression, frenzied kind of thinking as well as memory impairment (Hogan-Quigley & Palm, 2021). Patients might also be active and have insomnia.  In this case, however, the patient only has insomnia and does not meet the exact criteria used to diagnose schizophrenia.

Illness anxiety disorder:  this is also referred to as hypochondria. It usually develops mostly during adulthood and would be characterized by intense fear that they have got some serious condition and at times get worried when they present with minor symptoms (Hogan-Quigley & Palm, 2021).

Pharmacological treatment

Zyprexa (Olanzapine): It is an atypical antipsychotic that is mostly used to manage patients with bipolar symptoms or schizophrenia. It is also used to manage patient who have had depression that is resistant to treatment. The dosage includes 10 mg per day given orally.  It is metabolized through the liver and would be interfered with if the liver is affected (Carlo et al., 2021).

Buspirone: It is regarded as an antianxiety drug but also has got antidepressant effects. Its dosage is given as 45mg per day. However, the dosage may increase if combined with selective serotonin reuptake inhibitors or Tricyclic antidepressants especially among patient who have treatment-resistant depression. Its anxiolytic effects usually last for two to three weeks (Kopel, 2021).

Any contraindications to use or alterations in dosing

Monitor the patient closely since she is elderly and would be at a higher risk of having hyponatremia (Bickley et al., 2020). This is triggered by use of SSRIs especially among the elderly and other possible factors that need to be assessed include tumors, low body weight, smoking, central nervous system illness or any previous episodes of hyponatremia that the patient states.

Check points

A two-week follow up is necessary to rule out any drug interactions especially anti-depressant induced hyponatremia as well as stroke which may occur as a result of use of depression among patients with hypertension.

References

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2020). Bates’ pocket guide to physical examination and history taking. Lippincott Williams & Wilkins.

Carlo, A. D., Basu, A., & Unützer, J. (2021). Associations of common depression treatment metrics with patient-centered outcomes. Medical Care, 59(7), 579-587. https://doi.org/10.1097/mlr.0000000000001540

Hogan-Quigley, B., & Palm, M. L. (2021). Bates’ nursing guide to physical examination and history taking. Lippincott Williams & Wilkins.

Kopel, J. (2021). Zyprexa. Encyclopedia of Autism Spectrum Disorders, 5256-5257. https://doi.org/10.1007/978-3-319-91280-6_102100

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