Sample Answer for SHORT ANSWER ASSESSMENT NURS 6630 Included After Question
As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
TO PREPARE
- Review the Learning Resources for this week.
- Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders.
- Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.
TO COMPLETE:
Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.
- In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
- List 4 predictors of late onset generalized anxiety disorder.
- List 4 potential neurobiology causes of psychotic major depression.
- An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.
- List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.
BY DAY 7
This Assignment is due.
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A Sample Answer For the Assignment: SHORT ANSWER ASSESSMENT NURS 6630
Title: SHORT ANSWER ASSESSMENT NURS 6630
Drug Management of Major Depressive Disorder Co-occurring with Alcohol Abuse
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.
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.
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SHORT ANSWER ASSESSMENT NURS 6630 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
A Sample Answer 2 For the Assignment: SHORT ANSWER ASSESSMENT NURS 6630
Title: SHORT ANSWER ASSESSMENT NURS 6630
Neurons are information messengers with three main parts namely the cell body, axon, and the dendrites (Kringelbach et al., 2020). The cell body is made up of a nucleus and cytoplasm and produces protein required to construct other parts of the neuron. The axon, on the other hand, extends from the cell body and carries signals away from the cell body while the dendrites carry signals toward the cell body and have numerous synapses to receive the signal from nearby neurons. Upon stimulation, neurons transmit an electrical impulse that passes through the dendrite, to the cell body, axon, axon terminal, and finally, the stimulus is passed (Kringelbach et al., 2020). At the axonal terminal, the axon releases neurotransmitters that depolarize neighboring cells through synapses and by binding to the membrane of the dendrite.
Subcortical Structures
Other structures within the brain are subcortical structures that act as information hubs for the nervous system. Their main role is to relay and modulate information circulating in different areas of the brain. They include the basal ganglia, limbic structures, pituitary gland, and the diencephalon (Malinowski, 2019).
The limbic systems play a great role in learning and memory addiction. The systems provide the anatomical substrate for emotions and motivated behaviors, including the circulatory for reward-related events and stress responses. Specifically, the hippocampus is used to mediate a cognitive/spatial form of memory. It controls learning and declarative memory which covers the memory of facts and events (Malinowski, 2019). The dorsal striatum also helps in memory by mediating the stimulus-response habit memory. Addiction on the other hand is linked to the limbic system through the orbitofrontal cortex and anterior cingulate gyrus (Malinowski, 2019).
In line with motor control, the nigra striatal region offers two anatomically and functionally distinct portions knowns as the substantia nigra pars compacta and the substantia nigra pars reticulata.
Glial Cells
Other essential components in the central nervous system are the glial cells. They include the astrocytes whose role is to maintain the environment for neuronal signaling by controlling the level of neurotransmitters surrounding the synapses (Hirbec et al., 2020). Equally, oligodendrocytes wrap around the axons forming a protective layer called myelin sheath which enhances neuron signaling. The cells also include microglia, ependymal cells, and radial glial whose roles are clearing dead cells or removing harmful toxins, maintaining homeostasis, and regenerating neurons and other glial cells like astrocytes and oligodendrocytes respectively.
Neuron Communication
Neurons communicate with each other through synaptic transmission. A chemical synapse is registered at the axon terminal of the presynaptic neuron and the dendrite of the postsynaptic neuron (Malinowski, 2019). The dendrite picks up signals and passes the signals down to the axon, into the axon terminals, and into the synapses. The role of the chemical synapse is to transform the electrical signal in the presynaptic cell’s axon into a chemical signal and back into an electrical signal in the postsynaptic cell.
Neuroplasticity
Brain plasticity denotes the ability of the brain to reorganize itself and form new neural connections in response to extrinsic or intrinsic stimuli. Through axonal sprouting, the undamaged axons develop new nerve endings and reconnect neurons with severed or injured links (Mateos-Aparicio & Rodríguez-Moreno, 2019). For instance, undamaged brain sites of stroke patients rewire themselves to take over functions of the damaged brain sites. Similarly, the undamaged axons sprout nerve endings that connect with other undamaged nerve cells to form new neural pathways (Mateos-Aparicio & Rodríguez-Moreno, 2019). For example, exposing the brain to specific grammatical rules helps it process and develop language.
SHORT ANSWER ASSESSMENT NURS 6630 References
Hirbec, H., Déglon, N., Foo, L. C., Goshen, I., Grutzendler, J., Hangen, E., … & Escartin, C. (2020). Emerging technologies to study glial cells. Glia, 68(9), 1692-1728. https://doi.org/10.1002/glia.23780
Kringelbach, M. L., Cruzat, J., Cabral, J., Knudsen, G. M., Carhart-Harris, R., Whybrow, P. C., … & Deco, G. (2020). Dynamic coupling of whole-brain neuronal and neurotransmitter systems. Proceedings of the National Academy of Sciences, 117(17), 9566-9576. https://doi.org/10.1073/pnas.1921475117
Malinowski, M. N. (2019). Anatomy of the brain and brain stem. In Deer’s Treatment of Pain (pp. 49-59). Springer, Cham.
Mateos-Aparicio, P., & Rodríguez-Moreno, A. (2019). The impact of studying brain plasticity. Frontiers in cellular neuroscience, 13, 66. https://doi.org/10.3389/fncel.2019.00066
A Sample Answer 3 For the Assignment: SHORT ANSWER ASSESSMENT NURS 6630
Title: SHORT ANSWER ASSESSMENT NURS 6630
Mood disorders are the most common mental health illnesses encountered by populations. Major Depressive Disorder (MDD) is a type of mood disorder characterized by sadness or depressed mood, which is persistent for two weeks. Other symptoms of MDD include loss of interest in everyday activities, loss/gain of appetite, loss/gain of weight, lack of energy, feelings of guilt, low concentration, sleep disturbances, and sometimes suicidal thoughts. in most cases, MDD co-occurs with substance use disorder. Substance use can be the cause of depression or a consequence of the illness, which results from the maladaptive need to cope with the negative impact of the depression (Alsheikh et al., 2020). The presence of substance use disorder complicates the treatment of the underlying depression. The purpose of this assignment is to demonstrate knowledge of pharmacological treatment for patients with multiple mental health conditions.
Drug Therapy
The appropriate drug therapy for a patient with an alcoholism problem is Paroxetine, based on evidence for its effectiveness in treating social anxiety in patients with alcohol abuse problems (Gimeno et al., 2018). In general, alcohol use while taking antidepressants is not advisable because of the risk of drug-induced depression or exacerbating central nervous side effects such as drowsiness, confusion, and dizziness (Agabio et al., 2018). Some MDD drugs that are contraindicated with alcohol include Bupropion because of the risk of seizure and duloxetine due to the increased risk of liver damage. Finally, it takes 4 to 8 weeks for the remission of MDD symptoms.
List 4 predictors of late-onset generalized anxiety disorder
- Childhood issues such as parental loss/separation/inadequate support
- History of parental mental illness
- Poverty
- Recent adverse life events (Welzel et al., 2021)
List 4 potential neurobiology causes of psychotic major depression.
- Default Mode Network (DMN) functional connectivity
- Abnormalities in the subgenual cortex
- Decreased gamma-Aminobutyric acid neurotransmission (Croarkin, 2018)
- DMN hyperactivity
Symptoms of an episode of major depression
- Feelings of sadness or hopelessness
- Irritability or anger outbursts
- Sleep disturbances
- Agitation or restlessness
- Lack of energy
- Trouble concentrating
- Feelings of worthlessness
Drugs that precipitate insomnia
- Selective serotonin reuptake inhibitors example Zoloft (Xu et al., 2022)
- Anticonvulsants for example Topiramate
- Beta-agonists for example propranolol
Conclusion
MDD is a mood-based disorder characterized by episodes of extreme sadness, loss of energy or interest in activities, sleep disturbances and other symptoms that often last for two weeks. When MDD occurs in a person with a history of alcohol abuse, treatment becomes challenging because mixing antidepressants with alcohol can cause more damage, for example, further induce depression. Therefore, it is important to evaluate the risk and benefits of the antidepressant for every patient and closely monitor them to determine tolerability. Some antidepressant drugs are contraindicated in people with alcohol use disorder, for example, duloxetine and Bupropion because they can cause serious side effects such as seizures. Finally, people with MDD undergo an episode of depression characterized by sadness, loss of energy, sleep disturbances, agitation, restlessness, issues with appetite, and trouble concentrating.
References
Agabio, R., Trogu, E., & Pani, P. (2018). Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database of Systematic Reviews, https://doi.org/10.1002/14651858.CD008581.pub2.
Alsheikh, A. M., Elemam, M., & El-bahnasawi, M. (2020). Treatment of Depression With Alcohol and Substance Dependence: A Systematic Review. Cureus , 12(10): e11168. doi:10.7759/cureus.11168.
Croarkin, P. (2018). Indexing the neurobiology of psychotic depression with resting state connectivity: Insights from the STOP-PD study. EBioMedicine, 37:32-33. https://doi.10.1016/j.ebiom.2018.10.010.
Gimeno, C., Dorado, M., Roncero, C., Szerman, N., Vega, P., Balanzá-Martínez, V., & Alvarez, F. (2018). Treatment of Comorbid Alcohol Dependence and Anxiety Disorder: Review of the Scientific Evidence and Recommendations for Treatment. Front Psychiatry, 8:173. https://doi.10.3389/fpsyt.2017.00173.
Welzel, F., Luppa, M., Pabst, A., Pentzek, M., Fuchs, A., Weeg, D., & Bickel, H. (2021). Incidence of Anxiety in Latest Life and Risk Factors. Results of the AgeCoDe/AgeQualiDe Study. Int J Environ Res Public Health, 18(23),12786. https://doi.10.3390/ijerph182312786.
Xu, G., Li, X., & Xu, C. (2022). Effect of insomnia in the major depressive disorder. BMC Neurology, 22, 341. https://doi.org/10.1186/s12883-022-02869-x.
SHORT ANSWER ASSESSMENT NURS 6630 Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
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Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three or more of the following elements
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| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in the all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three of the following elements
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| 10 Points | 9 Points | 6 Points | 0 Points | |||
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
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Demonstrated 3 of the following:
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Demonstrated 2 of the following:
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Demonstrated 1 or less of the following:
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| 8 Points | 7 Points | 6 Points | 5 Points | 4 Points | 0 Points | |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
AND
AND
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The following was present:
AND/OR
AND/OR
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The following was present:
AND/OR
AND/OR
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The following was present:
AND/OR
AND/OR
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The following was present:
AND/OR
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The following was present:
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| 0 Points Deducted | 5 Points Lost | |||||
| Participation
Requirements |
Demonstrated the following:
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Failed to demonstrate the following:
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| 0 Points Lost | 5 Points Lost | |||||
| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |