Sample Answer for STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS NURS 6630 Included After Question
Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, you will develop a study guide for an assigned psychotropic agent for treating patients with Schizophrenia Spectrum and Other Psychotic Disorders. You will share your study guide with your colleagues. In sum, these study guides will be a powerful tool in preparing for your course and PMHNP certification exam.
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 FOR THIS ASSIGNMENT:
- Review this week’s Learning Resources, including the Medication Resources indicated for this week.
- Reflect on the psychopharmacologic treatments you might recommend for treatment of patients with Schizophrenia Spectrum and Other Psychotic Disorders.
- Research your assigned psychotropic medication agent using the Walden Library. Then, develop an organizational scheme for the important information about the medication.
- Review Learning Resource: Utah State University. (n.d.). Creating study guides. https://www.usu.edu/academic-support/test/creating_study_guidesLinks to an external site.
THE ASSIGNMENT
Create a study guide for your assigned psychotropic medication agents. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the FDA-approved and Evidenced-Based, Clinical Practice Guidelines Research but also supported by at least three other scholarly resources.
Areas of importance you should address, but are not limited to, are:
- Title page
- Description of the Psychopharmacological medication agent including brand and generic names and appropriate FDA indication uses
- Any supporting, valid and reliable research for non-FDA uses
- Drug classification
- The medication mechanism of action
- The medication pharmacokinetics
- The medication pharmacodynamics
- Mechanism of Action
- Appropriate dosing, administration route, and any considerations for dosing alterations
- Considerations of use and dosing in specific specialty populations to consider children, adolescents, elderly, pregnancy, suicidal behaviors, etc.
- Definition of Half-life, why half-life is important, and the half-life for your assigned medication
- Side effects/adverse reaction potentials
- Contraindications for use including significant drug to drug interactions
- Overdose Considerations
- Diagnostics and labs monitoring
- Comorbidities considerations
- Legal and ethical considerations
- Pertinent patient education considerations
- Reference Page
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formattingLinks to an external site..
BY DAY 7
You will need to submit your Assignment to two places: the Week 7 Study Guide discussion forum as an attachment and the Week 7 Assignment submission link. Although no responses are required in the discussion forum, a collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned psychotropic medication agent for study.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK7Assgn_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
A Sample Answer For the Assignment: STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS NURS 6630
Title: STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS NURS 6630
Antipsychotic agents, also called neuroleptic or major tranquilizers, are used primarily to treat schizophrenia. Schizophrenia is characterized primarily by a clear sensory but marked thinking disturbance. Second-generation/ Atypical antipsychotics are widely used due to their broad spectrum of receptor activity since they affect Serotonin, dopamine, and GABA neurotransmitters (de Miranda et al., 2020). Besides, they are better at alleviating negative symptoms and cognitive dysfunction than typical antipsychotics. The purpose of this assignment is to develop a study guide for an antipsychotic agent.
Drug Description
Quetiapine, whose brand name goes by Seroquel, is used in treating schizophrenia. It is FDA-approved for treating schizophrenia, Bipolar disorder, and major depressive disorder (MDD) as an adjunctive treatment (de Miranda et al., 2020).
Non-FDA uses
The non-FDA uses of Seroquel include the treatment of generalized anxiety disorder (GAD), Alcohol Dependence, and Insomnia.
- According to Ansara (2020), Seroquel exhibits efficacy in managing treatment-resistant-GAD as an adjunctive agent. In this case, smaller doses than those prescribed for schizophrenia and bipolar disorder are usually needed for symptom improvement.
- Seroquel has been found to reduce alcohol consumption in heavy drinkers and has the potential for treatment for alcohol dependence, particularly among heavy drinkers (Vatsalya et al., 2020).
- Low doses of quetiapine are usually prescribed for insomnia, although this is a non-FDA use due to potential adverse effects like weight gain and akathisia (Boafo et al., 2020).
Drug classification
Seroquel is an antipsychotic under second-generation antipsychotics.
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| MOA | Pharmacokinetics | Pharmacodynamics |
| An antagonist for D2 receptors and serotonin receptors. | Absorption: Bioavailability: 100%
Peak plasma time: Immediate release-1.5 hr; extended release-6 hrs |
Reduces the hallucinations and delusions associated with schizophrenia by blocking dopamine receptors in the mesolimbic system of the brain. |
| Acts on dopaminergic D1 and D2 receptors. | Metabolism: Metabolized in the liver by CYP3A4 | |
| Elimination:
Excretion: Urine (73%), feces (20%). |
Appropriate dosing: 150-750 mg/day (Immediate release); 400-800 mg/day (extended release).
Children <12 years: safety not established.
Children >12 years: Dose range 400-800 mg/day (de Miranda et al., 2020).
Geriatrics: 50-200 mg/day (Immediate); 50 mg/day (Extended)
Pregnant and breastfeeding women: Not recommended.
Route of Administration: Orally.
Considerations for dosing alterations: Elderly and patients predisposed to hypotensive reactions.
Half-life: The time it takes for the concentration of a drug to decrease to half of its initial dose in the body.
- Understanding half-life is important because it determines a drug’s excretion rates and steady-state concentrations. After one half-life has passed, half of the starting drug amount is eliminated from the body (Smith et al., 2018).
- Seroquel has a half-life of 6 hours for immediate release formulation and 7 hours for extended-release formulation.
Side effects/adverse reaction potentials
Seroquel is associated with various adverse effects, including somnolence fatigue, dry mouth, constipation, increased appetite, weight gain, orthostatic hypertension, and dizziness (de Miranda et al., 2020). Neuroleptic malignant syndrome is a possible adverse effect due to the drug’s D2 receptor blockage.
STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS NURS 6630
Contraindications for use including significant drug-to-drug interactions
- Currently, no identified FDA contraindications of quetiapine.
- It is contraindicated in patients with documented hypersensitivity.
- However, quetiapine is associated with an increased risk of death in elderly patients with dementia-related psychosis (Osborne et al., 2020).
- Precaution is needed with drugs that prolong QT intervals and patients with prolonged QT intervals.
Contraindications due to drug-to-drug interactions
- Amisulpride
- Goserelin
- Lefamulin
- Leuprolide
Overdose Considerations
Seroquel can be life-threatening if taken in an overdose. Toxicity occurs with levels > 1500 ng/mL.
Supportive care is the mainstay of treatment in an overdose.
Measures for acute toxicity include: Maintaining the airway; Ensuring adequate oxygenation; Ventilation (Osborne et al., 2020).
Gastric lavage and administration of activated charcoal with a laxative can prevent more drug absorption if promptly given.
Diagnostics and labs monitoring
The prescribing clinician should monitor the patient’s metabolic panel focusing on fasting glucose, cholesterol and triglyceride levels, weight, and blood pressure (before and during treatment). Besides, patients on long-term treatment should have a lens exam every six months for cataract monitoring (Osborne et al., 2020). Leukopenia, neutropenia, and agranulocytosis can occur with Seroquel treatment, and thus a complete blood count (CBC) should be performed during the first few months of treatment (Osborne et al., 2020). In addition, orthostatic vital signs should be monitored in patients vulnerable to hypotension like geriatrics, patients with dehydration, hypovolemia, and those on antihypertensives.
Comorbidities considerations
- Precautions should be taken in patients with hypokalemia, cardiac arrhythmia, and hypomagnesemia. Metabolic panels should be obtained before initiating the drug (Osborne et al., 2020).
- Patients with diabetes mellitus should have their glucose monitored to avoid hyperosmolar coma.
Legal and ethical considerations
- The clinician prescribing Seroquel should uphold beneficence by ensuring that the drug will have the maximum benefit in treating a patient’s psychotic, bipolar, or MDD symptoms. Nonmaleficence should be upheld by considering the drug’s side effects and ensuring that the benefits outweigh the risks.
- The clinician should obtain consent from the patient before initiating treatment with Seroquel and explain the potential benefits and side effects for the patient to make an informed decision.
- Confidentiality of the patient’s health information should be maintained to prevent legal consequences.
Pertinent patient education considerations
The patient should be educated about the drug’s indications, benefits, and side effects. Patients should be informed that the drug can be discontinued if they experience severe side effects and if they have a decrease in WBCs (de Miranda et al., 2020). Besides, they should be educated that abrupt drug discontinuation poses a risk for withdrawal symptoms.
Conclusion
Seroquel is a second-generation antipsychotic, FDA-approved for treating schizophrenia, Bipolar disorder, and MDD. It is also used off-label in treating insomnia, treatment-resistant GAD, and alcohol dependence. Seroquel is an antagonist for D2 receptors and serotonin receptors, which results in reduced psychotic symptoms. Patients on Seroquel should be monitored for cholesterol and triglyceride levels, weight, blood pressure, fasting glucose, cataracts, complete blood count, and orthostatic vital signs. Ethical principles of beneficence, nonmaleficence, confidentiality, and consent should be upheld when prescribing patient Seroquel.
References
Ansara, E. D. (2020). Management of treatment-resistant generalized anxiety disorder. The mental health clinician, 10(6), 326–334. https://doi.org/10.9740/mhc.2020.11.326
Boafo, A., Greenham, S., Sullivan, M., Bazaid, K., Suntharalingam, S., Silbernagel, L., Magner, K., & Robillard, R. (2020). Medications for sleep disturbance in children and adolescents with depression: a survey of Canadian child and adolescent psychiatrists. Child and adolescent psychiatry and mental health, 14, 10. https://doi.org/10.1186/s13034-020-00316-8
de Miranda, A. S., Ferreira, R. N., Teixeira, A. L., & de Miranda, A. S. (2020). Mood Stabilizers: Quetiapine. NeuroPsychopharmacotherapy, 1-23.
Osborne, V., Davies, M., Evans, A., & Shakir, S. (2020). Observational assessment of safety in Seroquel (OASIS): a specialist cohort event monitoring (SCEM) study in England. Therapeutic advances in psychopharmacology, 10, 2045125320954616. https://doi.org/10.1177/2045125320954616
Smith, D. A., Beaumont, K., Maurer, T. S., & Di, L. (2018). Relevance of Half-Life in Drug Design. Journal of medicinal chemistry, 61(10), 4273–4282. https://doi.org/10.1021/acs.jmedchem.7b00969
Vatsalya, V., Kong, M., Marsano, L. M., Kurlawala, Z., Chandras, K. V., Schwandt, M. L., Ramchandani, V. A., & McClain, C. J. (2020). Interaction of Heavy Drinking Patterns and Depression Severity Predicts Efficacy of Quetiapine Fumarate XR in Lowering Alcohol Intake in Alcohol Use Disorder Patients. Substance abuse: research and treatment, 14, 1178221820955185. https://doi.org/10.1177/1178221820955185
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A Sample Answer 2 For the Assignment: STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS NURS 6630
Title: STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS NURS 6630
Case: An Elderly Widow Who Just Lost Her Spouse
The case study portrays a 75-year-old female patient presenting with a chief complaint of insomnia. She has a history of DM, HTN, and MDD. The patient’s husband passed away ten months ago. Since the husband’s demise, she states her depression has worsened and her sleep habits. She had no history of depression before her husband’s death.
Three Questions I Might Ask the Patient
- How has insomnia and depression affected your daily activities or interactions with people? The question will determine if the depressive symptoms have caused social and occupational dysfunction.
- When did you begin experiencing insomnia? To determine if insomnia started after starting Sertraline since it is an adverse effect of the drug.
- What is your current living status? The question will identify the persons currently living with the patient and her social support system. Living alone may be a cause of the depressive symptoms.
People in the Patient’s Life I Would Need to Speak To
Patient’s Primary Caregiver
- Which activities of daily living have the patient had difficulties in carrying out in the past days? The question will determine the impact of depression on the patient’s daily functioning.
- Does the patient engage in activities that put her life at risk? To identify the presence of self-mutilating behaviors.
- How have been your interactions with the patient in the past weeks? To determine whether the patient’s depression and insomnia have resulted in impaired interpersonal or social functioning.
Physical Exams and Diagnostic Tests Appropriate For the Patient
- Depression screening using the Patient Health Questionnaire (PHQ)-9. The PHQ-9 self-questionnaire will help rate the severity of the patient’s depression (Avasthi & Grover, (2018).
- Hemoglobin A1c- To identify the mean glycemic level and establish whether the patient has achieved adequate glycemic control.
- Cardiovascular Exam: To assess any abnormalities in the cardiovascular system, this can be caused by hypertension and diabetes mellitus.
- Thyroid-stimulating Hormone Test to rule out Hypothyroidism, which presents with depression (Avasthi & Grover, (2018).
- Mental Status Examination (MSE). An MSE will assess the patient’s affect, speech, memory, judgment, and cognition, which can be grossly affected by depression.
Differential Diagnoses
Major Depressive Disorder
Major depressive disorder (MDD) is a mood condition marked by a depressed mood or diminished pleasure or interest in most pleasurable activities. The DSM V diagnostic criteria require that a person presents with four other symptoms in addition to a depressed mood or diminished interest (APA, 2013). The symptoms are changes in appetite, weight changes, fatigue or low energy levels, sleeping difficulties, psychomotor agitation or retardation, reduced ability to concentrate and think or indecisiveness, feelings of worthlessness, and recurrent thoughts of death, suicidal ideations, or attempt (APA, 2013). MDD is a presumptive diagnosis based on the patient’s symptoms of worsening depression and insomnia. Besides, she has a history of MDD, which suggest a relapse of the disorder.
Insomnia
Insomnia is characterized by a continuous difficulty in initiating sleep, maintaining sleep, consolidation, or quality of sleep. Persons with insomnia present with difficulty falling asleep, frequent awakenings, or early morning awakening (APA, 2013). Persons with insomnia report dissatisfaction with quantity or quality of sleep. Insomnia is associated with daytime effects, such as fatigue, tiredness, lack of energy, irritability, reduced work performance, and difficulty concentrating (APA, 2013). Insomnia is a differential diagnosis based on the patient’s symptoms of difficulties in sleeping. Insomnia could be due to MDD, in which patients present with sleeping difficulties of insomnia or hypersomnia. Insomnia can also be attributed to the side effects of Sertraline.
Persistent Complex Bereavement Disorder (PCBD)
PCBD is a condition marked by unshakeable grief that does not follow the typical pattern of improvement over time. Persons continue to exhibit persistent and intense emotions or moods and unusual (APA, 2013). They also experience adverse symptoms that impair significant areas of functioning or cause extreme distress. Symptoms of PCBD include Indefinitely yearning for the deceased; A preoccupation with the events of the deceased’s death; Intense sorrow and distress that does not improve over time; Depression; Difficulty trusting others; Detachment and isolation (APA, 2013). In addition, one may experience difficulties pursuing interests or activities, persistent feelings of loneliness or emptiness, and impairment in occupational, social, and other areas of life (APA, 2013). PBCD is a differential diagnosis based on the patient’s report of depression and insomnia that has worsened since his husband’s death.
Pharmacologic Agents Appropriate For The Patient’s Antidepressant Therapy
- Fluoxetine (Prozac) 10 mg PO once daily.
Prozac is an antidepressant belonging to the class of Selective serotonin reuptake inhibitors (SSRIs). SSRIs are indicated as first-line agents in uncomplicated depression owing to their few anticholinergic effects. Prozac is a preferred treatment choice in geriatric patients due to its fewer side effects (Avasthi & Grover, (2018). The dose will be gradually increased by 10-20 mg after four weeks based on the patient’s tolerance to the drug. Contraindications for Prozac include hypersensitivity to the drug and concomitant administration of Pimozide or Thioridazine (Avasthi & Grover, (2018). According to Simon et al. (2015), African Americans have a worse response to SSRIs than Whites. If the patient were an African American, she would have a low response rate.
- Duloxetine (Cymbalta) 30 mg PO once daily.
Duloxetine is an antidepressant under the class of serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs are indicated as second-line agents in patients who have not responded to SSRIs (Muscatello et al., 2019). The patient will be started on a low dose of 30mg/day due to her advanced age. The dose will be increased after two weeks to a target dose of 60 mg/day. Contraindications for Duloxetine include concomitant administration of the drug with Monoamine oxidase inhibitors (MAOIs) prescribed to treat a psychiatric disorder (Muscatello et al., 2019). I would choose Prozac over Duloxetine since the former exerts no effect on cardiac conduction, heart rate, or blood pressure (Avasthi & Grover, (2018). It would thus be appropriate for this patient with HTN.
Check Points
After four weeks, I would evaluate the patient for improvement of depressive symptoms and insomnia. I would also assess for side effects. If there is a partial improvement of symptoms and no associated side effects with Prozac treatment, I will increase the dose to 20 mg per day. In week 8, I would assess for severity of depressive symptoms and compare them with the patient’s depression in the previous visit. If there is a partial improvement, I would increase the dose to 40 mg/day and monitor any side effects.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Avasthi, A., & Grover, S. (2018). Clinical Practice Guidelines for Management of Depression in the Elderly. Indian journal of psychiatry, 60(Suppl 3), S341–S362. https://doi.org/10.4103/0019-5545.224474
Muscatello, M., Zoccali, R. A., Pandolfo, G., Mangano, P., Lorusso, S., Cedro, C., Battaglia, F., Spina, E., & Bruno, A. (2019). Duloxetine in Psychiatric Disorders: Expansions Beyond Major Depression and Generalized Anxiety Disorder. Frontiers in psychiatry, 10, 772. https://doi.org/10.3389/fpsyt.2019.00772
Simon, G. E., Coleman, K. J., Waitzfelder, B. E., Beck, A., Rossom, R. C., Stewart, C., & Penfold, R. B. (2015). Should measures of antidepressant treatment quality be adjusted for race and ethnicity?. JAMA psychiatry, 72(10), 1055.https://doi.org/10.1001/jamapsychiatry.2015.1437
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
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The following was present:
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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:
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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. |