Category: Nursing

  • NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders 

    Assessing and Treating Pediatric Patients With Mood Disorders

    Therapy for Pediatric Clients with Mood Disorders

    An African American Child Suffering From Depression

    BACKGROUND INFORMATION

    The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

     Client complained of feeling “sad”

     Mother reports that teacher said child is withdrawn from peers in class

     Mother notes decreased appetite and occasional periods of irritation

     Client reached all developmental landmarks at appropriate ages

    NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

     Physical exam unremarkable

     Laboratory studies WNL

     Child referred to psychiatry for evaluation

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    MENTAL STATUS EXAM

    Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

    You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

    RESOURCES

    § Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

    Decision Point One

    Select what you should do:

    Begin Zoloft 25 mg orally daily

    Begin Paxil 10 mg orally daily

    Begin Wellbutrin 75 mg orally BID

    Introduction

    Growth and development are apparent and an inevitable process. As children progress through the developmental stages, they experience different psychological, emotional, sociological, and physical changes. During growth, the brain of a child is also under development, taking in various impulses into the neurons, which lead to the child’s decision making. One major contributor to a child’s brain development and reaction is the culture and society surrounding him or her during the development. As children are in their developmental stages, they perceive the environment differently, and some are often overwhelmed by the rapid developments (Petersen, 2017). It is the parents or the guardians’ responsibility to guide the young ones as they mature and begin to see life in different dimensions. However, some are unfortunate and get to experience different and difficult situations which may lead to mental health disorders such as depressions. In this paper, a case study of a young boy with symptoms of depression will be analyzed after which treatment decisions will be selected for the client. The client is a pediatric patient and thus it will be good to select the medications with good safety profile and few side effects/metabolic effects. The paper will also discuss the ethical issues likely to influence and affect the client’s treatment plan.

     

    Case Study

    The case study involves an eight-year-old African-American male who arrives at the ER with his mother accompanying him. According to his medical conditions, as described by his mother, he is exhibiting signs of depression with complains of feeling sad. His mother then states that his school teacher complained of his withdrawal from classwork and his peers and that he was no longer actively involved in school work and activities as before. His mother has also noticed a decrease in appetite, and his eating rate was going down to the drain. Also, his mother had occasionally noticed some sporadic episodes of irritation. Alex had successfully gotten past all developmental landmarks at the appropriate stages. physical examinations showed no abnormal findings. Alex was then referred to psychiatry for further evaluation.

    After examination, the boy’s mental status exam exhibited alert and oriented x3, which showed that the boy was aware of his environment and surroundings, and he knew who he was during a specific time. The mental exam showed that his speech was clear, spontaneous, goal-oriented, and coherent. He said that he felt sad, affect was somewhat blunted, but he smiled on various occasions during the clinical interview. During examination, he denies visual or auditory hallucinations. The assessment did not indicate any paranoid or delusional thought process and his insight and judgment appeared appropriate for his age. From the examination, it can be concluded that the boy is not endorsing active suicidal ideation, but at times he thinks of himself as dead and what it would be like to be dead. The client was administered with the Children’s Depression Rating Scale and scored 30, indicating significant depression. The client was thus diagnosed with depression. Treatment goal for this client will include administering pharmacological agents to enhancing his appetite, improve sleep patterns, and decrease social anxiety that the boy showed in school withdrawing from his peers.

    Decision Point One

    The decision that was made from a mental health provider’s perspective, putting in mind the boy’s age and condition, was to administer with Zoloft 25 mg, which was to be taken orally daily for four weeks (month) where he was required to return to the clinic for evaluation. Zoloft, also known as
    Sertraline
    , is majorly used to treat panic attacks, depression, social anxiety, traumatic stress disorder, and a severe form of the premenstrual disorder  (Karp, 2017). To recommend this drug, it was certain from the mental exam that the eight-year-old boy has exhibited some forms of depression, which led to him withdrawing from his peers in school and reducing his appetite. The safety and tolerability of Zoloft in children have been established (Locher et al., 2017). The medication is an Selective Serotonin Reuptake inhibitors (SSRI) whose mechanism of action is to elevate the level of serotonin in the brain. The increased amount of serotonin in the brain will improve the client’s mood and thus help in improving the depressive symptoms.

    Zoloft was the best option as while the other two options are also used to treat the same signs exhibited by the boy. It has not been clinically proven that Paxil, being administered 10mg in a day, would be the best option for a child. since Paxil is associated with numerous side effects such as sleep problems, nausea, loss of appetite, blurred vision, shaking, among other symptoms. Additionally, the drug is not known to be effective or safe among children, it has also been demonstrated to increase suicidal thoughts among children with depressive symptoms (Currie & MacLeod, 2018). Besides, Wellbutrin 75 mg orally BID was not a preferred option , while it can be used to treat depression, it is also associated with side effects such as vomiting, nausea, decreased appetite, sleep problems, increased swelling, dry mouth, headache, and blurred vision (Patel et al., 2016). Moreover, Locher et al (2017) explain that the tolerability, safety, and efficacy of Wellbutrin in the pediatric population have not been systematically studied.

    It is ethically important and crucial to discuss the type of drug that you administer to a client. They have the right to informed consent; hence as a counsellor, it is ethically important to communicate the effects of the decisions you are making towards their health. The client also should be willing to participate in their journey towards good health, which can only be achieved through effective and logical communication.  Also, it will be important for the PHMNP to ensure confidentiality of the client data and ensure the health information, including the diagnosis is only accessible to authorized individuals such as the parents (Hiriscau et al., 2016).

    Decision Point Two

    This treatment was geared towards the betterment of the patient, which after four weeks, there were no changes at all in the functioning of the client as he still manifested depressive symptoms. The lack of improvement is attributable to the low dosage of Zoloft that led to the low efficacy of the medication. Hieronymus et al (2016) explains that the efficacy of SSRI antidepressants such as Zoloft is characterized by a dose-response relationship. Hence resulted in a decision to increase the dosage from 25mg to 50mg of Zoloft to be administered orally daily. However, it would not have been a wise decision to change the medication because the maximum dose of Zoloft has not been administered, and hence there is no clinical reason to change the medication. The decision to increase the dose of Zoloft to 37.5 mg was not chosen since Zoloft treatment should start at a dose of 25 mg and the dose titrated upwards after a week to 50 mg (Santarsieri & Thomas, 2015). Additionally, the decision to change the treatment regimen to Paxil was not chosen because of the many side effects associated with Paxil (Wang et al., 2018).

    The ongoing treatment needed to bring back negative results so it could be ruled out for discontinuation. The client needs to understand the stakes that come along with an increase in the dosages and the side effects that may follow as a result. However, due to the need to get better, one must also understand the positive results of taking the prescribed dosage (Goldberg & Ernst, 2018). The second decision results were positive as, after the client returns to the clinic after four weeks for examination, there are tremendous improvements, which indicated the recession of the depressive symptoms by 50%, and the client was coping up well mg and the client also tolerated the increased dose.

    Among the health and ethical considerations is giving the client the exact details of their medical conditions and letting them know of the options of the second decision as well as giving them an opportunity to be involved in making an informed decision. As explained above, it is crucial to let the client understand the reason behind your decisions, this will promote compliance and effective monitoring of side effects (Lomas et al., 2020).

    Decision Point Three

    The decision that was selected for decision three is to maintain the current dose, this decision was made based on the indication that the Zoloft 50 mg was effective and did not result in any side effects, this was manifested by the improvement of symptoms reported. According to Carvalho et al (2016) when selecting antidepressants like Zoloft, it is important to consider both the potential benefits, treatment responsiveness as well as side effects (Kato et al., 2018). Therefore, it is important to maintain the minimum effective dose to avoid potential side effects with increased dose. The decision to change the treatment regimen to SNRI was not chosen since there is no clinical reason as the client is already manifesting symptom remission. SSRIs are the first-line treatment choice when treating depression as they are effective and are associated with minimal side effects (Park & Zarate, 2019).

    The decision to increase the Zoloft dose from 50 mg to 75 mg was not chosen since the client is already manifesting adequate response to Zoloft 50 mg as indicated by 50% symptoms improvement. Additionally, the client is tolerating Zoloft 50 mg as he did not report any side effects, and hence increasing the dose to 75 mg may lead to side effects (Carvalho et al., 2016).

    Selecting the decision to maintain the current dose of Zoloft 50 mg expects that the client would continue exhibiting symptom improvement and finally achieve complete symptom remission. Additionally, it is expected that he would continue tolerating the medication, with few or no side effects.

    Decisions being made towards client health should involve all the stakeholders’ responsible (Lomas et al., 2020). His mother who is his main caregiver, took the provider’s instructions, where she would continue administering the drug for another four weeks to track the trend that the depression signs took over time and other major complications. Before making treatment decisions, it is important to involve the client and family to understand the importance of the treatment options and the pros and cons of each options. Also, the client’s consent is required for all treatment decisions being made since it majorly involves their health (Belitz, 2018).NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    Conclusion

    Mental disorders and mental health should be a priority in today’s society, and it should begin for the children at a young. Mental health for kids and children should be embraced by the guardians and parents, and the main key stakeholders to avoid mental health treatment for children at a very young age. Natural therapeutic sessions are supposed to be embraced in social institutions such as schools and churches. However, we cannot ignore the fact that medication is still needed in some instances. Zoloft can be administered to adults and pediatric patients whose conditions are beyond natural therapy. However, care must be taken, as children with problems such as kidney problems, liver problems, and other conditions can react differently towards the treatment highlighted. A health examination needs to be carried out on the kid before administration of the Zoloft dosage.

     

    References

    Belitz, J. (2018).
    Ethics in assessing and treating children and adolescents.
    In J. N. Butcher & P. C. Kendall (Eds.),
    APA handbooks in psychology®. APA handbook of psychopathology: Child and adolescent psychopathology
    (p. 589–606). American Psychological Association.

    Bodnar, C. N., Morganti, J. M., & Bachstetter, A. D. (2018). Depression following a traumatic       brain injury: uncovering cytokine dysregulation as a pathogenic mechanism.
    Neural             regeneration research
    ,
    13
    (10), 1693.

    Carvalho A, Sharma, M., Brunoni. A., Vieta, E. & Fava, G. (2016). The Safety, Tolerability, and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature.
    Psychother Psychosom
    , 2016(85), 270–288.

    Currie, J. M., & MacLeod, W. B. (2018).
    Understanding physician decision making: The case of depression
    (No. w24955). National Bureau of Economic Research.

    Goldberg, J. F., & Ernst, C. L. (2018).
    Managing the side effects of psychotropic medications
                       American Psychiatric Pub.

    Hieronymus, F., Nilsson, S. & Eriksson, E. (2016). A meta-analysis of fixed-dose trials reveals dose-dependency and rapid onset of action for the antidepressant effect of three selective serotonin reuptake inhibitors.
    Transl Psychiatry
    , 6(6), e834.

    Hiriscau E, Nicola S, Wasserman, D. & Theil, S. (2016). Identifying Ethical Issues in Mental Health Research with Minors Adolescents: Results of a Delphi Study.
    Int J Environ Res Public Health
    , 13(5), 489.

    Karp, D. A. (2017).
    Speaking of sadness: Depression, disconnection, and the meanings of illness
    .    Oxford University Press.

    Locher C, Koechlin H, Zion S, Werener C, Pine D, Kirsch I, Kessler R & Joe K. (2017). Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents.
    JAMA Psychiatry
    , 74(10), 1011–1020.

    Lomas, T., Roache, A., Rashid, T., & Jarden, A. (2020). Developing ethical guidelines for positive psychology practice: An ongoing, iterative, collaborative endeavor.
    The            Journal of Positive Psychology
    ,
    15
    (6), 716-721.

    Patel, K., Allen, S., Haque, M. N., Angelescu, I., Baumeister, D., & Tracy, D. K. (2016). Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant.
    Therapeutic advances in psychopharmacology
    ,
    6
    (2), 99–144. https://doi.org/10.1177/2045125316629071

    Petersen, A. (2017). 
    Brain maturation and cognitive development: Comparative and cross-          cultural perspectives
    . Routledge.

    Santarsieri, D. & Thomas, S. (2015). Antidepressant efficacy and side-effect burden: a quick guide for clinicians.
    Drugs Context
    , 2015(4).

    Wang, S. M., Han, C., Bahk, W. M., Lee, S. J., Patkar, A. A., Masand, P. S., & Pae, C. U. (2018). Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review.
    Chonnam medical journal
    ,
    54
    (2), 101–112. https://doi.org/10.4068/cmj.2018.54.2.101

     

     

    Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.

    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 the assessment and treatment of pediatric patients requiring antidepressant therapy.

    The Assignment: 5 pages

    Examine 
    Case Study: An African American Child Suffering From Depression
    . You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

    At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    Introduction to the case (1 page)

    Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

    Decision #1 (1 page)

    Which decision did you select?

    Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    Decision #2 (1 page)

    Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    Decision #3 (1 page)

    Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    Conclusion (1 page)

    Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

    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. NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    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 formatting.

    Psychopharmacologic Approaches to Treatment of Psychopathology (laureate.net)

    NURS_6630_Week4_Assignment_Rubric

    Grid View

    List View

    Excellent

    Point range: 90–100

    Good

    Point range: 80–89

    Fair

    Point range: 70–79

    Poor

    Point range: 0–69

    Introduction to the case (1 page)

    Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

    9 
    (9%)
     – 10 
    (10%)

    The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

    The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.

    8 
    (8%)
     – 8 
    (8%)

    The response accurately summarizes the case for the Assignment.

    The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.

    7 
    (7%)
     – 7 
    (7%)

    The response inaccurately or vaguely summarizes the case for the Assignment.

    The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

    0 
    (0%)
     – 6 
    (6%)

    The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

    The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

    Decision #1 (1–2 pages)

    • Which decision did you select?

    • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    18 
    (18%)
     – 20 
    (20%)

    The response accurately and clearly explains in detail the decision selected.

    The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

    The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

    The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

    The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

    Examples provided fully support the decisions and responses provided.

    16 
    (16%)
     – 17 
    (17%)

    The response accurately explains the decision selected.

    The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

    The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

    The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

    NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

    Examples provided support the decisions and responses provided.

    14 
    (14%)
     – 15 
    (15%)

    The response inaccurately or vaguely explains the decision selected.

    The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

    The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

    The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

    The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

    Examples provided may support the decisions and responses provided.

    0 
    (0%)
     – 13 
    (13%)

    The response inaccurately and vaguely explains the decision selected.

    The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

    The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

    The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

    The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

    Examples provided do not support the decisions and responses provided, or is missing. NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    Decision #2 (1–2 pages)

    • Which decision did you select?

    • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    18 
    (18%)
     – 20 
    (20%)

    The response accurately and clearly explains in detail the decision selected.

    The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

    The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

    The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

    The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

    Examples provided fully support the decisions and responses provided.

    16 
    (16%)
     – 17 
    (17%)

    The response accurately explains the decision selected.

    The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

    The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

    The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

    The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

    Examples provided support the decisions and responses provided.

    NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    14 
    (14%)
     – 15 
    (15%)

    The response inaccurately or vaguely explains the decision selected.

    The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

    The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

    The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

    The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

    Examples provided may support the decisions and responses provided.

    0 
    (0%)
     – 13 
    (13%)

    The response inaccurately and vaguely explains in detail the decision selected.

    The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

    The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

    The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

    The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

    Examples provided do not support the decisions and responses provided, or is missing.

    Decision #3 (1–2 pages)

    • Which decision did you select?

    • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

    • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

    18 
    (18%)
     – 20 
    (20%)

    The response accurately and clearly explains in detail the decision selected.

    The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

    The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

    The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

    The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

    Examples provided fully support the decisions and responses provided.

    16 
    (16%)
     – 17 
    (17%)

    The response accurately explains the decision selected.

    The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

    The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response.

    The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response.

    The response accurately explains how ethical considerations impact the treatment plan and communication with patients.

    Examples provided support the decisions and responses provided.

    14 
    (14%)
     – 15 
    (15%)

    The response inaccurately or vaguely explains the decision selected.

    The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

    The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

    The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

    The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

    Examples provided may support the decisions and responses provided.

    0 
    (0%)
     – 13 
    (13%)

    The response inaccurately and vaguely explains in detail the decision selected.

    The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

    The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

    The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

    The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

    Examples provided do not support the decisions and responses provided, or is missing.

    Conclusion (1 page)

    • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

    14 
    (14%)
     – 15 
    (15%)

    The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.

    The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.

    12 
    (12%)
     – 13 
    (13%)

    The response accurately summarizes the recommendations on the treatment options selected for this patient.

    The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided.

    11 
    (11%)
     – 11 
    (11%)

    The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient.

    The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided.

    0 
    (0%)
     – 10 
    (10%)

    The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing.

    The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing.

    Written Expression and Formatting – Paragraph Development and Organization:

    Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

    5 
    (5%)
     – 5 
    (5%)

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

    A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

    4 
    (4%)
     – 4 
    (4%)

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

    Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

    3.5 
    (3.5%)
     – 3.5 
    (3.5%)

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

    NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

    Purpose, introduction, and conclusion of the assignment is vague or off topic.

    0 
    (0%)
     – 3 
    (3%)

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3.5  (3.5%)  – 3.5  (3.5%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 3  (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3.5  (3.5%)  – 3.5  (3.5%) Contains several (3 or 4) APA format errors. 0  (0%)  – 3  (3%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6630_Week4_Assignment_Rubric       NURS 6630 Case Study: An African American Child Suffering From Depression – Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

  • Discussion: Foundational Neuroscience

    Discussion: Foundational Neuroscience Initial Posting

    Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.

    A molecule, such as a hormone, neurotransmitter, or drug that binds to a cell receptor site causing cell to become more active, causing a specific physiological response that can be natural or artificial (Christie, 2016). An antagonist a substance that blocks the action of another, as a drug that binds to a receptor for a hormone, neurotransmitter, or another drug blocking the action of that substance without producing any physiologic effect itself (Grandy, 2016). A partial agonist are drugs that can activate the receptors, and can decrease the response of an activated receptor by a stronger agonist (Kenakin, 2017). An inverse antagonist binds to the receptor and decreases the activity of the receptor, which reverses the effect of the binding agonist (Berg & Clarke, 2018). Discussion: Foundational Neuroscience

    BUY A PLAGIARISM-FREE PAPER HERE

    Compare and contrast the actions of g couple proteins and ion gated channels.

    The G-protein coupled receptors (GPCRs) are the largest and most versatile protein family. The g protein has the most abundant membrane receptors, responsible for specific functions in human. This makes them a great attraction for drug binding and interaction (Johnson & Lovinger, 2016). Ion gated channels bind to a receptor opening a channel that only allows specific ions to pass, once the channel is open the membrane may be polarized or depolarized (Bylund, 2014).

    Explain how the role of epigenetics may contribute to pharmacologic action.

    Epigenetics is the study of changes in gene expression that does not involve change the DNA sequence, thus a change in phenotype, not genotype, and affects how cells read genes (Rasool et al, 2015). “Epigenetic mechanisms in health and disease has uncovered changes in DNA methylation and chromatin structure that may contribute to psychiatric disorders” (Schuebel, Gitik, Domschke, & Goldman 2016). Recent studies in epigenetics have revealed a correlations between DNA and depression; using epigenetics can help personalized a patient’s medication regimen, especially if they are not responding to traditional medicines (Rasool et al, 2015).

    Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health

     

    Understanding how a drug will affect the patient and the way the patient’s body will affect the drug is critical when prescribing medications (Laureate Education, n.d.). Knowing that labs should be obtained periodically certain medication like lithium for bipolar to monitor therapeutic ranges, kidney function and toxicity. Lithium can cause renal insufficiencies.

     

    Nurse practitioner must be aware of the medication’s action.

    In order to safely prescribed medications and prevent adverse reactions, a Nurse Practitioner should have an understanding of drug-drug interactions and food-drug interactions (Laureate Education, n.d.). It is impossible to know all interactions, so the clinician should have resources readily available, such as a drug book or PDA (Laureate Education, n.d.). Understanding the medication’s action will require the Nurse Practitioner to have knowledge of pharmacokinetics and pharmacodynamics in particular age groups. For example, if prescribing a medication to an elderly patient that excretes through the kidneys, the clinician should understand that as a person ages, kidney functioning decreases, which depending on the drug that  can cause toxicity (Ponticelli, Sala, & Glassock, 2015). The goal is to effectively treat the patient without causing harm.

     

    References

    Berg, K. & Clarke, W. (2018). Making Sense of Pharmacology: Inverse Agonism and Functional Selectivity. 
    International Journal of Neuropsychopharmacology
    , 21(10), 962–977, 
    https://doi.org/10.1093/ijnp/pyy071

    Bylund, D. (2014). Reference Module in Biomedical Science. 
    Science Direct. 
    Retrieved from https://www.sciencedirect.com/referencework/9780128012383/biomedical-sciences

    Christie, M. (2016 April 28). Explainer: how do drugs work? 
    The Conversation
    . Retrieved from https://theconversation.com/explainer-how-do-drugs-work-48665

    Grandy, D. (2016). Neuropathology of Drug Addictions and Substance Misuse. 
    Science Direct. 
    Retrieved from 
    https://www.sciencedirect.com/book/9780128002124/neuropathology-of-drug-addictions-and-substance-misuse
    .

    Johnson, K., & Lovinger, D. (2016). Presynaptic G Protein-Coupled Receptors: Gatekeepers of Addiction? 
    Frontier in Cellular Neuroscience. 
    Retrieved from https://www.frontiersin.org/articles/10.3389/fncel.2016.00264/full

    Kenakin, T. (2017). Pharmacology in Drug Discovery and Development Understanding Drug Response.
     Science Direct.
     Retrieved from 
    https://www.sciencedirect.com/book/9780128037522/pharmacology-in-drug-discovery-and-development
    .

    Laureate Education (producer). (n.d.) 
    Introduction to advanced pharmacology
     [Video File]. Baltimore, MD: Author

    Rasool, M., Malik, A., Naseer, M. I., Manan, A., Ansari, S., Begum, I., Qazi, M. H., Pushparaj, P., Abuzenadah, A. M., Al-Qahtani, M. H., Kamal, M. A., & Gan, S. (2015). The role of epigenetics in personalized medicine: challenges and opportunities. 
    BMC medical genomics
    , 
    8 Suppl 1
    (Suppl 1), S5. https://doi.org/10.1186/1755-8794-8-S1-S5

    Schuebel, K., Gitik, M., Donschke, K., & Goldman, D. (2016). Making Sense of Epigenetics. 
    International Journal of Neuropsychopharmacology
    , 19(11). 
    https://doi.org/10.1093/ijnp/pyw058

    Discussion: Foundational Neuroscience

    As a psychiatric nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat patients, you must not only understand the pathophysiology of psychiatric disorders but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

    Photo Credit: Getty Images/Cultura RF

    For this Discussion, review the Learning Resources and reflect on the concepts of foundational neuroscience as they might apply to your role as the psychiatric mental health nurse practitioner in prescribing medications for patients.

    By Day 3 of Week 2

    Post
     a response to each of the following:

    Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.

    Compare and contrast the actions of g couple proteins and ion gated channels.

    Explain how the role of epigenetics may contribute to pharmacologic action.

    Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action. Discussion: Foundational Neuroscience

    Read 
    a selection of your colleagues’ responses.

    By Day 6 of Week 2

    Respond
     to 
    at least two
     of your colleagues on 
    two different days
     in one of the following ways:

    If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.

    If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on 
    Submit
    , you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
    Submit!
    Discussion: Foundational Neuroscience

    Week 2 Initial Post

    COLLAPSE

    Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact psychopharmacologic treatments’ efficacy.

    An agonist is a drug that binds with the receptor and changes the receptor activity to produce a response with neurotransmitters and hormones. An antagonist will bind with the receptor but will not cause any changes to occur with the receptor activity. Opioids are agonists; they activate the opioid receptors. Naloxone is an antagonist as it attaches to the opioid receptors, blocking the opioids, but does not activate the opioid receptors. Discussion: Foundational Neuroscience

    A partial agonist is a substance that can activate receptors but cannot elicit the maximum response from the receptor system; for example, tramadol is a partial agonist of the mu receptor. An inverse agonist: substances that bind to the same binding site of the agonist in the receptor and produce an opposite pharmacological effect of a receptor agonist; for example, a benzodiazepine is an inverse agonist.

    Berg, K. A., & Clarke, W. P. (2018). Making sense of pharmacology: Inverse agonism and functional selectivity. 
    The International Journal of Neuropsychopharmacology
    , 
    21
    (10), 962–977. https://doi.org/10.1093/ijnp/pyy071

    Compare and contrast the actions of g couple proteins and ion gated channels. Discussion: Foundational Neuroscience

     

    A neurotransmitter can affect a postsynaptic cell’s activity by two different receptor proteins: ionotropic or ligand-gated ion channels and metabotropic receptors.

    G-proteins can be understood as transducers that combine neurotransmitter binding to postsynaptic ion channel regulation. – Ion channel -linked receptors attach a ligand and open a channel through the membrane that permits specific ions to move through. G-protein-linked receptors bind a ligand and initiate a membrane protein called a G-protein, which then networks with an enzyme or an ion channel in the membrane

    Lodish H, Berk A, Zipursky SL, et al. Molecular Cell Biology. (4th ed.) New York: W. H. Freeman; 2000. Section 21.5, Neurotransmitter Receptors.
      https://www.ncbi.nlm.nih.gov/books/NBK21586/

    Explain how the role of epigenetics may contribute to pharmacologic action. Discussion: Foundational Neuroscience

     

    Epigenetics is a gene regulation mechanism where DNA, RNA, and even proteins undergo reversible modifications that alter the genes’ expression patterns and can be transferred to the next generation. Epigenetic modifications are not only regulated by mutations but also by the environment. Most of these modifications are methylation, acetylation, phosphorylation, ubiquitylation, and sumoylation. The best known epigenetic modification in DNA is DNA methylation, where the addition or removal of a methyl group (CH3) predominantly occurs in the cytosine bases repressing the genes. DNA interacts with proteins and is also packed into chromatins. These histone proteins undergo epigenetic modifications like acetylation, phosphorylation, and methylation to either activate or repress the gene transcription. This epigenetic modification of histone proteins results in chromatin remodeling. The acetylation of the K14 and K9 lysines histone H3 tails by histone acetyltransferase enzymes is known to cause transcriptional activation. Discussion: Foundational Neuroscience

    Cholewa-Waclaw,J., Adrian Bird, A., von Schimmelmann, M.,   Schaefer, A., Yu, H., Song, H., Madabhushi,R., and Tsai, L. (2016). The role of epigenetic mechanisms in the regulation of gene expression in the nervous system. 
    Journal of Neuroscience
     36 (45): 11427-11434; DOI: 10.1523/JNEUROSCI.2492-16.2016

     

    Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

    When prescribing medication, it is essential to know the various drugs that all providers prescribe to the patient. It is crucial to ensure that the patient is not taking any antagonist medications if prescribed an agonist medication due to the agonist drug’s nullifying effect; otherwise, the patient will receive no benefit from the medication. To not provide the patient with too much of a response as would be the case with two agonist medications for synergistic effect, care must be taken. For example, if a patient were to take aspirin and warfarin, the result would be excessive bleeding. Discussion: Foundational Neuroscience

    If we use two agonists, it will have a synergistic effect, and the total response that we will get will be maximum, whereas if we use an agonist and an antagonist, the antagonistic effect will result in a decreased response, for example, phenobarbital and warfarin result sin a reduced impact.

    Berg, K. A., & Clarke, W. P. (2018). Making Sense of Pharmacology: Inverse Agonism and Functional Selectivity. 
    The International Journal of Neuropsychopharmacology
    , 
    21
    (10), 962–977. https://doi.org/10.1093/ijnp/pyy071

    Drugs.com (2020). https://www.drugs.com/drug-interactions/warfarin.html Discussion: Foundational Neuroscience

  • Foundational Neuroscience Essay

    Foundational Neuroscience Essay Main Post

                                The Agonist-to-antagonist spectrum of action of psychopharmacologic agents

           Agonists are drugs that bind to target receptors and can alter receptor activity to produce a response. They therefore have both affinity as well as intrinsic efficacy. Antagonists on the other hand have affinity but lack intrinsic efficacy which means that they do not induce a response though they can bind to the target receptor. Drugs that are partial agonists can not only bind but also activate a specific receptor but are partially effective when compared to a full agonist at a receptor Foundational Neuroscience Essay. Inverse agonists on the other hand can bind as an agonist to a receptor but produces a pharmacological response or effect that differs from that of the agonist. that can reduce the constitutive activity of a receptor. Generally, a full agonist elicits the utmost response a system is capable of, while a partial agonist elicits a below maximum response. Although it is clear that the intrinsic efficacy of a partial agonist is less than that of a full agonist, full agonists can also differ in intrinsic efficacy Notably, a drug can be an agonist, an antagonist, and an inverse agonist at the same time acting at the same receptor. Therefore, even though affinity gets a drug to a receptor, it does not direct what functional outcome of the drug-receptor interaction (Berg & Clarke, 2018) Foundational Neuroscience Essay.

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    The actions of g couple proteins and ion gated channels

           G couple proteins receptors are made up of a group of seven-transmembrane domain-containing proteins that team up with G proteins or GRT-binding proteins over cell membranes stimulating various cellular responses by controlling the activity of ion channels and many enzymes. G proteins control a large amount of ion channels. Ion gated channels as transmembrane unlock passage of neurotransmitters, and let ions pass through neurons. G-proteins act as transducers that pair neurotransmitter binding to the control of postsynaptic ion channels.  Ligand-gated ion channels as membrane proteins have a pore that regulates the flow of selected ions across the plasma membrane. Ion channels as pore-forming proteins fused into the cell membranes of cells, and the channels let distinct ions go across cell membranes, depending on the electrochemical ion gradients in the middle of inside and outside of the cell. G protein-mediated modulations of ion channel activity indirectly includes sympathetic stimulation in the heart. For instance Noradrenaline coming from the nerve termini activates Gs by binding to the beta1-adrenergic receptor, augmenting adenylyl cyclase leading to  conversion of ATP to cyclic AMP directly activating the pore-forming cyclic nucleotide-gated non-selective cation channel subunit, leading to an increased heartbeat (Inanobe & Kurachi, 2014) Foundational Neuroscience Essay.

                                The role of epigenetics may contribute to pharmacologic action

           Epigenetics describes the way an individual’s behaviors and environments can give rise to changes that impact the way genes function. Although genes play a crucial role in the health of an individual, behaviors and environment affect health too, for instance active lifestyle or exercise and diet. Epigenetic changes can be reversed unlike genetic change.  Although they can change the way the body reads a DNA sequence, they do not however change the DNA sequence (Centers for Disease Control and Prevention [CDC], 2020).

    Due to current advancements in understanding real function of the entire genome, pharmacology has to adjust itself to embrace ways of fighting diseases more global‐response sense instead of the traditional drug‐receptor sense. The design of drugs may focus on making them capable of being more broad‐acting over a variety of epigenetic large‐scale incidents instead of making them to be exact to a certain gene or protein subtype. These epigenetic regulatory mechanisms that are in a larger‐scale proportion may cross more than one gene or proteins family and may even regulate large genes groups. Some diseases like cancer that usually has many different mutation variations that are complex, unpredictable, not easily detectable, and difficult to treat, giving rise to relapse. Epigenetics of cancers might be the answer to more effective treatments (Stefanska & MacEwan, 2015). Epigenetics may affect the way drugs, psychopharmacologic agents, and treatments work for individuals. That a drug like Abilify (Aripiprazole) works for one patient does not mean it will work for the other.

                          How information may impact the way I prescribe medications to patients

           This information may impact the way I prescribe medications to patients, as individual body make up is different. The psychiatric mental health NP must understand that patient safety is the priority when prescribing medications, and that has to take into consideration the drug’s mechanism of action and drug to drug interactions. Proper evaluation is important to make the right diagnosis so that the patient can get the right treatment that will improve the outcome of care. Patients also have to be monitored for side effects and educated on the importance of drug compliance.

           For instance, a 69-year-old male patient with depression prescribed daily dose of 25 mg orally of Zoloft (Sertraline) an SSRI that works by altering a chemical messenger (serotonin) in the brain. Zoloft (Sertraline) an SSRI is usually the first line of treatment of moderate to severe as SSRIs impede the serotonin reabsorption into neurons, thereby increasing the activity of serotonin in the brain. Zoloft (Sertraline) which is used to treat depression acts as a Dopamine transporter (DAT) inhibition and sigma-1 receptor binding and is not only FDA approved, but is safe for long-term use. Common side effects include dry mouth, bruising, tremors, sexual dysfunction, and gastrointestinal constipation, and bruising. The NP in this case has to consider low doses for special populations like the elderly and risk reduction of sociality for individuals from ages 65 years and above, as well as risk of SIADH and changes for persons with hepatic and kidney impairments (Potter, 2019). As an NP in this case , I would take the patients age into consideration when prescribing, and avoid wanting to give higher doses of medications but rather start with drugs that are low dose, as well as safer, and tolerable like Zoloft with the goal of keeping the patient at lower doses that will not compromise the frug effectiveness. It is also important to monitor for side effects like erectile dysfunction.

           The NP has to bear in mind that studies shows that a once a day drug such as Wellbutrin XL (Bupropion XL), a norepinephrine and dopamine reuptake inhibitor, is known to improve sexual function. Wellbutrin XL (Bupropion XL) is also generally well tolerated with no major safety concerns. It also works well with Zoloft in managing the side effects of sexual dysfunction that may result from Zoloft (Shen et al., 2019) Foundational Neuroscience Essay

                                                                                    References

    Berg, K. A., & Clarke, W. P. (2018). Making sense of pharmacology: Inverse agonism and functional selectivity. 
    International Journal

           of Neuropsychopharmacology
    , 
    21
    (10), 962–977. 
    https://doi.org/10.1093/ijnp/pyy071

    Centers for Disease Control and Prevention. (2020). 
    What is Epigenetics?
     
    https://www.cdc.gov/genomics/disease/epigenetics.htm

    Inanobe, A., & Kurachi, Y. (2014). Membrane channels as integrators of g-protein-mediated signaling. 
    Biochimica et Biophysica Acta

           (BBA) – Biomembranes
    , 
    1838
    (2), 521–531. 
    https://doi.org/10.1016/j.bbamem.2013.08.018

    Potter, D. R. (2019). Major Depression Disorder in Adults: A Review of Antidepressants. 
    International Journal of Caring Sciences
    , 
    12
    (3),

           936–1942. 
    https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=7&sid=b2d9f73d-7902-43bf-82

           
    b0-903ed3e0bb63%40sessionmgr101

    Shen, Y., Zhao, Q., Yu, Y., Tan, Y., Zhang, H., Xu, X., Wang, Z., Li, Y., Hu, J., Zhong, J., & Li, H. (2019). Efficacy and safety of        bupropion hydrochloride extended-release versus escitalopram oxalate in Chinese patients with major depressive disorder: Results

           from a randomized, double-blind, non-inferiority trial. 
    Journal of Affective Disorders
    , 
    257
    , 143–149. 
    https://doi.org/10.1016/j.jad.2019.07.023

    Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. 
    British Journal of Pharmacology
    , 
    172
    (11), 2701–

           2704. 
    https://doi.org/10.1111/bph.13136

     

    Discussion: Foundational Neuroscience

    As a psychiatric nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat patients, you must not only understand the pathophysiology of psychiatric disorders but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

    Photo Credit: Getty Images/Cultura RF

    For this Discussion, review the Learning Resources and reflect on the concepts of foundational neuroscience as they might apply to your role as the psychiatric mental health nurse practitioner in prescribing medications for patients.

    By Day 3 of Week 2

    Post
     a response to each of the following:

    Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.

    Compare and contrast the actions of g couple proteins and ion gated channels.

    Explain how the role of epigenetics may contribute to pharmacologic action.

    Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action. Foundational Neuroscience Essay

    Read 
    a selection of your colleagues’ responses.

    By Day 6 of Week 2

    Respond
     to 
    at least two
     of your colleagues on 
    two different days
     in one of the following ways:

    If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained. Foundational Neuroscience Essay

    If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on 
    Submit
    , you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
    Submit!

    Thank you for such a thorough discussion post. The way you succinctly summarized the agonist-antagonist spectrum helped solidify that information a bit more for me. It was also interesting to understand that the affinity a drug has to a receptor does not change (higher is typically better), but the intrinsic efficacy can be manipulated by scientists and is valuable at different levels. These different levels represent the agonism/antagonism continuum (Berg & Clarke, 2018).

    In investigating epigenetics further, I found some information about DNA methylation and learned about it’s crucial role in activating or repressing gene expression. Specifically, how disruption of DNA methylation of HTR2A can lead to Major Depression. DNA methylation is also associated with turning off repetitive types of coding as well to maintain stability (Kuehner et al., 2019). Although the science and exploration of methylation in the brain is continuing to grow, alteration to intrinsic patterns have been associated with things like early life stressors and abuse (Kuehner et al., 2019). Foundational Neuroscience Essay

    Thank you again for a thought provoking post.

    Adria

    References

    Berg, K. A., & Clarke, W. P. (2018). Making Sense of Pharmacology: Inverse Agonism and Functional Selectivity. 
    The International Journal of Neuropsychopharmacology,
     21(10), 962–977. https://doi.org/10.1093/ijnp/pyy071

    Kuehner, J. N., Bruggeman, E. C., Wen, Z., & Yao, B. (2019). Epigenetic Regulations in Neuropsychiatric Disorders. 
    Frontiers in Genetics
    , 10, 268. https://doi.org/10.3389/fgene.2019.00268

     

    Thank you for your explanation. I like what you said about epigenetics and how genes, including behaviors, age, disease state, and environment, play an important in individuals’ health.  As individuals, we have to be conscious of our surroundings and the things that can affect us. We have to include diet, exercise nutritious foods in our lifestyle. Doing our parts will be beneficial in the long run. Although genetic change can be a regular and natural occurrence, the change in epigenetics can also lead to a damaging effect such as cancers.  The environment is being researched as an essential influence on epigenetic tags and also on diseases. For example, Pollution has become a significant focus in the research area as scientists are finding that air pollution may affect methyl tags on DNA  and increase one’s risk for neurodegenerative diseases such as Parkinson’s and Alzheimer’s. Fortunately, Vitamin B may protect against harmful epigenetic effects of pollution and may be able to combat the harmful effects that particular matter has on the body (“Epigenetic: Fundamentals,” n.d) Foundational Neuroscience Essay

    References:

    Epigenetics and drug discovery
    . (2018, July 27). Drug Discovery from Technology Networks. 
    https://www.technologynetworks.com/drug-discovery/articles/epigenetics-and-drug-discovery-306821

    Epigenetics: Fundamentals
    . (n.d.). https://www.whatisepigenetics.com/fundamentals/#:~:text=Epigenetics%20is%20the%20study%20of,how%20cells%20read%20the%20genes. Foundational Neuroscience Essay

  • NURS 6630 week 2 Discussion: Foundational Neuroscience

    NURS 6630 week 2 Discussion: Foundational Neuroscience

    Agonist-To-Antagonist Spectrum of Action of Psychopharmacologic Agents

    In medicine, drugs can act either as agonist or antagonist. As an agonist, drugs bind to target receptor, changing its activity to produce a response. Agonist medications activates the full receptor in the brain while a partial agonist produces a sub-maximal response when in contact with a receptor (Berg & Clarke, 2018). On the other hand, antagonist, binds to target receptors but produces no response, hence preventing agonist from occupying the receptor. Inverse agonists lower the activity of a receptor replicating the opposite effect of an agonist (Berg & Clarke, 2018) NURS 6630 week 2 Discussion: Foundational Neuroscience.

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    Actions of g Couple Proteins and Ion Gated Channels.

    GPCR, found in eukaryotes, comprise of the largest known class of plasma membrane receptors. They act as principal targets for most of prescribed drugs and binds to many different types of ligands (Weir, 2019. They convert signals from extracellular ligands to signals in intracellular relay proteins, and when bonded with nucleotide guanosine triphosphate (GTP), hydrolyze it to form GDP. Ion gated channels are proteins that regulates the flow of selected ions passively across the plasma membrane. As a gated channel, they only open under specific conditions like for specific ligands (ligand-gated ion channels), or for a specific electrical potential (voltage-gated channels).

    Role of Epigenetics and Pharmacologic Action

    Epigenetics describes thestudy of genetic information, changes and modifications coded in gene expression. Its study has led to the understanding of many disease processes and the manufacturing of drugs to counteract such diseases (Stefanska & MacEwan, 2015). Diseases such as cancers and neurodegenerative disorders, are often associated with epigenetic alteration, can be generated by a single base mutation. With genome testing /screening, pharmacological treatments are personalized with precise disease management and prediction (Rasool et al., 2015)

    Pharmacogenomics and The Impact on Mental Health Patients

    Pharmacogenomics help clinicians personalized treatment to patients based on their individual’s genetic pattern and response to drugs (Butler, 2018). In the psychiatry environment, knowing the genetic make-up of patients and how they respond to specific medications can help providers predict the tolerability and metabolic impact to patients. For instance, individuals with genetic variant with CYP2C9 gene alleles with reduced enzyme activity will require a reduced dose of most medications compared to patients with a normal CYP2C9. Lithium toxicity can easily occur in patients with reduced or no enzyme activity as they metabolize medications slower leading to build of the drug in the system. The reverse can occur with patients with duplications/multiplications of the wild-type allele (Butler, 2018), metabolizes medications faster and may require a higher dose of medications.

    References

    Berg, K. A., & Clarke, W. P. (2018). Making sense of pharmacology: Inverse Agonism and functional selectivity. 
    International Journal of Neuropsychopharmacology
    , 
    21
    (10), 962-977. 
    https://doi.org/10.1093/ijnp/pyy071

    Butler, M. (2018). Pharmacogenetics and psychiatric care: A review and commentary. 
    JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY
    , 
    2
    (2), 17-24. 
    https://doi.org/10.29245/2578-2959/2018/2.1120

    Rasool, M., Malik, A., Naseer, M. I., Manan, A., Ansari, S. A., Begum, I., Qazi, M. H., Pushparaj, P. N., Abuzenadah, A. M., Al-Qahtani, M. H., Kamal, M. A., & Gan, S. H. (2015). The role of epigenetics in personalized medicine: Challenges and opportunities. 
    BMC Medical Genomics
    , 
    8
    (S1). 
    https://doi.org/10.1186/1755-8794-8-s1-s5

    Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. 
    British Journal of Pharmacology
    , 
    172
    (11), 2701-2704. 
    https://doi.org/10.1111/bph.13136

    Weir, C. J. (2019). Ion channels, receptors, agonists and antagonists. 
    Anaesthesia & Intensive Care Medicine
    , 
    21
    (1), 62-68. 
    https://doi.org/10.1016/j.mpaic.2019.10.022

     

    responses

    I appreciate your example of how genetic variations can contribute to impaired metabolism of psychotropic medications in critical ways. Especially with medications such as Lithium that have such a narrow therapeutic window.  Kronfol et al. (2020) describe changes to the p450 system that can occur with aging due to reduced DNA methylation of CYP2E1 genes in mice. As prescribers, it is also important to understand how metabolism of medications changes with aging and why this occurs. Hopefully the ability to genetically test for specific variations will continue to expand.

    An interesting study in mice by Kabir et al. (2017) linked alterations in genes, to alterations in specific calcium channel pathways, that than disrupt  signaling of dopamine in ventral tegmental areas (VTA). This connection may shed some light on the pathology around behaviors such as cocaine abuse and depression in humans which are associated with dysfunction in dopamine activity in the VTA (Kabir et al., 2017). The authors found that medications to correct the calcium channel dysfunction resulted in changes in the mice behavior. This study shows both the complexity of the  neuropsychiatric underpinnings of behavior and sheds light into possible ways that medications can be used to alleviate illness.

    Thank you for a thought provoking post.

    References

    Kabir, Z.D., Martínez-Rivera, A. & Rajadhyaksha, A.M. (2017). From Gene to Behavior: L-Type Calcium Channel Mechanisms Underlying Neuropsychiatric Symptoms. 
    Neurotherapeutics
     14, 588–613 (2017). https://doi-org.ezp.waldenulibrary.org/10.1007/s13311-017-0532-0

    Kronfol, M.M., Jahr, F.M., Dozmorov, M.G. (2020). DNA methylation and histone acetylation changes to cytochrome P450 2E1 regulation in normal aging and impact on rates of drug metabolism in the liver. 
    GeroScience 42
    , 819–832 (2020). https://doi-org.ezp.waldenulibrary.org/10.1007/s11357-020-00181-5

     

    The use of medications and how they exert their pharmacological process can be said to be a biological/scientific process that if not fully understood can cause more harm for the patient that it is intended for. Hence, it is important to always educate one’s self, even acquiring the license to practice.

    There are different principles that needs to be put into consideration before a provider prescribes medications for patients. One of these pharmacological actions is the agonist-to-antagonist spectrum of action. The agonist-to-antagonist spectrum of action pharmacological agent describes how some medications are agonists, thereby causing a direct binding effect to the receptor sites to cause the desired action, while there are some that are antagonist, which would just bind to the receptor sites without eliciting any response or produce an undesired/unexpected action (Bolin et al., 2016).

    Another action that should be considered is the actions of g couple proteins and ion gated channels. The g couple proteins and ion gated channels are neurotransmitter receptors that binds to postsynaptic sites from the presynaptic sites to get a response (Alexander et al., 2019). In understanding how they differ, Ion gated channels would elicit a rapid response within/across the cell membrane (Alexander et al., 2019), while g-couple protein activate a response at a slower rate outside of the membrane.

    Finally, epigenetics would put into consideration a person’s DNA without alteration to develop a pharmacological treatment. Using epigenetics as you have mentioned would be very beneficial in the treatment of inheritable diseases like cancer (Fu & Imani, 2018). Hence, constant education is needed so has to be current on new research about these types of medications that would help people with the same DNA.

    All these actions alongside side effects and comorbidities have to be considered in order to develop a pharmacological treatment that would be effective in treating patients. Thanks for an education post.

     

     

     

     

    References

    Alexander, S. P. H., Mathie, A., Peters, J. A., Veale, E. L., Striessnig, J., Kelly, E., Armstrong, J.

    F., Faccenda, E., Harding, S. D., Pawson, A. J., Sharman, J. L., Southan, C., & Davies, J. A. (2019). THE CONCISE GUIDE TO PHARMACOLOGY 2019/20: Ion channels. British Journal of Pharmacology, 176 Suppl 1, S142–S228. 
    https://doi-org.ezp.waldenulibrary.org/10.1111/bph.14749

    Bolin, B. L., Alcorn III, J. L., Reynolds, A. R., Lile, J. A., & Rush, C. R. (2016). Human drug

    discrimination: A primer and methodological review. 
    Experimental and clinical             psychopharmacology, 24
    (4), 214.

    Fu, J., & Imani, S. (2018). Epigenetics in cancer. Science Press. 
    https://search-ebscohost-

    com.ezp.waldenulibrary.org/login.aspx?direct=true&db=cat06423a&AN=wal.EBC5684596&site=eds-live&scope=site.

     

    Discussion: Foundational Neuroscience

    As a psychiatric nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat patients, you must not only understand the pathophysiology of psychiatric disorders but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues. NURS 6630 week 2 Discussion: Foundational Neuroscience

    Photo Credit: Getty Images/Cultura RF

    For this Discussion, review the Learning Resources and reflect on the concepts of foundational neuroscience as they might apply to your role as the psychiatric mental health nurse practitioner in prescribing medications for patients.

    By Day 3 of Week 2

    Post
     a response to each of the following:

    Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.

    Compare and contrast the actions of g couple proteins and ion gated channels. NURS 6630 week 2 Discussion: Foundational Neuroscience

    Explain how the role of epigenetics may contribute to pharmacologic action.

    Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

    Read 
    a selection of your colleagues’ responses.

    By Day 6 of Week 2

    Respond
     to 
    at least two
     of your colleagues on 
    two different days
     in one of the following ways:

    If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained. NURS 6630 week 2 Discussion: Foundational Neuroscience

    If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on 
    Submit
    , you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
    Submit! NURS 6630 week 2 Discussion: Foundational Neuroscience

     

    Discussion Week 2

    On the cellar level the ligand gated ion channel an agonist can bind to a receptor and cause the same phycological response as a natural ligand.  An antagonist binds to the receptor and do not cause a phycological response but block that receptor preventing the natural ligand from going into that receptor. For example, most antipsychotic drugs act as dopamine receptor antagonist.  Blocking reuptake of dopamine (Howland, 2016).  Some antipsychotic drugs also act as inverse agonist at the serotonin receptor causing an opposite effect. An inverse agonist produces a opposite effect of the agonist.

    In regard to the efficacy of a drug treatments, the NP has to provide a very good patient assessment to provide the patient with an accurate diagnosis.  The NP having knowledge, can correctly prescribe the drug (agonist, antagonist or reverse agonist) that will act on the on the targeted neurotransmitter to produce the desired effect in the patient.

    Ion gated channels pull and bond to the agonist changing the protein.  G coupled proteins are proteins used by the cell to convert intracellular signals into responses (Zhao, Deng, Jiang, Oing, 2016).

    Epigenetics is modifications in gene expression that is controlled by various fundamental epigenetic mechanisms leading to various physical and psychiatric diseases.  As a result, traditional treatment may often prove ineffective with these patients because these mechanisms regulate cellular and gene expression, just to name a few (Rasool, et al., 2015).

    As practitioner, my patient assessment may also include an education and discussion concerning pharmacogenomics.  Particularly, if the patient comes to me after having been on various medication treatments that were unsuccessfully.   Knowledge of a medications action is important for example; treating a patient with Bipolar I that is exhibiting depression symptoms but also reported that he maxed out his credit card last week on video games. With the knowledge that an antidepressant should not be given because the action of the antidepressant would cause the patient to go into mania. NURS 6630 week 2 Discussion: Foundational Neuroscience

     

    References

     

    Berg, K., A., Clarke, W., P. (2018).  Making Sense of Pharmacology: Inverse Agonism and

    Functional Selectivity, 
    International Journal of Neuropsychopharmacology
    , Volume 21, Issue 10, October 2018, Pages 962–977, 
    https://doi.org/10.1093/ijnp/pyy071

     

    Howland, R. H. (2016). Pimavanserin: An inverse agonist antipsychotic drug.
     Journal of

    Psychosocial Nursing & Mental Health Services, 54
    (6), 21-24. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.3928/02793695-20160523-01

     

    Rasool, M., Malik, A., Naseer, M. I., Manan, A., Ansari, S., Begum, I., Qazi, M. H., Pushparaj,

    P., Abuzenadah, A. M., Al-Qahtani, M. H., Kamal, M. A., & Gan, S. (2015). The role of epigenetics in personalized medicine: challenges and opportunities. 
    BMC medical genomics
    , 
    8 Suppl 1
    (Suppl 1), S5. https://doi.org/10.1186/1755-8794-8-S1-S5 NURS 6630 week 2 Discussion: Foundational Neuroscience

     

    Zhao, J., Deng, Y., Jiang, Z., Oing, H. (2016). G Protein-Coupled Receptors (GPCRs) in

    Alzheimer’s Disease; A Focus om BACE1 Related GPCRs. 
    Frontier in Aging Neuroscience
    .,  
    https://doi.org/10.3389/fnagi.2016.00058

     

    Response

    Interesting post you have here, i like how you describe all the terms.

    Agonist-to-antagonist spectrum of action is crucial in the human body when discussing pharmacology. It expresses the action of the two antagonize each other. An agonist produces action and the antagonist opposes the action which means the two spectrum operates in opposite direction. This describes the mechanism of drug interaction in the human body.

    There are agonist, partial agonist, inverse agonist and antagonist. The inverse agonist is the drug that bind to a receptor as an agonist but block or reduces the effect of the agonist. The partial agonist will bind a receptor partially not like the full agonist (Stahl, 2013). An agonist drug is a drug that bind and active a receptor. An antagonist at the other hand is the drug that bind a receptor but will not activate the receptor. The antagonist will decrease the action of the receptor from binding to another agonist. NURS 6630 week 2 Discussion: Foundational Neuroscience

    G-protein-coupled receptors (GPCRs) mediate most of our physiological responses to hormones, neurotransmitters and environmental stimulants, and so have great potential as therapeutic targets for a broad spectrum of diseases. They are also fascinating molecules from the perspective of membrane-protein structure and biology G-protein-coupled receptors (GPCRs) mediate most of our physiological responses to hormones, neurotransmitters and environmental stimulants, and so have great potential as therapeutic targets for a broad spectrum of diseases. They are also fascinating molecules from the perspective of membrane-protein structure and biology. The g-couple proteins and ion gated channel are receptor which are useful in their different area and can interact by binding to ligand and cause a chemical response. This action is mostly triggered by the presence of neurotransmitters (Stahl, 2013) NURS 6630 week 2 Discussion: Foundational Neuroscience

    G- couple protein also known as G-protein-coupled receptors (GPCRS) are receptors that live on cell membrane and able to bind with ligands to cause a change. These GPCRS receptors are responsible for most physiological processes such as light, odour, hormones, and pain. G-protein can be used to predict poor prognosis in some cancer, and some of these protein function as a potential biomarker for some diagnosis (Zhu, Huang & Jin, 2018).

    Ion gated channel allow the regulation of movement of ions thorough the cell membrane. The ion gated channel are transmembrane protein complexes that conduct the flow of ion channel in response to binding of a neurotransmitter. NURS 6630 week 2 Discussion: Foundational Neuroscience

     

    Stahl, S. M. (2013). Stahl’s essential psychopharmacology: 
    Neuroscientific basis and practical applications
     (4
    th
     ed.). New York. NY: Cambridge University Press

     

    Zhu, X., Huang, G., & Jin, P. (2018). Clinicopathological and prognostic significance of aberrant G Protein-Couple Receptor 110 (GPR110) expression in gastric cancer. 
    Pathology- Research and Practice
    . https://doi-org.ezp.waldenulibrary.org/10.1016/j.prp.2018.12.004 NURS 6630 week 2 Discussion: Foundational Neuroscience

  • NURS 6630 week 1 Assignment: Short Answer Assessment

    NURS 6630 week 1 Assignment: Short Answer Assessment

    Psychopharmacological Approaches to Treatment

    Introduction

    The brain, which is the most complex part of the human body, is responsible for the regulation and function of the human body. It is made up of billions of nerves that play critical roles in the human body (). The human body can reach its maximum potential through the presence of neurons that control numerous functions such as memory, learning, motivation, homeostasis, and emotion. This implies that nerve cells help people to understand their surroundings by initiating activities like smelling, hearing, touching, and sensing. A neuron is a basic unit of the nervous system which is involved in the transmission of information across nerve cells, glands, and muscles (Beaulieu-Laroche, 2018. This paper aims to discuss the anatomy of neurons, functionalities, its components, and the concept of neuroplasticity. NURS 6630 week 1 Assignment: Short Answer Assessment

    BUY A PLAGIARISM-FREE PAPER HERE

    Anatomy of the Neuron

    A neuron that is the basic unit of the nervous system is a nerve cell responsible for transmitting information to muscles, glands, and other nerve cells. A neuron has six major parts: synapse, myelin sheath, axon, soma, nucleus, and dendrites. Synapses play the role of sending electrical signals to other neurons while dendrites receive electrical signals from nearby cells (Beaulieu-Laroche, 2018). The soma comprises of cell’s organelle while the nucleus contains the DNA of cells. The axon transmits electrical signals from cells to synapses, while the myelin sheath insulates the axon to control electrical signals. Electrical impulse conduction takes place through the axon, cell body, and dendrite pathway. Impulse termination occurs when it reaches the synapse and communication takes place. Examples of impulses include touch, light, and sound. NURS 6630 week 1 Assignment: Short Answer Assessment

     

    Major Components of Subcortical Structures

    Subcortical structures are neural formations in the brain which perform complex activities like hormone production, pleasure, emotion, and memory. The structures act as nervous system information hubs by relaying and modulating information in various parts of the brain. The major elements of subcortical structures include;

    Diencephalon- It is the posterior of the forebrain and is made up of the epithalamus, thalamus, subthalamus, and hypothalamus that perform primary relay and processing of sensory information (Vertes, 2015).

    Pituitary glands- It is an extension of the hypothalamus, which consists of the anterior lobe and posterior lobe and is responsible for secreting, stimulating, and releasing hormones. NURS 6630 week 1 Assignment: Short Answer Assessment

    Hippocampus- It is also known as the hippocampal formation and is in charge of spatial navigation and long-term memory.

    Basal ganglia- It is made up of nuclei and is responsible for fine-tuning moto neuron functions.

    Limbic structures- It is composed of cortical, subcortical, and brain areas, and it controls memory, emotion, olfactory, motivation, learning, and body homeostasis. NURS 6630 week 1 Assignment: Short Answer Assessment

    Which Component Plays a Role in Learning, Memory, and Addiction?

    The cerebrum or the cortex, which is the largest part of the brain, plays a major role in the control of learning. The limbic system, including the cingulate gyri are responsible for learning. Although different parts of the brain may be responsible for different kinds of memory, the hippocampus and amygdala are generally responsible for memory. While, the nucleus accumbens and is responsible for influencing addiction through feelings of pleasure or reward (Surgeon General, 2016). NURS 6630 week 1 Assignment: Short Answer Assessment.

     

    Key Neurotransmitters Located in Nigra Striatal Area of the Brain

    Dopamine

    Norepinephrine

    GABA Gamma-Aminobutyric Acid

    The Function of Glia Cells in the Central Nervous System

    Glia cells are also known as neuroglia or glial cells, are non-neuronal cells that are found both in the central nervous systems (CNS) and peripheral nervous system (PNS). Glia cells offer a supporting role to neurons and do not take part in the production of electrical impulses. The main functions of glial cells include the formation of myelin, maintaining homeostasis, and offering support and protection to neurons. The functions of glial cells are depicted from its different types, which include astrocytes, microglia, oligodendrocytes, and Schwann cells located in PNS (de Castro et al., 2015). Astrocytes control the floor of the blood in the brain, normalizes communication amongst neurons, and sustain fluid composition around neurons. Astrocytes also offer assistance to neurons during development by locating their destination and creating blood barriers in the brain. This is essential as it helps protect the brain from toxic substances. Microglia act as hunters, which eliminates dead cells and other waste substances. Oligodendrocyte components of glia cells take part in myelin’s production that insulates axons surrounding neurons and increases action potential in the central nervous system.

    Part Of Neurons that are Communicating with each Other

    Neuronal communication involves the transmission of electrochemical from one component to another. Synapses refer to the intersection between an axon of one neuron and the dendrite of another neuron where communication takes place (Andreae & Burrone, 2018). With this, the parts of neurons that communicate with one another are axons and dendrites. Axons conduct electrical impulses away from nerve cells to other neurons through a process called an action potential. On the other hand, dendrites comprise neurotransmitter receptors, which are released by neurons. If electrical impulses being released are strong, an action potential will travel down the area of the axon in the terminal buttons to release neurotransmitters in the synapse and completes the process of communication (The University of Queensland, 2017). Neuron communication occurs in the downward direction, which is determined by the action potential NURS 6630 week 1 Assignment: Short Answer Assessment.

    The Concept of “Neuroplasticity.”

    Neuroplasticity/brain plasticity is defined as structural and functional changes that the brain adapts through the formation of new neural connections that result in new experiences in an individual’s environment (Voss et al., 2017). The concept of neuroplasticity describes the human brain’s ability to adapt, learn new skills, store information and memory, and being able to overcome traumatic brain injury. Neuroplasticity occurs through sprouting and rerouting processes naturally or through brain plasticity exercises and cognitive training. Sprouting involves the development of a new connection between neurons, while rerouting is the development of a new neural pathway by eliminating damaged nerve cells where new connections are formed between active neurons. During sprouting, neuron pathways are stimulated by repetitive cognitive functions that reinforce synaptic communication amongst neurons. Examples of neuroplasticity include neurogenesis, synaptogenesis, and long-term potential, and depression. For example, during neurogenesis, new neurons are created in the hippocampus and olfactory bulb. In long-term potential, synapses are strengthened by recurring actions like studying aimed at promoting learning and memory. NURS 6630 week 1 Assignment: Short Answer Assessment

     

    Conclusion

    Indeed, neurons are significant elements of the brain that are involved in the transmission of information to other neurons. A neuron consists of synapses, axons, dendrites, myelin sheath, soma, and a nucleus, which helps in neurotransmission. Therefore, the components allow a human being to manage learning, emotion, memory, and homeostasis activities with ease. NURS 6630 week 1 Assignment: Short Answer Assessment

    References

    Andreae, L. C., & Burrone, J. (2018). The role of spontaneous neurotransmission in synapse and circuit development. 
    Journal of neuroscience research
    , 
    96
    (3), 354-359.

    Beaulieu-Laroche, L., Toloza, E. H., van der Goes, M. S., Lafourcade, M., Barnagian, D., Williams, Z. M., … & Harnett, M. T. (2018). Enhanced dendritic compartmentalization in human cortical neurons. 
    Cell
    , 
    175
    (3), 643-651.

    De Castro, G. M., Deja, N. A., Ma, D., Zhao, C., & Franklin, R. J. (2015). Astrocyte activation via Stat3 signaling determines the balance of oligodendrocyte versus Schwann cell remyelination. 
    The American journal of pathology
    , 
    185
    (9), 2431-2440.

    The University of Queensland (2017). 
    Action potentials and synapses
    . Queensland Brain Institute – University of Queensland. 
    https://qbi.uq.edu.au/brain-basics/brain/brain-physiology/action-potentials-and-synapses

    Surgeon General (2016). The neurobiology of substance use, misuse, and addiction. Retrieved from 
    https://addiction.surgeongeneral.gov/sites/default/files/chapter-2-neurobiology.pdf

    Vertes, R. P. (2015). Major diencephalic inputs to the hippocampus: supramammillary nucleus and nucleus reuniens. Circuitry and function. In 
    Progress in brain research
     (Vol. 219, pp. 121-144). Elsevier.

    Voss, P., Thomas, M. E., Cisneros-Franco, J. M., & de Villers-Sidani, É. (2017). Dynamic brains and the changing rules of neuroplasticity: implications for learning and recovery. 
    Frontiers in psychology
    , 
    8
    , 1657. NURS 6630 week 1 Assignment: Short Answer Assessment

     

    Assignment: Short Answer Assessment

    As a psychiatric nurse practitioner, before you can recommend potential pharmacotherapeutics to address a patient’s condition or disorder, you must understand the basic function and structure of the neuron and central nervous system. For this Assignment, you will review and apply your understanding of neuroanatomy by addressing a set of short answer prompts.

    To Prepare:

    Review the Learning Resources for this week in preparation to complete this Assignment.

    Reflect on the basic function and structure of the neuron in relation to the central nervous system.

    Reflect on the inter-connectedness between neurons and the central nervous system, including the pathway and distribution of electrical impulses. NURS 6630 week 1 Assignment: Short Answer Assessment

    Reflect on how neurons communicate with each other and review the concept of neuroplasticity.

    Photo Credit: Getty Images/Science Photo Libra

    To complete:

    Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

    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. NURS 6630 week 1 Assignment: Short Answer Assessment

    Answer the following (listing is acceptable for these questions):

    What are the major components that make up the subcortical structures?

    Which component plays a role in learning, memory, and addiction?

    What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?

    In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.

    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.

    In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples. NURS 6630 week 1 Assignment: Short Answer Assessment

     

    NURS_6630_Week1_Assignment_Rubric

    Grid View

    List View

    Excellent

    Point range: 90–100

    Good

    Point range: 80–89

    Fair

    Point range: 70–79

    Poor

    Point range: 0–69

    In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous sytem, 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.

    12 
    (16%)
     – 13 
    (17.33%)

    The response accurately and clearly describes in detail the anatomy of the neuron. The response accurately and clearly describes in detail each part of the neuron, and it includes a detailed explanation of the general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse.

    Examples fully support the response provided.

    NURS 6630 week 1 Assignment: Short Answer Assessment

    11 
    (14.67%)
     – 11 
    (14.67%)

    The response accurately describes the anatomy of the neuron. The response accurately describes each part of the neuron, and it includes a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse.

    Examples support the response provided.

    10 
    (13.33%)
     – 10 
    (13.33%)

    The response provides an inaccurate or vague description of the anatomy of the neuron. The response inaccurately or vaguely describes each part of the neuron, and it includes an inaccurate or vague overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse.

    Examples vaguely support the response provided.

    0 
    (0%)
     – 9 
    (12%)

    The response provides an inaccurate or incomplete description of the anatomy of the neuron, or is missing. The response inaccurately or incompletely describes each part of the neuron, and it includes an inaccurate or vague overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse, or is missing.

    Examples do not support the response provided, or is missing.

    Answer the following (listing is acceptable for these questions):

    a. What are the major components that make up the subcortical structures?

    b. Which component plays a role in learning, memory, and addiction?

    c. What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?

    12 
    (16%)
     – 13 
    (17.33%)

    The response accurately and clearly details the major components that make up the subcortical structures.

    The response accurately and clearly details which component plays a role in learning, memory, and addiction.

    The response accurately and clearly identifies the two neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control.

    11 
    (14.67%)
     – 11 
    (14.67%)

    The response accurately identifies the major components that make up the subcortical structures.

    The response accurately identifies which component plays a role in learning, memory, and addiction.

    The response accurately identifies the two neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control.

    10 
    (13.33%)
     – 10 
    (13.33%)

    The response inaccurately identifies the major components that make up the subcortical structures.

    The response inaccurately identifies which component plays a role in learning, memory, and addiction.

    The response inaccurately identifies two neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control.

    0 
    (0%)
     – 9 
    (12%)

    The response inaccurately and incompletely identifies the major components that make up the subcortical structures, or is missing.

    The response inaccurately and incompletely identifies which component plays a role in learning, memory, and addiction, or is missing.

    The response inaccurately and incompletely identifies two neurotransmitters in the nigra striatal region of the brain that play a major role in motor control, or is missing.

    In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.

    12 
    (16%)
     – 13 
    (17.33%)

    The response accurately and clearly explains in detail how glia cells function in the central nervous system.

    Examples fully support the response provided.

    11 
    (14.67%)
     – 11 
    (14.67%)

    The response accurately explains how glia cells function in the central nervous system.

    Examples support the response provided.

    10 
    (13.33%)
     – 10 
    (13.33%)

    The response inaccurately or vaguely explains how glia cells function in the central nervous system.

    Examples inaccurately or vaguely support the response provided.

    0 
    (0%)
     – 9 
    (12%)

    The response inaccurately and vaguely explains how glia cells function in the central nervous system, or is missing.

    Examples do not support the response provided, or is missing.

    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.

    12 
    (16%)
     – 13 
    (17.33%)

    The response accurately and clearly explains in detail the part of the neurons that communicate with each other and the direction in which this communication occurs.

    11 
    (14.67%)
     – 11 
    (14.67%)

    The response accurately explains the part of the neurons that communicate with each other and the direction in which this communication occurs.

    10 
    (13.33%)
     – 10 
    (13.33%)

    The response inaccurately or vaguely explains the part of the neurons that communicate with each other and the direction in which this communication occurs.

    0 
    (0%)
     – 9 
    (12%)

    The response inaccurately and vaguely explains the part of the neurons that communicate with each other and the direction in which this communication occurs, or is missing.

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

    12 
    (16%)
     – 13 
    (17.33%)

    The response accurately and clearly explains in detail the concept of neuroplasticity.

    Examples provided fully support the response provided.

    11 
    (14.67%)
     – 11 
    (14.67%)

    The response accurately explains the concept of neuroplasticity.

    Examples provided support the response provided.

    10 
    (13.33%)
     – 10 
    (13.33%)

    The response inaccurately or vaguely explains the concept of neuroplasticity.

    Examples inaccurately or vaguely support the response provided.

    0 
    (0%)
     – 9 
    (12%)

    The response inaccurately and vaguely explains the concept of neuroplasticity, or is missing.

    Examples do not support the response provided, or is missing.

    Written Expression and Formatting – English writing standards:

    Correct grammar, mechanics, and proper punctuation

    5 
    (6.67%)
     – 5 
    (6.67%)

    Uses correct grammar, spelling, and punctuation with no errors.

    4 
    (5.33%)
     – 4 
    (5.33%)

    Contains a few (1 or 2) grammar, spelling, and punctuation errors.

    3.5 
    (4.67%)
     – 3.5 
    (4.67%)

    Contains several (3 or 4) grammar, spelling, and punctuation errors.

    0 
    (0%)
     – 2 
    (2.67%)

    Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

    Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

    5 
    (6.67%)
     – 5 
    (6.67%)

    Uses correct APA format with no errors.

    4 
    (5.33%)
     – 4 
    (5.33%)

    Contains a few (1 or 2) APA format errors.

    3.5 
    (4.67%)
     – 3.5 
    (4.67%)

    Contains several (3 or 4) APA format errors.

    0 
    (0%)
     – 2 
    (2.67%)

    Contains many (≥ 5) APA format errors.

    Total Points: 75

    Name: NURS_6630_Week1_Assignment_Rubric

    NURS 6630 week 1 Assignment: Short Answer Assessment

  • NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

    NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

    Mini-Mental State Exam (MMSE)

    Health care providers alway use the Mini-Mental State Exam (MMSE)While gathering subjective and objective data to evaluate the mental health status of the elderly. MMSE is a standardized tool used to assess cognitive function changes over time. The 11 items measuring orientation, registration, attention and calculation, recall, ability to follow commands, and language it takes approximately 5 to 10 minutes to administer NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. The maximum score is 30. A score 20 or less may be associated with dementia, and a score of 26 or higher is not associated with dementia.Higher education is associated with higher MMSE scores, even when dementia is present. MMSE has been translated into multiple languages and adapted for many cultures, and in some cases external validity, sensitivity, and specificity have been evaluated (Ball et al., 2019).

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     This test is often used to help diagnose Alzheimer’s disease and dementia. This quantitative-styled survey scores one’s as either zero (incorrect), one (correct), six (item administered, participant does not answer), or nine (test item not administered/unknown). Out of thirty points, a score that ranges between twenty to twenty-four marks mild dementia; thirteen to twenty defines moderate dementia; and anything less than twelve is classified as severe dementia (Alzheimer’s Association, 2019) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. This tool is often used to get a baseline on the degree of dementia and used to evaluate the effectiveness of medications that function to delay the progression of the disease. While the MMSE provides useful information that adds to a mental health diagnosis, this test should not be the only information used. The National Institute on Aging (2017) asserts that in addition to neuropsychological tests such as the MMSE, providers also use laboratory tests and brain scans to validate a diagnosis of dementia. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

    The MMSE method has many advantages. The method is popular and it has a large quantity of data that is readily available to find standards that can be used for comparison in various circumstances and settings. It has been made popular because of its standardized structure that can be applied universally that has enabled it to be accepted by many as a measurement unit and a basis for assessing the severity of CI and DEM (Palsetia et al., 2018). Again its structure enables assessment of various cognitive aspects and its rating scale has been accepted globally for measuring mental functioning  It is very quick and easy to practice where it involves less instructions which can be administered in ten minutes and therefore it can be administered with less training and is widely taught in most institutions.. Their scoring system is standardized which makes it easy to calculate the results. The method can be applied using different languages since instructions are simple and can be applied NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

           The test method also has several disadvantages. The main disadvantage is the fact that the method is not very useful in identifying mild impairment (Palsetia et al., 2018). It also offers problems in detecting changes that occur in severe dementia. The method does not give accurate information for people who are educated because of the ceiling effect (Palsetia et al., 2018). Furthermore, the method does not offer fine details for impairments such as neglect, aphasia and apraxia that occur for people in post-stroke NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. The method does not put more emphasis for memory loss since it is given only three points while orientation and language are given more most points (Palsetia et al., 2018). This shows that the method is not dedicated to assess the core domain for cognitive ability (Palsetia et al., 2018). Furthermore, the lack of full standardization for the method offers another problem. Three words for the registration stage are critical in the memory stage but there are no criteria for choosing these words. Freedom is given to the examiner to choose these three words of which the choice can be affected by several factors such as frequency of use, familiarity, imaginability others. Other items that are not standardized are drawings and calculations. Besides, some of the instructions require reading and writing skills which limits its use on illiterate people.

    In conclusion, MMSE has become a very popular tool for assessing cognitive impairment for older people. Some of the reasons for its popularity is because of shorter instructions, ease of administering and ease of translating the instructions into different languages all over the world. The method fits well for the older generation because it takes a few minutes to complete it. The method reliability was proved to be adequate and its validity was also adequate with a high sensitivity and specificity.

      References

     Alzheimer’s Association. (2019). Medical tests. Retrieved from

    https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests

    Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to

    physical examination: An interprofessional approach (9th ed.) St Louis, MO: Elsevier

    Mosby.

     National Institute on Aging. (2017, December 31). Basics of Alzheimer’s disease and dementia.

    Retrieved from

    https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis

     Palsetia, D., Rao, G. P., Tiwari, S. C., Lodha, P., & De Sousa, A. (2018). The clock drawing test

    versus mini-mental status examination as a screening tool for dementia: A clinical

    comparison. Indian journal of psychological medicine, 40(1), 1-10.

    Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

    Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

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

    To Prepare:

    Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.

    Consider the elements of the psychiatric interview, history, and examination.

    Consider the assessment tool assigned to you by the Course Instructor. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

    By Day 3 of Week 2

    Post
     a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

    Read
     a selection of your colleagues’ responses.

    By Day 6 of Week 2

    Respond
     to at least 
    two
     of your colleagues on 
    2 different days
     by comparing your assessment tool to theirs.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
    Submit!

     

    Week 2 initial post Positive and Negative Syndrome Scale

              This week’s resources give us as students a plethora of information that can help us to diagnose many different psychiatric disorders that we will experience as advance nurse practitioners. The key is to use the tools that will be the most effective and give us the best outcomes for our clients and their families. The decisions we make will help us to diagnose and treat clients effectively and to determine the best tools to use we will be examining those tools individually and together through this discussion forum. The Positive and Negative Symptom Scale may be a tool that can help with the diagnosis of Schizophrenia, Schizoaffective disorder and Schizophreniform however It seems that the reliability of this tool has not been proven to be consistent with different diagnosticians (Kølbæk et al, 2018). Not because it is ineffective, but due to the time constraints which are not always amenable to the client’s condition in a crisis (Kølbæk et al, 2018).

    According to Sadock, Benjamin et al., the psychiatric interview is the most valuable element of the evaluation and care of clients with mental illness (2017). However, without the medical and mental history as well as the examination of the client and questioning of family or people close to the client the diagnosis may be skewed. Many clients with schizophrenia or any diagnosis that has delusional aspects or hallucinations may have knowledge that is corrupt in nature due to the nature of their illness (Andresen et al., 2006). Additionally, a patient may have a medical condition that is causing their psychosis. For this reason, the medical including drug or alcohol use need to be considered and ruled out prior to diagnosing a client with a psychotic disorder (Psychiatry Lecture, 2020).

    The Medical history is the first component I feel is important to the interview of a patient that is having psychosis simply to rule out any organic causes for the psychosis such as infection, trauma or tumor. These things can be ruled out by taking completing blood tests, diagnostic imaging, and a system review. Taking care of the client’s physical needs may be the answer to help resolve his psychosis (Sadock et al, 2017).

    The psychiatric history of the client and the family is a second component that is especially important with psychotic patients. Knowing the history and how long the client has been suffering with the symptoms will help to determine the diagnosis of the client. If the client has been dealing with his or her current symptoms for more than 6 months, and they have a family history of schizophrenia, then the risk for the patient regarding schizophrenia is much higher (American Psychiatric Association, 2013).

    The third component which is particularly important is the history and current use of substances including alcohol, medication, and illegal substances. I believe it is important to talk about all substances including medications the patient is currently taking as well as the amounts they are taking. The client could be taking their prescribed medications incorrectly, causing an exaggerated reaction or side effect which can be remedied easily by educating the client on proper use and dosing (American Psychiatric Association, 2016) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

    The assessment tool assigned to me is the Positive and Negative Symptom Scale (PANSS). This tool is one of many primarily used for diagnosis by giving a reliable method of determining the severity of the symptomology presented by clients in psychosis (Fleishhacker, 2016). The second purpose of the tools for diagnosis of schizophrenia and other psychotic diagnosis’ is to determine the effectiveness of treatment (Fleishhacker, 2016). The PANSS tool which was published in 1987 (Ostergaard, Opler & Correll, 2017) is considered the gold standard for diagnosis of psychotic mental health issues once medical reasons for the psychosis is ruled out (Takeuchi et al, 2016). The psychometric properties of the PANSS have proven this to be an exceptionally reliable and valid instrument for determining the factors in schizophrenia and other psychotic disorders especially for research (Østergaard, Opler, & Correll, 2017). However, the practicality of using this tool with clients who are presenting in crisis is questionable. It requires 45 to 60 minutes of uninterrupted time with a client to administer this test which makes it impractical in many psychiatric intake settings (Kølbæk et al., 2018.)

    This instrument is valuable for research and to help evaluate clients who are stable and able to verbalize their feelings and symptoms. In clinical practice it may be more effective for us as advance practice nurses to use an abbreviated version of this tool such as the 6-item positive and negative syndrome scale (PANSS-6) or the Simplified negative and positive symptom interview (SNAPSI) (Ostergaard, Opler & Correll, 2017).

    The PANSS is a 30 item Positive and Negative as well Global symptoms. Positive symptoms are those that are added to a clients’ “normal” These consist of things like hallucinations, delusions, disorganized concepts, hostility, grandiosity, suspicion, and excitement Negative symptoms are when the client is lacking where his or her personality is concerned. For instance, if a client is not socializing with others. Negative symptoms included on the PANSS are blunted affect, emotional withdrawal, poor rapport, apathy or social withdrawal, problems with abstract thinking, no spontaneity and stereotypical thinking. The third factor of the PANSS is the general psychopathology scale. This consist of 16 items which include anxiety, somatic concerns, depression, poor attention, poor impulse control and preoccupation. The lowest that can be scored on any one of the items is 1. So, the lowest score possible is 30 (Kay, Fiszbein, & Opler, 1987).

    To have a high degree of reliability with this instrument, there must be training for those rating the clients using said instrument (Opler, Yavorsky, & Daniel, 2017). In the case of the PANSS raters there are 4 principles that are required.

    Each item definition and points must be interpreted as literally as possible.

    The highest rating possible must be given if it applies.

    The reference period and time frame must be considered for each item.

    All information given in the interview must be considered for each item, therefore the instrument must be completed after the interview is completed.

    The training for rating this instrument should be included in clinical training (Opler, Yavorsky, & Daniel, 2017).

    This instrument and the other many instruments that are available in psychiatric practice helps me to understand there is still so much to learn. I know that this is only the tip of the iceberg and I am looking forward to using the different tools available to us. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

     

    References

    American Psychiatric Association. (2013). Section I DSM-5 basics. In Diagnostic and statistical manual

    of mental disorders (5
    th
     ed., pp. 5-29). Author.

    https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

    The American Psychiatric Association. (2016). Practice Guidelines for the Psychiatric Evaluation of

    Adults (3
    rd
     ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

    Andresen, B., Moritz, S., Moritz, S., & Woodward, T. S. (2006). Positive and Negative and Disorganized

    Symptoms Scale. 
    Journal of Abnormal Psychology
    , 
    115
    (1), 15–25. N

    Fleischhacker, W. W. (2016). The usefulness of rating scales in patients with schizophrenia. 
    Acta

              Psychiatrica Scandinavica
    , 
    133
    (6), 435. 
    https://doi-

    org.ezp.waldenulibrary.org/10.1111/acps. 12588

    Kay, S.R., Fiszbein, A, Opler, L.A. (1987). The positive and negative syndrome scale (PANSS) for

    schizophrenia. Schizophr Bull. 1987;13:261-276.

    . Kølbæk, P., Blicher, A. B., Buus, C. W., Feller, S. G., Holm, T., Dines, D., O’Leary, K. M., Sørensen,

    R.S., Opler, M., Correll, C. U., Mors, O., Bech, P., & Østergaard, S. D. (2018). Inter-rater

    reliability of ratings on the six-item Positive and Negative Syndrome Scale (PANSS-6) obtained

    using the Simplified Negative and Positive Symptoms Interview (SNAPSI). 
    Nordic Journal of

              Psychiatry
    , 
    72
    (6), 431–436. 
    https://doi-
      de

    org.ezp.waldenulibrary.org/10.1080/08039488.2018.1492014

    Opler, M.G.A., Yavorsky, C., & Daniel, D.G. (2017). Positive and Negative Syndrome Scale (PANSS)

    Training: Challenges, Solutions, and Future Directions. 
    Innovations in Clinical

              Neuroscience
    , 
    14
    (11/12), 77–81.erg/watch/schizophrenia-and-other-psychotic-

    Østergaard, S. D., Opler, M. G. A., & Correll, C. U. (2017). Bridging the Measurement Gap

    Between Research and Clinical Care in Schizophrenia: Positive and Negative Syndrome Scale-6

    (PANSS-6) and Other Assessments Based on the Simplified Negative and Positive Symptoms

    Interview (SNAPSI). 
    Innovations in Clinical Neuroscience
    , 
    14
    (11/12), 68–72.

    Psychiatry Lecture: How to do a Psychiatric Assessment Retrieved December 7, 2020 from

     

    https://www.youtube.com/watch?v=IRiCntvec5Urh/schizophrenia-and-r-psychotic-disorderstch/schizophrenia-and-other-psychotic-disorders NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

    Sadock, Benjamin, et al. 
    Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry
    , Wolters

    Kluwer, 2017.
     ProQuest Ebook Central
    ,

    https://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=5340671
    .

    Takeuchi, H., Fervaha, G., Lee, J., Agid, O., & Remington, G. (2016). A preliminary examination of the

    validity and reliability of a new brief rating scale for symptom domains of psychosis: Brief Evaluation

    of Psychosis Symptom Domains (BE-PSD). 
    Journal of Psychiatric Research
    , 
    80
    , 87–92. 
    https://doi-

    org.ezp.waldenulibrary.org/10.1016/j.jpsychires.2016.06.005

    Classroom Productions (Producer2015). Schizophrenia and other psychotic disor NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

  • Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

    NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

    The Psychiatric Evaluation and Evidence-Based Rating Scale

    According to Saddock, Saddock, and Ruiz (2015), the psychiatric interview is the most important element in the evaluation and care of persons with mental illness.  It is how we obtain information that will drive the criteria-based diagnosis and ultimately, the plan of care.  From the beginning, the interview will establish the client-provider relationship which, can have a profound influence on the outcome of treatment.  Three important elements of the psychiatric interview include past psychiatric illness, mental status exam, and formulation NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

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    Past Psychiatric Illness

    The past psychiatric history should include all psychiatric illnesses, symptoms, and treatment over the patient’s lifespan.  The symptoms should include, when they occurred, how long they lasted, and the frequency and severity of episodes (Saddock, Saddock, & Ruiz, 2015) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.  Special considerations, such as, suicidal or homicidal ideations, and episodes of self-injury should be assessed.  Treatment episodes should include outpatient, inpatient, day, and voluntary/involuntary treatment.  The practitioner should collect and review information about medication use and other modalities such as electroconvulsive therapy (ECT) that have been used and the response experienced by the patient.  Did the patient experience side effects or any other negative effects from the treatment?  Finally, was a diagnosis made in previous episodes that should be considered now.

    Mental Status Exam

    The mental status exam (MSE) is intended to explore all areas of mental functioning and denotes evidence of signs and symptoms of mental illness (Saddock et al, 2015).  The practitioner will begin the MSE upon initiation of the interview through observation, direct questioning, and the cognitive screening.  According to Sadock et al (2015), components of the screening include appearance, behavior, motor, speech, mood, affect, cognition, abstract reasoning, and thought process.  If suicidal ideations are present, intention, methods, motivation, reason for living, and the patient’s therapeutic alliance should also be assessed (American Psychiatric Association, 2016) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

    Formulation

    Formulation consists of the culmination of all the data collected, the diagnosis, recommendations, and treatment planning.  The formulation should include a brief summary of the patient’s history, presentation, and current status (Saddock et al, 2015) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.  Combined, these elements should lead to the differential diagnosis of the patient’s illness as well as the provisional diagnosis.  The formulation should include a summary of the safety assessment, an estimate of the patient’s suicide risk, rationale for treatment selection, and treatment related preferences (American Psychiatric Association, 2016).  All should be explained and collaborated with the patient; differential diagnosis, risks of untreated illness, treatment options, and benefits and risks of treatment (American Psychiatric Association, 2016). NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

    Psychometric Properties of the Geriatric Depression Scale

    The Geriatric Depression Scale has been tested and used extensively with the older population. The GDS is a self-report measure of depression in older adults.  The response is a yes/no format and was formulated because of their high correlation with depressive symptoms in previous validation studies (American Psychiatric Association, 2020).  Of the 15 items on the assessment, 10 indicate the presence of depression when answered positively while the other 5 are indicative of depression when answered negatively (short form) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

    American Psychiatric Association (2020).  
    Geriatric Depression Scale (GDS)
    .  Retrieved from https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/geriatric-depression

    American Psychiatric Association. (2016). 
    Practice guidelines for the psychiatric evaluation of adults (3
    rd
     ed.
    ). https//psychiatriconline.org/doi/pdf/10.1176/appi.books..9780890426760

    Greenberg, Sherry A. (2020).  
    The Geriatric Depression Scale (GDS)
    . Hartford Institute for Geriatric Nursing. Retrieved from https://hign.org/consultgeri/try-this-series/geriatric-depression-scale-gds

    Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

     

    Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

    Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

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

    To Prepare:

    Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.

    Consider the elements of the psychiatric interview, history, and examination.

    Consider the assessment tool assigned to you by the Course Instructor.

    By Day 3 of Week 2

    Post
    a
    brief explanation of three important components of the psychiatric interview and why you consider these elements important
    . Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

    Read
     a selection of your colleagues’ responses.

    By Day 6 of Week 2

    Respond
     to at least 
    two
     of your colleagues on 
    2 different days
     by comparing your assessment tool to theirs.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
    Submit!

    Main Discussion Post

     
    Examining, assessing, and diagnosing the client are all important aspects of being a psychiatric mental health nurse practitioner. Becoming skilled and confident in these areas helps providers to develop appropriate and effective treatment plans. One thing that has been emphasized in our reading this week and last week is the client-provider relationship. The initial assessment is where the provider lays the groundwork for a positive rapport to be developed. Sadock et al. (2015) stated one of the crucial aspects of the examination is showing empathy while retaining objectivity. Providing privacy, confidentiality, respect, and comfort are all significant factors of the assessment process as well. American Academy of Child and Adolescent Psychiatry (1995) recommended providers approach the interview with three things in mind: to obtain a diagnosis, determine if treatment will be indicated, and develop a treatment plan that will keep the client engaged. One of the objectives for this class is to feel confident with assessment tools and deciding which ones are appropriate for which clients. This post will discuss three important components of the psychiatric interview. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion I will also be discussing the Positive and Negative Symptom Scale (PANSS) and how the provider uses it to determine appropriate diagnoses and treatment.

     
    The psychiatric interview, also referred to as an examination or assessment, is complex and time-consuming. With a cooperative client, the process can still take around an hour to complete. Three crucial components of the interview include the social history, family history, and past medical history NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. The social history gives the provider vital information about how the client functions and what kinds of coping skills they currently employ. This part of the interview also allows the provider to assess the client’s use and history with illicit drugs and alcohol. Sadock et al. (2017) recommended approaching this section of the interview carefully, as the provider will need honest information to get a clear picture of the client’s situation. Asking questions about substance use and abuse should be done without judgment. This tactic includes tone of voice, inflection, and body language. This information is critical in determining which symptoms could be related to substance abuse and what treatment would be most appropriate for each individual client. An example would be a client who presents with attention deficit disorder and reveals that they have a history of meth use. In this case, the provider would probably want to steer away from effective medications such as Adderall due to the possibility of abuse NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.
     

     
    Many psychiatric disorders have a genetic component that can be assessed during the interview’s familial history portion. The provider can use this information to determine an accurate diagnosis and treatment. For example, if a client came in complaining of symptoms that seemed to align with anxiety and then stated her mom, sister, aunt, and grandmother all had been diagnosed with anxiety, it is very likely the client has a genetic predisposition for that particular disorder. Because genetics can also affect how successful treatment is, it could be useful to know how the client’s family responded to treatment. Another significant part of the family history is the history of suicide attempts and aggressive behaviors. American Psychiatric Association (2016) found that a family history of suicidal ideation and aggression puts the client at higher risk for the same behaviors. As a provider, I would use this information to focus a few more questions in these areas for a clearer picture of my client’s situation.
     

     
    A client’s past medical history is important for a variety of reasons. A medical history can give the provider insight into possible risk factors for mental disorders. It also will affect how the provider develops a treatment plan. American Psychiatric Association (2016) stated that the provider would also need to determine how any current medical conditions could be affecting the presentation of symptoms and how that will influence the diagnosis. An example of this could be head injuries. The medical history is also important because it will cover any allergies or drug sensitivities the client may have had in the past. Providers use this information when developing their treatment plan if it includes medications. Another crucial component of the medical history is the current medications and supplements the client is taking. The provider will need to ensure that anything they propose to add to the client’s regimen will not cause adverse effects. Lastly, a past medical history gives the provider insight into other professionals they can collaborate with regarding the client. The physical health of the client is important and should be monitored while receiving psychiatric treatment.
    NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

     
    One tool that can be used during a psychiatric interview is the PANSS. This tool is used to determine the severity of the disorder and the client’s quality of life. Once the diagnosis of schizophrenia is decided on, this tool can be used to determine the direction of effective treatment. Therefore, this tool is only used at the end of an interview and only when the client has been appropriately diagnosed with schizophrenia. The symptoms of schizophrenia are classified as positive and negative. Positive symptoms include things like hallucinations, delusions, paranoia, and grandiosity. Negative symptoms include social withdrawal, blunted affect, difficulty communicating with a natural flow, and apathy. This assessment can take up to 45 minutes, so it may be beneficial to schedule a time to perform just this assessment after the first consultation and diagnosis are complete. Depending on the client’s condition, the provider should also plan to include caregivers during the evaluation and information gathered from previous providers. The client is rated in 30 different areas from one to seven. The areas are broken down into positive symptoms, negative symptoms, and general psychopathology NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. There is a PANSS-6 that only assesses six of the core symptoms of schizophrenia and a Simplified Negative and Positive Symptoms Interview (Kølbæk et al., 2018). These could be used in place of the more detailed assessment if time were a factor. One study I researched found that vitamin D levels directly correlated to the PANSS score. Prasanty et al. (2018) stated that the lower the level of vitamin D, the higher the PANSS score was. Ordering a vitamin D level would be worthwhile when treating a client with schizophrenia.
     

     
    Psychiatric interviews should be client-centered, and the treatment should reflect the client’s goals, not those of the provider (Sadock et al., 2015). Client-centered interviews and treatment focus on the client’s strengths and culture, as well as areas identified by the client that need work. Providers should take the interview as an opportunity to begin a solid foundation of collaborative decision making between them and the client. Open-ended questions are helpful at the beginning of the interview, with more focused questions used to clarify the information required to determine differential diagnoses and treatment. Prioritizing the client’s symptoms and diagnoses will also be an important aspect of the assessment because many clients have comorbid conditions. The client’s social history, family history, and past medical history are all crucial aspects of the psychiatric interview.
    NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

     

    References

    American Academy of Child and Adolescent Psychiatry. (1995).
     
    Practice parameters for the assessment and treatment of children and adolescents.
     
    https://www.aacap.or/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessments_practice_parameter.pdf

    American Psychiatric Association. (2016).
     
    Practice guidelines for the psychiatric evaluation of adults.
     
    (3
    rd
    ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.boooks.9780890426760

    Kølbæk, P., Blicher, A. B., Buus, C. W., Feller, S. G., Holm, T., Dines, D., O’Leary, K. M., Sørensen, R. S., Opler, M., Correll, C. U., Mors, O., Bech, P., & Østergaard, S. D. (2018). Inter-rater reliability of ratings on the six-item Positive and Negative Syndrome Scale (PANSS-6) obtained using the Simplified Negative and Positive Symptoms Interview (SNAPSI).
     
    Nordic Journal of Psychiatry
    ,
     
    72
    (6), 431–436. https://doi-org.ezp.waldenulibrary.org/10.1080/08039488.2018.1492014

    Prasanty, N., Amin, M. M., Effendy, E., & Simbolon, J. (2018). Low vitamin D serum level increases severity symptoms in schizophrenic patients measured by Positive and Negative Symptoms Scale (PANSS) in Batak Tribe Sumatera Utara, Medan-Indonesia.
     
    Bali Medical Journal, 7
    (1), 249-254. https://doi-org.ezp.waldenulibrary.org/10.15562/bmj.v7i1.921

    Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015).
     
    Kaplan & Sadock’s synopsis of psychiatry
    (11
    th
    ed.). Philadelphia, PA: Wolters Kluwer.

    Sadock, B. J., Sadock V. A., & Ruiz, P. (2017).
     
    Kaplan and Sadock’s concise textbook of clinical psychiatry
     
    (4
    th
    ed.). Philadelphia, PA: Wolters Kluwer. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

  • Hamilton Anxiety Rating Scale (HAM-A)

    Hamilton Anxiety Rating Scale (HAM-A)

    Week 2 Initial Post

               The psychiatric interview is the basis upon which all the other work of the PMHNP is based. It is during this assessment that the key data points are collected that are needed for diagnosis and treatment planning. The purpose of this discussion to briefly explain three components of the psychiatric interview and to look at the psychometric properties of the Hamilton Anxiety Rating Scale.

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                The first component, and arguably the most important, is the history of present illness (HPI). This section discusses, chronologically, the events and the symptoms that lead the client to seek treatment. It also covers other changes that may impact these symptoms, such as interpersonal relationships, personal habits, physical health, and behaviors (Sadock, Sadock, and Ruiz, 2017). Because this part of the interview sets the tone for the remainder of the visit, and also allows for the collection of data relating to the client’s primary concerns, it is critical for a proper diagnosis and treatment plan Hamilton Anxiety Rating Scale (HAM-A).

    The second component this post will discuss is the past psychiatric history (PH). This piece allows the provider to obtain relevant data related to the client’s psychiatric illnesses, including symptoms and treatment over the course of their lifetime (Sadock, Sadock, and Ruiz, 2017). These elements are important, as they help to create a complete picture of the mental illness that the client is seeking help for.

    The third component is the family history. Hamilton Anxiety Rating Scale (HAM-A) This part of the interview covers mental health diagnoses, substance use issues, and suicidal or violent behaviors in biological relatives (American Psychiatric Association, 2016). This information is important, as genetic links have been found to influence the development of psychiatric illness in individuals.

    In addition to the psychiatric interview, clinicians often use rating scales to get a clearer picture of the symptoms that clients report, such as severity, triggers, and other variables. For anxiety, the Hamilton Anxiety Rating Scale (HAM-A) is often utilized by practitioners. This scale discusses fourteen symptoms of anxiety, ranging from anxious mood to autonomic symptoms, and asks the client to rate them from 0, or not present, to 4, or very severe (Hamilton, 1959). It would be appropriate to use this scale during the history of present illness portion of the psychiatric interview (American Psychiatric Association, 2016). Utilizing the HAM-A at this point of the interview allows the PMHNP to determine if the described symptoms do support the diagnosis of anxiety and to what severity.

    In conclusion, the psychiatric interview is crucial to the assessment, diagnosis, treatment planning, and evaluation of clients with mental health issues. Each section allows the collection of critical data for the PMHNP to utilize. In addition, clinical rating scales add to this information and allow for an objective piece of data to support the subjective data collected during the interview. When taken together, the big picture of a client’s concerns can be formulated and needs addressed. Hamilton Anxiety Rating Scale (HAM-A)

    References

    American Psychiatric Association. (2016
    ). Practice guidelines for the psychiatric evaluation of adults (3rd ed.)
    . https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

    Hamilton, M. (1959). Hamilton anxiety rating scale (HAM-A). 
    Br J Med Psychol 1959
    ; 32:50–55. Retrieved from https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf

    Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. 
    Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed.)
    . pp. 9–15. Wolters Kluwer.

    responses

    Thank you for an informative and interesting post on the Hamilton Anxiety Scale (HAM-A). This tool is a widely used interview scale that measures the severity of a patient’s anxiety. The scale predates the current definition of generalized anxiety disorder (GAD). However, it covers many of the features of GAD and can be helpful also in assessing its severity (Porter et al., 2017). The major value of the HAM-A is to document results of the psychotherapy, rather than as a diagnostic or screening tool. It takes roughly 15 minutes to complete the interview and scoring. Each item is given a 5 point score, 0 (not present) to 4 (severe). The questionnaire consist of a total of 14 questions (Porter et al., 2017). The scale has demonstrated high levels of accuracy and validity, and the results give important clues to possible mental disorders that warrant follow-up by a health care provider (Porter et al., 2017).

    The assessment tool I chose was the CAGE Questionnaire. This test is widely used and measures the possibility of alcohol dependency. The test is composed of a total of 4 yes or no questions. Each question answered yes increases the chances of alcohol dependency. Answering with 2-3 yes responses often indicates alcohol abuse or dependency (Bush et al., 2016). The CAGE questionnaire aims to evaluate the current state of an individual rather than long-term (Bush et al., 2016). The questionnaire is reported to accurately identify people with alcohol dependency 93 percent of the time (Bush et al., 2016). This makes the questionnaire relatively accurate, and a quick way to screen people for alcohol dependency.

    References

    Bush, B., Shaw, S., Cleary, P., Delbanco, T. L., & Aronson, M. D. (2016). Screening for alcohol abuse using the cage questionnaire. 
    The

                   American Journal of Medicine
    , 
    82
    (2), 231–235. 
    https://doi.org/10.1016/0002-9343(87)90061-1

    Porter, E., Chambless, D. L., McCarthy, K. S., DeRubeis, R. J., Sharpless, B. A., Barrett, M. S., Milrod, B., Hollon, S. D., &

    Barber, J. P. (2017). Psychometric properties of the reconstructed hamilton depression and anxiety scales. 
    The

                Journal of 
    Nervous and Mental Disease
    , 
    205
    (8), 656–664. 
    https://doi.org/10.1097/nmd.0000000000000666

     

     

    Thank you for your insight on the Hamilton Anxiety Rating Scale (HAM-A) and your overall view of the psychiatric evaluation. The

    American Psychiatric Association also states that in the initial exam the interviewer may have to return to elaborate on certain aspects of the exam depending on the presentation of the client (2016).  I think it is important for us to remember as you indicated that we need to focus on the presenting problem and not get to tied up with making sure that every single line item on the intake exam be covered on the first visit.

    I am dealing with a patient who has a huge amount of anxiety. His issues are overwhelming to him. He has Congestive Heart Failure, debilitating arthritis and now he is positive with Covid-19.  He is so afraid that it will get in his lungs and kill him. His pain with the arthritis sends him in a tailspin and he feels like his worst problem is Covid-19.  His oxygen saturation is 99% when he says he cannot catch his breath. He has perseverated about having this dreaded virus since he tested positive 3 weeks ago. He is still saying he does not want it to get into his lungs and kill him. However, he is refusing to do anything such as taking medication or supplements or even a breathing treatment when he is feeling short of breath. His breath sounds are clear. He is not suffering from Covid related shortness of breath, but his anxiety is making him feel like he is at deaths door.

    I think the clients’ medical history is extremely important to how they are presenting. A head-to-toe exam may help the patient who is suffering from anxiety, feeling like they are surely dying to have some comfort. A physical exam with laboratory testing may help this patient to relax so that he can recover more effectively from the Covid. In case studies done with current heart patients, anxiety can cause clients to manifest the symptoms they fear the most (Giannitsi et al.,2020) (Tully, Cosh, & Baumeister, 2014) Hamilton Anxiety Rating Scale (HAM-A).

    References

    The American Psychiatric Association. (2016). Practice Guidelines for the Psychiatric Evaluation of

    Adults (3
    rd
     ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

    org.ezp.waldenulibrary.org/10.1080/08039488.2018.1492014

    Giannitsi, S., Tsinivizov, P., Poulimenos, L. E., Kallistratos, M. S., Varvarousis, D., Manolis, A. J.,

    Tsamakis, K., Rizos, E., Spandidos, D. A., Tsiptsios, D., & Triantafyllis, A. S. (2020). [Case Report]

    Stress induced (Takotsubo) cardiomyopathy triggered by the COVID-19 pandemic. 
    Experimental &

              Therapeutic Medicine
    , 
    20
    (3), 2812./watch/schizophrenia-and-other-psychotic-

    Tully, P. J., Cosh, S. M., & Baumeister, H. (2014). The anxious heart in whose mind? A systematic review

    and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity

    risk in coronary heart disease. 
    Journal of Psychosomatic Research
    , 
    77
    (6), 439–448 
    https://doi-

    org.ezp.waldenulibrary.org/10.1016/j.jpsychores.2014.10.001 Hamilton Anxiety Rating Scale (HAM-A)

    Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

    Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

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

    To Prepare:

    Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.

    Consider the elements of the psychiatric interview, history, and examination.

    Consider the assessment tool assigned to you by the Course Instructor.

    Hamilton Anxiety Rating Scale (HAM-A)

    By Day 3 of Week 2

    Post
     a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

    Read
     a selection of your colleagues’ responses.

    By Day 6 of Week 2

    Respond
     to at least 
    two
     of your colleagues on 
    2 different days
     by comparing your assessment tool to theirs.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
    Submit! Hamilton Anxiety Rating Scale (HAM-A)

  • Discussion: Networking Opportunities

    Discussion: Networking Opportunities Introduction

    My name is xxxx. I am a native of xxx. I have been living in America with my family for the past eleven years. This year in May mark my five years of becoming a nurse. I love my being a nurse, and I find so much happiness and passion in it. I have worked in various settings in the last five years, and I have enjoyed taking care of every kind of population. I want to learn more in-depth about the disease process and medications with advanced degrees and training. Hence the Family Nurse Practitioner is something that incorporates all my clinical experiences at an advanced level.

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    My Goals and University Vision and Mission 

     
    As a nurse, I think it is important to have a career goal to progress and succeed. According to the American Nurses Association’s (ANA) 2015 Code of Ethics for Nurses with Interpretive Statements, it is the nurse’s responsibility to maintain competence and incorporate fundamental values and duties beyond individual patient interactions to practice within an ever-changing healthcare environment. Nursing requires ongoing training and education, and there are many specialties in healthcare to learn and grow. Discussion: Networking Opportunities

    My ultimate goal is to become a Family Nurse Practitioner (FNP). I looked into several universities to obtain my degree in Family Nurse Practitioner. Among all the universities, I found Walden University to be one that meets my career goal. According to Walden University (WU) of Nursing’s vision statement, the degrees offer diverse specialization and an opportunity for growth (University, Vision, Mission, and Goals, 2020). From WU’s vision statement, the degree from them will be useful and relevant to help the graduate try to solve society’s problems around the world. Discussion: Networking Opportunities

     
    Our country is very diverse, and we are increasingly getting patients from all different religious backgrounds. Walden University’s (2020) mission is to “provide a diverse community of career professionals with the opportunity to transform themselves as scholar-practitioners so that they can effect positive social change.” I want to be able to provide essential care with mutual respect and evidence-based knowledge to all those from different backgrounds.

    WU’s goals and outcomes match my academic and professional goals. Upon completing the program, I hope to have a deeper understanding of nursing theories and emphasize ethical and critical decision-making skills.

    I hope to learn to apply my leadership skills in the provision of high-quality nursing care.

    Incorporation of Social Change 

    WU wants its graduates to obtain knowledge and skills that will help them make the world a better place. Professional nursing is defined as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (Epstein, B., Turner, M. 2015). For me, nursing is the holistic care of all kinds of patients, regardless of their age, gender, race, and religion, in a comfortable environment with full confidentiality, right, and respect of a patient. I plan to bring positive change into practice settings, meet the patient’s unique, holistic needs, and make an incredible difference in the patient’s healthcare experience. Discussion: Networking Opportunities

    Academic and professional collaboration

    English is my third language. Due to the language barrier, I often struggle with academic and professional development. I will be taking advantage of Walden’s writing center and academic skills center to help to grow academically. My professional goal is to continue to work full time as a float pool nurse. Discussion: Networking Opportunities

     

    References

     

    Epstein, B., Turner, M., (May 31, 2015) “The Nursing Code of Ethics: Its Value, Its

    History” 
    OJIN: The Online Journal of Issues in Nursing
    . Retrieved from 
    http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/The-Nursing-Code-of-Ethics-Its-Value-Its-History.html

     

    Fowler, M. D. M. (2015). 
    Guide to the code of ethics for nurses with interpretive
     

    statements: development, interpretation, and application
    . American Nurses Association. Retrieved from 
    http://search.ebscohost.com.ezproxy.coloradomesa.edu/login.aspx?direct=true&db=cat01465a&AN=cmu.b54440063&site=eds-live&scope=site

     

    Walden University
    . (2020). Vision, Mission, and Goals. Retrieved June 1, 2020,
     

    from 
    https://catalog.waldenu.edu/content.php?catoid=172&navoid=59420

     

     

     

    response

    Hi xxx, in response to your comment about the need of culturally competent professionals to address our ever-changing society, I believe it’s an important component in today’s healthcare system so each patient gets the best care they deserve. There is an overwhelming evidence which suggests that providing sensitive care using patient-centered culturally sensitive care yields better outcomes for patients and the healthcare system overall, as it was published in the journal of Health Psychology. This article titled, “Patient-Centered Culturally Sensitive Health Care: Model Testing and Refinement”, presents a model to improve care for ethnically diverse patients seen in community-based primary care clinics (Tucker, Marsiske, & Rice, 2011).

    Choosing Walden’s university was the right step toward your goal, becoming FNP. As you’ve mentioned, graduating to a diverse society requires professionals equipped with a new set of skills. Discussion: Networking Opportunities. As we all know, America’s diversity will continue growing each year and the health disparities will grow along with it, as predicted. However, if nurses and other healthcare providers take action in culturally and socially competent ways, then health disparities may be “altered, and the mandate to reduce and ultimately eliminate disparities may be realized sooner” (Giger et al, 2007). I look forward collaborating with you!

    References

    Giger, Joyce & Davidhizar, Ruth & Purnell, Larry & Harden, J & Phillips, Janice & Strickland, Ora. (2007). American Academy of Nursing Expert Panel Report. Journal of transcultural nursing : official journal of the Transcultural Nursing Society / Transcultural Nursing Society. 18. 95-102. 10.1177/1043659606298618.

    Tucker, C. M., Marsiske, M., Rice, K. G., Nielson, J. J., & Herman, K. (2011). Patient-centered culturally sensitive health care: model testing and refinement. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 30(3), 342–350. 
    https://doi.org/10.1037/a0022967

     

    Discussion: Networking Opportunities

    In this module, you begin laying the foundation for your academic and professional success. Your efforts begin with a vision that includes your own definition of success. Your vision may vary from those of your colleagues, but this does not mean you have to take these first steps alone.

    Walden University and the College of Nursing also have a vision and mission, which include helping you to make your own vision a reality. Members of your new academic community, such as faculty, support teams, and fellow students, can also be helpful. Current practitioners and other member of the professional community can also help you to clarify your vision.

    This Module’s Discussion asks you to consider how the Walden mission and vision as well as the College of Nursing’s mission and vision apply to your professional and academic goals. You will also begin to identify individuals and teams who can help you along the way as you begin designing the “blueprint”—your Academic Success and Professional Development Plan—that will guide you toward your own vision for academic and professional success.

    To Prepare:

    Review the Walden and College of Nursing mission and vision statements, Walden’s goals and University Outcomes, and the MSN Program Learning Outcomes presented in this Module’s Learning Resources.

    Reflect on your professional and academic goals as they relate to your program/specialization.

    Consider how the information in these resources fit with your own goals and to your becoming a scholar-practitioner.

    Also consider academic and professional individuals and teams with whom you may collaborate in support of your efforts as a student at the university and as a professional within your organization and career. Discussion: Networking Opportunities

    By Day 3 of Week 1

    Post
     a brief introduction of yourself to your colleagues. Include an explanation as to how Walden’s vision, mission, goals, and social change initiatives relate to your professional and academic goals and to your becoming a scholar-practitioner. Also include an explanation for how the Walden MSN Program Outcomes and perspectives relate to your professional and academic goals and to your becoming a scholar-practitioner.

    By Day 6 of Week 1

    Respond
     to at least 
    two
     of your colleagues’ posts by suggesting additional individuals and/or teams with whom you wish to collaborate or by offering additional networking strategies.

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    Hello my name is xxx and I am enrolled in the Post Masters Psychiatric NP program.  I reside in Virginia Beach Virginia and I am a traveling nurse.  I enrolled in the Post Master Psychiatric program in hopes to  address and identify problems and challenges within communities.

    Walden University was founded on the platform and need for social change in the community by expanding access to higher education. The mission of the University is to provide a diverse community of career professionals with the opportunity to transform themselves as scholar- practitioners to effect positive social change (Walden University, 2020). Discussion: Networking Opportunities This is especially significant to me as I am on the path to becoming a psychiatric nurse practitioner, and I understand the need for knowledgeable and skilled practitioners to practice in the community and effect change. Through the program at Walden, I expect that I will be equipped with the skills that will enable me translate research and knowledge into practice, to address the issues affecting the psychiatric patients in the community. This is also in line with the vision of the University where the aim is to ensure that the knowledge gained can be applied by the graduates to address key issues in the society (Walden University, 2020) Discussion: Networking Opportunities. As a graduate psychiatric nurse practitioner, I expect that with the combination of the knowledge and skills gained, I will be able to identify challenges in the community and apply the same to develop solutions (Kverno, 2016). I also expect that I will be able to improve practice by applying knowledge based on the context and needs of the patients to advance social change and improve patient outcomes.

    The Walden MSN program outcomes have a focus on meeting the demand for mental health providers who are equipped with advanced skills and practicum training for the provision of care. Through these, I will be able to meet my professional and academic goals by becoming knowledgeable and equipped in the use of evidence based practice in the provision of care. This will require me to be able to engage in and utilize research in my practice to identify new output and interventions that have been identified through research, and apply them to my clinical context while considering the needs of the patient (Kverno, 2016). Through this, I will be on the way to becoming a scholar practitioner by translating evidence into practice to ensure improved patient outcomes. Discussion: Networking Opportunities

    References

    Kverno, K. (2016). Promoting access through integrated mental health care education. 
    The Open Nursing Journal
    , 
    10
    , 73.

    Walden University. (2020). About Walden. Retrieved from: 
    https://www.waldenu.edu/about
     Discussion: Networking Opportunities

  • Yale-Brown Obsessive-Compulsive Scale

    Yale-Brown Obsessive-Compulsive Scale

    Psychiatric Interview Components

    One important component of the psychiatric interview is gathering the history of present illness (HPI) (Carlat, 2017). One piece of the HPI is gathering information on the current and premorbid level of functioning (Carlat, 2017). I find this component important because it establishes which symptoms of the illness may be interfering with the patient’s daily activities. For example, a patient may state that their anxiety has gotten to the point where they are no longer able to participate in family gatherings, which is something they once enjoyed. In addition, this establishes a baseline for the patient (Carlat, 2017). This information may establish treatment goals for the patient. Yale-Brown Obsessive-Compulsive Scale

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    A second component of the psychiatric interview is obtaining a family psychiatric history (Carlat, 2017). I find this component of the interview important because oftentimes psychiatric illnesses, or risk of substance use disorders, have a familial tie. For example, for a patient presenting to the clinic with depressive symptoms that have a significant family history of bipolar, it may be pertinent to inquire about symptoms of mania that the patient may not recognize as symptoms of a psychiatric disorder.

    A third component of the psychiatric interview is obtaining a psychiatric history (Carlat, 2017). I find this piece of the psychiatric interview important because it gathers information about past treatments and the age of onset of symptoms (Carlat, 2017) Yale-Brown Obsessive-Compulsive Scale. It is important for a clinician to know which treatments were already tried and whether or not they were successful.

    Psychometric Properties

    The rating scale that I was assigned to explore and discuss is the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Originally developed for adults, this is a ten-item scale that establishes the severity of Obsessive-Compulsive Disorder (OCD) after a formal diagnosis is made (Stanford Medicine, 2020). The scale was developed in 1989, it showed psychometric properties in measuring the effects of medication and psychotherapy for the treatment of OCD (Castro-Rodrigues et al., 2018). However, the original scale showed a weakness in measuring severe cases and inconsistently measuring resistance to obsessions (Castro-Rodrigues et al., 2018).

    The scale was revised in 2000, now known as the Y-BOCS-II (Castro-Rodrigues et al., 2018). Items in the scale were rephrased and the order of assessments were changed; this is now used as the gold standard to measure the severity of OCD symptom (Castro-Rodrigues et al., 2018) Yale-Brown Obsessive-Compulsive Scale.

    Rating Scale Used in Practice

    As stated above, the Y-BOCS is not used to make a case for the diagnosis of OCD, but rather establish the severity of symptoms. A clinician may implement this assessment and then share it with their patient in an attempt to assist the patient in recognizing the severity of their symptoms, and which symptoms may be part of their illness (Standford Medicine, 2020). In addition, a response to treatment may be measured through a decrease in scoring on the sale (Stanford Medicine, 2020).The revised scale, Y-BOCS II, has been found to have excellent psychometric properties in the measurement of the severity of OCD symptoms (Castro-Rodrigues et al., 2018) Yale-Brown Obsessive-Compulsive Scale.

    Since its creation in 1989 for use in adult patients, the scale has been modified to assess children and adolescents (Lopez-Pina et al., 2015). In addition to assessing the severity of symptoms in OCD, the scale is useful in measuring the severity of symptoms where compulsions are a symptom of the disorder; for example, such as eating disorders, gambling, etc. (Lopez-Pina et al., 2015).

    References

    Carlot, D. (2017).
    The psychiatric interview
    (4
    th
    ed.). Wolters Kluwer.

    Castro-Rodrigues, P., Camacho, M., Almeida, S., Marinho, M., Soares, S., Barahona-

    Correa, J., & Oliveira-Maia, A. (2018). Criterion validity of the Yale-Brown Obsessive-Compulsive Scale second edition for the diagnosis of obsessive-compulsive disorder in adults.
    Frontiers in Psychiatry, 9,
    431. https://www.frontiers.org/articles/10.3389/fpsyt.2018.00431/full Yale-Brown Obsessive-Compulsive Scale

    Lopez-Pina, J., Sanchez-Meca, J., Lopez-Lopez, J., Marin-Martinez, F., Nunez-Nunez,

    R., Rosa-Alcazar, A., … & Ferrer-Requena, J. (2015). The Yale-Brown Obsessive-Compulsive Scale: a reliability generalization meta-analysis.
    Assessment, 22
    (5), 619.628. https://www.researchgate.net/profile/Ja-Lopez-Pina/publication/266380252_The_Yale-Brown_Obessive_Compulsive_Scale/links/550090d70cf2de950a6ea031/The-Yale-Brown-Obsessive-Compulsive-Scale.pdf

    Stanford Medicine. (2020). Obsessive-compulsive and related disorders.

    https://med.stanford.edu/ocd/about/diagnosis.html Yale-Brown Obsessive-Compulsive Scale

     

    Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

    Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy. Yale-Brown Obsessive-Compulsive Scale

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

    To Prepare:

    Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.

    Consider the elements of the psychiatric interview, history, and examination.

    Consider the assessment tool assigned to you by the Course Instructor.

    By Day 3 of Week 2

    Post
     a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

    Read
     a selection of your colleagues’ responses.

    By Day 6 of Week 2

    Respond
     to at least 
    two
     of your colleagues on 
    2 different days
     by comparing your assessment tool to theirs.

    Note:
     For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
    Submit! Yale-Brown Obsessive-Compulsive Scale

     

    Responses

    Thank you for your very educational post.  I enjoyed reading yours and our colleagues’ posts this week because I am learning a lot in terms of various evidence-based rating scales.  I admit I am only familiar with a very few and those that we use in the hospital for our interviews and assessments with patients. Yale-Brown Obsessive-Compulsive Scale

    Your post caught my attention because I have never heard of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).  This is one scale that we do not normally use in our hospital setting as clinicians.  Upon further research, I found out that The YBOCS was developed in the late 1980s by Drs Wayne Goodman and Dennis Charney to measure the severity of symptoms in OCD (Yale School of Medicine, n.d.).  As you mentioned, it has ten items rated based on a semistructured interview. The first five items concern obsessions: the amount of time that they consume, the degree to which they interfere with normal functioning, the distress that they cause, the patient’s attempts to resist them, and the patient’s ability to control them. The remaining five items ask parallel questions about compulsions (Sadock et al., 2015).  This scale is considered the gold standard to evaluate OCD.  According to Rector and Arnold (2016), the Y-BOCS was designed to measure and compare the efficacy of treatments, initial medical treatment, and then CBT in the field of OCD.  Sadock et al., (2015), added that the YBOCS has become the standard instrument for assessing OCD severity and is used in virtually every drug trial. It may also be used clinically to monitor treatment response.  This scale has been used in the first clinical trials demonstrating the efficacy of the medications that are now standard treatments for the disorder – the SSRIs and the neuroleptics. Yale-Brown Obsessive-Compulsive Scale

    References

    Rector, N., & Arnold, P. (2016, March). Yale-Brown Obsessive Compulsive Scale. Retrieved December 10, 2020, from https://www.sciencedirect.com/topics/medicine-and-dentistry/yale-brown-obsessive-compulsive-scale

    Sadock, B. J., Ruiz, P., & Sadock, V. A. (2015). 
    Kaplan et Sadocks synopsis of psychiatry: Behavioral sciences, clinical psychiatry
     (11th ed.). Philadelphia: Wolters Kluwer.

    Yale School of Medicine. (n.d.). History of the Clinic. Retrieved December 10, 2020, from https://medicine.yale.edu/psychiatry/ocd/aboutus/history/ Yale-Brown Obsessive-Compulsive Scale

     

     

     

    Thanks for your post!

    When comparing the Hamilton Anxiety Rating Scale to the Yale-Brown Obsessive-Compulsive Scale, similarities become quickly apparent. Because Obsessive-Compulsive disorder is a specific type of anxiety disorder, it makes sense the two scales would address some of the same symptoms (Storch, et al., 2010). Like the HAM-A, the Y-BOCS is used to establish the severity of symptoms, but not as a tool for diagnosis. Both scales are subjective and require the provider to observe clinical presentation in addition to the scale results themselves, and then to interpret accordingly. Though the Y-BOCS is directed at a more specific subset of symptoms, they are very comparable in their purpose. Yale-Brown Obsessive-Compulsive Scale

    References

    Hamilton, M. (n.d.). Hamilton anxiety rating scale (HAM-A). 
    Br J Med Psychol 1959
    ; 32:50–55. Retrieved from https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf

    Storch, E. A., Rasmussen, S. A., Price, L. H., Larson, M. J., Murphy, T. K., & Goodman, W. K. (2010). Yale-Brown Obsessive-Compulsive Scale–Second Edition. 
    Psychological Assessment,
    22(2), 223–232. Yale-Brown Obsessive-Compulsive Scale