The only approved therapy in the United States for moderate to severe Alzheimer’s disease is which of the following? – NRNP 6675 Final Exam Walden University
Question 4 1 pts
The only approved therapy in the United States for moderate to severe Alzheimer’s disease is which of the following?
Group of answer choices
Donepezil
Memantine
Rivastigmine
Galantamine
Nurse Practitioner Professional Career Planner
As you approach the end of your Master of Science in Nursing program and prepare for a career as a nurse practitioner, you will want to create a cover letter, resume, and portfolio that best represent your knowledge, skills, and abilities as a professional in the field of nursing.
For this Assignment, you will create a Career Planner, which includes these elements, that you can use as you pursue your next professional role.
To Prepare
Review the Career Planner Guide. This document contains the requirements for the Assignment as well as resources to consult.
Seek out other resources on cover letters, resumes, and other professional resources, as needed. The Walden University Career Planning and Development site has information on many topics of relevance
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
The Assignment
Develop a cover letter, resume, philosophy statement, and other professional resources that meet the requirements outlined in the Career Planner Guide.
By Day 7 of Week 10
Submit
your Career Planner.
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the
Turnitin Drafts
from the
Start Here
area.
To submit your completed assignment, save your Assignment as
WK10Assgn1_LastName_Firstinitial
Then, click on
Start Assignment
near the top of the page.
Next, click on
Upload File
and select
Submit Assignment
for review.
Rubric
NRNP_6675_Week10_Assignment1_Rubric
NRNP_6675_Week10_Assignment1_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
The cover letter is: • Presented and formatted in professional business manner • Addressed properly • Clear and concise (no more than one page) and includes an introduction, body, and conclusion• Written in a professional tone
10
to >
8.0
pts
Excellent 90%–100%
Response is presented and formatted in a very clear and professional business manner…. Response is addressed properly…. Response is clear and concise (no more than one page) and includes a well-written and compelling introduction, body, and conclusion…. Response uses a professional tone.
8
to >
7.0
pts
Good 80%–89%
Response is presented and formatted in a clear and professional business manner…. Response is addressed properly…. Response is clear and concise (no more than one page) and includes an appropriate introduction, body, and conclusion…. Response uses a professional tone.
7
to >
6.0
pts
Fair 70%–79%
Presentation and formatting are somewhat uneven or inappropriate for the context…. Response is addressed adequately but may be missing one or more components…. Response contains an introduction, body, and conclusion but may be somewhat vague or unclear. May not adhere to the one-page limit…. Tone is not uniformly professional.
6
to >
0
pts
Poor 0%–69%
Presentation and formatting are uneven or inappropriate for the context…. Response is not addressed appropriately…. Response may be missing an introduction, body, and/or conclusion. Does not adhere to the one-page limit…. Tone is not appropriate or response is missing.
10
pts
This criterion is linked to a Learning Outcome
The Resume is clear, concise and well organized and includes: • Name, location (city/town and state), business phone number, and email address (centered at top of resume) • Objective: 2–3 sentences describing your goal/objective for employment• Certifications & licenses • Education • Professional experience • Honors/Awards • References
30
to >
26.0
pts
Excellent 90%–100%
Response is presented and formatted in a very clear and professional business manner…. Response is addressed properly…. Response contains a clear and well-written objective for employment…. Response clearly, accurately, and concisely describes certifications, licenses, education, professional experience, and honors/awards…. Response provides three references.
26
to >
23.0
pts
Good 80%–89%
Response is presented and formatted in a clear and professional business manner…. Response is addressed properly…. Response contains a clear objective for employment…. Response clearly and accurately describes certifications, licenses, education, professional experience, and honors/awards…. Response provides three references.
23
to >
20.0
pts
Fair 70%–79%
Response may contain minor errors in presentation and formatting…. Response is addressed but may be missing a component…. Response contains an objective for employment…. Response describes certifications, licenses, education, professional experience, and honors/awards, as applicable, but may be somewhat unclear or disorganized…. Response provides two references.
20
to >
0
pts
Poor 0%–69%
Response contains errors in presentation and formatting…. Response is not addressed…. Response does not contain an objective for employment…. Response is missing two or more of the following components: certifications, licenses, education, professional experience, and honors/awards…. Response provides one or no references.
30
pts
This criterion is linked to a Learning Outcome
The Portfolio is clear, concise and well organized and includes: • Personal philosophy statement • Personal goals (short term and long term) • Self-assessment
50
to >
44.0
pts
Excellent 90%–100%
Response is presented and formatted in a very clear and professional business manner…. Response contains a well-articulated philosophy statement that reflects synthesis of concepts…. Response contains clear and well-written personal goals and self-assessment.
44
to >
39.0
pts
Good 80%–89%
Response is presented and formatted in a clear and professional business manner…. Response contains a clear philosophy statement that reflects synthesis of concepts…. Response contains clear personal goals and self-assessment.
39
to >
34.0
pts
Fair 70%–79%
Presentation and formatting detracts from the content and/or is somewhat inappropriate for business…. Response contains a somewhat general philosophy statement…. Personal goals and self-assessment are somewhat vague or unclear.
34
to >
0
pts
Poor 0%–69%
Presentation and formatting detracts from the content and/or are inappropriate for business…. Several or all components are vague, inaccurate, or missing.
50
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list.
5
to >
4.0
pts
Excellent 90%–100%
Uses correct APA format with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 APA format errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 APA format errors
3
to >
0
pts
Poor 0%–69%
Contains ≥ 5 APA format errors
5
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and punctuation
5
to >
4.0
pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation errors
3
to >
0
pts
Poor 0%–69%
Contains ≥ 5 grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5
pts
Total Points:
100
NRNP 6675 Final Exam – Treatment aimed at reducing intimate partner violence and domestic violence includes which of the following?
Question 3 1 pts
Treatment aimed at reducing intimate partner violence and domestic violence includes which of the following?
Group of answer choices
Enhancing self-efficacy of the victim.
Reducing recidivism of the abuser.
Hormonal therapy for the perpetrator of abuse
A and B only
NRNP-6675 Week 9: Discussion – Prescribing for Older Adults and Pregnant Women
Prescribing for Older Adults and Pregnant Women
After assessing and diagnosing a patient, PMHNPs must take into consideration special characteristics of the patient before determining an appropriate course of treatment. For pharmacological treatments that are not FDA-approved for a particular use or population, off-label use may be considered when the potential benefits could outweigh the risks.
In this Discussion, you will investigate a specific disorder and determine potential appropriate treatments for when it occurs in an older adult or pregnant woman.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Choose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the
DSM-5-TR
to use.
Use the Walden Library to research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one nonpharmacological intervention for treating the disorder in that population.
By Day 3 of Week 9
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.
Read
a selection of your colleagues’ responses.
By Day 6 of Week 9
Respond
to
at least two
of your colleagues on
2 different days
who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature.
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
Reply
button to complete your initial post. Remember, once you click on
Post Reply
, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on
Post Reply
!
This topic is closed for comments.
SO
Safurat Olaniba-Adebisi
Jan 29, 2023 10:56pm
Reply from Safurat Olaniba-Adebisi
Discussion week 9
Response 2
Thank you for your post. Your post is very interesting and highly educative.
According to Jahan et al., 2021, class C drugs are safe for use in treating pregnant women safe to use while expecting or nursing a baby. Therefore, Bupropion (Wellbutrin) and Duloxetine (Cymbalta) are an appropriate drug of choice for the pregnant woman. Nonpharmacological treatment is psychotherapy-CBT.
References
Jahan, N., Went, T. R., Sultan, W., Sapkota, A., Khurshid, H., Qureshi, I. A., & Alfonso, M. (2021). Untreated depression during pregnancy and its effect on pregnancy outcomes: A Systematic Review.
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Safurat Olaniba-Adebisi
Jan 28, 2023 10:32pm
Reply from Safurat Olaniba-Adebisi
Discussion week # 9
Depression in an elderly patient.
The DSM criteria for Depression in the elderly. We must have five or more symptoms present for at least two weeks and at least either one of 1- depressed mood 11 loss of interest/ pleasure need to be present.
The five symptoms are Fatigue or loss of interest, insomnia/ hypersomnia, thought of death, or SI.
FDA-APPROVED ANTIDEPRESSANTS FOR THE ELDERLY
Sertraline is FDA-approved drug, and a safe medication for the elderly due to its tolerability rate, it can be used alone or as an adjunct with another medication possibly SSRI’s .In the journal analysis, it was noted that Sertraline has efficacy and tolerability for different kinds of depression as in other medications, Sertraline has some side effects, such as EPS, dystonia, parkinsonism, and dyskinesia. Therefore, patient education is necessary for better outcomes.
The off-label drug for depression in an elderly is Seroquel, “Quetiapine is an atypical antipsychotic approved for treating schizophrenia, bipolar depression, and mania but is frequently used in an off-label manner to control the behavioral and psychological symptoms of dementia in elderly patients with dementia.”(Ganzetti et al., 2021).
Thanks
Safurat
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Kately Anne Sylvia
Jan 28, 2023 4:14pm
Reply from Kately Anne Sylvia
Week 9: Special Considerations Related to a Vulnerable Population
Kately Anne Sylvia
College of Nursing- PMHNP, Walden University
NRNP 6665: PMHNP Across the Lifespan II
Dr. Madeleine Reyes
January 29, 2023
Week 9: Special Considerations Related to a Vulnerable Population
Introduction
This purpose of this discussion is to address special considerations related to a vulnerable population; this population is older adults with major depressive disorder (MDD). The discussion will include the following: one, a recommendation for a Federal Drug Administration (FDA) approved drug, an off-label drug and a non-pharmacological intervention for treating older adults with MDD. Two, a risk assessment will be identified to help to inform the treatment decision making, and the risks and benefits of the FDA-approved medication and the off-label medication will be addressed. Last, the clinical practice guidelines of MDD for the older population will be discussed.
FDA-Approved Drug, Off-Label Drug and a Non-Pharmacological Intervention
Later-life depression occurs in older adults who are 60 years or older (Sozeri-Varma, 2012 as cited in Robertson et al., 2019). Also, depression often goes undetected or is inadequately treated in older adults (Kok & Reynolds, 2017). Antidepressants are usually the first line approach to treatment for MDD. However, an off-label medication and a non-pharmacological intervention may significantly help the patient with their symptoms of depression. A FDA-approved medication therapy for older patients with MDD that will be chosen is one of the selective serotonin reuptake inhibitors (SSRI) called fluoxetine. An off-label drug that will be selected for MDD in older adults is modafinal. Last, a non-pharmacological intervention chosen for this population is interpersonal psychotherapy (IPT). IPT focuses on stressful life events “that are associated with the onset, exacerbation, or perpetuation of current symptoms, while helping patients to connect with social supports and to improve the quality of their relationships (Ravitz & Watson, 2014; Weissman et al., 2007, as cited in Cuijpers et al., 2016).
A Risk-Assessment & the Risks and Benefits of the FDA-Approved and Off-Label Drug
A risk assessment I would use to inform my treatment decision making is the Beers Criteria (BC). BC is a tool that evaluates drugs for “potentially inappropriate medication (PIM) in older adults” (Khamis et al., 2019). PIM is the benefits of the medication must outweigh a drug’s potential for adverse effects; the BC goal is to decrease the PIM to improve the quality and safety of care to older adults (Khamis et al., 2019).
The benefits of SSRIs is they have a better safety profile than other classes of antidepressants “including fewer antimuscarinic and cardiotoxic side effects, rarely fatal in overdose, less dosage titration, once daily administration and greater patient adherence (Mottram et al., 2006; National Institute for Health and Care Excellence [NICE], 2009; Taylor et al., 2018, as cited in Robertson et al., 2019). Some of the more serious risks associated with SSRIs in older adults with co-morbidities are some of the following: first, SSRIs increase the risk of gastrointestinal bleeding, history of bleeding or using such drugs as non-steroidal anti-inflammatory drug (NSAID) or warfarin (Anglin et al., 2014; Jiang et al., 2015; NICE, 2009; Taylor et al., 2018, as cited in Robertson et al., 2019).
According to Kaser (2018), cognitive problems are persistent in depression such as memory, concentration and decision making problems, and cognitive problems do not respond to anti-depressant medications. The off-label drug, modafinal, has been found to have beneficial effects in cognitive functioning (Kaser, 2018). In a study by Kaser (2018), it “showed feasibility of modafinal use to address decision-making problems in depression,” and showed “decision-making cognition can lead to better outcomes in depression.” Side effects that are more common and do not need medical attention are anxiety, nausea, nervousness and headache (Mayo Clinic, 2023). Some side effects that are less common, but most likely will need immediate medical care are the following: black stool, blurred vision, chest pain, clumsiness, confusion, problems with memory, shortness of breath, shaking, troubling voiding, unusual bleeding, and unusual weakness (Mayo Clinic, 2023).
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Clinical Practice Guidelines
The clinical practice guidelines from the American Psychological Association (APA) Guideline Development Panel recommend for the initial treatment of MDD for older adults is the following: “1. Either group life review treatment or Group Cognitive Behavioral Therapy (either alone or added to usual care) over no treatment.” or “2. Combined pharmacotherapy and IPT over IPT alone” (APA, 2019, p 13). For the pharmacotherapy, the panel recommends a second-generation antidepressant because of decreased potential for side effects. The strength of recommendation for use of this initial therapy for MDD in older adults is that APA recommends it for use (2019, p. 14). APA has other therapies, but the strength of the recommendations are “conditional recommendation for use,” and “Insufficient evidence for a recommendation” (APA, 2019, p. 14). Furthermore, for the prevention of recurrence of MDD in older adults APA recommends either the following: “combination interpersonal psychotherapy and pharmacotherapy” or “combination supportive care and pharmacotherapy” (APA, 2019, p. 17). The strength of the recommendation for the prevention of recurrence of MDD in older adults is that APA recommends this for use (2019, p. 17).
Conclusion
Vulnerable populations such as older adults have unique mental health needs compared to younger and middle aged adults. Psychiatric Mental Health Nurse Practitioners (PMHNP) need to be aware of all the drug-to-drug interactions associated with poly-pharmacy because of the co-morbidities the older adult patient’s have that may cause potential harm. Moreover, it is recommended for older adults with MDD to take SSRIs because they have a better safety profile, and to start interpersonal psychotherapy (IPT), which is recommended by APA. An off-label drug such as modafinal can be tried because of its’ positive effects on cognitive functioning in older adults, and a non-pharmacological intervention such as IPT should be started because it helps patients connect with social supports and to improve the quality of their relationships. Furthermore, it is important for PMHNPs to know if the benefits outweigh the risks when taking antidepressants for MDD. Beers Criteria (BC) is a risk assessment that is to decrease the potentially inappropriate medication (PIM) to improve the quality and safety of care to older adults. Last, clinical practice guidelines should be used to verify if the best treatment is initiated and maintained for older adults with MDD to ensure best patient outcomes.
Reference
s
American Psychological Association. (2019).
APA clinical practice guideline for the treatment of depression across three age cohorts
. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.apa.org/depression-guideline/guideline.pdf
Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal psychotherapy for mental health problems: A comprehensive meta-analysis.
The American Journal of Psychiatry, 173
(7). doi.org/10.1176/appi.ajp.2015.15091141
Khamis, S., Abdi, A. M., Uzan, A., & Basgut, B. (2019). Applying Beers criteria for elderly patients to assess rational drug use at a university hospital in Northern Cyprus.
J Pharm Bioallied Sci, 11
(2). doi: 10.4103/jpbs.JPBS_208_18
Kok, R. M., & Reynolds, C. F. (2017). Management of depression in older adults: A review.
JAMA,
317
(20). doi:10.1001/jama.2017.5706
Mayo Clinic. (2023). Modafinal (oral route). https://www.mayoclinic.org/drugs-supplements/modafinil-oral-route/side-effects/drg-20064870?p=1
Robertson, L., Bertolini, F., Meader, N., Davies, S. J. C., Barbui. C., Gilbody, S., & Churchill, R. (2019). Antidepressants for major depression disorder in older people: A network meta‐analysis.
Cochrane Database of Systematic Reviews, 9
. doi:10.1002/14651858.CD013394. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727180/
Kaser, M. (2018, November 8).
Computational approach to reinforcement learning in patients with remitted depression: Results from a double-blinded, randomised, placebo-controlled study
[Video]. The Academy of Medical Sciences. Youtube.
https://www.youtube.com/watch?v=eerHwrg_6YM.
Links to an external site.
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.apa.org/depression-guideline/guideline.pdf
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Tina Baker
Jan 26, 2023 7:15pm
Reply from Tina Baker
WK9Assgn+Baker+T6675.docx
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Colette Affiah
Jan 26, 2023 5:35pm
| Last reply Jan 27, 2023 12:36am
Reply from Colette Affiah
Initial Post-Colette Affiah
According to antidepressants, risk can be decreased and the medication more tolerable if the dose is started slowly and titrated slowly up to a tolerable level. Depression in the elderly, according to Robertson et al. (2019), affects the mood and causes anhedonia are lack of pleasure in once-enjoyed activities. Depression also causes low appetite and feeling worthless or hopeless. Pt. also has sleep disturbance, and some patients have an increased rate of suicidality. The elderly, considered adults aged 60 and above, have what is considered later-age depression. As noted by Robertson et al., depression affects 7.5% of women and 5.5% of men aged 55 to 74. The elderly population is prone to taking at least four or more medications for other health issues so drug to drug or drug to disease, as noted by Robertson et al. (2019), so careful dosing becomes a priority in the dosing and treatment plan for the elderly living with Major Depression disorder. According to Robertson et al., antidepressants should be prescribed to the elderly with consideration to their age, physical health, and drug-drug interactions. Depression, as postulated by Robertson et al., is because by the decrease of the monoamines, which include serotonin, norepinephrine, and dopamine, the key brain mood regulators. By taking serotonin, the activities of serotonin become enhanced, allowing for mood regulation for elderly patients.
FDA-APPROVED ANTIDEPRESSANTS FOR THE ELDERLY
Sertraline, an FDA-approved medication, is a Selected Serotonin reuptake Inhibitor and is recognized for treating Major Depression Disorder. According to Lenze & Ajam (2019), in the systematic review and the meta-analysis of comparative studies of antidepressants in older adults, the key finding was that SNRIs but not SSRIs were associated with adverse events versus placebo during acute treatment. Sertraline also has its risk and benefits in the treatment of MDD. Lenze & Ajam (2019) noted that Sertraline is safe for the elderly with a good tolerability rate, adding that it is significantly used in patients aged 65 and over and sometimes in combination with other central nervous system-active agents. The studies by Alexopoulos (2011) noted that the sertraline efficacious rate was higher than that of the placebo effect. Though Alexpoulos (2011) noted that for all types of depression, Sertraline was rated highest for efficacy and tolerability, the new studies have differed in the results, which may be partly due to the low doses of Sertraline prescribed to ensure tolerability and low incidence of side effects. Even with the efficacy of Sertraline also comes with some side effects, including extrapyramidal symptoms like dystonia, parkinsonism, and dyskinesia. As such, there must be followed up scheduled to monitor for the presence of these symptoms. As speculated by Edinoff et al. (2021), the most concerning adverse reaction are the side effect of hyponatremia, which is common in the elderly. According to Edinoff et al. (2021), serotonin may increase the antidiuretic hormone, thereby causing the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
OFF-LABEL MEDICATION FOR DEPRESSION
Seroquel is an off-label to treat depression, and studies show that using this medicine in low doses has good tolerability and efficacy in patients with depression. Seroquel, an antipsychotic according to Rowe (2007), can improve low mood, which is a significant problem with depression. As noted by Muller et al. (2020), Quetiapine, an antipsychotic drug used for schizophrenia and bipolar disorder, is usually prescribed to the elderly with an indication of depression. The side effect of this medication is that even in very low doses, it can cause serious adverse drug events of hip fractures, orthostatic hypotension, and pneumonia. Muller et al. (2020), in the study of Seroquel in nursing homes of Southern Switzerland, also stated that this medication is used in the presence of dementia, a common problem among the elderly, and is linked with increased risk for mortality. Mueller et al. (2020) also stated that the anonymous data collected during September and November 2016 in 15 nursing homes from either electronic or paper documentation. Out of the total of 1173 patients analyzed, Muller et al. Stressed that 379 patients were prescribed Seroquel. As noted by Muller et al. (2020), the side effects of Seroquel consist of impaired cognitive and functional capabilities. The Clinician is therefore faced with the challenges of ensuring that the elderly safety and tolerance level are maintained while treating the psychological condition of Major Depression Disorder.
According to Park et al.(2014), in the study of the evidenced-based, non-pharmacological treatment guideline for depression in Korea, Cognitive behavioral therapy was stated can be effective for the treatment of depression in mild to moderate depression. Park et al. (2014) state that the non-pharmacological considered by the clinical psychiatrist could provide a good adjunct to the pharmacological approach to producing successful stories of improvement in depressed patients. As clinicians, the success of treating depressed patients is to encourage the patient’s involvement in cognitive behavioral therapy. According to the World Health Organization (WHO), between 2015 and 2050, Gramaglia et al. (2021) noted that the estimated number of older adults that would be diagnosed with MDD is almost estimated to double to 22%. Moreover, Gramaglia et al. (2021) postulated that cognitive behavioral therapy effectively treats MDD in the elderly.
References
Alexopoulos GS. Pharmacotherapy for late-life depression. J Clin Psychiatry. 2011 Jan;72(1):e04. doi: 10.4088/JCP.7085tx2cj. PMID: 21272511; PMCID: PMC3314291.
Edinoff AN, Akuly HA, Hanna TA, Ochoa CO, Patti SJ, Ghaffar YA, Kaye AD, Viswanath O, Urits I, Boyer AG, Cornett EM, Kaye AM. Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review. Neurol Int. 2021 Aug 5;13(3):387-401. doi: 10.3390/neurolint13030038. PMID: 34449705; PMCID: PMC8395812.
Lenze EJ, Ajam Oughli H. Antidepressant Treatment for Late-Life Depression: Considering Risks and Benefits. J Am Geriatr Soc. 2019 Aug;67(8):1555-1556. doi: 10.1111/jgs.15964. Epub 2019 May 29. PMID: 31140584; PMCID: PMC6684410.
Müller L, Noseda R, Bertoli R, Bissig M, Ceschi A. Off-label use of quetiapine in nursing homes: Does medical specialty of prescribing physicians play a role? Br J Clin Pharmacol. 2020 Jul;86(7):1444-1445. doi: 10.1111/bcp.14232. Epub 2020 Feb 25. PMID: 32100324; PMCID: PMC7318997.
Robertson L, Bertolini F, Meader N, Davies SJC, Barbui C, Gilbody S, Churchill R. Antidepressants for major depression disorder in older people: a network meta‐analysis. Cochrane Database Syst Rev. 2019 Sep 5;2019(9):CD013394. doi: 10.1002/14651858.CD013394. PMCID: PMC6727180. NRNP-6675 Week 9: Discussion – Prescribing for Older Adults and Pregnant WomenNRNP-6675 Week 9: Discussion – Prescribing for Older Adults and Pregnant Womenand discussion thread from Colette Affiah
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Neethu John
Jan 25, 2023 11:05pm
| Last reply Jan 26, 2023 2:15pm
Reply from Neethu John
Anxiety disorders are prevalent in pregnant women with equal or higher incidence and are often underdiagnosed (Lemon, Vanderkruik, Arch, & Dimidjian, 2020). The first line treatment for generalized anxiety disorder amony pregnant women is cognitive behavioral therapy which has good results, but patients who still need medications should take caution but has to consult the provider for options for medications. Survey shows majority of women that have taken antidepressants stop at the time of pregnancy and the abrupt discontinuation of SSRI’s can harm in many ways and the discontinuation must be discussed with the provider (Lemon, Vanderkruik, Arch, & Dimidjian, 2020). Escitalopram is an SSRI that is approved for use in pregnancy if the benefit outweighs the risks (FDA, 2017). A study conducted with seven full term pregnant women with escitalopram did not show any major fetal harm and had normal Apgar scores upon delivery. Infants who were exposed to escitalopram also did not show any major health problems as well (Bellantuono, Bozzi & Orsolini, 2013). There are drugs that has not been approved by the FDA but is still the first line treatment for some conditions. The drugs that have not been FDA approved does not have enough research and studies behind it. Off the label drugs can be as effective as FDA approved drugs. Since FDA approved drugs are based on vast research, it is considered to be a safer option with the back up of studies. When off the label drugs are used, it is like they are not studied properly and thus considered with more impact (Wittich, Burkle, &Lanier, 2012).
Reference
Bellantuono, C., Bozzi, F., & Orsolini, L. (2013). Safety of escitalopram in pregnancy: A case series. Neuropsychiatric disease and treatment. Retrieved, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772871/
FDA. (2017). Lexapro (escitalopram oxalate).
Lemon, E., Vanderkruik, R., Arch, J. J., & Dimidjian, S. A. (2020). Treating anxiety during pregnancy: Patient concerns about pharmaceutical treatment. Maternal and Child Health Journal, 24(4), 439–446. https://doi.org/10.1007/s10995-019-02873-7
Wittich, C. M., Burkle, C. M., & Lanier, W. L. (2012, October). Ten common questions (and their answers) about off-label drug use. Mayo Clinic proceedings. Retrieved, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538391/
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Solange Ndah Missibi
Jan 25, 2023 11:01pm
| Last reply Jan 27, 2023 4:05pm
Reply from Solange Ndah Missibi
WK 9 Discussion
Selected Disorder: Major Depressive Disorder (MDD) in Pregnant Women
Major Depressive Disorder (MDD) is widespread in pregnant women and lactating mothers due to hormonal changes, physical limitations, social and economic impact, and stress. According to the American Congress of Obstetricians and Gynecologists (ACOG, 2021), about 14-23% of pregnant mothers nationwide are affected by depression annually, and often goes untreated and can result in high suicide tendencies, substance abuse, poor maternal medical health, fetal growth and birth weight, poor interpersonal relations as well as increase risk of premature birth (American Congress of Obstetricians and Gynecologists, 2021). The risk of injury to the fetus also increases during treatment with some antidepressants resulting in congenital disabilities and withdrawal symptoms in the newborn (Mayo Clinic, 2020).
When treating depression in pregnant women, the decision to prescribe or treat is strictly case-by-case basis based on the patient’s symptoms and severity, as there are currently no FDA-approved antidepressant drugs totally safe for use in this population (Gorun, 2018). Antidepressant drugs may have neonatal consequences; however, untreated depression has been shown to have more maternal and fetal consequences (MGH, 2018). Therefore, the patient and clinician must decide whether to initiate or continue therapy for depression during pregnancy.
One selected drug of choice is
Fluoxetine.
Approximately 1.1 million pregnant women with depression in 2016 were treated with an antidepressant, with the most commonly prescribed being SSRIs such as Sertraline, Citalopram, Escitalopram, and Fluoxetine with the exception of Paroxetine (Centers for Disease Control and Prevention (CDC), 2017).
Risks and Benefits of Fluoxetine
Fluoxetine, like most antidepressants, falls into Category C, meaning not enough well-controlled studies in humans due to the risk in this group, but potential benefits may warrant the use of the drug in pregnant women despite potential risks (MGH, 2018). Fluoxetine has been linked with maternal weight changes, neonatal syndrome like jitteriness, irritability, respiratory problems, low Apgar score, hypoglycemia, convulsions, as well as premature birth and neonatal persistent pulmonary hypertension with increased risk seen in late gestational use (Mayo Clinic, 2020).
Risk Assessment
Risk assessments crucial in treatment decision-making and choice of medication in pregnancy should be patient-centered as it greatly depends on the presenting symptoms and severity, poor response to psychotherapy, and patient’s medical history (MGH, 2018). According to the CDC, pregnant women with severe depressive symptoms with suicidal ideations, functional difficulties, and weight loss ought to stay on their drug regime (CDC, 2017). Another risk assessment is the high potential for relapse, worsening symptoms, increased risk of suicidal ideation, and worsening maternal physical health after drug discontinuation. If the decision is made to start treatment, the clinician should titrate the drug beginning with the lowest dose possible with close maternal and fetal monitoring (MGH, 2018). Depression and suicide screening tools such as the PHQ-9 for the severity of depression symptoms and the Columbia Suicide Severity Rating Scale (C-SSRS) for screening for the risk of suicide is essential in treatment planning.
Non-Pharmacologic Treatment
One of the most common and evidence-based non-pharmacologic treatments for depression is light therapy and psychotherapy (Rodriquez, 2019). Cognitive behavioral therapy (CBT) or interpersonal psychotherapy (IPT) has been recommended as a first-line treatment for depression in pregnant women and most other population groups of patients, with extensive research backing its efficacy or effectiveness and the low associated risk involved. (Rodriquez, 2019). CBT helps change negative thought processes and behavioral patterns, as well as teaches effective stress-coping strategies (Rodriquez, 2019).
OFF-LABEL DRUG
According to the National Center for Complementary and Integrative (NCCIH), one “off-label” drug used in treating depression in pregnant women is S-Adenosyl-methionine (SAMe) dietary supplements naturally found in the body and shown to alleviate depression symptoms (Cuomo et al., 2020). However, most studies were not of the highest scientific because they were short and done over a few weeks (Cuomo et al., 2020).
One risk of taking SAMe is that despite its benefits, studies on the long-term safety of SAMe and its safety for use during pregnancy have not been established according to the NCCIH; hence pregnant patients must talk to their doctor before taking any supplement, including SAMe (Cuomo et al., 2020).
CLINICAL PRACTICE GUIDELINES AND RECOMMENDATIONS
Due to the risk associated with the treatment of depression in pregnant women, the decision to treat and drug choice depends on the patient’s symptoms and severity, relapse potential, drug safety, gestation stage, medical history, and preferences. Psychotherapy might be initiated first due to the low risk to the mother and baby. If drugs must be initiated, the lowest therapeutic dosage possible is advised, and drug dosage may require an increase in the second half of pregnancy (American Congress of Obstetricians and Gynecologists, 2021). Medications are labeled and classified by the FDA into (A, B, C, D, and X) categories based on drug safety in pregnancy, and there is currently no available antidepressant in category A or B (MGH, 2018). Meanwhile, Category D, such as paroxetine, has strong evidence of fetal risk from human studies; potential benefits may permit use despite potential risks (MGH, 2018).
References
American Congress of Obstetricians and Gynecologists. (2021). Depression during pregnancy. Retrieved from https://www.acog.org/search#q=depression%20in%20pregnancy&sort=relevancy
Centers for Disease Control and Prevention. (2017). Antidepressant prescription claims among reproductive-aged women with private employer-sponsored insurance-United States 2008-2013. Retrieved from
https://www.cdc.gov/mmwr/volumes/65/wr/mm6503a1.htm?s_cid=mm6503a1_w
Links to an external site.
Cuomo, A., Beccarini Crescenzi, B., Bolognesi, S., Goracci, A., Koukouna, D., Rossi, R., & Fagiolini, A. (2020).
S
-Adenosylmethionine (SAMe) in major depressive disorder (MDD): a clinician-oriented systematic review.
Annals of general psychiatry
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19
, 50. https://doi.org/10.1186/s12991-020-00298-z
Gorun, A. (2018). Choosing and discussing SSRIs for depression in pregnancy: A basic guide for residents. Retrieved from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajprj.2018.130602
Mayo Clinic. (2020). Antidepressants: Safe during pregnancy? Retrieved from
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-byweek/indepth/antidepressants/art-20046420
Links to an external site.
MGH Center for Women’s Mental Health. (2018). Psychiatric disorders during pregnancy: Weighing the risks & benefits of pharmacologic treatment during pregnancy. Retrieved from https://womensmentalhealth.org/specialty-clinics/psychiatric-disorders-duringpregnancy/
Rodriguez, T. (2019). 5 non-pharmacological treatments for depression. Retrieved from https://medshadow.org/5-treatments-for-depression-without-meds/
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Safurat Olaniba-Adebisi
Jan 25, 2023 10:58pm
| Last reply Jan 27, 2023 9:28pm
Reply from Safurat Olaniba-Adebisi
Discussion week # 9
PRESCRIBING FOR OLDER ADULTS
Hello professor and fellow colleagues, The disorder that usually affects the geriatrics is dementia. Alzheimer’s disease is the most common type of dementia. People with dementia have problems with reasoning, judgement, problem solving, memory, communication and visual perception beyond typical age-related vision changes. (CDC,2022).
Alzheimer’s disease is caused by changes in the brain transmitters and it’s hereditary – runs in the family. The treatment depends on the underlying cause. Neurodegenerative dementia such as Alzheimer’s has no cure but medication to protect the brain or manage the anxiety. Such medication is Namenda.
Namenda reduces the actions of chemicals in the brain that may contribute to the symptoms of Alzheimer’s disease. Namenda is used to treat moderate to severe dementia of the Alzheimer’s type. Side effect of headache, dizziness, and bloating.
References
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of
psychiatry (11th ed.). Wolters Kluwer
CDC.2022
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Ndidi Joan Egemonu
Jan 25, 2023 10:49pm
| Last reply Jan 27, 2023 1:10pm
Reply from Ndidi Joan Egemonu
WEEK 9 Main DQ
Older adults are often affected by a decline in cognition due to Alzheimer’s and dementia. According to DSM-5 331.83 (31.84), a neurocognitive decline in older adults, also known as Alzheimer’s disease, is the cause of about 60 to 80 percent of dementia. Dementia impairs the mental ability to perform activities of daily living. It is not a disease; instead, a cluster of symptoms that impacts and alters the ability and subsequent deterioration of memory, reasoning, functioning, and logical thinking in the affected person. Alzheimer’s disease is one cardinal cause of dementia. As a cluster of symptoms, dementia can be mixed, resulting in the occurrence of multiple brain changes at the same time. Alzheimer’s disease, also called senile dementia, is a progressive disease that damages and impedes memory and other vital functions. As the number one cause of dementia, its pathology affects brain cell connections, and the brain cells degenerate and die, destroying memory and other vital mental functions. Alzheimer’s disease causes memory loss and confusion and has no cure. The goal of medication and management strategies is to improve symptoms and delay their ravaging advancement temporarily.
FDA-approved drug:
The Food and Drug Administration approves the following medications in the USA to help slow the progression of Alzheimer’s disease and improve memory and cognitive functioning, donepezil, galantamine, rivastigmine, memantine, and donepezil/memantine combination). Due to the progressive nature of Alzheimer’s disease, the efficacy of the above five medications will depend on the stage of the disease. According to FDA, in mild to moderate or moderate to severe Alzheimer’s disease, Aricept (donepezil) has been approved to be more effective. The National Institute on Aging, according to research, believes that Aricept (donepezil), galantamine (Razadyne), and rivastigmine (Exelon) may assist in slowing down behavioral symptoms in the interim and delay worsening symptoms.
One non-FDA-approved “off-label” drug:
Medications that fall under antipsychotics, antidepressants, anti-anxiety, and mood stabilizers can be used to alter the brain waves, thereby improving brain function. A drug like Seroquel can change a patient’s mood, perception, and consciousness with Alzheimer’s disease. The pharmacist can dispense such medicines because the FDA did not approve them, provided there is enough evidence documented, other than trial or experimental purposes, to prove that it is acceptable within reasonable health care clinical practice standards.
One nonpharmacological intervention for treating Alzheimer’s Disease.
Alzheimer’s disease progresses for the worse with time; therefore, a multi-dimensional approach to slow its progress is a sound clinical decision. Some nonpharmacological interventions that could be used include cognitive stimulation therapy, validation therapy, and reality reorientation, with reminiscence therapy as a holistic approach.
Explain the risk assessment you would use to inform your treatment decision-making.
Using the Mini-Mental Examination (MMSE), a set of eleven questions to validate a patient’s cognitive impairment will guide my decision-making. Other assessment tools that could be used include the Bristol Activities of Daily Living Scale (BADLS) and Genetic assessment risk factors obtained through comprehensive family history. There are many clinical guidelines that real-life modifications can help prevent the cause of the disease, delay disease progression, or even improve its ravaging side effects. Such lifestyle modifications include regular exercise, both physical and mental, moderate alcohol intake, and avoidance of tobacco and head injuries. A conflicting outcome does exist in the vascular studies that a systolic blood pressure below 140 mmHg is also associated with an increased risk for Alzheimer’s disease. A randomized study of the Guidelines for Neurocognitive disorder treatment conducted by Furey and Wilkins (2019) used three cholinesterase inhibitors, donepezil, rivastigmine, and galantamine, approved by the U.S. Food and Drugs as a baseline for the study of dementias. The treatment efficacy is based on the type of dementia, such as Alzheimer’s disease, vascular dementia, and other dementias, and whether it is mild, moderate, or severe. The participants who received Aricept (donepezil) proved to have more cognitive functioning and slowed the progression of their dementias than those who received placebos.
Most of the information to consider is that interdisciplinary and shared clinical decisions are crucial in the treatment of Alzheimer’s disease. It is what will guide pharmaceutical companies to comply and dispense a medication approved by FDA for one aliment when it is meant to be used as a non-approved for what it is prescribed for. It is also essential to verify the ethical and legal implications of prescribing “off-label medications for the patient’s benefit.
Reference
American Psychiatric Association. (2016).
The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia Links to an external site.
Links to an external site.
. https://doi.org/10.1176/appi.books.9780890426807
American Psychiatric Association (APA) 2013., Diagnostic and statistical manual of mental disorders 5
th
ed. DSM-5. American Psychiatric Publishing Washington, DC / London, England
Furey, K. & Wilkins, K. (2019). Prescribing “Off-Label”: What Should a Physician Disclose?
AMA J Ethics. 2016;18(6):587-593. DOI 10.1001/journalofethics.2016.18.6.ecas3-1606.
Patterson et al. (2008).Diagnosis and treatment of dementia: 1. Risk assessment and primary prevention of Alzheim er’s disease. CMAJ 2008;178:316-21.
www.cmaj.ca/cgi/content/full/178/5/548/DC1
Links to an external site.
Rabins, P.V. et al., (2014). Guide watch (October 2014): Practice guidelines for treating patients with Alzheimer’s disease and other dementias. APA Guideline
Watch;
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/alzheimerwatch.pd
Links to an external site.
American Psychiatric Association. (2020).
Geriatric telepsychiatry Links to an external site.
Links to an external site.
[Video].
https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry
Links to an external site.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11
th
ed.). Wolters Kluwer.” Chapter 33, “Geriatric Psychiatry”
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Kimberly Mary Baldor
Jan 25, 2023 8:37pm
| Last reply Jan 26, 2023 12:47pm
Reply from Kimberly Mary Baldor
NRNP6675week9BaldorK-1.docx
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Willie Feagin
Jan 25, 2023 8:31pm
| Last reply Jan 26, 2023 12:46pm
Reply from Willie Feagin
Prescribing for Older Adults and Pregnant Women
The DSM-5 diagnosis that affects older adults is a major depressive disorder. Depression is a huge public health issue due to its severe implications (Gabriel et al., 2020). Older adults are more likely to suffer from subsyndromal depression. This type of depression doesn’t always meet the full criteria for major depression. However, it can lead to major depression if left untreated. Depression in older adults can reduce the quality of life, and increases the risk of suicide and is linked to an increased risk of morbidity, an increased risk of suicide, poorer physical, cognitive, and social functioning, and increased self-neglect, all of which are linked to an increased risk of mortality (Gabriel et al., 2020). `
FDA-approved, Off label, and non-pharmacological intervention
Antidepressants have been shown to reduce the risk of depression recurrence in adults, justifying prolonged antidepressant maintenance therapy for most if not all patients. However, older depressed adults may be at increased risk for antidepressant adverse effects (Diniz & Reynolds, 2014). Historically, TCAs were the first‐line treatment for MDD, but other antidepressants have since been developed that have a better safety profile. SSRIs are generally used as first‐line therapy as they have several advantages over TCAs, including fewer antimuscarinic and cardiotoxic side effects, rarely fatal in overdose, less dosage titration, once-daily administration, and greater patient adherence (Robertson et al., 2019). Sertraline is a medication used to manage and treat major depressive disorder. It is in the SSRI class of medications. Sertraline is an antidepressant medication within the selective serotonin reuptake inhibitors (SSRIs) class. Sertraline is an antidepressant with primarily inhibitory effects on presynaptic serotonin reuptake (“Sertraline,” 2022). The FDA has authorized sertraline as a treatment for elderly patients with severe depression. The results of several carefully planned trials show that sertraline (50-200 mg/day) is effective in treating a major depressive disorder in elderly individuals (> or =60 years of age) (Chen & Shan, 2019). One off-label medicine chosen is fluoxetine, which is useful in treating older people with dementia and depression symptoms. Fluoxetine is the off-label drug chosen because it is effective in treating depression symptoms in older persons (Wang et al., 2021). Psychotherapy may be beneficial for LLD due to specific psychological conditions in old age and a low risk of side effects. Cognitive-behavioral therapy (CBT) is a successful and long-lasting treatment for late-life depression (Gabriel et al., 2020).
Risk and Benefit Assessment
Fortunately, numerous antidepressants have been effective in elderly patients suffering from MDD without psychotic symptoms. While selecting an antidepressant, it is advised that the best side effect profile and the lowest risk of drug-drug interactions be considered. Sertraline, for example, has lesser anticholinergic effects than previous antidepressants and is thus well tolerated by people with cardiovascular disease. Nausea, dry mouth, sleeplessness, somnolence, agitation, diarrhea, excessive perspiration, and, less commonly, sexual dysfunction are common adverse effects of SSRIs (Gabriel et al., 2020). It is critical to monitor sodium levels one month after commencing SSRI treatment, especially if the patient is also taking other drugs that have the potential to cause hyponatremia, like diuretics (Gartlehner et al., 2017). Fluoxetine is not related to the withdrawal syndrome reported with other SSRIs. Fluoxetine should not be shunned in the geriatric population, and in some cases, it may be the medicine of choice. Because of its long half-life and chronic negative effects, fluoxetine is generally not recommended for usage in the elderly. Paroxetine is also not normally suggested for use in the elderly since it has the most anticholinergic impact of any SSRI, comparable to that of the tricyclics desipramine and nortriptyline (Gabriel et al., 2020).
Clinical Guidelines
Clinical practice guidelines do exist for Major Depressive Disorder (MDD). The American Psychiatric Association (APA) and the American Medical Association (AMA) both have guidelines for the treatment of MDD. These guidelines generally recommend a combination of medication and psychotherapy as the first-line treatment for MDD. The APA’s guidelines recommend selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line medication options for MDD. They also suggest that psychotherapy, specifically cognitive-behavioral therapy (CBT), be used in conjunction with medication. The AMA’s guidelines similarly recommend SSRIs or SNRIs as first-line medication options and also suggest the use of psychotherapy, specifically cognitive-behavioral therapy (CBT), as an adjunctive treatment. When making recommendations for the treatment of MDD, it is important to consider the patient’s specific symptoms and medical history, as well as any comorbid conditions or risk factors. It’s also important to monitor the patient’s response to treatment and adjust as necessary. When elaborating on the treatment of MDD, it is important to note that medication and psychotherapy are not the only treatment options available. Electroconvulsive therapy (ECT) is also an effective treatment option for MDD, particularly for patients who have not responded to other treatments or who have severe or life-threatening symptoms. Another important aspect to consider when treating MDD is the patient’s preference and the availability of treatment options. For example, some patients may prefer to avoid medication due to side effects or personal beliefs, in which case psychotherapy alone may be a better option. Additionally, in some rural or low-income areas, access to mental health professionals may be limited, making teletherapy or self-help resources more appropriate options. It’s also important to consider comorbid conditions and risk factors, such as substance abuse, when treating MDD. Patients with comorbid substance abuse may require specialized treatment and support. It’s also important to monitor the patient’s response to treatment and adjust as necessary. This includes regularly checking the patient’s symptoms and side effects, as well as monitoring the patient’s progress in psychotherapy. If a patient is not responding to treatment, it may be necessary to adjust the medication dosage, switch to a different medication, or add or change the type of psychotherapy. It’s also important to provide support and education to the patient and their family, which can help to improve treatment adherence and outcome. In the absence of clinical practice guidelines, the general approach to the treatment of MDD is a combination of medication and psychotherapy. The choice of medication should be based on the patient’s specific symptoms and medical history, and the choice of psychotherapy should be based on the patient’s preference and the availability of the therapist. It’s also important to monitor the patient’s response to treatment and adjust as necessary.
The elderly may be more prone to depression due to psychological or biological reasons. As they get older, older people experience significant losses including losing a companion, their jobs, their social status, and their physical and mental abilities (Robertson et al., 2019). Due to physiological changes due to advanced age, the elderly may be more susceptible to drug therapy. Older individuals could need more cautious dose adjustments and be more vulnerable to the negative effects of drugs (Gartlehner et al., 2017). Elderly people commonly get medication for a variety of reasons, and drug interactions are a worry. Tricyclic antidepressants are no longer recommended as first-line therapy for elderly patients because of the possibility of side effects such as postural hypotension, which can cause falls and fractures, irregular cardiac conduction, and anticholinergic effects. The latter includes symptoms including delirium, urination, dry mouth, retention, and constipation (Van Poelgeest et al., 2021). Alzheimer’s disease, Parkinson’s disease, and cardiovascular issues are just a few of the illnesses that tricyclic antidepressants can make worse (Laird et al., 2019). Because they are less anticholinergic, nortriptyline and desipramine are the best alternatives when tricyclic is used as a second-line treatment. The starting dose of an antidepressant should be half that of a younger adult once it has been decided on for an elderly patient to minimize side effects. Age-related alterations in hepatic metabolism, coexisting medical conditions, and drug-drug interactions are believed to be the root of antidepressant adverse effects in the elderly. It should instead be the goal to progressively increase the dosage at 1- to 2-week intervals until it reaches an average therapeutic level (Gabriel et al., 2020). The average therapeutic dose is frequently lower than that recommended for younger individuals because of how aging affects hepatic metabolism, but there are many individual variations as well, it is now known. Some patients will require a greater therapeutic dosage than usual. Assume that a typical therapeutic dosage is used for 2 to 4 weeks and no appreciable improvement is observed. The dosage should be raised until there is a clinical improvement, serious adverse effects, or until the maximum dosage is achieved (Gabriel et al., 2020). Therefore, scheduling frequent follow-up sessions is essential to monitor therapeutic response, assess side effects, and modify dosage as necessary. Additionally, it’s critical to watch out for any indications of depression getting worse, agitation, or anxiety, as well as the risk of suicide, particularly in the beginning stages of therapy (Buckman et al., 2018). There is no proof that older people who use antidepressants have more suicidal thoughts.
References
Al-Azayzih, A., AlAmoori, R., & Altawalbeh, S. M. (2019). Potentially inappropriate medications prescribing according to beers criteria among elderly outpatients in jordan: A cross sectional study.
Pharmacy Practice
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17
(2), 1439.
https://doi.org/10.18549/pharmpract.2019.2.1439
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Diniz, B. S., & Reynolds, C. F. (2014). Major depressive disorder in older adults: Benefits and hazards of prolonged treatment.
Drugs & Aging
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31
(9), 661–669.
https://doi.org/10.1007/s40266-014-0196-y
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Gabriel, F., de Melo, D., Fráguas, R., Leite-Santos, N., Mantovani da Silva, R., & Ribeiro, E. (2020). Pharmacological treatment of depression: A systematic review comparing clinical practice guideline recommendations.
PLOS ONE
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(4), e0231700.
https://doi.org/10.1371/journal.pone.0231700
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Gartlehner, G., Wagner, G., Matyas, N., Titscher, V., Greimel, J., Lux, L., Gaynes, B. N., Viswanathan, M., Patel, S., & Lohr, K. N. (2017). Pharmacological and non-pharmacological treatments for major depressive disorder: Review of systematic reviews.
BMJ Open
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(6), e014912.
https://doi.org/10.1136/bmjopen-2016-014912
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Robertson, L., Bertolini, F., Meader, N., Davies, S., Barbui, C., Gilbody, S., & Churchill, R. (2019). Antidepressants for major depressive disorder in older people: A network meta-analysis.
Cochrane Database of Systematic Reviews
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https://doi.org/10.1002/14651858.cd013394
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Ruberto, V. L., Jha, M. K., & Murrough, J. W. (2020). Pharmacological treatments for patients with treatment-resistant depression.
Pharmaceuticals
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Sertraline. (2022).
van Poelgeest, E. P., Pronk, A. C., Rhebergen, D., & van der Velde, N. (2021). Depression, antidepressants, and fall risk: Therapeutic dilemmas—a clinical review.
European Geriatric Medicine
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Wang, J., Jiang, F., Yang, Y., Zhang, Y., Liu, Z., Qin, X., Tao, X., Liu, T., Liu, Y., Tang, Y., Liu, H., & Cotes, R. O. (2021). Off-label use of antipsychotic medications in psychiatric inpatients in china: A national real-world survey.
BMC Psychiatry
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American Psychiatric Association. (2016).
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.
https://doi.org/10.1176/appi.books.978089
WK9AssgnFeaginw.pdf
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Francis Archangel
Jan 25, 2023 7:08pm
| Last reply Jan 28, 2023 3:33pm
Reply from Francis Archangel
Main Question Post
Treatments for a Disorder in Older Adults
In this discussion, a neurocognitive disorder is selected as a focus in older adults. Alzheimer’s disease is a neurocognitive disorder that shows cognitive decline or impairment in older adults (American Psychiatric Association [APA], 2022). Dementia of the Alzheimer’s type is a major neurocognitive disorder that is typically diagnosed in individuals older than 65 years (Sadock et al., 2015). Older adults with dementia may experience delusions, depression, and intellectual disorientation (Sadock et al., 2015). Donepezil is a Food and Drug Administration (FDA) approved drug for dementia-related cognitive symptoms (Alzheimer’s Association, 2023). Donepezil is one of the drugs that can help control Alzheimer’s disease progression. Donepezil can be given to all stages of Alzheimer’s disease. Olanzapine is an antipsychotic drug used as an off-label in treating Alzheimer’s disease (Alzheimer’s Association, 2023). Olanzapine may be prescribed to control agitation in an individual with Alzheimer’s disease (Alzheimer’s Society, 2023). Individuals with dementia can be referred to a speech-language pathologist (SLP) for non-pharmacological interventions. SLP sessions for dementia will focus on controlling or improving the individual’s memory, attention, problem-solving, and thinking skills. (American Speech-Language-Hearing Association [ASHA] 023). SLPs will help the individual with dementia to learn important information, and they may also teach the family or caregivers how to best communicate with the patient. (ASHA, 2023).
Risk Assessments
Before prescribing medications, it is critical to consider the patient’s health in all aspects. The provider must understand how a particular drug could affect every organ system. The provider must be knowledgeable about drug interactions, potential side effects, adverse reactions, management of drug side effects or adverse reactions, and critical laboratory tests. The provider must conduct regular follow-up appointments to evaluate pharmacological and non-pharmacological interventions and possible modification of the management plan. The provider must assess the competency of the patient, family, and caregivers to participate in the treatment and their access to health. People with low health literacy typically need help understanding the processes involved in healthcare, have problems providing accurate health histories, and have challenges in health management engagement (Stewart & DeNisco, 2019).
Risks and Benefits of FDA-Approved and Off-Label Drugs
The benefits of drugs, in general, are the relief from symptoms such as blood pressure abnormalities, infections, and pain (FDA, 2018). The risks of medicines, in general, are unexpected or unwanted effects or reactions, including abdominal pain or liver damage. The FDA approves a drug when it has been determined to be safe enough for a particular health condition that outweighs its risks (FDA, 2018). All medicines have side effects; however, if the drug is FDA-approved, the side effects are generally not critical and are safe for use as intended (FDA, 2019). FDA approval means the drug underwent and passed a clinical trial effective for its intended use. The labels for FDA-approved medicines also include information about their risks and benefits (FDA, 2018). Moreover, the labels of FDA-approved drugs also show indications for use (Congressional Research Service, 2021)
On the other hand, off-label drug use is also legal in the United States (American Cancer Society [ACS], 2015). When the FDA approves a drug, physicians can use it in any way when they consider it medically appropriate. Medications without FDA approval are not regulated (ACS, 2015). Providers may consider off-label prescriptions to incorporate the latest ideas or treatment approaches available (Congressional Research Service, 2021). Many insurance companies do not reimburse off-label drugs and mark them as experimental or investigational. Off-label use of drugs is a legal risk because it did not pass appropriate clinical trials and is not a standard of care that could result in poor patient outcomes (ACS, 2015).
Clinical Practice Guidelines for Alzheimer’s Disease
Clinical practice guidelines exist for Alzheimer’s disease. Donepezil is an FDA-approved drug for treating Alzheimer’s disease (Alzheimer’s Association, 2023). Donepezil can treat mild, moderate, and severe Alzheimer’s, which inhibits the breakdown of acetylcholine in the brain (National Institute on Aging [NIA], 2021). Individuals with Alzheimer’s disease have low levels of acetylcholine in the brain, which is important in sending messages between nerve cells. (Alzheimer’s Society, 2023). A higher level of acetylcholine in the brain may ease the symptoms of Alzheimer’s (Alzheimer’s Society, 2023). Donepezil is typically started in low dosages and is increased as determined necessary. However, higher doses of donepezil have a higher risk of side effects (NIA, 2021). Patients on donepezil must be monitored regularly due to potential side effects, including allergic reactions and abdominal upset. Behavioral symptoms of Alzheimer’s disease, such as agitation, restlessness, depression, wandering, and aggression, can be treated to provide patient comfort. Different anti-anxiety drugs, sleeping aids, antipsychotics, and anticonvulsants can be used to treat or control the behavioral symptoms of Alzheimer’s. In addition, managing the behavioral symptoms of Alzheimer’s will make it less complicated for the patient’s family to take care of them (NIA, 2018).
References
Alzheimer’s Association. (2023).
Medications for memory, cognition, and dementia-related
behaviors.
https://www.alz.org/alzheimers-dementia/treatments/medications-for-
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memory#:~:text=Donepezil%20(Aricept%C2%AE)%3A%20approved,moderate%20stag
es%20of%20Alzheimer’s%20disease.
Alzheimer’s Association. (2023).
Treatments for behavior.
https://www.alz.org/alzheimers-
Links to an external site.
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Alzheimer’s Society. (2023).
Antipsychotics and other drug approaches in dementia care.
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drugs#:~:text=The%20off%2Dlabel%20antipsychotics%20most,other%20symptoms%20
of%20these%20conditions.
Alzheimer’s Society. (2023).
How do drugs for Alzheimer’s disease work?
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drugs-alzheimers-disease-
work#:~:text=In%20the%20brain%20of%20a,use%20acetylcholine%20are%20also%20lost.
American Cancer Society. (2015, March 17).
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American Psychiatric Association. (2022).
Diagnostic and statistical manual of mental
disorders, fifth edition, text revision (DSM-5-TR).
American Speech-Language-Hearing Association. (2023).
Dementia.
https://www.asha.org/public/speech/disorders/dementia/
Links to an external site.
Congressional Research Service. (2021).
Off-label use of prescription drugs
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National Institute on Aging. (2021, July 8).
How is Alzheimer’s disease treated?
https://www.nia.nih.gov/health/how-alzheimers-disease-treated
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015).
Kaplan & Sadock’s synopsis of psychiatry
(11th
ed.). Wolters Kluwer
Stewart, J. G., & DeNisco, S. M. (2019).
Role development for the nurse practitioner
(2nd
ed.)
.
Jones & Bartlett Learning.
United States Food and Drug Administration. (2018, June 18).
Think it through; managing the
benefits and risks of medicines.
https://www.fda.gov/drugs/information-consumers-and-
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patients-drugs/think-it-through-managing-benefits-and-risks-medicines
United States Food and Drug Administration. (2019, October 28
). Frequently asked questions
about CDER.
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,Once%20FDA%20approves%20a%20drug%2C%20does%20this%20mean%20that%2
0the,effects%20are%20generally%20not%20serious.
6675 WK 9 Discussion.docx
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Pamela Mccleary
Jan 25, 2023 4:27pm
| Last reply Jan 28, 2023 5:41pm
Reply from Pamela Mccleary
Women with bipolar disorder have a 50% increased risk for exacerbations during the perinatal period, so discontinuing treatment increases the risk of symptom worsening and changing their ability to function and engage in risky behaviors, including substance abuse and poor prenatal compliance (Clark, 2020). Another concern is that exposing a fetus to untreated bipolar disorder can lead to low birth weight, preterm birth, small gestational age, and microcephaly (Clark, 2020). During pregnancy, pharmacokinetics are altered, causing metabolism and elimination of medications to change substantially, requiring close monitoring of any treatment. Clinicians will need to adjust treatment throughout the pregnancy (Montiel et al., 2022
Lithium is still one of the best treatments for bipolar disorder, and if the client is stable on Lithium, consider continuing Lithium during the pregnancy. The risk for cardiac malformations, including Epstein’s anomaly, was less than previously reported; there is also a risk of increased birth weight, hypoglycemia tremor, and heart rate (Clarke, 2020). Mothers with hyperemesis, pre-eclampsia and renal insufficiency are at risk for Lithium toxicity and must be closely monitored. Completing an ultrasound at 16–20 weeks to rule out congenital malformations is also recommended (Clarke, 2020).
Invega (paliperidone) can be used off-label to treat bipolar disorder. There is a limited study available about the effects of its use during pregnancy. However, studies have shown no evidence of teratogenic or harmful impact on the mother or fetus (Onken et al., 2018). Since Invega is cleared renally, plasma levels depend on renal clearance, which increases during pregnancy. If Invega is tolerated well before pregnancy, current literature supports continuing the medication with frequent monitoring after reviewing the benefits versus risks of continued treatment.
There are clinical practice guidelines in place, but they are inconsistent internationally. Pregnancy has had limited studies and updates to guidelines due to the FDA having limited research information about pregnant women who use antipsychotic drugs. The guidelines recommend closely monitoring lithium levels, review of benefits versus risks, increasing monitoring in the third trimester, and not recommending breastfeeding (Malhi et al., 2017). If possible, stopping Lithium in the first trimester is also recommended. The recommendations are clear and concise and include the best practice so that I would incorporate them into my practice. However, there will always be a chance of a client that doesn’t fit into the guidelines, and as a practitioner, a review of the latest evidence-based research will be necessary to meet that client’s needs.
Risks versus benefits for both FDA-approved and off-label use would include considering the client’s symptoms and disease history. Untreated bipolar disease can lead to risky behaviors and general health neglect, and studies show increased fetal/infant health risks. Also, with untreated bipolar disorder, postpartum depression and difficulty stabilizing the mother’s mood becomes a concern. So maintaining some form of treatment during pregnancy may be the preferable course of care. If a client is pregnant or telling you they are considering pregnancy, reviewing each of their medications using evidence-based research is indicated to discuss the medication’s risks and benefits so that decisions can be made using current research findings. Increased assessment and monitoring of the mood and medication levels will also be part of the treatment plan. The decision to prescribe any medication during pregnancy should be thoroughly assessed, and medications should only be prescribed when the risk of untreated maternal disorder outweighs the potential risk to the fetus from exposure to the medication. Clinicians should prescribe the minimum effective dose. The close collaboration of care with the OB/GYN is essential.
Bright Light Therapy (BLT) is a non-pharmacological treatment for mood disorders, including bipolar disorder. BLT can be used alone or as adjunctive therapy, and results have been seen in as little as one week. If effective medication doses could be decreased, further reducing the risk of fetal injury. The therapy works by regulating the biological mechanisms and mediating dysregulation of the circadian rhythm by affecting the pineal gland light, which induces melatonin production and balances cortisol. This is a natural, noninvasive, and safe treatment option that can quickly and safely be incorporated into a treatment plan (Cuomo et al., 2023)
References
Clark, C. T. (2020). Psychotropic drug use in perinatal women with bipolar disorder.
Seminars in Perinatology
,
44
(3), 151230.
https://doi.org/10.1016/j.semperi.2020.151230
Links to an external site.
Cuomo, A., Carmellini, P., Garo, M. L., Barillà, G., Libri, C., Spiti, A., Goracci, A., Bolognesi, S., & Fagiolini, A. (2023). Effectiveness of light therapy as adjunctive treatment in bipolar depression: A pilot study.
Journal of Affective Disorders
,
321
, 102–107.
https://doi.org/10.1016/j.jad.2022.10.009
Links to an external site.
Grover, S., & Avasthi, A. (2015). Mood stabilizers in pregnancy and lactation.
Indian Journal of Psychiatry
,
57
(Suppl 2), S308.
https://doi.org/10.4103/0019-5545.161498
Links to an external site.
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of Lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines.
Journal of Affective Disorders
,
217
, 266–2https://doi.org/10.1016/j.jad.2017.03.052
Montiel, C., Newmark, R. L., & Clark, C. T. (2022). Perinatal use of lurasidone for the treatment of bipolar disorder.
Experimental and Clinical Psychopharmacology
,
30
(2), 249–252.
https://doi.org/10.1037/pha0000509
Links to an external site.
Onken, M., Mick, I., & Schaefer, C. (2018). Paliperidone and pregnancy—an evaluation of the German Embryotox database.
Archives of Women’s Mental Health
,
21
(6), 657–662.
https://doi.org/10.1007/s00737-018-0828-z
Links to an external site.
Uguz, F. (2020). Pharmacological prevention of mood episodes in women with bipolar disorder during the perinatal period: A systematic review of current literature.
Asian Journal of Psychiatry
,
52
.
https://doi.org/10.1016/j.ajp.2020.102145
Links to an external site.
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Ogechukwu Christiana Obiajulu
Jan 25, 2023 3:34pm
| Last reply Jan 28, 2023 9:56pm
Reply from Ogechukwu Christiana Obiajulu
Week 9 Discussion
Prescribing for pregnant women
Schizophrenia is a developmental disease that is caused by an interaction of genetic susceptibilities combined with environmental insults .The genetic contribution is well-established, with up to a 10-
fold increase in the risk of developing
schizophrenia
(Bates et al., 2018)
.
Schizophrenia is one particular DSM-5-TR disease that may have an impact on expectant mothers. Hallucinations, delusions, and disorganized thinking are all symptoms of the mental illness schizophrenia. Psychotherapy and antipsychotic medications are frequently used in the treatment of schizophrenia. The possible dangers and advantages of the medicine for both the mother and the growing fetus must be taken into account while treating pregnant women with schizophrenia (Bates et al., 2018).
FDA-approved drug
There are numerous therapies for schizophrenia in expectant mothers that are supported by evidence. Clozapine is one drug used to treat schizophrenia that has FDA approval. An antipsychotic drug called clozapine helps lessen hallucinations, delusions, and disordered thinking. Clozapine use during pregnancy, however, should be thoroughly monitored by a healthcare professional due to the drug’s increased risk of agranulocytosis (Uguz, 2020).
One off-label drug
Quetiapine, an antipsychotic drug that has not received FDA approval for use during pregnancy, provides an additional option for treating schizophrenia in expectant patients (Zheng et al., 2020). But compared to clozapine, quetiapine has been demonstrated to be beneficial in lowering schizophrenia symptoms and is linked to a lower incidence of agranulocytosis (Zheng et al., 2020). Last but not least, nonpharmacological treatments like psychotherapy can be effective in treating schizophrenia in expectant women (Gentile & Fusco, 2019)
T
he risk assessment
used
to inform my
treatment
decision making
.
Clinical practice guidelines provide direction for the management of schizophrenia in both pregnant women and older persons. According to these recommendations, antipsychotic drugs should be used as the first line of treatment for schizophrenia. Clozapine is advised as a first-line option for pregnant women, and quetiapine is advised as a second-line alternative. The recommendations make psychotherapy a second-line or adjunctive treatment for schizophrenia. Assessing risks to humans and the environment for remediation programs is technically feasible. The risk assessment will be based on the benefits and drawbacks that the drug has for the patient. Going through the drug leaflet, understanding the contraindications of the drug, knowing the drug interaction, and completing a wholesome psychiatric evaluation, as well as monitoring the drug effects, are all part of risk assessment.
Risks and benefits of the FDA-approved medicine
U.S Food and Drug Administration (FDA) -approved medicine has some risks and benefits towards an individual’s healthy life. Gourgari et al. (2017) analyzed that some FDA-approved drugs like sedatives and anti-anxiety medications can cause low blood pressure, slowed breathing, and memory problems which can be a considerable threat to a patient’s health. On the other hand, FDA-approved medicines can be of much benefit in that a patient is fully aware of their effectiveness and safe to consume. The U.S federal law requires drugs to be examined and proved to be safe for patients.
Risks and benefits of the off-label drug
Off-label drugs are drugs that have unapproved use. Off-label drugs are beneficial because they can be prescribed for a disease that is not approved to treat (Good & Gellad, 2016). For instance, antipsychotics approved to treat a particular type of mental condition can also treat a different kind of psychosis because it is not approved for a specific type. The risk associated with off-label drugs includes such a drug can cause a client to experience adverse body events like allergic response, drug interaction, and drug reaction (Good & Gellad, 2016).
Clinical practice guidelines for schizophrenic pregnant women
Clinician-developed clinical practice guidelines are statements that make recommendations for enhancing patient care. They are educated through a thorough study of the facts as well as an assessment of the benefits and risks of different care alternatives
.
Clinical practice guidelines do exist for the treatment of schizophrenia in pregnant women adults. Patients and Healthcare providers must look for side effects. Clinicians’ practice guidelines allow noncompliance and therapy-associated adverse effects when creating a thorough treatment plan to manage schizophrenia. The American Psychiatric Association’s (APA’s) clinical practice standards are critical in helping healthcare practitioners to select healthcare options for schizophrenic patients. The therapeutic procedures for schizophrenia are founded on proven medication and non-pharmacological therapies. To the guidelines, mentally ill persons like people with schizophrenia should be treated with an antipsychotic drug and their efficacy and adverse reactions should be monitored carefully (Avasthi et al., 2017)
References.
Avasthi, A., Grover, S., Chakrabarti, S., & Kulhara, P. (2017). Clinical Practice Guidelines for Management of Schizophrenia.
Indian Journal of Psychiatry
,
59
(5), 19.
https://doi.org/10.4103/0019-5545.196972
Links to an external site.
Bates, V., Maharjan, A., Millar, J., Bilkey, D. K., & Ward, R. D. (2018). Spared motivational modulation of cognitive effort in a maternal immune activation model of schizophrenia risk.
Behavioral Neuroscience
,
132
(1), 66–74.
https://doi.org/10.1037/bne000023
Links to an external site.
Gentile, S., & Fusco, M. L. (2019). Schizophrenia and motherhood.
Psychiatry and Clinical Neurosciences
,
73
(7), 376–385.
https://doi.org/10.1111/pcn.12856
Links to an external site.
Good, C. B., & Gellad, W. F. (2016). Off-label Drug Use and Adverse Drug Events.
JAMA Internal Medicine
,
176
(1), 63.
https://doi.org/10.1001/jamainternmed.2015.6068
Links to an external site.
Gourgari, E., Wilhelm, E. E., Hassanzadeh, H., Aroda, V. R., & Shoulson, I. (2017). A comprehensive review of the FDA-approved labels of diabetes drugs: Indications, safety, and emerging cardiovascular safety data.
Journal of Diabetes and Its Complications
,
31
(12), 1719–1727.
https://doi.org/10.1016/j.jdiacomp.2017.08.005
Links to an external site.
Harris, M. G., Kazdin, A. E., Chiu, W. T., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi,A., … & WHO World Mental Health Survey Collaborators. (2020). Findings from worldmental health surveys of the perceived helpfulness of treatment for patients with major depressive disorder JAMA psychiatry,77(8), 830-841
Uguz, F. (2020). The Use of Clozapine During Pregnancy And Lactation: A Case Report.
Psychiatry and Clinical Psychopharmacology
,
30
(2), 193.
https://doi.org/10.5455/pcp.20200502080433
Links to an external site.
Zheng, L., Tang, S., Tang, R., Xu, M., Jiang, X., & Wang, L. (2020). Dose Adjustment of Quetiapine and Aripiprazole for Pregnant Women Using Physiologically Based Pharmacokinetic Modeling and Simulation.
Clinical Pharmacokinetics
,
60
(5), 623–635. https://doi.org/10.1007/s40262-020-00962-3
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Preston Eyerman
Jan 25, 2023 12:42pm
| Last reply Jan 26, 2023 12:45pm
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When treating schizophrenia in older adults, the safest approach is to always start at a low dosage and titrate slowly. One FDA-approved drug that is available for the treatment of schizophrenia is Abilify. When treating patients with antipsychotics, especially older adults, it is imperative to educate the patient and closely monitor them for side effects. Some of the more concerning side effects for this population include anticholinergic effects (such as urinary retention, constipation, and cognitive impairments) and orthostatic hypotension (which increases the risk for falls) and sedation (Marder, 2022). The benefits of using Abilify in patients with schizophrenia would be an improvement in psychotic symptoms. Though it takes about 2 weeks to achieve a steady-state, it may take up to 4-6 weeks to observe a desired response after an effective dose is reached (Marder, 2022).
In treatment resistant schizophrenia, Clozapine is typically the next suggested treatment modality. A patient is categorized as treatment-resistant if they are experiencing moderate symptoms, functional impairment, and have had at least two unsuccessful trials of antipsychotic treatment (Kane, Rubio, Kishimoto, & Correll, 2021). Antipsychotic treatment trials must have been at least six weeks at the highest tolerated dose. If clozapine is not an option, then the use of ECT to augment the current antipsychotic is recommended. This is based off of a meta-analysis of 11 random clinical trials that compared ECT augmentation of a non-clozapine antipsychotic versus treatment of a non-clozapine antipsychotic alone. The study found that the patients who augmented treatment with ECT had enhanced symptom improvement compared to those treated with antipsychotic monotherapy. The most common risks associated with ECT includes memory impairment and headache.
If the patient does not have a significant clinical response to ECT (after an 8-week trial of ECT 2-3 times per week), and clozapine therapy is not a possibility, then Lamotrigine is the next recommended choice of treatment (Kane, Rubio, Kishimoto, & Correll, 2021). This recommendation is based upon consistent, though limited, evidence supporting its use in this population. Three randomized studies have revealed a decrease in psychotic symptoms with the use of adjunctive lamotrigine (in combination with an antipsychotic) compared to placebo. Lamotrigine, a mood stabilizer, carries a boxed warning for potentially causing serious rashes. If a patient develops a rash, then the medication should be discontinued in hopes to avoid progression to a more serious form of the rash such as Stevens-Johnson syndrome or toxic epidermic necrolysis (Lamotrigine: Drug information, n.d.). Other risks include blood dyscrasias, suicidal ideation, and nausea.
Clinical guidelines do exist for the treatment of Schizophrenia. First-line treatment of a second-generation antipsychotic is typically recommended for acute psychosis and ongoing maintenance therapy. Second-generations are preferred over first generation due to their decreased risk for EPS production. Though these are the general guidelines, a first-line antipsychotic, such as Haldol, may be more appropriate in some cases such as during extreme agitation. This methodology excludes the use of clozapine as a first-line option. Though it has been proven to be more effective than other antipsychotics, Clozapine is reserved for treatment-resistant patients due to its associated side effects and necessity for frequent monitoring (Marder, 2022).
References
Kane, J., Rubio, J., Kishimoto, T., & Correll, C. (2021). Evaluation and management of treatment-resistant schizophrenia.
Up to date
. Retrieved from
https://www.uptodate.com/contents/evaluation-and-management-of-treatment-resistant-schizophrenia?search=schizophrenia%20&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5#H1536388995
Links to an external site.
Lamotrigine: Drug information. (n.d.).
Up to date
. Retrieved from
https://www.uptodate.com/contents/lamotrigine-drug-information?search=schizophrenia%20&topicRef=14808&source=see_link#F186309
Links to an external site.
Marder, S. (2022). Psychosis in adults: Initial management. Up to date. Retrieved from
https://www.uptodate.com/contents/psychosis-in-adults-initial-management?sectionName=INITIAL%20MANAGEMENT&search=schizophrenia%20treatment&topicRef=14805&anchor=H4035521878&source=see_link#H498310159
Links to an external site.
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Chasity Cooper
Jan 25, 2023 11:16am
| Last reply Jan 26, 2023 12:45pm
Reply from Chasity Cooper
Treating Depression in Pregnant Women
Chasity Cooper RN,BSN
PMHNP Care Across the Lifespan II
Dr.Reyes
1/25/22
Treating Depression in Pregnant Women
Many pregnant women experience increased sadness and cognitive changes during pregnancy. Especially, if they are unaccepting of the bodily changes or unable to complete their normal daily routines. Depression during pregnancy is called prenatal depression. According to Jahan and others (2021), prenatal depression in studies has proven to lead to pre-term delivery, poor birth weight, slow fetal development, anemia, and uterine problems. The Edinburgh Postnatal Depression Scale and Patient Health Questionaire are effective screening tools for depression (Niel & Payne, 2020).
The FDA’s approval for medication use to treat depression in pregnancy is often unclear. In many drug books it sees controlled studies have not be done on pregnant women.The FDA has created categories to label medications for their warnings during pregnancy. SSRI’s are usually the first line treatment option for depression during pregnancy. The FDA categorizes most SSRI’s in the C category. The C category informs clinicians that complications are possible, but the benefits may outweigh the risks. Sertraline and citalopram are believed to have the smallest risk. The dose of Zoloft should be on the lower scale and avoid use in the first trimester if possible. Effective non-pharmacologic treatment options for depression are yoga, psychotherapy, and cognitive behavioral therapy.
When it is time to discuss the risks associated with treatment of the perinatal depression, I would used information from the CDC. The CDC runs a Pregnancy Risk Assessment Monitoring System. It is a questionnaire that assesses depression in women during pregnancy and postpartum (Ellington, 2021). The CDC records stats of the incidences of depression among pregnant women and complications. As mentioned above the EDPS is effective for making a decision to treat the depression. Molenaar and others (2018), have created clinical practice guideline and the researchers promote psychotherapy for mild to moderate cases. The authors state that if antidepressants are used, cardiovascular monitoring should take place. Treatment with antidepressants can cause pre-term delivery, low birth weight, congenital heart defects, new-born, pulmonary hypertension, and gestational diabetes (Hlongwane & Phoswa, 2021). However, as mentioned above studies have shown the benefits of medications may outweigh the risks.
References
Hlongwane, R., & Phoswa, W. N. (2021). Effect of antidepressants in pregnancy outcomes: A protocol for systematic review and meta-analysis.
Medicine
,
100
(50), e27885. https://doi.org/10.1097/MD.0000000000027885
Jahan, N., Went, T. R., Sultan, W., Sapkota, A., Khurshid, H., Qureshi, I. A., & Alfonso, M. (2021). Untreated Depression During Pregnancy and Its Effect on Pregnancy Outcomes: A Systematic Review.
Cureus
,
13
(8), e17251.
https://doi.org/10.7759/cureus.17251
Links to an external site.
Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V. (2018). Guidelines on treatment of perinatal depression with antidepressants: An international review.
The Australian and New Zealand journal of psychiatry
,
52
(4), 320–327. https://doi.org/10.1177/0004867418762057
Niel, M. S. V., & Payne, J. L. (2020, May 1).
Perinatal depression: A Review
. Cleveland Clinic Journal of Medicine. Retrieved January 24, 2023, from https://www.ccjm.org/content/87/5/273
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Jennifer Lisa
Jan 25, 2023 7:06am
| Last reply Jan 25, 2023 8:43am
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Jennifer Lisa — Week 9 Discussion Post (Initial Post)
NRNP 6675 Week 9 Discussion — MDD in pregnancy.docx
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Cindy Mecham
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Jan 25, 2023 2:17am
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Cindy Mecham
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Mbalu Madlene Kebbie
Jan 25, 2023 1:55am
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Reply from Mbalu Madlene Kebbie
Evidence shows that depression, which is a serious mood disorder characterized by persistent feelings of sadness which affects the way a person feels, behaves and thinks is commonly seen among older adults, whereas clinical depression is not a normal part of aging, and when left untreated, can profoundly affect a person’s functioning and overall quality of life (National Institute on Aging, 2021). Older adults could experience different types of depression including Major Depressive Disorder, evidenced by symptoms that last a minimum of two weeks interfering with one’s ability to perform daily tasks, Persistent Depressive Disorder, known as Dysthymia which is a depressed mood lasting more than two years, wherein the person may be still able to perform daily tasks, Substance/Medication-Induced Depressive Disorder which pertains to the use of substances such as alcohol and pain medications, and Depressive Disorder, due to a medical condition which concerns with separate illnesses such as diabetes or heart disease (National Institute on Aging, 2021). Clinical application to treat depression in older adults recommends three psychotherapeutic interventions as well as a second-generation antidepressant- selective-serotonin reuptake inhibitors-SSRIs, selective-norepinephrine reuptake inhibitors-SNRIs, or norepinephrine-dopamine reuptake inhibitors- NDRIs (apa.org, 2019).
FDA Approved Drug for Treating Depression in Older Adults.
An FDA-approved drug for clinical use in the treatment of depression in older adults is Citalopram hydrobromide, which is a SSRI that acts as an antidepressant by potentiating serotonergic activity in the central nervous system, and selectively inhibiting serotonin reuptake in presynaptic neurons (National Library of Medicine, 2021).
Off-Label Drug for Treating Depression in Older Adults.
An off-label drug is one that has been approved by the FDA, with an unapproved use to treat a disease or medical condition, wherein a health care provider makes an appropriate and sound clinical judgement to determine that the off-label drug is medically appropriate for prescription for their patients, given that there may not be an approved drug to treat that specific illness or medical condition, or in other instances wherein the patient may have tried all other approved treatments without seeing benefits or results, or the drug prescribed for the particular illness is either too expensive or inaccessible (U.S. Food & Drug Administration). Trazodone, used for insomnia is an off-label medication used for depression in older adults, which works by aiding to restore the balance of serotonin in the brain, improving mood and energy, and decreasing anxiety and insomnia which are thought to be related to depression (drugs.com, 2022).
Non-pharmacological Intervention for Treating Depression in Older Adults
Among others, a non-pharmacological intervention used to treat older adults with depression is Life-Review Therapy, which involves an adult person referencing their past to attain a sense of peace and empowerment about their lives, allowing a person to put his or her life into perspective, while revealing significant memories about friends and loved ones, thereby aiding the person to deal with challenging or unresolved conflicts that are preventing them from feeling at peace (healthline.com).
Risk Assessment Used to Inform Treatment Decision-Making.
To simplify, risk assessment primarily involves a series of processes and measures put in place to assess, monitor, and mitigate risks, while improving desired outcomes (HealthCare Compliance Pros). In prescribing pharmacological and therapeutic treatments for older adults with depression, it’s prudent that the provider takes into consideration the patient’s medical and psychiatric condition with adequate clinical evidence to make appropriate diagnosis and treatment plan that is patient-centered, aimed at treating/managing the symptoms in ways that the benefits far outweigh potential risks, to improve patient outcomes. In managing risk assessment pertained to prescribing medications and treatments, it’s important that the provider assess a drug or treatment’s benefit-risk balance, implement tools that minimizes risks while preserving benefits, evaluate effectiveness of tools used and re-assessing their benefits-risk balance and making appropriate adjustments to risk minimization tools to further improve the benefit-risk balance, while ultimately providing patient information about their prescribed drug or treatment, with inclusion of package inserts that provide the prescribing information which highlights essential information about the safe and effective use of the drug or treatment (U.S Food & Drug Administration). Other areas of relevance include assessing the patient’s allergy history to prevent adverse and negative treatment outcomes, and fostering interprofessional collaboration that involves providers, pharmacists, nurse practitioners and other clinicians to engage in the implementation and execution of policies and care to improve the patient’s health outcomes (National Library of Medicine, 2022).
Benefits of FDA Approved Medicines
FDA approved medications bear many benefits which includes regulating the safety and effectiveness of drugs sold in the U.S, with ongoing monitoring of the drug for its safety and effectiveness for as long as it’s on the market (Congressional Research Services). In addition, FDA approved medications undergo rigorous clinical trials and scrutiny to validate their efficacy and ensures that the manufacturer meets required specifications including the safety and effectiveness in the drug’s proposed use, appropriateness of the proposed labeling, adequacy of manufacturing methods to assure the drug’s identity, strength, quality, and purity, to optimize treatment outcomes and preserve public/consumer safety (Congressional Research Services).
Risks Of FDA Approved Medicines.
Risks of FDA approved drugs include the likelihood that the drug may not work for its intended use, the possibility of a harmful interaction of the drug with other drugs, food or supplements, and the potential for abuse by consumers, which could cause more harm than good, offsetting its intended purpose and possibly causing patient harm, and the chances that the drug may cause additional problems including addiction which contributes to medical and psychiatric problems (U.S Food & Drug Administration).
Benefits of Off-Label Drugs.
The benefits of off-label drugs include accessibility and cost-effectiveness for consumers, there may be evidence to demonstrate that the drug works for its off-label use, prevents prolonged waiting for treatment interventions in instances when FDA approved drugs are in shortages, or in cases wherein other approved FDA drugs have failed to treat the patient’s condition (Medical News Today).
Risks Associated in Use of Off-Label Drugs.
Potential risks associated in use of off-label drugs include a lack of strong scientific evidence to back up its efficacy in treating a specific illness or condition which potentiates increased risks of adverse effects, in addition to lack of coverage by insurance for off-label drugs, which may pose financial burden to the patient who may already have financial hardship (drugs.com, 2022). In addition, off-label drugs have legal action potential, given that its use often does not reflect “standard of care” treatment, posing legal risks to the provider in the event of unwanted drug/treatment outcomes, lacks sufficient scientific information on the best way to use the drug other than for its intended approval, as well as ethical issues related to its use in patients and for unintended purposes (American Cancer Society).
Clinical Practice Guidelines for Depression In Adults
Clinical practice guidelines are primarily intended to be a central determinant of treatment choice, and mainly pertains to systematic review of evidence about efficacy of treatment in illnesses including depression, data regarding risk of harm gotten from treatments, data regarding patient preferences, values regarding treatments, and data regarding applicability of treatments across populations and settings, serving as essential tool for providers, and guides clinical decision-making for patients to receive the care they need (American Psychological Association). Clinical practice guidelines for older adults with depression specifies a step-by-step action involved in treatment proceedings while monitoring progress to determine effectiveness or modification of plan of care, which is ultimately aimed at improving practice and patient outcomes, hence my recommendation for its utilization in clinical practice, given its evidence-based credibility.
References
American Cancer Society. Off-Label Drug Use: What Is Off-Label Drug Use?
https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/off-label-drug-use.html#:~:text=What%20problems%20can%20be%20caused%20by%20off-label%20drug,does%20not%20regulate%20the%20practice%20of%20medicine.%20
Links to an external site.
American Psychological Association, (2022). Using the APA Clinical Practice Guidelines for The Treatment of Depression in Adults.
https://www.apa.org/depression-guideline/decision-aid-adults.pdf
Links to an external site.
American Psychological Association, (2017). Placing Clinical Practice Guidelines in Context.
https://www.apa.org/about/offices/directorates/guidelines/context
Links to an external site.
apa.org, (2019). Depression Treatments for Older Adults.
https://www.apa.org/depression-guideline/older-adults
Links to an external site.
Congressional Research Services. How FDA Approves Drugs and Regulates Their Safety and Effectiveness.
https://sgp.fas.org/crs/misc/R41983.pdf
Links to an external site.
drugs.com, (2022). Trazodone: What is Trazodone?
https://www.drugs.com/trazodone.html
Links to an external site.
drugs.com, (2022). Off-Label Drug Use: What Is It?
https://www.drugs.com/slideshow/off-label-or-off-limits-
Links to an external site.
1237#:~:text=What%20Are%20the%20Drawbacks%20to%20Off-Label%20Prescribing%3F%201,cancer%20regimens%20when%20used%20in%20an%20off-label%20manner.
HealthCare Compliance Pros. Risk Assessment HealthCare: Why Does It Matter?
https://www.healthcarecompliancepros.com/risk-assessment-healthcare#:~:text=Risk%20assessment%20in%20healthcare%20is%20a%20complex%20procedure.,safeguarding%20your%20patient%20information%20and%20other%20organizational%20assets
Links to an external site.
.
healthline.com. Life-Review Therapy: What Is Life-Review Therapy?
https://www.healthline.com/health/life-review-therapy
Links to an external site.
National Institute on Aging, (2021). Depression and Older Adults.
https://www.nia.nih.gov/health/depression-and-older-adults
Links to an external site.
National Library of Medicine, (2022). Risk Management Event Evaluation and Responsibilities.
https://www.ncbi.nlm.nih.gov/books/NBK559326/
Links to an external site.
National Library of Medicine, (2021). Citalopram.
https://www.ncbi.nlm.nih.gov/books/NBK482222/#:~:text=Mechanism%20of%20Action%20Citalopram%20hydrobromide%20acts%20as%20an,norepinephrine%20%28NE%29%20and%20dopamine%20%28DA%29%20neuronal%20reuptake.%20
Links to an external site.
Medical News Today. What To Know About Off-Label Drug Use.
https://www.medicalnewstoday.com/articles/off-label-drug-use
Links to an external site.
U.S Food & Drug Administration. Understanding Unapproved Use of Approved Drugs “Off-Label”
https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
Links to an external site.
U.S Food & Drug Administration. FDA’s Role in Managing Medication Risks.
https://www.fda.gov/drugs/risk-evaluation-and-mitigation-strategies-rems/fdas-role-managing-medication-risks
Links to an external site.
U.S. Food & Drug Administration. Think It Through: Managing The Benefits and Risks Of Medications.
https://www.fda.gov/drugs/information-consumers-and-patients-drugs/think-it-through-managing-benefits-and-risks-medicines
Prescribing For Older Adults and Pregnant Women
Insomnia is a common condition among pregnant women, affecting up to 80% of women in the third trimester. Insomnia is experienced as difficulty falling asleep, staying asleep, and waking too early in the morning. This can be especially troublesome for pregnant women, as it can interfere with the rest needed for a healthy pregnancy. Insomnia can negatively affect a woman’s emotional, physical, and mental health, as well as the fetus. As such, it is important to understand the causes and possible treatments of insomnia in pregnant women. The post will recommend one FDA-approved drug, one off-label, and one nonpharmacological intervention for treating insomnia disorder in pregnant women. It will explain the risk assessment I would use to inform my treatment decision-making, the risk and benefits of the FDA medicine, and the risk and benefits of the off-label drug. It will then explain whether clinical practice guidelines exist for insomnia disorder.
FDA-Approved Drug, Off-Label Drug and Nonpharmacological Intervention for Treating Insomnia
An FDA-approved medicine for treating insomnia disorder in pregnant women is doxepin. Doxepin is a tricyclic antidepressant that is effective in treating insomnia. It is thought to work by increasing the amount of serotonin in the brain, which helps regulate mood and sleep cycles. It is generally considered safe for pregnant women, though there is some evidence that it may increase the risk of preterm delivery. Therefore, it is essential to discuss the risks and benefits of doxepin with the pregnant woman and her care provider before starting the medication (Stahl, 2020). Melatonin is an off-label drug that could be used to treat insomnia disorder in pregnant women. Melatonin is a hormone naturally produced in the body that helps regulate sleep cycles. It is available in supplement form and is considered safe for pregnant women. However, there is not enough evidence to suggest that melatonin effectively treats insomnia in pregnant women. Therefore, it is important to discuss the risks and benefits of melatonin with the pregnant woman and her care provider before starting the medication (Hollifield & Manber, 2018).
A nonpharmacological intervention for treating insomnia disorder in pregnant women is cognitive-behavioral therapy (CBT). CBT is a type of psychotherapy that helps people identify and change their thinking and behavior patterns that are causing distress. It is considered a safe and effective treatment for insomnia in pregnant women and can help them learn how to manage their sleep cycles better (Sivertsen et al., 2020).
Risk Assessments used to Inform my Treatment Decision Making
When making treatment decisions for pregnant women with insomnia disorder, it is important to consider each treatment option’s potential risks and benefits. For the FDA-approved medicine, doxepin, the potential risks include preterm delivery and other adverse effects, while the potential benefits include improved sleep and possibly improved mood. For the off-label medicine, melatonin, the potential risks include unknown effectiveness and possible side effects, while the potential benefits include improved sleep and possibly improved mood (Stahl, 2020). For the nonpharmacological intervention, CBT, the potential risks include the time and effort required to complete the therapy, while the potential benefits include improved sleep, improved mood, and improved coping skills (Sivertsen et al., 2020).
Clinical practice Guidelines
Clinical practice guidelines exist for treating insomnia disorder in pregnant women. The American College of Obstetricians and Gynecologists (ACOG) guidelines recommend that pregnant women with insomnia consider behavioral interventions, such as CBT, as first-line treatments. If these interventions are ineffective, ACOG then recommends using pharmacologic treatments, such as doxepin, as second-line treatments. If these treatments are also ineffective, ACOG recommends the off-label use of melatonin (Sivertsen et al., 2020). Therefore, the recommendations for treating insomnia disorder in pregnant women align with the ACOG guidelines.
A multifaceted approach is recommended to treat insomnia disorder in pregnant women. An FDA-approved drug, such as Doxepin and Zolpidem, should be used with caution due to their potential side effects, including dizziness, confusion, and daytime drowsiness. An off-label drug, such as melatonin, should also be considered an alternative, as it has few known side effects. A nonpharmacological approach, such as mindfulness meditation, may help reduce stress and improve sleep quality. Clinical practice guidelines should also be consulted to determine the safest and most effective treatment for this disorder.
References
Hollifield, M., & Manber, R. (2018). Benzodiazepines for Insomnia: A Review of Effectiveness and Safety. Current Psychiatry Reports, 20(7), 44.
Sivertsen, B., Mork, E., Pallesen, S., Nordhus, I. H., & Bjorvatn, B. (2020). Non-pharmacological Treatment of Insomnia: A Review. Sleep Medicine Reviews, 49, 101098.
Stahl, S. M. (2020). Insomnia: Pharmacological Treatment Options. CNS Spectrums, 25(4), 347–355.
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Saffie Conteh
Jan 24, 2023 3:58pm
Reply from Saffie Conteh
Applied Informatics
Saffie Conteh
NRNP-6675
Dr. Madeleine Reyes
Date 1/24/20203
Applied Informatics
Ideas in Medical Informatics applied in administration and operations to improve data.
The field of healthcare administration informatics is one of the models of applied informatics used in healthcare administration. The relevance of applied informatics in healthcare administration is based on the primary concern of implementing evaluation, acquisition, and implementation of proper day-to-day operations of the healthcare organization (Motiwala et al., 2022). The relevant aspect of implementing applied informatics in healthcare administration is that information technology has made it easier for healthcare managers to use technology systems to support all administrative and clinical functions.
The use of informatics in the management of data for healthcare administration has improved healthcare delivery since all the provider-related issues are essentially addressed. For instance, healthcare providers have difficulty managing provider data regarding which medical experts should operate during which shifts (Pramanik et al., 2020). However, with provider portals, it remains possible to manage to assign changes. The healthcare organization’s daily operations are improved and effectively approved. These administrative decisions are only made better by healthcare-applied informatics in administration. Healthcare administrators can tailor incentive plans to patients through healthcare administrators. Below are how to apply these aspects to healthcare organizations.
Applications of these ideas
In the assisted living organization, applied informatics can be used to achieve proper day-to-day operations of various systems. One area that healthcare administration informatics could apply is to have patient-generated data. Patient-generated data would help manage the patients so the organizations do not have to deal with aspects relating to leaked patient information that can attract legal suits. In conclusion, applied informatics for healthcare administration is a perfect way to deal with challenges regarding day to day operations of the organization.
References
Motiwala, T., Zhang, P., Gregory, M., Fareed, N., Ning, X., Coombes, K., … & Hebert, C. (2022). Review of applied health informatics courses in a multidisciplinary biomedical informatics department.
Learning Health Systems
,
6
(4).
https://www.proquest.com/openview/3306585991d2e670bdb8f7945d951206/1?pq-origsite=gscholar&cbl=4370300
Links to an external site.
.
Pramanik, M. I., Lau, R. Y., Azad, M. A. K., Hossain, M. S., Chowdhury, M. K. H., & Karmaker, B. K. (2020). Healthcare informatics and analytics in big data.
Expert Systems with Applications
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152
, 113388.
https://www.sciencedirect.com/science/article/pii/S0957417420302128
Links to an external site.
.
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Oluwaseun Obajolu
Jan 24, 2023 8:17am
| Last reply Jan 28, 2023 4:33pm
Reply from Oluwaseun Obajolu
Discussion: Prescribing for Pregnant Women
Postnatal depression and prenatal depression share many characteristics, with depression experienced at other times. Depression is characterized by anxious and pessimistic thoughts directed at the unborn child (Khanghah et al., 2020). Women frequently doubt their abilities to be excellent parents and worry about how others see them. Unfortunately, women often delay receiving therapy for prenatal or postnatal depression much longer than is necessary because they, their families, and occasionally even medical professionals may not recognize the condition (Jahan et al., 2021). This is due to a variety of factors. There is some overlap between typical pregnancy symptoms and depression. Still, women assume incorrectly that their symptoms are a natural aspect of pregnancy or transitioning to having a new baby (Frieder et al., 2018). Unnecessarily, some people worry that others could judge them as unfit parents. Another frequent emotion is shame over not being joyful and ecstatic. Anyone can have perinatal mental health concerns, so if you feel you might be having a problem, don’t hesitate to ask for assistance.
FDA-Approved Drug: Bupropion (Wellbutrin)
The FDA has approved this drug to treat depression, seasonal affective disorder, and substance use disorders linked to smoking. These cover solely adult therapy options. Norepinephrine-dopamine reuptake inhibitors include bupropion. By boosting the levels of dopamine and norepinephrine in the brain by inhibiting their reabsorption following synaptic transmission, the medication improves the patient’s mood, as implied by the name. Bupropion is a class C drug (Jahan et al., 2021). Since there are little to no dangers associated with the medicine on either the patient or the unborn, it is safe for use in treating pregnant women. It is safe to use while expecting or nursing a baby.
Off-Label Drug: Duloxetine (Cymbalta)
This drug is authorized to treat recurrent musculoskeletal pain. However, as a medicine taken off-label, it treats adult depression, including prenatal and postnatal depression. Because multiple studies have demonstrated its usefulness in such processes, it is used unconventionally (Khanghah et al., 2020). It is classified as a Class C medication, which means that even though there are side effects, the benefits exceed the unwanted effects (Jahan et al., 2021). By raising the levels of serotonin and noradrenaline in the brain, the selective serotonin and norepinephrine reuptake inhibitor duloxetine enhances brain function.
Non-pharmacological Intervention: Cognitive-Behavioral Therapy
The most specific psychosocial intervention for treating mental illnesses is this one. It operates on the tenet that our thoughts influence our moods and behaviors. CBT enables patients to recognize and replace negative ideas with positive ones. The patient can consequently have an improved mood (Frieder et al., 2018). It also aids the patient in developing stronger coping mechanisms. In many cases, CBT is said to be more effective than medicine. Combination therapy is strongly advised, nevertheless.
Risk Assessment for Duloxetine and Wellbutrin
Wellbutrin has not been linked to any known adverse effects when used to treat pregnant women. However, it has been linked to sleeplessness, headaches, constipation, mouth dryness, tachycardia, weight gain, and vomiting. However, there is a slight possibility of experiencing negative effects (Kaufman et al., 2022). According to reports, duloxetine might result in nonteratogenic side effects such as cyanosis, sleep apnea, seizures, eating problems, vomiting, hypoglycemia, and hypertonia (Khanghah et al., 2020). However, because it falls under group C, its advantages exceed these negative effects.
Clinical Guidelines
Consensus recommendations for treating depression during pregnancy were recently released by the American Psychiatric Association and the American College of Obstetricians and Gynecologists. The objective was to thoroughly analyse the literature and treatment suggestions from authorities in prenatal psychiatry and obstetrics (Frieder et al., 2018). Given the rising concerns about using antidepressants during pregnancy and the growing, somewhat confused body of literature covering this topic, this significant publication comes at a critical moment.
If a pregnant woman has depression, treatment should be suggested. Psychotherapy is advised as the first line of treatment for mild to moderate depression. Although there is research specifically looking at the effectiveness of psychotherapy for depression during pregnancy, there is much evidence to support its use in the general population (Frieder et al., 2018). Psychotherapy referrals are based on the patient’s willingness, availability of qualified professionals, and financial ability. The final two obstacles must be removed because pregnant individuals are probably more inclined to prefer psychotherapy over drugs. But not every patient, not even those with a comparable ailment, will benefit from a single recommended medication, which includes psychotherapy (Khanghah et al., 2020). To provide alternatives if necessary, a patient who is referred for psychotherapy should continue to have her progress monitored.
Antidepressant use during pregnancy is the main emphasis of the American Psychiatric Association/American College of Obstetricians and Gynecologists guidelines. According to scientists, there is evidence linking the usage of selective serotonin reuptake inhibitors with tiny for gestational age newborns (Khanghah et al., 2020). The absolute difference in birth weight is minor and of uncertain clinical relevance, and it is unclear if this depends on the duration of exposure (Jahan et al., 2021). Although there is evidence linking antidepressant usage during pregnancy to preterm birth (defined as occurring before 37 weeks gestation), the differences between exposed and unexposed groups are minor.
References
Frieder, A., Fersh, M., Hainline, R., & Deligiannidis, K. M. (2019). Pharmacotherapy of postpartum depression: Current approaches and novel drug development.
CNS drugs
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33
(3), 265–282.
https://doi.org/10.1007/s40263-019-00605-7
Links to an external site.
Jahan, N., Went, T. R., Sultan, W., Sapkota, A., Khurshid, H., Qureshi, I. A., & Alfonso, M. (2021). Untreated depression during pregnancy and its effect on pregnancy outcomes: A Systematic Review.
Cureus
,
13
(8), e17251.
https://doi.org/10.7759/cureus.17251
Links to an external site.
Kaufman, Y., Carlini, S. V., & Deligiannidis, K. M. (2022). Advances in pharmacotherapy for postpartum depression: a structured review of standard-of-care antidepressants and novel neuroactive steroid antidepressants.
Therapeutic Advances in Psychopharmacology
,
12
, 20451253211065859.
https://doi.org/10.1177/20451253211065859
Links to an external site.
Khanghah, A. G., Khalesi, Z. B., & Hassanzadeh, R., Afagh (2020). The importance of depression during pregnancy.
JBRA Assisted Reproduction
,
24
(4), 405–410.
https://doi.org/10.5935/1518-0557.20200010
Links to an external site.
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Sward Kamarah
Jan 23, 2023 8:20pm
| Last reply Jan 28, 2023 9:05am
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Shawn Osborne
Jan 23, 2023 7:29pm
| Last reply Jan 28, 2023 9:17pm
Reply from Shawn Osborne
According to Mitchell and Goodman (2018), up to 10 percent of pregnant women will be prescribed an antidepressant while pregnant. There have been some studies that suggest risks including birth defects and health problems with antidepressant use during pregnancy, however, this is controversial and is not supported by strong evidence. The FDA recommends that women do not use antidepressants, but if needed, providers should follow their regular prescribing methods. In the following assignment, I will utilize literature and evidence to make treatment choices ,appropriate for a pregnant woman.
FDA-approved drug, off label drug, and nonpharmacologic intervention
I chose sertraline for my FDA approved drug, which is labeled category C. Use of antidepressants is more likely to cause possible harm in early and late stages of pregnancy, so with this in mind, I felt a drug that was easy to stop and restart as needed would be beneficial. Many others are difficult to wean off, and can cause distressful symptoms. Sertraline is less known to cause such problems, and can often be weaned without difficulty.
Molenaar et al., (2018) Share that treatment
guidelines
for practice are either neutral, or lack evidence when recommending wether to continue or stop antidepressants during pregnancy. When depression is a new occurrence during pregnancy they found recommendations for CBT or other psychotherapy, and if severe, the preferred antidepressant that most prescribed was Sertraline. The authors discuss the controversy over the safety of SSRI’s during pregnancy, and conversely, the possible harm and negative outcomes that may result from no treatment, such as increased suicide, interrupted or poor bonding, and post-partum depression. They report that some possible but not proven effects from taking an SSRI during pregnancy can result in: heart defects, pulmonary hypertension, premature birth, and low birth weight. They also share that depression without treatment can result in: premature birth, low birth weight, and fetal death. This is important to consider when making treatment decisions, and assessing risk in pregnant patients. The risks are similar in treatment vs. non-treatment. But it appears that with treatment, postpartum outcomes may be preferential. A discussion of risks and benefits with the patient is essential, so that an informed decision can be made. The patient is taking all the risk, and needs to have accurate and comprehensive education to make this decision.
An off-label drug I would use is Buspar, which is FDA pregnancy label B. The NIH (2022) highlights the use of Buspirone as an augmenting agent to help with depression, as well as evidence that Buspirone can be effective as monotherapy for depression. The risks of Buspar in pregnancy is unknown but considered safer than others, as it is a category B drug. Nervousness, agitation, and activation can be experienced with Buspirone as well as headaches and dizziness. The benefits are similar to Sertraline, as the negative effects of non-treatment are avoided.
A non-pharmacologic intervention I would use is psychotherapy. Specifically, cognitive behavioral therapy, or interpersonal therapy, which according to Li et al., (2020), are considered the gold standard for treating depression and anxiety during pregnancy. The authors performed a meta-analysis and found evidence for psychotherapy as beneficial during pregnancy at decreasing depression and increasing quality of life. They found results could be maintained, and had positive effects on cognitive processes and self-monitoring abilities. And notable, is the side effects and complications that can be avoided if therapy is sufficient and medication is not needed.
Conclusion
Choosing medications is a complex task, as there are usually risks and benefits for each. Sharing the information with the patient and discussing the preferences and outcome desires, can aid the decision process. Informed consent, and an informed decision are imperative concepts that must be assured for our patients, as they are personally taking the risk.
References
Li, C., Sun, X., Li, Q., Sun, Q., Wu, B., & Duan, D. (2020). Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life.
Medicine
,
99
(27), e20947.
https://doi.org/10.1097/md.0000000000020947
Links to an external site.
Mitchell, J., & Goodman, J. (2018). Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: A systematic review.
Archives of Women’s Mental Health
,
21
(5), 505–516.
https://doi.org/10.1007/s00737-018-0844-z
Links to an external site.
Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V. (2018). Guidelines on treatment of perinatal depression with antidepressants: An international review.
Australian & New Zealand Journal of Psychiatry
,
52
(4), 320–327.
https://doi.org/10.1177/0004867418762057
Links to an external site.
NIH. (2022). Buspirone.
National Library of Medicine
. Retrieved January 22, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK531477/
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Teresa Kangethe
Jan 23, 2023 5:53pm
| Last reply Jan 29, 2023 9:10pm
Reply from Teresa Kangethe
Student Name: Teresa Kangethe
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan II
Faculty Name: Dr. Reyes
Discussion on Pregnant mothers on psychotropic medications.
There is no extensive testing that has been done on pregnant and lactating mothers. To treat a pregnant woman suffering from the anxiety, gabapentin is one of the FDA approved medications. According to the study gabapentin has no increased risk of major congenital malformations but one study showed increase preterm birth, low birth weight and NICU admission. Monitor gabapentin level due to metabolic changes that occur during pregnancy. An off label anxiety medication is Clonidine and psychotherapy is the nonpharmacological treatment. Other medication mentioned is Pregabalin then buspirone that has no data in human but has had congenital malformations in animals (Fryane, 2021).
The biggest problem is that there is no enough study extensively done with pregnant mothers and babies. In Arizona when a mother become pregnant, they are suppose to call
1-866-961-2388
number to register. This is one way that is used to collect data and do research in most psychotropic medications during pregnancy. The study follows them even after delivering so they can monitor the effects of psychotropic at long run. Pregnant mothers are vulnerable to relapse during the pregnancy. There is a tendency of reducing the dosing especially during the first trimester but this brings more harm to the mother and baby. Patient taking psychotropic are at risk factors of taking street drugs, alcohol, over the counter medications than patient with other medical sickness like hypertension. This may affect the study outcome when other drugs interfere with the prescribed psychotropic doses. During pregnancy body changes including weight gain, metabolism is known to affect dosing,
There is no most recommended psychotropic medication for pregnant women. It is the work of the provider to study the medication they are on and weigh the pro and cons. If the mother relapse or is not mentally stable the harm is as worse as prescribing the psychotropic during pregnancy “one pregnant mother stated, I don’t want to hear my baby is fine in labor and delivery ward, I want to hear that my baby life is normal all his life and my psychotropic medication I took did not harm the baby” (Payne, 2016)
Reference
Frayne, J., Watson, S., Snellen, M., Nguyen, T., & Galbally, M. (2021). The association between mental illness, psychotropic medication use and hypertensive disorders in pregnancy: A multicentre study.
Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health
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24
, 22–26. https://doi.org/10.1016/j.preghy.2021.02.002
Byatt N, Hicks-Courant K, Davidson A, et al. Depression and anxiety among
high-risk obstetric inpatients. Gen Hosp Psychiatry 2014;36:644-9
Thiels C. Pharmacotherapy of psychiatric disorder in pregnancy and
during breastfeeding: a review. Pharmacopsychiatry 1987;20:133-46.
Chisolm , M. S., & Payne, J. L. (2016).
Management of psychotropic drugs during pregnancy
Links to an external site.
.
British Medical Journal
,
352
. https://doi.org/10.1136/bmj.h5918
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Laura Assanga Eyong
Jan 22, 2023 4:43pm
| Last reply Jan 27, 2023 8:47pm
Reply from Laura Assanga Eyong
Accessing, Diagnosing, and Treating of Depression in Pregnant Women
A DSM-5 definition for depression is a lack of enjoyment or interest in life, low energy, weight gain or loss, mood swings, sleep difficulty, guilt, suicidal thoughts, etc. Numerous medications are teratogens during pregnancy, increasing the risk of congenital disabilities, spontaneous abortions, stillbirths, and maternal mortality. Pregnancy-related treatment and pharmaceutical use are restricted and necessitate knowledge of the pharmacodynamics and effects of the medicine on the expectant mother.
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women
The preferred medication for treating personality disorders and mental impairment is typically an antidepressant. Selective Serotonin Reuptake Inhibitors (SSRIs), including Citalopram, are a class of drugs that have received FDA approval (Celexa). It prevents serotonin (5-HT) reuptake by neurons in the synaptic cleft. However, it can also cause drowsiness, vertigo, and sweating (Bérard et al., 2017). Vortioxetine is an off-label medication that has demonstrated its effectiveness. However, it is not yet approved due to its recent regulatory approval into the antidepressant family (Shweiki et al., 2021). Although the medicine is still being studied and has not yet received praise, it has demonstrated strength and had positive results when used to treat depressive episodes in pregnancy.The most effective non-pharmacological treatment for a major depressive illness during pregnancy is psychotherapy (Snapper et al., 2018). It improves function and well-being by helping to eliminate and regulate bothersome symptoms.
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of FDA-approved medicine? What are the risks and benefits of the off-label drug?
Antidepressants’ teratogenicity and effects on the developing fetus, such as heart abnormalities, primary pulmonary hypertension in newborns, or poor neonatal adaption syndrome, are the main risks associated with using them during pregnancy. After prolonged use, especially in the third trimester, drugs can cause fetal mortality. A non-teratogenicity prescription should guide the medicine selection.
According to Berard et al. (2017), there is a link between Citalopram (an FDA-approved drug) and a higher incidence of poor newborn adaption syndrome. It can result in changes in crucial genes for development during the embryogenic stage, resulting in congenital disabilities. On the other side, vortioxetine increases the chance of injury to the infant and the mother relapsing into depression (Shweiki et al., 2021). However, it offers the advantage of lessening and stopping depressive episodes while having fewer adverse effects. Nevertheless, it is effective in treating pregnancy-related depression.
Explain whether clinical practice guidelines exist for this disorder and if so, use them to justify your recommendations. If you still need to, explain what information you need to consider.
There are clinical practice recommendations for mental retardation and personality problems in pregnancy. These include prescription drugs and counseling. Remission is emphasized as the primary objective of psychotherapy. Medication, however, specifies the drug combinations for treating severe depressive disorder. These include combining tricyclic antidepressants (TCAs) like imipramine, amitriptyline, or nortryptyline with SSRIs like citalopram, escitalopram, fluoxetine, or paroxetine. Therefore, to treat major depressive disorder during pregnancy, I advise utilizing both medication and psychotherapy.
References
(1). Austin, M.-P., Frilingos, M., Lumley, J., Hadzi-Pavlovic, D., Roncolato, W., Acland, S., … Parker, G. (2008). Brief antenatal cognitive behavior therapy group intervention to prevent postnatal depression and anxiety: A randomized controlled trial. Journal of Affective Disorders, 105(1–3), 35–44.
https://doi.org/10.1016/j.jad. 2007.04.001
Links to an external site.
(2). Bérard, A., Zhao, J. P., & Sheehy, O. (2017). Antidepressant Use during Pregnancy and the Risk of Major Congenital Malformations in a Cohort of Depressed Pregnant Women: An Updated Analysis of the Quebec Pregnancy Cohort. BMJ Open, 7(1), e013372.
https://doi.org/10.1176/appi.ajp.2010.09121743
Links to an external site.
(3). Shweiki, S., & Diav‐Citrin, O. (2021). Pregnancy Outcome after First-Trimester Exposure to Vortioxetine: A case series. Birth Defects Research, 113(6), 511-515.
(4). Snapper, L. A., Hart, K. L., Venkatesh, K. K., Kaimal, A. J., & Perlis, R. H. (2018). A Cohort Study of the Relationship between Individual Psychotherapy and Pregnancy Outcomes. Journal of affective disorders, 239, 253-257.
(5). Sangini S. Sheth, Jenell Coleman, Tirza Cannon, Lorraine Milio, Jean Keller, Jean Anderson & Cynthia Argani (2015) Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV, AIDS Care, 27:3, 350-354, DOI:
10.1080/09540121.2014.998610
Links to an external site.
10.1080/09540121.2014.998610
Download 10.1080/09540121.2014.998610
10.1080/09540121.2014.998610
NRNP 6675 Final Exam – Curriculum content that supports the NP scientific foundation competency area includes which of the following? Select all that apply.
Question 2 1 pts
Curriculum content that supports the NP scientific foundation competency area includes which of the following? Select all that apply.
Group of answer choices
Comparison of patient data sets with evidence-based standards to improve care
Science from other disciplines relevant to health care
High-reliability organization principles.
Compliance issues related to patient privacy with use of technology.
Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
In 2–3 pages, address the following:
Florida state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released
.
There are two ways a person can be held involuntarily in Florida when safety is compromised. The Baker Act (BA) is a short-term involuntary placement of a person with questionable cognition who appears to be a danger to self and others in a designated psychiatric facility until the need for extended hospitalization is determined. It should be at most 72 hours. The second is the Marchman Act (MA) which is meant to assist those struggling with substance abuse and should not exceed 72 hours. During the 72-hour psych hold for BA or MA, a specific set of guidelines is geared towards stabilizing the individual and validating the case to determine if there is a need for a more extended stay in the facility. In Florida, if a competent court adjudicates a person incapacitated under part V of chapter 744 of the Mental Health Act, a guardian is appointed to make health decisions on behalf of the individual. A child’s biological parents or court-appointed legal guardians should make decisions for the minor. Due to the significance of involuntarily placing a person in a treatment facility, specific measures must be met by the individual to qualify. These measures include the person’s inability to make a rational decision about self. If the person declines examination, the person is at risk of harming himself or manifesting adverse effects from self-neglect, and the person poses a risk of harming others. It also includes when the person is using substances that could cause harm to him or others and cannot decide on his own to seek help for addiction. Those authorized to file and place a hold on a patient include a doctor, law enforcement officer, spouse, parents, or a close relative of the person involved. In some extreme conditions, a non-relative, such as a roommate, can get a patient involuntarily admitted to a drug rehabilitation facility if two other witnesses can confirm the risk to self or others’ claim. Physical examination on arrival rules out a person’s immediate physical distress and must be done within minutes of arrival but not exceeding 24 hours. It includes drug tests and other assessments to validate possible reasons for a patient’s escalated behavior. A confidential psychological examination is also carried out within 72 hours of the person’s hold. The information gathered will help the facility make a professional recommendation to the court regarding whether to continue an extended hold on the person. Most individuals calm down within 72 hours of stabilization, can make a more definitive decision, and are allowed to seek voluntary treatment, which changes their status.
Explain the differences between emergency hospitalization for evaluation/psychiatric hold, inpatient, and outpatient commitment in your state
Under the Florida Mental Health Act, which is also known as the Baker Act and Marchman Act (MA) sections 394-451, addressed as legislative intent, the Department of Children and Families (DCF) is the parastatal designated with the permission to evaluate, research, plan, and recommend to the governor and the legislature programs designed to reduce the incidence, severity, duration and disabling aspects of mental, emotional and behavioral health issues. Severe mental health can affect a person’s ability to make sound or reasonable decisions. In Florida, involuntary outpatient commitments are court orders mandating persons with severe mental illness and repeated hospitalization to adhere to community-based treatment. To take a patient involuntarily, all available less restrictive treatment alternatives which would offer an opportunity to improve the patient’s condition would have been judged appropriately. There should be sworn statements of experts testifying in involuntary inpatient placement hearings about the availability and appropriateness of less restrictive community alternatives (394.467(b), FS). The person must meet the statutory criteria for admission to a state treatment facility. The Baker Act also specifies in s.394.461(2), FS, that it governs the designation of receiving and treatment facilities that a civil patient shall not be admitted to a state treatment facility without undergoing a transfer evaluation. A mandatory form CF-MH 3089, “Transfer Evaluation,” as referenced in subsection 65E-5.1301(1), FAC, the process for conducting such transfer evaluations shall be developed by the community mental health center or clinic and approved by the district or regional office of the department where the center or clinic is located shall be completed.
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Explain the difference between capacity and competency in mental health contexts.
A clinician or hospitalist familiar with a patient can make a specific decision based on a functional assessment of the patient to assist with clinical determination. Capacity is usually defined by state law and varies by jurisdiction. It is evident when a patient’s functional assessment is questionable, and the hospitalist has to decide independently of a consultant. Four cardinal components are assessed in evaluating functional capacity assessment: communicating a choice, understanding, appreciation, and rationalization/reasoning. Capacity is variable, on hand, and not static. A clinician who has earned rapport with the patient and is familiar with the case details can make the determination. In contrast, competency in mental health is a global assessment and legal determination made by a judge in court. The MacArthur Competence Assessment Tools for Treatment (MacCAT-T) serves as a yardstick to measure capacity assessment aid.
Select one of the following topics and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy.
The vulnerability of patients living with mental health poses a lot of legal and ethical issues. Providers and clinicians must apply ethical reasoning when faced with clinical challenges to improve patient outcomes. In psychiatric emergencies, when a patient requires involuntary placement, his autonomy and ability to make a sound decision are queried and removed. It is legally binding under the emergency to assess the decision-making capacity of the patient using the four criteria communication, understanding, appreciation, and reasoning. The goal of placing a patient involuntarily is to protect him from harm, not to expose him to where he is capable of autonomous decision-making, not dangerous, or not impaired by their psychiatric illness using the least restrictive means possible. It is, therefore, ethically and legally required to re-assess the patient after the acute phase to determine his mental status and possible removal of his involuntary status.
Identify one evidence-based suicide risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified
The Columbia-Suicide Severity Rating Scale (C-SSRS) is one evidence-based suicide risk assessment tool used to assess suicidal behaviors. It uses questions to detect patients at risk for suicide through the intensity of the suicide ideation, potentially self-injurious act committed with at least some wish to die due to the act and thought of as a method to kill oneself. It is important to note that the intent does not have to be 100%; instead, the intent/desire to die associated with the act can be considered an actual suicide attempt. Potential for injury or damage without any actual injury or damage is considered a suicidal attempt, for example, a headshot or jumping from the window of a high floor/story. A highly destructive act is not an accident but is considered intent for suicide, and the same applies to when one denies intent to die but thinks that what he did could be lethal; intent may be inferred. Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
Identify one evidence-based violence risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.
The violence risk assessment screening tool is used to identify patients prone to violent attacks on caregivers and providers, thereby creating avenues for prompt interventions. According to research, about 90% of doctors, nurses, and patient caregivers encounter violent attacks from their patients. The V-RISK-10 checklist uses the rater to collect information about the potential violent intentions of the patient expressed in a yes or no response. It is from the responses that the severity of the intent to inflict injury will be rated in degree terms as severe, low, or no risk.
References:
King, C. A., Horwitz, A., Czyz, E., & Lindsay, R. (2017). Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk.
Journal of clinical psychology in medical settings
,
24
(1), 8.
https://doi.org/10.1007/s10880-017-9486y
Anderson, K. K., & Jenson, C. E. (2019). Violence risk-assessment screening tools for acute care mental health settings: A literature review.
Archives of psychiatric nursing
,
33
(1), 112–119. https://doi.org/10.1016/j.apnu.2018.08.012
Doyle M, Dolan M: Predicting community violence from patients discharged from mental health services. Br J Psychiatry. 2006, 189: 520-526. 10.1192/bjp.bp.105.021204.
Sjöstrand, M., Sandman, L., Karlsson, P., Helgesson, G., Eriksson, S., & Juth, N. (2015). Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists.
BMC medical ethics
,
16
, 37.
https://doi.org/10.1186/s12910-015-0029-5
Link– https://pubmed.ncbi.nlm.nih.gov/30663614/
Link –
[HTML]
Patient health questionnaire depression scale as a suicide screening instrument in depressed primary care patients: a cross-sectional study
source: Ganzini L, Volicer L, Nelson WA, Fox E, Derse AR. Ten myths about decision-making capacity.
J Am Med Dir Assoc.
2004;5(4):263-267.
https://app.grammarly.com/ddocs/1903514634
Legal and Ethical Issues Related to Psychiatric Emergencies
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.
In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.
To Prepare
Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
The Assignment
In 2–3 pages, address the following:
Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
Explain the difference between capacity and competency in mental health contexts.
Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
Identify one evidence-based suicide risk assessment that you could use to screen patients.
Identify one evidence-based violence risk assessment that you could use to screen patients.
By Day 7 of Week 8
Submit
your Assignment. Attach copies of or links to the suicide and violence risk assessments you selected.
submission information
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Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
Rubric
NRNP_6675_Week8_Assignment_Rubric
NRNP_6675_Week8_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
In 2–3 pages, address the following: • Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
15
to >
13.0
pts
Excellent 90%–100%
The response includes a thorough and well-organized explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.
13
to >
11.0
pts
Good 80%–89%
The response includes an accurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.
11
to >
10.0
pts
Fair 70%–79%
The response includes a somewhat vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.
10
to >
0
pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies. Or the response is missing.
15
pts
This criterion is linked to a Learning Outcome
• Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
15
to >
13.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
13
to >
11.0
pts
Good 80%–89%
The response includes a well-organized explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
11
to >
10.0
pts
Fair 70%–79%
The response includes a somewhat vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
10
to >
0
pts
Poor 0%–69%
The response includes a vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Or the response is missing.
15
pts
This criterion is linked to a Learning Outcome
• Explain the difference between capacity and competency in mental health contexts. Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
10
to >
8.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of the difference between capacity and competency in mental health contexts.
8
to >
7.0
pts
Good 80%–89%
The response includes an accurate explanation of the difference between capacity and competency in mental health contexts.
7
to >
6.0
pts
Fair 70%–79%
The response includes a somewhat vague or incomplete explanation of the difference between capacity and competency in mental health contexts.
6
to >
0
pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of the difference between capacity and competency in mental health contexts. Or the response is missing.
10
pts
This criterion is linked to a Learning Outcome
• Select one of the following topics and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
15
to >
13.0
pts
Excellent 90%–100%
The response accurately and concisely explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.
13
to >
11.0
pts
Good 80%–89%
The response accurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.
11
to >
10.0
pts
Fair 70%–79%
The response somewhat vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.
10
to >
0
pts
Poor 0%–69%
The response vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies. Or, response is missing.
15
pts
This criterion is linked to a Learning Outcome
•Identify one evidence-based suicide risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.
15
to >
13.0
pts
Excellent 90%–100%
The response identifies and explains an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
13
to >
11.0
pts
Good 80%–89%
The response identifies an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
11
to >
10.0
pts
Fair 70%–79%
The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.
10
to >
0
pts
Poor 0%–69%
The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.
15
pts
This criterion is linked to a Learning Outcome
• Identify one evidence-based violence risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.
15
to >
13.0
pts
Excellent 90%–100%
The response identifies and explains an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
13
to >
11.0
pts
Good 80%–89%
The response identifies an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
11
to >
10.0
pts
Fair 70%–79%
The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.
10
to >
0
pts
Poor 0%–69%
The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.
15
pts
This criterion is linked to a Learning Outcome
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
to >
4.0
pts
Excellent 90%–100%
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
to >
3.5
pts
Good 80%–89%
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
to >
3.0
pts
Fair 70%–79%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.
3
to >
0
pts
Poor 0%–69%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.
5
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5
to >
4.0
pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation errors
3
to >
0
pts
Poor 0%–69%
Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5
pts
This criterion is linked to a Learning Outcome
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
to >
4.0
pts
Excellent 90%–100%
Uses correct APA format with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 APA format errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 APA format errors
3
to >
0
pts
Poor 0%–69%
Contains five or more APA format errors
5
pts
Total Points:
100 Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
NRNP 6675 Final Exam The independent credentialing body for the ANA is known as which of the following?
Question 1 1 pts
The independent credentialing body for the ANA is known as which of the following?
Group of answer choices
ANCC
AECN
ACCN
CCNE
NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
Introduction
Personality disorder poses a significant challenge to psychiatric practice because of their heterogeneity nature. Over the years, people with personality disorders remain in denial and do not seek help. The functional impairment associated with a personality disorder is ignored, and as a result, the outcome of Axis 1 disorder is affected. People suffering from personality disorders lack awareness of the consequences of their behavior and frequently remain indifferent or blame others for the distress caused by their actions and interactions. Diagnosing personality disorder is challenging due to its cluster and variable presentations. Generally, the individual diagnostic criteria of personality disorder are very similar in ICD-10 and DSM-IV, but it differentiated Axis II from mental state disorders Axis I. The personality disorder I chose for this paper is antisocial personality disorder (ASPD) type B (Borderline type). It is described as a heterogeneity disorder and classified into four types: Impulsive borderline personality disorder, discouraged borderline personality disorder, self-destructive borderline personality disorder, and petulant borderline personality disorder. Differentiating personality disorders from other forms of disorders is complex due to the similarities in their presentations. The above four categories have not been updated in the DSM-5, but the criteria for their diagnosis are spelled out in the American Psychiatric Association. They present with fear of being abandoned by family and friends, have unstable relationships, have a poor self-image, are very self-critical, have impulsive behaviors, engage in excessive spending, unsafe sex, reckless driving, or misuse or overuse of substances, and self-harming behavior with the risk of threatening or attempting suicide. The person may experience outbursts of anger, mood swings, and feelings of shame and guilt.
Explain the controversy that surrounds your selected personality or paraphilic disorder.
Some of the controversy surrounding ASPD personality disorder is on the classification. Clinicians need to know and understand the best way to classify it as a category or dimension. Depression and schizophrenia can be categorically approached, but it is challenging to approach ASPD similarly due to its heterogeneity characteristics. Another issue or controversy surrounding borderline personality is how to determine which personality variable to assess in the personality disorder assessment. How does the clinician diagnose a personality disorder in the regular or abnormal personality continuum? What instruments or parameters will the clinician use since there are many inconsistencies in assessment across both instruments and raters? If the clinician chooses to use cross-instrument reliability between self-report and interview assessments, the outcome is usually inferior in personality disorders. Referencing the DSM-5, which states the diagnosis of personality disorder is pervasive, but current overwhelming evidence shows that its symptoms are unstable, it appears questionable whether its diagnosis is stable. The confusion as to whether ASPD personality disorder can be graded by severity is another concern or controversy.
GET ASSIGNMENT HELP HERE
Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature
.
An antisocial personality disorder is genetically linked; however, some environmental contributors like childhood trauma and abuse (sexual, physical, neglect ), behavioral anomalies such as conduct disorder, ADHD, and psychopathology may play a role (Fisher & Hany, 2019). Patients diagnosed with ASPD also indulge in substance abuse which occurs co-currently and is always why they seek medical help. The lack of insight and functional impairment associated with ASPD makes psychological intervention therapy inefficient. It is, therefore, crucial for the clinician to focus on symptomatic relief and treatment of the co-occurring illness while educating them to be insightful. Patience, empathy, understanding, and psychological support are needed by clinicians and caregivers while caring for a person with ASPD because of their ability to push their limits without taking responsibility for them. They are stigmatized as ‘’con men’’ with insensitive and annoying personalities NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders.
Explain strategies for maintaining the therapeutic relationship with a patient that may present with this disorder.
People diagnosed with ASPD pose many challenges with their care. Caregivers tend to be frustrated and overwhelmed by their inability to take responsibility for their actions. Adequate training of caregivers and strategic management of the patients will foster therapeutic alliance. Due to the imbalance in the mental process of a person with this condition, the mentalizing tool is used to tackle, enhance or fix the mental imbalance. It uses the four dimensions of self and other, cognitive and affective, automatic and controlled, and external and internal, to reset the thought process (Bateman, 2022) NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
Finally, explain ethical and legal considerations related to this disorder that you need to bring to your practice and why they are essential.
The ethical implication of classifying ASPD in legal luminary for defense is filled with controversy, with many stating that it does not meet the current justice system insanity defense (Jurjako et al., 2018). The controversy results from less than one percent using the diagnosis for defense in criminal cases, recording a 26% success rate. However, according to Jurjako et al.,2018 about 90% of those who ever had ASPD as a defense in criminal cases end up being diagnosed with a significant mental health disorder later in life.
References.
Guilé, J. M., Boissel, L., Alaux-Cantin, S., & Rivière, L. (2017). Borderline personality disorder in adolescents: Prevalence, diagnosis, and treatment strategies. Adolescent Health, Medicine and Therapeutics, 9, 199-210. https://doi.org/10.2147/AHMT.S156565
Bateman, A. W. (2022). Mentalizing and group psychotherapy: A novel treatment for antisocial
personality disorder. American Journal of Psychotherapy, 75(1), 32–37.
https://doi.org/10.1176/appi.psychotherapy.20210023
Jurjako, M., Malatesti, L., & Brazil, I. A. (2018). Some ethical considerations about the use of
biomarkers for the classification of adult antisocial individuals. International Journal of
Forensic Mental Health, 18(3), 228–242.
https://doi.org/10.1080/14999013.2018.1485188
Fisher, K., & Hany, M. (2019). Antisocial Personality Disorder. Europe PMC.
https://europepmc.org/article/nbk/nbk546673#free-full-text
Kim, Y. R., & Tyrer, P. (2010). Controversies surrounding the classification of personality disorder.
Psychiatry investigation
,
7
(1), 1–8.
https://doi.org/10.4306/pi.2010.7.1.1
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5®) (5th ed.). American Psychiatric Publishing, Inc
Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan & Sadock’s synopsis of psychiatry (12th ed.)
NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
[ebook]. Wolters Kluwer Health
Kim, Y. R., & Tyrer, P. (2010). Controversies surrounding the classification of personality disorder. Psychiatry investigation, 7(1), 1–8.
https://doi.org/10.4306/pi.2010.7.1.1
Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2004;65:948–958. [
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Oran P, Jenkins R, Tylee A, Blizard R, Mann A. The prevalence of personality disorder among UK primary care attenders. Acta Psychiatr Scand. 2000;102:52–57. [
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American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edition. Washington, DC: American Psychiatric Association; 1994. [
Google Scholar
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World Health Organization. ICD 10 Classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 2020. [
Google Scholar
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Tyrer P, Alexander J, Ferguson B. Personality Assessment Schedule. In: Tyrer P, editor. Personality disorders: diagnosis, management, and course. 2nd ed. London: Arnold, London; 2000. [
Google Scholar
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Ref list
]
Moran P, Jenkins R, Tylee A, Blizard R, Mann A. The prevalence of personality disorder among UK primary care attenders. Acta Psychiatr Scand. 2000;102:52–57. [
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Google Scholar
]
Controversy Associated with Personality and Paraphilic Disorders
Between 10% and 20% of the population experience personality disorders. They are difficult to treat as individuals with personality disorders are less likely to seek help than individuals with other mental health disorders. Treatment can be challenging as they do not see their symptoms as painful to themselves or others.
Paraphilic disorders are far more common in men than in women, and generally quite chronic, lasting at least two years. Treatment of these disorders usually involves both psychotherapeutic and pharmacologic treatments.
In this
Assignment
, you will explore personality and paraphilic disorders in greater detail. You will research potentially controversial elements of the diagnosis and/or treatment and explain ethical and legal considerations when working with these disorders.
To Prepare
Review this week’s Learning Resources and consider the insights they provide on assessing, diagnosing, and treating personality and paraphilic disorders.
Select a specific personality or paraphilic disorder from the
DSM-5-TR
to use for this Assignment.
Use the Walden Library to investigate your chosen disorder further, including controversial aspects of the disorder, maintaining the therapeutic relationship, and ethical and legal considerations.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
The Assignment
In 2–3 pages:
Explain the controversy that surrounds your selected disorder.
Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature.
Explain strategies for maintaining the therapeutic relationship with a patient that may present with this disorder.
Finally, explain ethical and legal considerations related to this disorder that you need to bring to your practice and why they are important.
By Day 7 of Week 7
Submit
your Assignment.
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the
Turnitin Drafts
from the
Start Here
area.
To submit your completed assignment, save your Assignment as
WK7Assgn_LastName_Firstinitial
Then, click on
Start Assignment
near the top of the page.
Next, click on
Upload File
and select
Submit Assignment
for review.
NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
Rubric
NRNP_6675_Week7_Assignment_Rubric
NRNP_6675_Week7_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
In 2–3 pages, address the following: • Explain the controversy that surrounds your selected personality or paraphilic disorder.
15
to >
13.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of the controversy within the field related to the disorder.
13
to >
11.0
pts
Good 80%–89%
The response includes an accurate explanation of the controversy within the field related to the disorder.
11
to >
10.0
pts
Fair 70%–79%
The response includes a somewhat vague or inaccurate explanation of the controversy within the field related to the disorder.
10
to >
0
pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of the controversy within the field related to the disorder. Or the response is missing.
NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
15
pts
This criterion is linked to a Learning Outcome
• Explain your professional beliefs about your selected disorder, supporting your rationale with at least three scholarly references from the literature.
25
to >
22.0
pts
Excellent 90%–100%
The response includes a thorough and well-organized explanation of the student’s professional beliefs about the disorder. Rationale demonstrates critical thinking and is strongly supported with three scholarly references.
22
to >
19.0
pts
Good 80%–89%
The response includes a well-organized explanation of the student’s professional beliefs about the disorder. Rationale is clear and appropriately supported with three scholarly references.
19
to >
17.0
pts
Fair 70%–79%
The response includes a somewhat vague explanation of the student’s professional beliefs about the disorder. Rationale is somewhat unclear and references either provide weak support for the rationale or are not scholarly/current.
17
to >
0
pts
Poor 0%–69%
The response includes a vague explanation of the student’s professional beliefs about the disorder. Rationale is unclear and references are inappropriate. Or the response is missing.
25
pts
This criterion is linked to a Learning Outcome
• Explain strategies for maintaining the therapeutic relationship with a client that may present with the disorder.
30
to >
26.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.
26
to >
23.0
pts
Good 80%–89%
The response includes an accurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.
23
to >
20.0
pts
Fair 70%–79%
The response includes a somewhat vague or incomplete explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.
20
to >
0
pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder. Or the response is missing.
30
pts
This criterion is linked to a Learning Outcome
• Finally, explain ethical and legal considerations related to the disorder that you need to bring to your practice and why they are important. NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
15
to >
13.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.
13
to >
11.0
pts
Good 80%–89%
The response includes an accurate explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.
11
to >
10.0
pts
Fair 70%–79%
The response includes a somewhat vague or incomplete explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.
10
to >
0
pts
Poor 0%–69%
The response includes a vague and inaccurate explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important. Or, response is missing.
15
pts
This criterion is linked to a Learning Outcome
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
to >
4.0
pts
Excellent 90%–100%
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
to >
3.5
pts
Good 80%–89%
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
to >
3.0
pts
Fair 70%–79%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.
3
to >
0
pts
Poor 0%–69%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.
5
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5
to >
4.0
pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation errors
3
to >
0
pts
Poor 0%–69%
Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5
pts
This criterion is linked to a Learning Outcome
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
to >
4.0
pts
Excellent 90%–100%
Uses correct APA format with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 APA format errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 APA format errors
3
to >
0
pts
Poor 0%–69%
Contains five or more APA format errors
5
pts
Total Points:
100
SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
Name: SHERMAN TREMAINE
DOB: November 3, 1968
Sex: Male
Race: African American
Subjective:
CC (chief complaint): ‘’Well, my sister made me come in. I was living with my mom, and she died. I was living and not bothering anyone, and those people– those people, they won’t leave me alone.’’
HPI: A 54-year-old male walked into the clinic on an appointment for an evaluation patient states that his sister advised him to see the doctor. According to the patient, he lived with his Mom until she passed on to glory three years ago. The patient states that he was not bothering anyone, and those people– those people, they won’t leave him alone.’ ’The ones outside his window watching. They watch him, he said. He can hear them and sees their shadows. They think he doesn’t see them, but he says he does. The government sent them to watch me, so my taxes are high in the sky. Do you know that bird? Hear that– hear that heavy metal music? They want you to think it’s weak, but it’s heavy. SHERMAN stated that this started for weeks, weeks, and weeks and weeks, affecting his sleep. The voices are loud and keep him up for days and days. He said that he tries to watch TV, but they watch him through the screen, and they come in and poison his food. He said that he tricked them, though, and locked everything up in the fridge. They aren’t getting in there.
Past psychiatric history• Hospitalized three times at age 20 for an unspecified mood disorder.
Medication trials and current medications• Takes metformin for diabetes. Tried Haldol, Thorazine, Risperidone, and Seroquel.( All discontinued)
Psychotherapy or previous psychiatric diagnosis• No history of prior psychotherapy but had three hospital admissions at age 20.
Substance Current Use: SHERMAN states that he smokes about three packs of cigarettes daily and smokes all day. SHERMAN drinks about 12 packs back alcohol weekly, with the last drink being yesterday. The history of marijuana and previous use three was three years. The patient denies using cocaine.
Family psychiatric/substance use: Dad was crazy with paranoid schizophrenia. Mom had anxiety. Dad drank alcohol and had a history of Marijuana when mom was alive. Dad was hospitalized in the old state hospital.
BUY A SOAP NOTE HERE
Social: Raised by my mom and my sister, he currently lives with his sister. Never been married, have no children, my highest level of education is 10
th
grade, I smoke (Three packs a day.), live with my mom, and she died, drink alcohol about 12 packs a week. Denies DUIs or legal issues from drugs or alcohol. Does not go to the grocery store. History of marijuana three years ago when mother was alive. Prohibits use of any cocaine, Deniny blackouts or seizures or ,see or hearing things from drugs or alcohol. No history of family members or relatives committing suicide. It does not work, so smoking and drinks pop stuff he does for fun. He denies ever being arrested orconvicted for anything legally but was warned to quit calling 911 about the people outside. SHERMAN confirmed childhood trauma/abuse from his dad when he was alive.
Medical: History: diabetes, fatty liver
Allergies: No history of any allergies.
Reproductive Hx
: History of gynecomastia (boobs) side effect from Risperidone, denies sexual history or abuse
ROS:
GENERAL
: well-groomed for the season, no weight loss, no distress, and no hotness of body.
HEENT:
No vision problem. Ears normal shape with no discharges. Nose normal shape; no bleeding or septal deviation or drainage. No sore throat or swelling around the neck.
SKIN: Skin intact and appropriate; no rash or lesion noted
CARDIOVASCULAR: no cardiovascular abnormality
RESPIRATORY: Lungs sound clear, and no adventitious lung sound
GASTROINTESTINAL: All bowel sounds on all four quadrants
GENITOURINARY: No disorder or problem with this system
NEUROLOGICAL: alert and oriented to person, place, time, and situation but easily distracted.
MUSCULOSKELETAL: All extremities are moveable; some tremors noted in upper extremities
HEMATOLOGIC: No bleeding or purpura
LYMPHATICS: No swollen lymph nodes
ENDOCRINOLOGIC: controlled diabetes type 2
Objective
:
Physical exam:
Vital signs:
Obtained and recorded
Weight= Height = BMI
=( obtained and recorded)
Diagnostic results,
including any labs and imaging: No diagnostic test is ordered or required at this time
Assessment:
Mental Status Examination:
A 54-year-old male, alert and oriented, appears to be a stated age. The patient was groomed for the weather and well-nourished. The patient remained cooperative with the assessment and answered questions without fidgeting. He is a good historian and maintained good eye contact with occasional distractibility. The patient appeared anxious, coherent, illogical, and slightly frightened. The patient was seated upright without any excess abnormal body movement. Noted patient with a constricted flat affect, no acute psychosis documented. The patient had audio-visual hallucinations and was responding to internal stimuli. He was paranoid, delusional, and intrusive without insight into his mental health. Denies suicidal or homicidal ideations. Speech is clear, of average volume and pitch, with no echolalia. The patient could recall past and present memories with mild forgetfulness, as he could not state the date.
Diagnostic Impression:
Schizophrenia Paranoid type.
The patient’s primary diagnosis is Schizophrenia. Schizophrenia is a mental illness of unknown etiology characterized by the person’s inability to think, feel or behave appropriately. It is associated with alteration in brain function, and It is believed that Schizophrenia has both genetic and environmental factors that play a role in its cause. It is also described as psychosis, and the sufferer loses touch with reality. To be diagnosed with schizophrenia, according to DSM-5, specific criteria must be met, including delusions, hallucinations, and disorganized speech or thoughts. There are negative symptoms such as paranoid or catatonic behavior, all lasting at least six months. The patient in this scenario, Mr. S T, presented with paranoid behavior, evidenced by the fact that he said the government was after him. He was also delusional and heard voices as he asked the clinician if she heard or could see them from the window; three hospitalizations evidenced the duration and symptoms over six months at the age of 20 years.
Schizoaffective Disorder:
This chronic, relatively rare mental health disorder occurs prevalence in only 0.3% of the population. It affects males as much as females, with early onset in males than in females. It manifests with schizophrenic symptoms such as hallucinations or delusion and symptoms of mood disorders such as mania and depression. Its etiology is unknown; however, some schools of thought link it to genetics, brain chemistry and structure alteration, extreme stress, and substance abuse such as psychoactive drugs like LSD. Schizoaffective disorder poses significant challenges with the diagnosis because of conflicting or overlapping symptoms of schizophrenia and either depression or bipolar disorder. It is classified as schizo-affective disorder bipolar or depressive type, and close monitoring is essential as signs are based on the style. This condition is ruled out in Mr. ST because he did not show any depressive symptoms. To diagnose a patient with schizo- affective disorder, a major mood disorder, either depression or mania, occurs at the same time that symptoms of schizophrenia are present with delusions or hallucinations for two or more weeks in the absence of a major mood episode(DSM-5)
Delusion of Persecution
: Delusion is a fictitious belief that is baseless to the observer but is meaningful to the person. The content of the idea to the thinker is that of doom, mishap, and problem. While the onlooker or observer cannot see this, the person involved is overwhelmed by the thoughts. It is a baseless belief that does not correlate with the person’s level of education, intelligence, or cultural background. The person suffering from delusion has a solid grip on his belief despite apparent reasons not to believe it. In the delusion of persecution, the person feels ill-treated, hunted by authorities, and constantly makes phone calls to authorities to report the baseless allegations. Criteria for diagnosis, according to DSM-5, include delusion for at least one month, an unfounded phobia that impacts a person’s daily activities, hallucinations associated with the delusions, frequent reporting to authorities, and irresistible feeling of threat without reason. The patient in this scenario met all these criteria. SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
Reflections:
Accurate diagnosis, planning, and treatment of a patient start with comprehensive data collection or patient histories. This includes past and present medical/surgical, psychiatric, family, and social accounts. It also includes records of past and current substance use/ abuse, hospitalizations, support system, and medical and behavioral assessments. Building trust and communication starts from the first encounter as the patient walks into the clinic. Recognizing that patients living with mental are often disrespected and taken advantage of, it is vital to integrate the patient’s culture and beliefs into his care. Analyzing this case scenario as an NP, I would do a few things differently.
Case Formulation and Treatment Plan
: Psychosocial treatments enable people to compensate for or eliminate the barriers caused by their schizophrenia and learn to live successfully. If a person participates in psychosocial rehabilitation, she is likelier to continue taking their medication and less likely to relapse. Schizophrenia is treated with antipsychotics together with other medications and psychotherapy. Mr. ST had been introduced to Haldol, Thorazine, Risperidone, and Seroquel; however, he exhibited non-compliance syndrome. Some factors contributing to ST’s relapse include substance, lack of insight, and lousy habit of taking medications. Patients and caregivers should be educated on the need to keep treatment regimens, monitor medication side effects, and sign in for drug rehabilitation.
In the Plan section, provide:•
Plan for psychotherapy•
Cognitive behavioral therapy (CBT) is one of the psychotherapy plans I will recommend for Mr. ST. This therapy will help identify and address negative thoughts, which will change unwanted behavior patterns. It will equally offer the opportunity for family and group participation which builds support for the patient. Otherwise known as a talk show, it provides a safe space to discuss ways the patient can manage the symptoms. The use of psychotherapy in treating patients is based on regular personal interactions to help the person change their behavior, increase happiness, and overcome problems. If psychotherapy is to be effective, the patient’s motivation is crucial. Mental health affects the individual as much as it affects families, loved ones, and caregivers.
Alternative therapies.
Supplements like Fish oil, Rhodiola Rosea., S-adenosylmethione, N-acetylcysteine., Choline, and Inositol. St. John’s wort and Calming techniques have not been scientifically proven; they can be used; however, they should not replace the provider’s orders. The patient should verify with the provider before using them to avoid an adverse reaction.
Pharmacologic and Nonpharmacologic treatments:
The best treatment for schizophrenia is a combination of medication, psychological therapy, and community support. Antipsychotics, Mood stabilizer antiepileptics, and antidepressant-antipsychotics. Never give an SSRI alone to a manic patient because of the fear of flipping over the euthymic level into the manic state.
Follow-up parameters as well as a rationale for this treatment and management plan.
Since schizophrenia has public health implications and its pathomechanism is not fully understood, follow-up must be ongoing. Severe limitations characterize antipsychotics, with treatment being efficient for about half of the patients, depending on the group of symptoms presenting, positive, negative, and cognitive. Due to the interactions of antipsychotics with various neurotransmitter receptors, severe neurological and metabolic side effects may lead to sexual dysfunction or agranulocytosis, e.g. (clozapine); close monitoring is essential.
Incorporate one health promotion activity and one patient education strategy.
Interpersonal and social rhythm therapy that synchronizes the patient’s daily habits and activities, such as sleeping, eating, and exercise, is one health promotion activity I will recommend for ST. Embracing this health promotion and incorporating them efficiently into her daily activities could help her have fewer mood swings and less severe outcomes. Integrating Psychoeducational into the treatment of Mr ST is essential as it will help him and his support system learn about his circumstance and their management by identifying early mood signs and handling them timely.
Discussion includes what may be done differently with this patient if the student conducted the session agai
n.
The debilitating nature of schizophrenia and the involvement of three groups of positive, negative, and cognitive symptoms make its treatment and patient compliance challenging. As an NP, I am also the patient advocate. I will validate the reason for the patient’s non-compliance with the prior prescriptions, making sure that he does not have problem with affordability. I may suggest approval for a long-acting injectable for ST if he has issues taking his medications daily.
Legal/ethical considerations:
According to healthy people 2020, neighborhood/environment, economic stability, education, social and community context, health, and healthcare are significant determinants of health. Living in a high-density public housing complex or poor neighborhood with poor access to social amenities and good healthcare could have contributed to Mr ST’s. constant relapse. Disease and infections associated with overcrowding, environmental pollution, airborne diseases, poor nutrition with malnutrition complications, water contamination resulting in waterborne diseases, violence, bullying, drug abuse, and sex trafficking are some risks Mr.ST can face. Assessing his . ability to afford his medications, does he have a provider? What legislature is impacting his zip code? Does he have resources for community support? Can he afford his prescriptions? The practitioner is legally and ethically obligated to advocate for her patients. It is ethical to maintain a therapeutic alliance and the responsibilities of both the therapist and the participants when referred to psychotherapy. In psychiatry, ethical issues are viewed differently from other medical disciplines because of the vulnerability of these groups and the stigma associated with mental illness. Issues related to informed consent, confidentiality, conflict of interest, therapeutic misconception, placebo-related, vulnerability, exploitation, and operational challenges are some SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
References
McCutcheon, R., Reis Marques, T., & Howes, O. (2020). Schizophrenia—An Overview. JAMA
Psychiatry, 77(2), 201. https://doi.org/10.1001/jamapsychiatry.2019.3360
Stępnicki, P., Kondej, M., & Kaczor, A. (2018). Current Concepts and Treatments of Schizophrenia.
Molecules, 23(8), 2087. https://doi.org/10.3390/molecules23082087
American Psychiatric Association. (2013).
Diagnostic and Statistical Manual of Mental
Disorders,
fifth edition DSM-5 American Psychiatric Association, 2013.
Bachem, R., & Casey, P. (2018). Schizoaffective Disorder: A diagnosis whose time has come.
Journal of Affective Disorders
,
227
, 243-253. https://doi.org/10.1016/j.jad.2017.10.034
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2014).
Kaplan and Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.).
Philadelphia, PA: Wolters Kluwer
PsychScene Hub. (2017, April 24). Movement disorders with antipsychotic medication linked to an external site.- Conversations with Dr. Stephen Stahl [Video]. YouTube.
PsychScene Hub. (2017, April 24). Movement disorders with antipsychotic medication Links to an external site.- Conversations with Dr. Stephen Stahl [Video]. YouTube. https://www.youtube.com/watch?v=ipW5AcbFzzE
Vallejo, E. (2020). Realistic schizophrenia simulation Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=63lHuGMbscU
Walden University. (2021). Case study: Sherman Tremaine. Walden University Canvas. https://waldenu.instructure.com
Vallejo, E. (2020). Realistic schizophrenia simulation links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=63lHuGMbscU
Walden University. (2021). Case study: Sherman Tremaine. Walden University Canvas. https://waldenu.instructure.com SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
Psychotic disorders change one’s sense of reality and cause abnormal thinking and perception. Patients presenting with psychotic disorders may suffer from delusions or hallucinations or may display negative symptoms such as lack of emotion or withdraw from social situations or relationships. Symptoms of medication-induced movement disorders can be mild or lethal and can include, for example, tremors, dystonic reactions, or serotonin syndrome.
For this Assignment, you will complete a focused SOAP note for a patient in a case study who has either a schizophrenia spectrum, other psychotic, or medication-induced movement disorder.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare
Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
Review the video,
Case Study: Sherman Tremaine
. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
The Assignment
Develop a focused SOAP note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:
Subjective:
What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective:
What observations did you make during the psychiatric assessment?
Assessment:
Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, and list them in order from highest priority to lowest priority. Compare the
DSM-5-TR
diagnostic criteria for each differential diagnosis and explain what
DSM-5-TR
criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan:
What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
Reflection notes:
What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you were able to follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
By Day 7 of Week 5
Submit
your Focused SOAP Note.
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the
Turnitin Drafts
from the
Start Here
area.
To submit your completed assignment, save your Assignment as
WK5Assgn_LastName_Firstinitial
Then, click on
Start Assignment
near the top of the page.
Next, click on
Upload File
and select
Submit Assignment
for review.
Rubric
NRNP_6675_Week5_Assignment_Rubric
NRNP_6675_Week5_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
Create documentation in the Focused SOAP Note Template about your assigned patient.In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS
15
to >
13.0
pts
Excellent 90%–100%
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
13
to >
11.0
pts
Good 80%–89%
The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
11
to >
10.0
pts
Fair 70%–79%
The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis but is somewhat vague or contains minor innacuracies.
10
to >
0
pts
Poor 0%–69%
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or the subjective documentation is missing.
15
pts
This criterion is linked to a Learning Outcome
In the Objective section, provide:• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses
SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
15
to >
13.0
pts
Excellent 90%–100%
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
13
to >
11.0
pts
Good 80%–89%
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.
11
to >
10.0
pts
Fair 70%–79%
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.
10
to >
0
pts
Poor 0%–69%
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed. Or the objective documentation is missing.
15
pts
This criterion is linked to a Learning Outcome
In the Assessment section, provide:• Results of the mental status examination, presented in paragraph form• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
20
to >
17.0
pts
Excellent 90%–100%
The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
17
to >
15.0
pts
Good 80%–89%
The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.
15
to >
13.0
pts
Fair 70%–79%
The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or innacuracy.
13
to >
0
pts
Poor 0%–69%
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or the assessment documentation is missing.
20
pts
This criterion is linked to a Learning Outcome
In the Plan section, provide:• Your plan for psychotherapy• Your plan for treatment and management, including alternative therapies. Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. • Incorporate one health promotion activity and one patient education strategy.
25
to >
22.0
pts
Excellent 90%–100%
The response provides an evidence-based, detailed, and appropriate plan for psychotherapy for the patient…. The response provides an evidence-based, detailed, and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. A strong rationale for the plan is provided that demonstrates critical thinking and content understanding…. The response includes at least one evidence-based health promotion activity and one evidence-based patient education strategy.
22
to >
19.0
pts
Good 80%–89%
The response provides an evidence-based and appropriate plan for psychotherapy for the patient…. The response provides an evidence-based and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. An adequate rationale for the plan is provided…. The response includes at least one health promotion activity and one patient education strategy.
19
to >
17.0
pts
Fair 70%–79%
The response provides a somewhat vague or inaccurate plan for psychotherapy for the patient…. The response provides a somewhat vague or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is weak or general…. The response includes one health promotion activity and one patient education strategy, but it may contain some vagueness or innacuracy.
17
to >
0
pts
Poor 0%–69%
The response provides an incomplete or inaccurate plan for psychotherapy for the patient…. The response provides an incomplete or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is inaccurate or missing…. The health promotion and patient education strategies are incomplete or missing.
25
pts
This criterion is linked to a Learning Outcome
• Discussion include what may be done differently with this patient if student conducted the session again. Discussed the next intervention if you could follow up with this patient. The discussion was related to legal/ethical considerations (demonstrated critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that take into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
5
to >
4.0
pts
Excellent 90%–100%
Reflections are thorough, thoughtful, and demonstrate critical thinking. Reflections contain a discussion of all elements described within assignment directions.
4
to >
3.5
pts
Good 80%–89%
Reflections demonstrate critical thinking. Reflections contain 2 out of 3 (legal/ethical considerations, social determinate of health, health promotion) with consideration of patient factors and risk factors.
3.5
to >
3.0
pts
Fair 70%–79%
Reflections are somewhat general or do not demonstrate critical thinking. Reflections contain 2 out of 3 (legal/ethical considerations, social determinate of health, health promotion) without consideration of patient factors and risk factors.
3
to >
0
pts
Poor 0%–69%
Reflections are incomplete, inaccurate, or missing.
5
pts
This criterion is linked to a Learning Outcome
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
10
to >
8.0
pts
Excellent 90%–100%
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
8
to >
7.0
pts
Good 80%–89%
The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.
7
to >
6.0
pts
Fair 70%–79%
Three evidence-based resources are provided to support the assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.
6
to >
0
pts
Poor 0%–69%
Two or fewer resources are provided to support the assessment and diagnosis decisions. The resources may not be current or evidence based.
10
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list.
5
to >
4.0
pts
Excellent 90%–100%
Uses correct APA format with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 APA format for parenthetical/in-text citations and reference list errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 APA format for parenthetical/in-text citations and reference list errors
3
to >
0
pts
Poor 0%–69%
Contains five or more APA format for parenthetical/in-text citations and reference list errors
5
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and punctuation
SHERMAN TREMAINE Focused SOAP Note for Schizophrenia Spectrum, Other Psychotic, and Medication-Induced Movement Disorders
5
to >
4.0
pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation format errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation format errors
3
to >
0
pts
Poor 0%–69%
Contains five or more grammar, spelling, and punctuation format errors that interfere with the reader’s understanding
5
pts
Total Points:
100
Medicines related to treating anxiety disorders, OCD, PTSD, and related disorders
Medication Review
Review the FDA-approved use of the following medicines related to treating anxiety disorders, OCD, PTSD, and related disorders:
Anxiety
Generalized anxiety disorder
Panic disorder
alprazolam
amitriptyline
amoxapine
buspirone
chlordiazepoxide
citalopram
clomipramine
clonazepam
clonidine
clorazepate
cyamemazine
desipramine
diazepam
dothiepin
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
gabapentin (adjunct)
hydroxyzine
imipramine
isocarboxazid
lofepramine
loflazepate
lorazepam
maprotiline
mianserin
mirtazapine
moclobemide
nefazodone
nortriptyline
oxazepam
paroxetine
phenelzine
pregabalin
reboxetine
sertraline
tiagabine
tianeptine
tranylcypromine
trazodone
trifluoperazine
trimipramine
venlafaxine
vilazodone
alprazolam
citalopram
desvenlafaxine
duloxetine
escitalopram
fluoxetine
fluvoxamine
mirtazapine
paroxetine
pregabalin
sertraline
tiagabine (adjunct)
venlafaxine
alprazolam
citalopram
clonazepam
desvenlafaxine
escitalopram
fluoxetine
fluvoxamine
isocarboxazid
lorazepam
mirtazapine
nefazodone
paroxetine
phenelzine
pregabalin
reboxetine
sertraline
tranylcypromine
venlafaxine
Posttraumatic stress disorder
Reversal of benzodiazepine effects
Social anxiety disorder
citalopram
clonidine
desvenlafaxine
escitalopram
fluoxetine
fluvoxamine
mirtazapine
nefazodone
paroxetine
prazosin (nightmares)
propranolol (prophylactic)
sertraline
venlafaxine
flumazenil
citalopram
clonidine
desvenlafaxine
escitalopram
fluoxetine
fluvoxamine
isocarboxazid
moclobemide
paroxetine
phenelzine
pregabalin
sertraline
tranylcypromine
venlafaxine
Obsessive-compulsive disorder
citalopram
clomipramine
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine
vilazodone
Medicines related to treating anxiety disorders, OCD, PTSD, and related disorders