NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology

Dicussion: Treatment for a Patient With a Common Condition

Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.

_Reference:_{Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29}

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.

*Utilize at least 3 scholarly, peer reviewed resources.

*Utilize SafeAssgn Drafts to obtain originality report before final submission

*NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology*

Case: An elderly widow who just lost her spouse.

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:

Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86

NUR 602 Milestone one for MR X Pharmacology

By Day 3 of Week 7

Post a response to each of the following:

List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
Indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

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NURS 6630 Week7 Discussion Rubric

Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.–

Levels of Achievement:

Excellent

Point range: 90–100 40 (40%) – 44 (44%)

Good

Point range: 80–89 35 (35%) – 39 (39%)

Fair

Point range: 70–79 31 (31%) – 34 (34%)

Poor

Point range: 0–69 0 (0%) – 30 (30%)

Main Posting:

Writing–

Levels of Achievement:

Excellent

Point range: 90–100 6 (6%) – 6 (6%)

Good

Point range: 80–89 5 (5%) – 5 (5%)

Fair

Point range: 70–79 4 (4%) – 4 (4%)

Poor

Point range: 0–69 0 (0%) – 3 (3%)

Main Posting:

Timely and full participation–

Levels of Achievement:

Excellent

Point range: 90–100 9 (9%) – 10 (10%)

Good

Point range: 80–89 8 (8%) – 8 (8%)

Fair

Point range: 70–79 7 (7%) – 7 (7%)

Poor

Point range: 0–69 0 (0%) – 6 (6%)

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.–

Levels of Achievement:

Excellent

Point range: 90–100 9 (9%) – 9 (9%)

Good

Point range: 80–89 8 (8%) – 8 (8%)

Fair

Point range: 70–79 7 (7%) – 7 (7%)

Poor

Point range: 0–69 0 (0%) – 6 (6%)

First Response:
Writing–

Levels of Achievement:

Excellent

Point range: 90–100 6 (6%) – 6 (6%)

Good

Point range: 80–89 5 (5%) – 5 (5%)

Fair

Point range: 70–79 4 (4%) – 4 (4%)

Poor

Point range: 0–69 0 (0%) – 3 (3%)

First Response:
Timely and full participation–

Levels of Achievement:

Excellent

Point range: 90–100 5 (5%) – 5 (5%)

Good

Point range: 80–89 4 (4%) – 4 (4%)

Fair

Point range: 70–79 3 (3%) – 3 (3%)

Poor

Point range: 0–69 0 (0%) – 2 (2%)

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.–

Levels of Achievement:

Excellent

Point range: 90–100 9 (9%) – 9 (9%)

Good

Point range: 80–89 8 (8%) – 8 (8%)

Fair

Point range: 70–79 7 (7%) – 7 (7%)

Poor

Point range: 0–69 0 (0%) – 6 (6%)

Second Response:
Writing–

Levels of Achievement:

Excellent

Point range: 90–100 6 (6%) – 6 (6%)

Good

Point range: 80–89 5 (5%) – 5 (5%)

Fair

Point range: 70–79 4 (4%) – 4 (4%)

Poor

Point range: 0–69 0 (0%) – 3 (3%)

Second Response:
Timely and full participation–

Levels of Achievement:

Excellent

Point range: 90–100 5 (5%) – 5 (5%)

Good

Point range: 80–89 4 (4%) – 4 (4%)

Fair

Point range: 70–79 3 (3%) – 3 (3%)

Poor

Point range: 0–69 0 (0%) – 2 (2%)

Total Points: 100

NURS 6630 Discussion: Treatment for a Patient with a Common Condition

The case study is about a 75-year-old female with insomnia. She has a history of diabetes, hypertension, and depression. Her depression and insomnia have worsened since her husband passed away 10 months ago. The purpose of this discussion is to discuss appropriate additional questions to ask, physical exams and tests, differential diagnosis, and pharmacologic therapy.

Questions You Might Ask the Patient If She Were In the Office

Which other symptoms have you been experiencing? To establish other symptoms common in depression.
How often have you been feeling fatigued in the last two weeks? Patients with depression often have diminished energy levels (Giannelli, 2020).

How have the current symptoms negatively impacted your daily life activities? To identify impairments in the patient’s life.

People in the Patient’s Life I Would Need to Speak to or Get Feedback From

I would need to speak with the patient’s caregiver to obtain more information on the patient’s symptoms that the patient may have omitted. I would ask the caregiver about any odd behaviors and changes in mood in the patient (Giannelli, 2020). In addition, I would inquire from the caregiver if the client experiences any challenges in carrying out activities of daily living. Besides, I would ask if the patient expresses inappropriate guilt or death wishes at home to identify the presence of suicidal thoughts.

Appropriate Physical Exams and Diagnostic Tests

A complete head-to-toe exam would be appropriate for this patient due to her medical history of hypertension and diabetes. It would help identify any underlying abnormalities or disease comorbidities. Appropriate diagnostic tests include a Hemoglobin A1c test to assess the patient’s average glycemic level in the past three months. In addition, a Thyroid-stimulating Hormone (TSH) test would be appropriate to assess for Hypothyroidism, which has similar features to MDD (Giannelli, 2020).

Differential Diagnosis

The differential diagnosis is Major depressive disorder (MDD), which manifests with two primary features a depressed mood or a diminished interest in pleasurable activities. MDD is the differential owing to the patient’s history of MDD and report of worsening depression and insomnia (Giannelli, 2020). Insomnia is a common symptom of MDD. The patient has been on an antidepressant (Sertraline), which means that she could be having treatment-resistant depression.

Pharmacologic Agents

Duloxetine 30 mg PO once daily. This agent was chosen because it is an SNRI, the recommended second-line agents when SSRIs such as Sertraline are ineffective (Ruberto et al., 2020).
Wellbutrin SR 150 mg orally once daily. Wellbutrin was selected because it is an antidepressant used in treatment-resistant depression (Ruberto et al., 2020).

Selected Drug Therapy

Duloxetine would be chosen over Wellbutrin because the former has a stronger safety profile and thus will have fewer side effects. Besides, Duloxetine has better tolerance and a higher compliance rate than Buproprion, making it a better agent for this patient. However, Duloxetine is contraindicated in patients on Monoamine oxidase inhibitors due to psychotic disorders (Avasthi & Grover, 2018). In addition, the patient should be monitored for Serotonin syndrome, and the drug discontinued if the syndrome’s symptoms occur. Supportive therapy would be provided if the patient developed Serotonin syndrome from the Duloxetine.

Conclusion

It is important to obtain additional information about the patient’s mood and behavioral symptoms from the caregiver. Appropriate tests include a head-to-toe exam, HbA1c, and a TSH test. The differential diagnosis is MDD and the most appropriate drug therapy is Duloxetine, due to its safety profile.

References

Avasthi, A., & Grover, S. (2018). Clinical Practice Guidelines for Management of Depression in Elderly. Indian journal of psychiatry, 60(Suppl 3), S341–S362. https://doi.org/10.4103/0019-5545.224474

Giannelli, F. R. (2020). Major depressive disorder. Journal of the American Academy of PAs, 33(4), 19-20. https://doi.org/10.1097/01.JAA.0000657208.70820.ab

Ruberto, V. L., Jha, M. K., & Murrough, J. W. (2020). Pharmacological treatments for patients with treatment-resistant depression. Pharmaceuticals, 13(6), 116. https://doi.org/10.3390/ph13060116