Discussion: Decision Making When Treating Psychological Disorders

Decision Making When Treating Psychological Disorders

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2). AT LEAST 5 REFERENCES, NO MORE THAN 5 YEARS

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4). Please review and follow the grading rubric details well, and include each component in the assignment as required. Also, follow the APA writing rules and style

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.  For this Discussion, you will select an interactive media piece to practice decision-making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine the potential impacts of pharmacotherapeutics on a patient’s pathophysiology Discussion: Decision Making When Treating Psychological Disorders.

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To Prepare
  • Review this week’s interactive media pieces and select one to focus on for this Discussion.
  • Reflect on the decision steps in the interactive media pieces, and consider the potential impacts of the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

 

BACKGROUND INFORMATION

The client is a 70-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after a “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.

SUBJECTIVE

During today’s clinical interview, the client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities and states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago but has been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work Discussion: Decision Making When Treating Psychological Disorders.

MENTAL STATUS EXAM

The client is alert and oriented to person, place, time, and event. He is casually dressed. Speech is clear but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. The effect is somewhat constricted but improves as the clinical interview progresses. He denies visual or auditory hallucinations, and no overt delusional or paranoid thought processes are readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).

RESOURCES

§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale was designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

Decision Point One

Decision Point One

Select what you should do:

Begin Zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

  • The client returns to a clinic in four weeks
  • Reports a 25% decrease in symptoms
  • The client is concerned over the new onset of erectile dysfunction

Decision Point One

Begin Effexor XR 37.5 mg orally daily

RESULTS OF DECISION POINT ONE

  • The client returns to a clinic in four weeks
  • The client reports that there is no change in depressive symptoms at all

Decision Point One

Begin Phenelzine 15 mg orally TID

RESULTS OF DECISION POINT ONE

  • The client returns to a clinic in four weeks
  • The client reports that he was rushed to the Emergency Room 2 weeks ago after collapsing at the warehouse where he works. He was taken by ambulance to the local community hospital. He was diagnosed with postural hypotension
  • The client was treated with fluid bolus and told to stop taking his phenelzine and to follow up with his primary care provider within one week, and you within that same time frame. Discussion: Decision Making When Treating Psychological Disorders

Decision Point Two

Select what you should do next:

Decision Point Two

Restart Phenelzine and counsel the client on dietary choices and the importance of hydration

RESULTS OF DECISION POINT TWO

  • The client reports that although he had no more episodes of passing out, he has been dizzy when he gets up at night to use the bathroom
  • The client also reports that at various times throughout the day when he goes from a sitting to a standing position, he feels light-headed

Decision Point Two

Phenelzine is not reinitiated. Instead, we began therapy with Lexapro 20 mg orally daily after an appropriate “wash out” period (5 half-lives)Discussion: Decision Making When Treating Psychological Disorders.

RESULTS OF DECISION POINT TWO

  • The client returns to the clinic in four weeks
  • The client had no more syncopal episodes or episodes of orthostatic hypotension
  • The client reports a decrease in depressive symptoms by approximately 25 percent on the MADR scale

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Decision Point Two

Re-start Phenelzine 7.5 mg orally TID

RESULTS OF DECISION POINT TWO

  • The client returns to a clinic in four weeks
  • A client reported that he still has a little dizziness
  • The client also reports that his depression has improved greatly (a 35% decrease in the MADR scale from 51 to 33)

Decision Point Three

Select what you should do next:

Decision Point Three

Continue current drug dose and counsel client on dietary modifications and orthostatic hypotension safety

Guidance to Student
The initiation of an SSRI or SNRI should not begin until an adequate “wash out” period of MAOI- this is generally defined as the time it takes for 5 half-lives of the drug to be metabolized. Co-administration of SSRI, SNRI, or TCA with MAOI is contraindicated as it can cause serotonin syndrome and can actually be fatal. You can continue the current dose and counsel client as to dietary modifications as well as orthostatic hypotension safety, however, it should be remembered that he works in a warehouse and may be at risk for falls/injury due to orthostatic hypotension. A “watch and wait” approach may be appropriate if the client has failed all other antidepressants. Increasing the dose back to 15 mg orally TID is not indicated as his orthostatic hypotension will likely worsen Discussion: Decision Making When Treating Psychological Disorders.

Also check: Demographic and Epidemiological Assessment