NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology, Walden University, Adult/Geriatric Depression Therapy, Hispanic Male with MDD
NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Walden University Adult/Geriatric Depression Therapy, Hispanic Male with MDD
BACKGROUND INFORMATION
The client is a 32-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 the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after “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.
Nurs 6630 Adult/Geriatric Depression therapy
SUBJECTIVE
During today’s clinical interview, 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, 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 have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.
MENTAL STATUS EXAM
The client is alert, 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. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers 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 designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
BEST CUSTOM NURSING PAPER WRITERS READY TO HELP
Decision Point One
Begin Zoloft 25 mg orally daily
Effexor XR 37.5 mg orally daily AND Phenelzine 15 mg orally TID ARE THE OTHER OPTION I DID NOT USE
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Reports a 25% decrease in symptoms
Client is concerned over the new onset of erectile dysfunction.
What should the PMHNP DO NEXT?
Decision Point Two
Add augmenting agent such as Wellbutrin IR 150 mg in morning
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client stated that depressive symptoms have decreased even more and his erectile dysfunction has abated
Client reports that he has been feeling “jittery” and sometimes “nervous”
What should the PMHNP DO NEXT?
Decision Point Three
Change Wellbutrin to XL 150 mg orally daily in AM
Guidance to Student
The PMHNP should be aware that Zoloft or Wellbutrin could be responsible for the client complaints of Jitteriness. This feeling is usually temporary with SSRIs, however. The cause of the client’s complaint of “jitteriness” is most likely related to the Wellbutrin immediate release. As a result, the most appropriate answer would be to change the Wellbutrin to an extended release formulation. It would not be appropriate to add Ativan as the PMHNP should never add an additional medication to treat the side effect of another medication without first attempting to modify/change the medication causing the side effect.
The Assignment : NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Walden University Adult/Geriatric Depression Therapy, Hispanic Male with MDD
Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
- At each decision point stop to complete the following:
- Decision #1
- Which decision did you select?
- Why did you select this decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
- Decision #2
- Why did you select this decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
- Decision #3
- Why did you select this decision? Support your response with evidence and references to the Learning Resources.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
- Decision #1
- Also include how ethical considerations might impact your treatment plan and communication with clients.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Walden University Adult/Geriatric Depression Therapy, Hispanic Male with MDD
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
- Chapter 6, “Mood Disorders”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.
Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Retrieved from https://www.researchgate.net/profile/Marie_Asberg/publication/22697065_A_New_Depression_Scale_Designed_to_be_Sensitive_to_Change/links/09e41513f85c708fee000000.pdf
Required Media
Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.
To prepare for this Assignment:
- Review this week’s Learning Resources. Consider how to assess and treat adult and geriatric clients requiring antidepressant therapy.
Get answers from qualified nursing paper experts
Sample paper on NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Walden University Adult/Geriatric Depression Therapy, Hispanic Male with MDD
Paper type: Research Paper
Course Level: Master
Subject Area: Nursing
# Pages: 6
A major depressive disorder is a mental problem that is common among the elderly populations. The condition may cause significant psychological, emotional, and economic problems not only to the patient but also to his or her family members and relatives. The goal of every nurse is to effectively address the health care needs of their clients (American Psychiatric Association, 2013). For instance, the advanced practice nurse must be able to identify the pharmacological agents that can help an elderly male Hispanic patient to manage symptoms of the major depressive disorder effectively. The subjective data of the patient described in the case study reveals that; he has difficulty in engaging in his daily activities, he has gained an abnormal weight within the past 30 days, and that he experiences episodes of insomnia. When selecting the most appropriate drugs for this patient, the clinician must consider all the factors that may affect his pharmacodynamic and pharmacokinetic processes (Stahl, 2013). Ideally, the ability of the 32-year-old Hispanic male patient to recover from symptoms of major depressive disorder largely depends on the types and dosages of drugs administered.
Decision Point One
Selected Decision
Begin Zoloft 25 mg orally daily
Reason for Selection
Zoloft has been selected as the best drug for the patients due to its effectiveness in treating severe cases of depression. During the mental status examination of the patient using the MADRS scale, the PMHNP has obtained a tally of 51 which indicates that he is suffering from severe depression (Montgomery, & Asberg, 1979). Although Effexor XR will produce similar effects as Zoloft, it has not been selected because its administration may generate significant side effects bearing in mind that he is currently troubled with insomnia. Phenelzine has not been chosen because it is often administered in cases where other anti-depressants have proven to be ineffective (Stahl, 2014b). Therefore, the best drug out of the three available options that can best relieve symptoms of severe depression is 25mg of Zoloft which should be administered orally on a daily basis (Stahl, 2014b).
Expected Results
Three major changes are expected to take place in the patient within a period of two weeks following the oral administration of 25 mg of Zoloft. From the subjective data, it is evident that the client has a diminished interest in taking part in the daily activities. One of the expected results, therefore, is a motivation for performing his daily activities as usual. Besides, during the assessment, the patient has reported that he is troubled at work due to poor concentration. After taking the drug, his level of concentration should increase within a period of 14 days. Moreover, according to the patient, he has been experiencing troubles with insomnia. It is expected that he should be able to sleep well at night after using Zoloft for two weeks (Liu, Anderson, Mittmann, Axcell & Shear, 2015).
Differences Between Expected Results and Actual Results
Although the changes described above were expected by the PMHNP, some of the results are contrary to what was anticipated. For instance, the client has returned to the clinic after four weeks instead of two. Additionally, based on the client’s report, the clinician has concluded that only a 25% reduction in symptoms has occurred. On the other hand, a significant reduction in disease symptoms was anticipated. Moreover, the client has developed a new onset of erectile dysfunction which is not among the expected results. The observed change is one of the side effects of Zoloft (Gaboda, Lucas, Siegel, Kalay & Crystal, 2014). Despite the unique clinical presentation, it can be concluded that Zoloft is effective in reducing symptoms of severe depression on the patient, although at a relatively slower rate than expected.
Decision Point Two
Selected Decision
Add augmenting agent such as Wellbutrin IR 150 mg in morning
Reason for Selection
Although the client has reported that he had begun to recover from depressive symptoms, another complication emerges which he should be helped to manage. Precisely, the patient is troubled with erectile dysfunction which is a recognizable side effect of Zoloft. The best way to help him to gain a normal erectile functioning is to combine Zoloft with Wellbutrin IR which is also an antidepressant. When the client is allowed to use both drugs, he will be able to experience a significant reduction in depressive symptoms coupled with the normalization of erectile functioning (Flint & Rifat, 2013).
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Expected Results
Following the administration of 150 mg of Wellbutrin in the morning, the PMHNP expects to achieve two major results. First, the problem of erectile dysfunction should reduce significantly. Second, there should be a reduction in the previously existing symptoms of depression such as sleep disturbance, lack of concentration, and a diminished interest in performing daily activities. Essentially, the patient should report an increased ability to sleep at night, an improvement in concentration, and an encouragement to take part in activities. The anticipated results should occur following a combined activity of Wellbutrin and Zoloft (Flint & Rifat, 2013).
NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Walden University Adult/Geriatric Depression Therapy, Hispanic Male with MDD Sample paper
Differences Between Expected Results and Actual Results
The client has visited the healthcare facility for follow-up care after four weeks. He has reported two changes which were expected by the attending clinician. One of the changes is a significant reduction in symptoms of depression and normalization of erectile functioning. These observations portray the effectiveness of Wellbutrin and Zoloft in helping elderly patients to manage symptoms of major depression. However, a new thing, which was not anticipated by the PMHNP has emerged. The client has reported that he experiences feelings of nervousness and jittery. These occurrences could be as a result of the side effects of the two drugs administered (Gaboda et al., 2014). The new symptoms may be associated with either the individual contents of the drugs or their dosages.
Decision Point Three
Selected Decision
Change Wellbutrin to XL 150 mg orally in AM
Reason for Selection
The new problems that the clinician should assist the patient to manage in this case are feelings of nervousness and jitteriness. Since the client did not develop these feelings when Zoloft was first administered, it can be concluded that they are attributed to Wellbutrin release. The goal of the nurse, in this case, is to create a form of physiological balance in the patient’s body which cannot be achieved by treating the side effects of the drug. Instead, changing Wellbutrin to XL at a dosage of 150 mg administered in the morning is the most appropriate way to eliminate jitteriness in this case (Flint, 2012; Stahl, 2014b).
Expected Results
By administering the extended form of Wellbutrin, the clinician expects to help the patient to completely eliminate feelings of jitteriness. The response is expected to occur due to the antidepressant effects of the drug. As the feelings of agitation fade away, it is anticipated that the client will be able to experience significant improvement of the depressive symptoms. At this time, he should be able to resume normal activities, sleep normally at night, and to concentrate to do his job well as usual (Liu et al., 2015).
Differences Between Expected Results and Actual Results
There is a great concurrence between the actual and expected results following the administration of extended Wellbutrin. At this time, no recognizable side effects have been observed. The clinician has followed the right standards for administering a pharmacological therapy as described by Laureate Education (2016g). According to Laureate (2016g), it is inappropriate to treat the side effects of a drug. Instead, the pharmacologist should always strive to modify the way a given pharmacological agent is administered in order to eliminate its side effects. The most important thing that every clinician must understand is that almost all pharmacological agents have got side effects. In that regard, by attempting to treat side effects of a drug, the professional may just be inviting additional complications (Liu et al., 2015).
Ethical Considerations
When interacting with the client, the clinician has observed ethics by ensuring that every decision made is ethically justified. For instance, during the entire therapeutic relationship, the pharmacologist has aimed to assist the patient to achieve maximum benefits and to minimize harm in every step of the treatment process. Therefore, he or she has engaged solely in activities that will generate positive health outcomes for the client (Stahl, 2014b). For instance, the professional has recommended 25 mg of Zoloft taken orally on a daily basis to eliminate symptoms of severe depression. Again, he or she has considered the addition of an augmenting agent such as Wellbutrin IR 150 mg in the morning and administration of extended Wellbutrin to promote quick recovery for the client. By so doing, the professional has acted in accordance with the principles of utilitarianism ethics. Supporters of utilitarianism ethics assume that an action is ethically justified if it can generate happiness and pleasure to the largest number of the interest groups. Essentially, prescribing the right drugs for the patient will generate happiness and pleasure not only to himself but also to his family members. Moreover, the clinician has observed the privacy rights of the patient throughout their association by not disclosing his medical information to others (Stahl, 2013; Stahl, 2014b).
Conclusion
In summary, symptoms of major depressive symptoms among the elderly can effectively be managed through careful selection of pharmacological agents. For an advanced practice nurse to recommend the right drug for a geriatric client who is suffering from depression, he or she must possess a comprehensive knowledge of the factors that may affect the pharmacodynamic and pharmacokinetic processed of the patient. Generally, the nature of decision made by the pharmacologist concerning the most appropriate drug to administer largely depends on the patient’s medical history and his or her health status at the time of visit. Moreover, healthcare professionals must follow the right standards for administering a pharmacological therapy. Most importantly, the pharmacologist should always strive to modify the way a given pharmacological agent is administered in order to eliminate its side effects.
References: Sample paper on NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology Walden University Adult/Geriatric Depression Therapy, Hispanic Male with MDD
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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Note: Retrieved from Walden Library databases.
Flint, A. J. (2012). Choosing appropriate antidepressant therapy in the elderly. Drugs & aging, 13(4), 269-280.
Flint, A. J., & Rifat, S. L. (2013). The effect of sequential antidepressant treatment on geriatric depression. Journal of affective disorders, 36(3), 95-105.
Gaboda, D., Lucas, J., Siegel, M., Kalay, E., & Crystal, S. (2014). No longer undertreated? Depression diagnosis and antidepressant therapy in elderly long‐stay nursing home residents, 1999 to 2007. Journal of the American Geriatrics Society, 59(4), 673-680.
Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author.
Liu, B., Anderson, G., Mittmann, N., To, T., Axcell, T., & Shear, N. (2015). Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. The Lancet, 351(9112), 1303-1307.
Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Retrieved from https://www.researchgate.net/profile/Marie_Asberg/publication/22697065_A_New_Depression_Scale_Designed_to_be_Sensitive_to_Change/links/09e41513f85c708fee000000.pdf
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
