Posted: June 26th, 2024

NURS 6521 Discussion: Decision Making When Treating Psychological Disorders – Schizophrenia

Discussion 1:
Schizophrenia is a complex psychological disorder characterized by disturbances in thought, perception, and behavior. The interactive media piece presented a case of a 35-year-old patient with schizophrenia experiencing auditory hallucinations and paranoid delusions. The decision-making process involved assessing the patient’s symptoms, considering their medical history, and selecting an appropriate antipsychotic medication.

The first-line treatment for schizophrenia typically involves antipsychotic medications. Second-generation antipsychotics are often preferred due to their improved side effect profile compared to first-generation agents (Leucht et al., 2022). In this case, risperidone was selected as the initial treatment option. Risperidone acts primarily by blocking dopamine D2 receptors and serotonin 5-HT2A receptors, which helps alleviate positive symptoms such as hallucinations and delusions (Rosenthal and Burchum, 2018).

Administration of risperidone may impact the patient’s pathophysiology in several ways. The blockade of dopamine receptors in the mesolimbic pathway is thought to reduce positive symptoms by normalizing excessive dopaminergic signaling (Kring and Johnson, 2022). However, this action can also affect other dopaminergic pathways, potentially leading to side effects such as extrapyramidal symptoms or hyperprolactinemia.

The antagonism of serotonin 5-HT2A receptors may contribute to the medication’s efficacy in treating negative symptoms and cognitive deficits associated with schizophrenia. This action may also help mitigate some of the side effects caused by dopamine blockade (Rosenthal and Burchum, 2018). Additionally, risperidone’s effects on other neurotransmitter systems, such as histamine and alpha-adrenergic receptors, can lead to metabolic changes and cardiovascular effects.

These potential impacts inform treatment planning in several ways. First, regular monitoring of the patient’s symptoms and side effects is crucial. This includes assessing for improvement in positive and negative symptoms, as well as screening for extrapyramidal symptoms, weight gain, and metabolic changes. Blood tests to monitor prolactin levels and metabolic parameters may be necessary (Leucht et al., 2022).

Second, the treatment plan should include strategies to manage potential side effects. This may involve lifestyle interventions, such as diet and exercise recommendations, to mitigate metabolic risks. If significant side effects occur, dose adjustment or switching to a different antipsychotic medication with a more favorable side effect profile for the individual patient may be considered (Kring and Johnson, 2022).

Third, the treatment plan should address the multifaceted nature of schizophrenia. While antipsychotic medication is a cornerstone of treatment, a comprehensive approach including psychosocial interventions, such as cognitive-behavioral therapy and family psychoeducation, can improve outcomes (Menzies et al., 2024). These interventions can help patients manage residual symptoms, improve social functioning, and enhance medication adherence.

Lastly, the treatment plan should be tailored to the individual patient’s needs and preferences. This involves shared decision-making, where the patient is educated about their condition and treatment options, and their preferences are taken into account. Long-term planning is also essential, as schizophrenia is often a chronic condition requiring ongoing management (Leucht et al., 2022).

In conclusion, the selection of risperidone for treating schizophrenia is based on its efficacy in managing both positive and negative symptoms. Understanding its impact on the patient’s pathophysiology guides the development of a comprehensive treatment plan that addresses symptom management, side effect monitoring, and psychosocial support. This approach aims to optimize treatment outcomes and improve the patient’s quality of life.

References:

Kring, A.M. and Johnson, S.L., 2022. Abnormal psychology: The science and treatment of psychological disorders. John Wiley & Sons.

Leucht, S., Chaimani, A., Krause, M., Schneider-Thoma, J., Wang, D., Dong, S., Samara, M., Peter, N., Huhn, M., Priller, J. and Davis, J.M., 2022. The response of subgroups of patients with schizophrenia to different antipsychotic drugs: a systematic review and meta-analysis. The Lancet Psychiatry, 9(11), pp.884-893.

Menzies, R.E., Richmond, B., Sharpe, L., Skeggs, A., Liu, J. and Coutts‐Bain, D., 2024. The ‘revolving door’of mental illness: A meta‐analysis and systematic review of current versus lifetime rates of psychological disorders. British Journal of Clinical Psychology, 63(2), pp.178-196.

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
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Required Readings
Golubchik, P. and Weizman, A., 2021. Management of anxiety disorders in children with attention-deficit hyperactivity disorder: a narrative review. International Clinical Psychopharmacology, 36(1), pp.1-11.
Grilo, C.M., 2024. Treatment of eating disorders: Current status, challenges, and future directions. Annual Review of Clinical Psychology, 20.
Kring, A.M. and Johnson, S.L., 2022. Abnormal psychology: The science and treatment of psychological disorders. John Wiley & Sons.
Leucht, S., Chaimani, A., Krause, M., Schneider-Thoma, J., Wang, D., Dong, S., Samara, M., Peter, N., Huhn, M., Priller, J. and Davis, J.M., 2022. The response of subgroups of patients with schizophrenia to different antipsychotic drugs: a systematic review and meta-analysis. The Lancet Psychiatry, 9(11), pp.884-893.

Menzies, R.E., Richmond, B., Sharpe, L., Skeggs, A., Liu, J. and Coutts‐Bain, D., 2024. The ‘revolving door’of mental illness: A meta‐analysis and systematic review of current versus lifetime rates of psychological disorders. British Journal of Clinical Psychology, 63(2), pp.178-196.

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
• Chapter 24, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 231–246)
• Chapter 25, “Antidepressants” (pp. 247–265)
• Chapter 26, “Drugs for Bipolar Disorder” (pp. 267–274)
• Chapter 27, “Sedative-Hypnotic Drugs” (pp. 275–285)
• Chapter 28, “Management of Anxiety Disorders” (pp. 287–292)
• Chapter 29, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 293–299)

Discussion: Decision Making When Treating Psychological Disorders

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 potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

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 from 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.
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Discussion 2
This discussion explores decision-making in the treatment of major depressive disorder (MDD), focusing on a case study of a 28-year-old female patient presenting with symptoms of depression. The patient reports persistent feelings of sadness, loss of interest in previously enjoyable activities, difficulty concentrating, and sleep disturbances for the past three months. She has no history of suicidal ideation or previous psychiatric treatment.
The initial step in the decision-making process involves a thorough assessment of the patient’s symptoms, medical history, and potential risk factors. The severity of depression is evaluated using standardized scales such as the Patient Health Questionnaire-9 (PHQ-9) or the Hamilton Depression Rating Scale (HAM-D) (Kring and Johnson, 2022). Based on the assessment, the patient’s depression is classified as moderate, indicating the need for pharmacological intervention alongside psychotherapy.
Selective Serotonin Reuptake Inhibitors (SSRIs) are considered the first-line pharmacological treatment for MDD due to their efficacy and relatively favorable side effect profile (Rosenthal and Burchum, 2018). After careful consideration, escitalopram is selected as the initial treatment option. Escitalopram acts by selectively inhibiting the reuptake of serotonin in the synaptic cleft, thereby increasing serotonin availability and potentially alleviating depressive symptoms.
The administration of escitalopram may impact the patient’s pathophysiology in several ways. The increased availability of serotonin in the synaptic cleft is thought to enhance neurotransmission, potentially leading to improved mood regulation and cognitive function (Grilo, 2024). However, this action can also affect other serotonergic pathways throughout the body, which may result in side effects such as nausea, headache, or sexual dysfunction.
Furthermore, escitalopram’s effects on the serotonergic system may influence other neurotransmitter systems through complex feedback mechanisms. For instance, it may indirectly affect noradrenergic and dopaminergic systems, which could contribute to both therapeutic effects and potential side effects (Rosenthal and Burchum, 2018).
These potential impacts inform the treatment plan in several key ways:

Dosage and Titration: The treatment plan begins with a low dose of escitalopram (10 mg/day) to minimize initial side effects. The dose may be titrated up to 20 mg/day after 2-4 weeks if the response is inadequate and side effects are tolerable (Rosenthal and Burchum, 2018).
Monitoring and Follow-up: Regular follow-up appointments are scheduled to assess symptom improvement and monitor for side effects. The patient is educated about potential side effects and instructed to report any concerning symptoms promptly.
Addressing Side Effects: Strategies to manage common side effects are incorporated into the treatment plan. For instance, taking the medication with food may help mitigate nausea, while scheduling the dose in the morning may help minimize sleep disturbances (Kring and Johnson, 2022).
Comprehensive Approach: While pharmacotherapy is a crucial component, the treatment plan also includes cognitive-behavioral therapy (CBT) to address negative thought patterns and behaviors associated with depression. This combination of pharmacotherapy and psychotherapy has shown superior outcomes compared to either treatment alone (Menzies et al., 2024).
Long-term Planning: The treatment plan considers the chronic nature of MDD. It includes strategies for relapse prevention, such as continuation of medication for at least 6-12 months after symptom remission and ongoing psychotherapy (Grilo, 2024).
Patient Education and Engagement: The patient is educated about the nature of MDD, the importance of medication adherence, and the expected timeline for symptom improvement. This promotes patient engagement and improves treatment adherence (Kring and Johnson, 2022).
Lifestyle Modifications: The treatment plan incorporates lifestyle interventions such as regular exercise, sleep hygiene, and stress management techniques, which can complement pharmacological treatment and improve overall outcomes (Menzies et al., 2024).

In conclusion, the selection of escitalopram for treating MDD is based on its established efficacy and tolerability. Understanding its impact on the patient’s pathophysiology guides the development of a comprehensive treatment plan that addresses symptom management, side effect mitigation, and long-term wellness. This approach aims to optimize treatment outcomes and improve the patient’s quality of life while considering the complex nature of major depressive disorder.
References:
Grilo, C.M., 2024. Treatment of eating disorders: Current status, challenges, and future directions. Annual Review of Clinical Psychology, 20.
Kring, A.M. and Johnson, S.L., 2022. Abnormal psychology: The science and treatment of psychological disorders. John Wiley & Sons.
Menzies, R.E., Richmond, B., Sharpe, L., Skeggs, A., Liu, J. and Coutts‐Bain, D., 2024. The ‘revolving door’of mental illness: A meta‐analysis and systematic review of current versus lifetime rates of psychological disorders. British Journal of Clinical Psychology, 63(2), pp.178-196.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

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Tags: Discussion: Decision Making When Treating Psychological Disorders, NURS 6521, Schizophrenia, Treating Psychological Disorders, Treatment of major depressive disorder (MDD)