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Posted: May 6th, 2017

Discussion: Decision Making When Treating Psychological Disorders

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.

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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.
By Day 3 of Week 8
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

Week 8 Discussion
COLLAPSE
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 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.

Decision Point 1

I will begin Effexor XR 37.5 mg orally every day. At lower doses, the side effects of Venlafaxine XR are low. Venlafaxine XR can boost neurotransmitters serotonin, dopamine, and noradrenaline/norepinephrine (Ivanets et al., 2016). It has good tolerance and efficacy than SSRI for severe depression treatment. Venlafaxine XR can obstruct the reuptake serotonin pump to increase the neurotransmission of serotonin (Stahl, 2013). Zoloft has effects associated with sexual dysfunction and the man may still be sexually active. Phenelzine is ruled out because it is an MAOI that may be used i antidepressants fail. I hoped to see at least a 25% improvement in the symptoms because of the low dose of the medication. If the patient returns after four weeks with no change in depressive symptoms, I would not have achieved the actual outcome.

Decision Point 2

After the patient comes back with no changes, my next decision was to increase the dosage of Effexor XR orally to 75mg from 37.5mg daily. Therapeutic actions are not immediate and may take 2-3 weeks. If no changes are noticed within 6-8 weeks, the dosage should be increased. By increasing the dose to 75mg, I hope to see improvement in the symptoms and ratings on the Montgomery-Asberg Depression Rating Scale. The patient returns after four weeks with improvements and a reduction in the MADRS from 51-38%. This represents a 25% reduction in the presenting symptoms. The results are exactly what I hoped to see but I didn’t anticipate a much bigger reduction because, in the beginning, the lower dose did not have any effect.

Decision Point 3

Considering a 25% improvement in the symptoms, I will continue the same amount of dose because it seems to have an impact. In this situation, the healthcare professional may choose to continue the current dose or increase the medication if the patient does not experience side effects and feel much better (Laureate Education, 2016g). An increase in the medication may make the patient experience side effects. The highest amount of dose of Venlafaxine should be 225mg daily. The drug’s side effects depend on the dose (Ivanets et al., 2016). A high dose produces more side effects. The objective of the treatment is to eliminate the current symptoms and prevent any future conditions. Even after the decrease of the symptoms, treatment will continue for a year for the initial depression episode. I intended to see further improvement with the continuation of the dosage after 4 weeks.

Conclusion

The treatment of depression can be challenging particularly when choosing appropriate medication to reduce the patient’s symptoms. After looking at the three options, I chose to prescribe Venlafaxine because of the patient’s symptoms, potential side effects, and age. In the first decision, I prescribed a lower dose and no improvement was noted in the patient’s symptoms. However, after increasing the dose to 75mg, the patient started having improvements. I continued with the same dose in my third decision to ensure that the patient has maximum benefit of treatment.

References

Ivanets, N., Kinkul’kina, A., Tikhonova, G., & Izyumina, A. (2016). Venlafaxine in the treatment of moderate and severe depression: Approaches to increase treatment efficacy. Neuroscience and Behavioral Physiology, 46(5), 529-533. DOI:10.1007/s11055-016-0272-3

Laureate Education. (2016g). Case study: An elderly Hispanic man with the major depressive disorder [Interactive media file]. Baltimore, MD: Author. Retrieved from: https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/03/mm/adult_geriatric_depression/index.html

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

________________________
The psychological disorder presented in this case is depression in a 70-year-old Hispanic American male. The decision steps applied in completing the interactive media piece involved selecting the most appropriate pharmacotherapeutic option to treat the patient’s depression.

In Decision Point 1, Effexor XR (Venlafaxine) was chosen as the initial medication at a dose of 37.5 mg orally every day. Effexor XR is a serotonin-norepinephrine reuptake inhibitor (SNRI) that increases the neurotransmission of serotonin and norepinephrine in the brain. It was selected over other options like Zoloft (sertraline) and Phenelzine (MAOI) due to its efficacy and low side effect profile. The goal was to achieve at least a 25% improvement in the depressive symptoms with the initial low dose.

In Decision Point 2, since there was no improvement in symptoms after four weeks, the dosage of Effexor XR was increased to 75 mg orally daily. This decision was based on the therapeutic actions of Effexor XR, which may take 2-3 weeks to show effects. The patient returned after four weeks with improvements and a 25% reduction in the Montgomery-Asberg Depression Rating Scale (MADRS) score. The desired outcome was achieved with the increased dose.

In Decision Point 3, considering the 25% improvement in symptoms, it was decided to continue with the same dose of 75 mg daily. The rationale behind this decision was to prevent potential side effects associated with further dose increases, as high doses of Venlafaxine can produce more side effects. The treatment will continue for a year for the initial depressive episode, even after a decrease in symptoms.

The administration of Venlafaxine (Effexor XR) may impact the patient’s pathophysiology by increasing the neurotransmission of serotonin and norepinephrine in the brain. This can help regulate mood and alleviate depressive symptoms. By targeting these neurotransmitters, Effexor XR can improve the patient’s emotional well-being, reduce feelings of sadness and hopelessness, and potentially enhance overall functioning.

These potential impacts on the patient’s pathophysiology inform the treatment plan by suggesting that medications targeting serotonin and norepinephrine reuptake may be effective in managing depression symptoms. Additionally, it highlights the importance of individualized dosing based on the patient’s response and tolerability to the medication.

In conclusion, the treatment of depression in this case involved prescribing Venlafaxine (Effexor XR) due to the patient’s symptoms, potential side effects, and age. The decision to increase the dosage from 37.5 mg to 75 mg daily resulted in improvements in symptoms. Continuing with the same dose after observing a 25% reduction in depressive symptoms was chosen to maximize the benefits of treatment while minimizing potential side effects.

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