Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders
Advances in genetics and epigenetics have changed the traditional understanding of mood disorders, resulting in new evidence-based practices. In your role as a psychiatric mental health nurse practitioner, it is essential for you to continually educate yourself on new findings and best practices in the field. For this Assignment, you consider best practices for assessing and treating adult and geriatric clients presenting with mood disorders.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in adult and geriatric clients requiring antidepressant therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing antidepressant therapy to adult and geriatric clients
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through this link provided.
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 The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
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.
The Assignment
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?
Also include how ethical considerations might impact your treatment plan and communication_
_____________
Decision #1:
In this case, I would select the decision to prescribe an SSRI (Selective Serotonin Reuptake Inhibitor) such as escitalopram (Lexapro). This decision is based on several factors. Firstly, SSRIs are considered a first-line treatment for major depressive disorder (MDD) in adults and geriatric clients due to their efficacy and tolerability. The American Psychiatric Association’s practice guidelines recommend SSRIs as the initial treatment option for MDD. Secondly, escitalopram has shown effectiveness in treating depression in older adults and has a favorable side effect profile. According to Stahl (2013), escitalopram has a relatively low risk of adverse effects and drug-drug interactions, making it a suitable choice for geriatric clients who may be more susceptible to medication side effects.
By prescribing escitalopram, my goal is to achieve a reduction in depressive symptoms and an improvement in the client’s overall mood and quality of life. Escitalopram, as an SSRI, works by inhibiting the reuptake of serotonin, thereby increasing its availability in the brain. This can help alleviate depressive symptoms and restore a more balanced mood. I would also closely monitor the client’s response to the medication and make any necessary adjustments in dosage or treatment plan.
Decision #2:
For the second decision, I would choose to augment the treatment with psychotherapy, specifically cognitive-behavioral therapy (CBT). CBT has been shown to be effective in treating depression, including in older adults. Research suggests that combining medication with psychotherapy can lead to better outcomes compared to medication alone. CBT can help the client identify and change negative thought patterns and behaviors that contribute to depressive symptoms. It can also provide the client with coping strategies and skills to manage their mood and improve their overall well-being.
By incorporating CBT into the treatment plan, I hope to achieve a more comprehensive and holistic approach to the client’s care. Medication alone may address the neurochemical imbalances associated with depression, but therapy can address underlying psychological factors and help the client develop long-term strategies for maintaining mental health. The combination of medication and psychotherapy has the potential to provide synergistic effects and enhance the client’s recovery.
Decision #3:
For the third decision, I would consider a medication adjustment based on the client’s response and any potential side effects. In this case, the client is experiencing insomnia as a side effect of escitalopram. Insomnia can significantly impact the client’s quality of life and overall well-being. Therefore, I would consider prescribing a sedating antidepressant such as mirtazapine (Remeron) as an adjunct or alternative to escitalopram. Mirtazapine has a sedating effect and can help improve sleep quality.
By adding mirtazapine to the treatment regimen, I aim to address the client’s insomnia while still targeting the depressive symptoms. It is essential to balance the potential benefits of improved sleep with any potential side effects or drug interactions. I would closely monitor the client’s response to the medication adjustment, including changes in sleep patterns, mood, and any other side effects.
Ethical Considerations:
When prescribing antidepressant therapy to adult and geriatric clients, several ethical considerations come into play. Informed consent is crucial, and it is important to discuss the potential benefits, risks, and alternatives of medication with the client. In the case of geriatric clients, additional considerations such as cognitive impairment, polypharmacy, and potential drug-drug interactions need to be addressed.
Furthermore, it is essential to maintain open and honest communication with the client throughout the treatment process. This includes regularly assessing the client’s response to medication, addressing any concerns or side effects, and involving the client in shared decision-making. Respecting autonomy
