Depressive disorder (MDD)

As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders. Review the Learning Resources for this week. Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders. Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health. Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms? List 4 predictors of late onset generalized anxiety disorder. List 4 potential neurobiology causes of psychotic major depression. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.    
Short Answer Prompts
  1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
For a patient with major depressive disorder (MDD) and a history of alcohol abuse, selective serotonin reuptake inhibitors (SSRIs) such as sertraline or escitalopram are appropriate first-line pharmacotherapy options. These medications have shown efficacy in treating MDD and are generally well-tolerated. Tricyclic antidepressants (TCAs) like amitriptyline are contraindicated due to their potential for cardiac toxicity, which can be exacerbated by alcohol use. The patient should see a resolution of depressive symptoms within 4-6 weeks of starting treatment.
  1. List 4 predictors of late onset generalized anxiety disorder.
Predictors of late onset generalized anxiety disorder (GAD) may include:
  • Female gender
  • Presence of comorbid medical conditions
  • History of traumatic events or chronic stressors
  • Family history of anxiety disorders
  1. List 4 potential neurobiology causes of psychotic major depression.
The neurobiology causes of psychotic major depression may include:
  • Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to increased cortisol levels and impaired stress response.
  • Imbalance in neurotransmitters, particularly serotonin, dopamine, and norepinephrine, which are involved in mood regulation and psychosis.
  • Abnormalities in brain structure and function, including alterations in the prefrontal cortex, amygdala, and hippocampus.
  • Genetic factors, as there is evidence of a heritable component to psychotic major depression.
  1. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.
To meet the criteria for a major depressive episode, an individual must experience at least five of the following symptoms, which must be present nearly every day for a minimum of 2 weeks:
  • Depressed mood
  • Markedly diminished interest or pleasure in activities (anhedonia)
  • Significant weight loss or weight gain, or changes in appetite
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive guilt
  • Difficulty concentrating or making decisions
  • Recurrent thoughts of death or suicidal ideation
  1. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.
Three classes of drugs that can precipitate insomnia include:
  • Stimulants: Examples include amphetamines (e.g., Adderall) and methylphenidate (e.g., Ritalin), which are commonly used to treat attention-deficit/hyperactivity disorder (ADHD).
  • Selective serotonin reuptake inhibitors (SSRIs): Examples include fluoxetine (Prozac) and sertraline (Zoloft), which are commonly used to treat depression and anxiety disorders.
  • Corticosteroids: Examples include prednisone and dexamethasone, which are used to treat various inflammatory conditions. These medications can disrupt sleep patterns and cause insomnia.

Sample Solution

For a patient with major depressive disorder (MDD) and a history of alcohol abuse, selective serotonin reuptake inhibitors (SSRIs)

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