Read a selection of your colleagues’ responses and respond to two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

Provide 3 scholarly resources no older than 5 years for each psychiatric disorder response. 

 

First Case: ADHD Patient Scenario

Katie is an 8-year-old female whose teacher has recently expressed concerns regarding the possibility that Katie might have ADHD. Katie’s parents have brought her into the clinic today for evaluation. Katie’s teacher reports that Katie is inattentive, easily distracted, forgets things she has already learned, is poor in spelling, reading, and arithmetic. Katie also has a short attention span and only pays attention to things that interest her, and often starts things but never finishes them. Katie’s parents deny any symptoms of ADHD at home. Katie reports that school is boring, feeling lost in class, and that her mind often wanders. After a clinical exam Katie is diagnosed with Attention-Deficit/Hyperactivity Disorder, predominantly inattentive.

 

After discussing treatment options with Katie’s parents, they decide to first try a non-stimulant option. Wellbutrin (bupropion) XL 150 mg orally daily is prescribed for Katie and a 4-week appointment is made to follow up on Katie’s new medication. Bupropion is a dopamine reuptake inhibitor commonly used for depression and smoking cessation. Katie and her parents are educated on the side effects including anorexia, weight loss, nausea, nervousness, abdominal pain, and somnolence. They are also warned of possibility of suicidal ideation with this medication and Katie is instructed to report to her parents if this occurs (Ng, 2017).

 

At Katie’s 4-week follow-up her parents report that after 2 weeks of her taking the Wellbutrin Katie reported thoughts of harming herself so they immediately stopped giving the medication but stated they didn’t want to bother the office by reporting this. Due to Katie’s suicidal ideation and the parent’s fears, the Wellbutrin is discontinued and Strattera (atomoxetine) 10 mg orally daily is started. The parents and Katie are educated on the side effects of Strattera and again informed of the importance of reporting suicidal ideation to the office immediately as it can also happen with Strattera.

 

At Katie’s next follow-up appointment in her parent’s report that Katie’s teacher has noticed her ADHD symptoms are getting a bit better. Katie’s parents however are concerned about her decreased appetite since starting the Strattera. Katie and her parents are instructed to continue her current dose of Strattera and that the decreased appetite may improve with time. They are also informed that it can take 8-12 weeks for Strattera to become therapeutic and that Katie’s symptoms can continue to improve. After 12 weeks Katie will be reevaluated to determine if she needs her dose increased, or if another therapy such as stimulants is needed.

References

Atomoxetine (generic). (2007). Brown University Psychopharmacology Update, 18(6), 8.

Ng, Q. (2017). A systematic review of the use of bupropion for attention-deficit/hyperactivity disorder in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 27(2), 112–116. https://doi.org/10.1089/cap.2016.0124

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders.

 

Second Case: Adult Geriaric Depression

Late-life depression occurs in up to 4.5% American elderly adults (Wang & Blazer, 2015). This condition is diagnosed if an elderly adult presents with a minimum of a two-week duration of depressive symptoms. Antidepressant medications are indicated in the treatment of patients who present with moderate to severe depression (Burchum & Rosenthal, 2019). In the case described, a 70-year-old Hispanic male presented with severe depression with a score of 51 on Montgomery-Asberg Depression Rating Scale (Laureate Education, 2019). In the first decision step, decision-making requires a review of evidence to compare the efficacy and side effects of the given treatment options. Effexor XR 37.5mg orally daily was selected in the first decision step because of its clinical efficacy and improved tolerability in comparison to phenelzine and Zoloft. According to Burchum and Rosenthal (2019), phenelzine has a poor tolerability profile because it is associated with side effects. Zoloft is a selective serotonin reuptake inhibitor which has a similar clinical efficacy with Effexor, which is a selective serotonin norepinephrine reuptake inhibitor (Vallerand et al, 2019). Effexor reduces depressive symptoms by increasing the availability of serotonin in the central nervous system (Woo & Robinson, 2019). However, the extended-release formulation of Effexor  has an advantage in reducing treatment-associated side effects (Burchum & Rosenthal, 2019). The second step requires dose titration of Effexor to achieve a clinical response as seen in the third step of the decision-making. According to Burchum and Rosenthal (2019), the clinical efficacy of  antidepressants might not be evidence until  4 to 6 weeks after treatment initiation. In the last step of the decision-making, there is an option to either increase the dose of Effexor or to continue treatment using the same dose. This requires a shared decision-making with the patient because increasing the dose has the advantage of achieving a clinical response, but with the disadvantage of increasing the risk for unwanted side effects (Woo & Robinson, 2019). As such, when communicating with patients, it is important to discuss the advantages and disadvantages of therapeutic options during treatment.

References

Burchum, J. R., & Rosenthal, L. D. (2019). Lehne’s pharmacology for nursing care. St. Louis, MO: Elsevier/Saunders.

Laureate Education (Producer). (2019a). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.

Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). Davis’ drug guide for nurses (16th ed.). Philadelphia, PA: F. A. Davis Company.

Wang, S., & Blazer, D. G. (2015). Depression and cognition in the elderly. Annual Review of Clinical Psychology, 11(1), 331–360. doi:10.1146/annurev-clinpsy-032814-112828

Woo, T. M., & Robinson, M. V. (2019). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.). Philadelphia, PA: F.A. Davis Company.

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