Decision Making When Treating Psychological Disorders

Week 8 Discussion: Decision Making When Treating Psychological Disorders
Number of sources: 4
Paper instructions:
WEEK 8 Discussion: Decision Making When Treating Psychological Disorders

MEDIA FILE and Case are at the bottom of the instructions above the Rubric

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.

MEDIA FILE CASE
Adult/Geriatric Depression
Hispanic Male With MDD

Hispanic male

BACKGROUND INFORMATION
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 to your office 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.

SUBJECTIVE
During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.

MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).

RESOURCES
§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

Decision Point One
Select what you should do:

Begin zoloft 25 mg orally daily
Begin Effexor XR 37.5 mg orally daily
Begin Phenelzine 15 mg orally TID

Rubric Detail——
Sample Answers
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Decision Making when Treating Psychological Disorders

Making Treatment Decisions for Psychological Disorders

Prescription of Zoloft 2.5mg daily is the best option for the condition. The medication is essential for the elderly patient because it suppresses depression or bipolar disorder (Fisher et al., 2018). Prescription of a low dose of Zoloft also eliminates the risk of side effects that occur when patients take a high dose of Zoloft in the beginning. Taking Zoloft alone, however, is insufficient. According to Osei-Bonsu et al. (2017), the patient should also take a mood stabilizer to increase the likelihood of a positive outcome. The elderly nature of the patient should be considered when prescribing drugs. Clinicians exercise caution when prescribing medications to elderly patients to avoid toxicity (Chyurlia et al., 2019). The vital organs are incapable of metabolizing, distributing, or excreting the drug. Clinical decisions should also include recommendations for patient counseling programs. Pharmacological approaches are insufficient, according to evidence-based research. Patients require both non-pharmacological and pharmacological approaches to achieve better treatment outcomes (Jenkins & Youngstrom, 2016). Non-pharmacological professionals’ role is to assist patients in calming their minds and avoiding stress. Elderly people are predisposed to depression and bipolar disorder. To avoid negative outcomes that could jeopardize the recovery process, the high risk requires friendly treatment (Jenkins & Youngstrom, 2016). Zoloft is one of the most effective medications that clinicians can give to an elderly patient. To avoid overreaction, clinicians should avoid prescribing large amounts of drugs. All precautions must be taken in order to improve the quality of care and choose the best medication (Jenkins & Youngstrom, 2016). Patients should also avoid polypharmacy because it can result in additional side effects. They should stick to one medication and wait several weeks before administering another. Patients should also provide information on their progress so that clinicians can take the appropriate actions.
References
L. Chyurlia, G. A. Tasca, and H. Bissada (2019). An Integrative Approach to Clinical Decision-Making in the Treatment of Binge Eating Disorder Patients 10. Frontiers in Psychology
A. Fisher, V. Manicavasagar, L. Sharpe, R. LaidsaarPowell, and I. Juraskova (2018). Identifying and addressing treatment decisionmaking barriers in bipolar II disorder: a clinician’s perspective The Australian Psychologist, 53(1), pp. 40-51.
Jenkins, M. M., and E. A. Youngstrom (2016). A randomized controlled trial of cognitive debiasing improves pediatric bipolar disorder assessment and treatment selection. 84(4), 323, Journal of Consulting and Clinical Psychology.
P. E. Osei-Bonsu, R. E. Bolton, S. W. Stirman, S. V. Eisen, L. Herz, and M. E. Pellowe (2017). Decisions made by mental health providers regarding the implementation of evidence-based treatment for PTSD. Behavioral Health Services and Research, 44(2), 213-223.

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