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.
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.
INTERACTIVE MEDIA: Hispanic Male with major depressive disorder (MDD)
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.
Assignment: Write 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.
Expert Solution Preview
Introduction:
Major depressive disorder is a common psychological disorder that affects millions of people worldwide. It is characterized by persistent feelings of sadness, hopelessness, and a loss of interest in activities that were once enjoyable. In severe cases, it can lead to thoughts of self-harm and suicide. Advanced practice nurses (APNs) play an important role in the management and treatment of patients with major depressive disorder.
In completing the interactive media piece for a Hispanic male with major depressive disorder (MDD), I applied the following decision steps:
1. Assessment: I conducted a thorough clinical interview and mental status exam to assess the patient’s current symptoms and overall mental health. I also administered the Montgomery-Asberg Depression Rating Scale (MADRS) to assess the severity of the patient’s depression.
2. Diagnosis: Based on the patient’s symptoms and MADRS score, I diagnosed him with major depressive disorder.
3. Pharmacotherapy: I recommended the use of an antidepressant medication, specifically a selective serotonin reuptake inhibitor (SSRI), to treat the patient’s depression. I chose an SSRI because they are generally well-tolerated and have fewer side effects than other antidepressants.
The use of SSRI antidepressants may impact the patient’s pathophysiology by increasing the levels of serotonin in the brain, which can improve mood and reduce symptoms of depression. However, they can also have side effects, such as gastrointestinal upset, sexual dysfunction, and in rare cases, suicidal ideation.
These potential impacts inform how I would suggest treatment plans for this patient. I would closely monitor the patient for side effects and adjust the dosage or switch medications if needed. I would also provide education to the patient about the importance of taking the medication as prescribed and following up with regular appointments to monitor progress and adjust the treatment plan as necessary. Additionally, I would recommend the patient to a therapist or support group to provide additional emotional support and coping strategies.
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