4 hours ago
Idalmis Espinosa
Week 3-Main Discussion: Case #1
COLLAPSE
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NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology
Initial post
This is the case of a 63 years old patient whose antidepressants stopped working. Patient has recurrent depression that seem to be progressive as well. The depression is becoming resistant to the drugs that are prescribed and the periods between the episodes of recurrence are increasingly becoming shorter. Therefore, there are a number of questions that the patient can be asked. One is whether there are members of his family that suffer from depression. Secondly, there is need to ask the patient whether he has been having any suicidal thoughts in the recent past. This is because there is a common connection between depression and suicidal ideation (Bradvik, 2018). This is a necessary question that shall inform the intervention to be used on the patient. In addition, the best way to prevent attempts of suicide is by reporting of suicidal thoughts in the first place. The third question that the patient should be asked is how his sex life is and how he generally feels about his life. This is a question that is necessary to help with the intervention. This question will help in understanding he health beliefs of the patients as well as his cultural and spiritual perception of health. the question will help in the treatment process. For instance, sexual dysfunction is a significant reason to continue with antidepressants. Also, his spiritual beliefs and cultural perception of health are necessary to help with treatment and preventing recurrence as this may influence the necessary therapy.
Questions might also be asked to family members including his children, his wife and his colleague or spiritual leader of course with approval and consent from the patient. The wife should help in understanding his sex drive and normal functionality. The children may help in understanding how his behavior has changed and the spiritual leader may help in understanding his health beliefs and connection to life especially has he is getting old. Studies have shown that meaningful occupation is a marker for wellbeing and helps people find meaning in life as well as sense of self. For this patient, family history is not enough. There is also need to conduct a number of tests on the patient as well as physical examinations. According to the available guidelines, the s need for neuroimaging. This is required early especially in patients that have the first episode when they are old like in this case. A mental state examination should be done and the patient should be tested for BMI, renal function, liver function and thyroid function. There is always the need to also list differentia diagnoses and conduct test to rule them out, for instance, bipolar (Gautam, Jain, Gautam, Vahia & Grover, 2017). The most common differential diagnoses include adjustment disorder and depressed mood, bipolar disorder, sadness and burnout. The most likely in this case is adjustment disorder and depressed mood. This is a diagnosis that mostly occur due to psychosocial stress (Lyness, 2015). This is a patient that is getting old, retiring and starting to suffer from heart disease. These changes may have significant effect on the patient’s life.
This is a patient is experiencing recurrence in depression ad resistance to drugs. As such, in a case like this, there is need to use Mono Amine Oxidase Inhibitors. Options include Phenelzine 45-90mg/day or Isocarboxazid 30-60mg/day. The agent that might be effective in this case more than the other is Isocarboxazid 30-60mg/day. This is because the initial one is associated with drowsiness and orthostatic hypotension (Gautam, jain, Gautam, Vahia & Grover, 2017). Isocarboxazid is common for treatment resistant depression. It works by irreversibly blocking the monoamine oxidase from breaking serotonin, dopamine and norepinephrine. It then boosts dopaminergic, serotonergic and noradrenergic neurotransmission (Stahl, 2017). Lower than usual dose is also required because of his heart condition. It is also effective in older adults with the effect of preventing suicide and there is need for close monitoring due to side effects (Stahl, 2017). This is a drug that may not be effective in ethnic groups that are known to eat smoked meat and cheese as well as overripe fruits. This is because of the fact that there is need for low tyramine diet. There is also need to avoid combining this drug with other antidepressants. The lesson learned in this case is that drug ay work differently based on patient’s pharmacokinetics and pharmacodynamics and this can be influenced by ethnicity. Health habits and beliefs also need to be understood in order t o come up with the mist effective intervention.
References
Brådvik, L. (2018). Suicide Risk and Mental Disorders. Int J Environ Res Public Health, 15(9), 2028.
Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical practice guidelines for the management of depression. Indian journal of psychiatry, 59(Suppl 1), S34.
Lyness, J. M. (2015). Unipolar depression in Adults: Assessment and diagnosis. UpToDate. Waltham, MA: Denise S. Basow. Retrieved from
Mulholland, F., & Jackson, J. (2018). The experience of older adults with anxiety and depression living in the community: Aging, occupation and mental wellbeing. British journal of occupational therapy, 81(11), 657-666
Stahl, S. M. (2017). Prescriber’s Guide: Antidepressants: Stahl’s Essential Psychopharmacology. Cambridge University Press
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