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THEY CHECK FOR PLAGERISM.

INSTRUCTIONS IN THE ATTACHMENT 

500 words 

Advanced Psychopharmacology and Health Promotion

Unit 7 Medications for Psychosis and Schizophrenia Related Disorders 600W. APA. 4 references due 10-17-23.

Answer the following questions:

Which antipsychotics are considered first-generation and why are they used less often than second generation antipsychotics? Are second-generation antipsychotics more effective?

Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics.

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Use as a guide please do not copy this information. Also please use the textbook

1. Which antipsychotics are considered first-generation and why are they used less often than second generation antipsychotics? Are second-generation antipsychotics more effective? First generation antipsychotics, also referred to as “typical antipsychotics” were developed in the 1950s. Commonly prescribed first-generation antipsychotics include: Loxitane (loxapine); Mellaril (thioridazine); Moban (molindone); Navane (thiothixene); Prolixin (fluphenazine); Serentil (mesoridazine); Stelazine (trifluoperazine); Trilafon (perphenazine); and Thorazine (chlorpromazine). These first-generation antipsychotics are used less often than second generation antipsychotics because these medications have a high risk of side effects and some of those side effects can be severe. Second-generation antipsychotics, also known as “atypical antipsychotics,” were developed in the 1980s. Second-generation antipsychotics have more metabolic symptoms, including obesity, diabetes and hyperlipidemia (Heldt, 2017; Stahl et al., 2021). Side effects from first-generation antipsychotics include extrapyramidal effects, such as tardive dyskinesia, rigidity, tremors, and seizures. There is no evidence that second generation antipsychotics are significantly more effective than first generation antipsychotics in the treatment of cognitive and negative symptoms of schizophrenia (Stahl et al., 2021; Stroup, et al., 2003). 2. Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics. Tardive dyskinesia is one of the symptoms of long-term use of a first -generation antipsychotic. It is a condition where there is constant or rhythmic involuntary movements that usually involves the muscles of the mouth. It can appear as lip smacking, chewing, excessive eye blinking, grimacing. These symptoms appear slowly over time. Tardive dyskinesia will not go away once the antipsychotic is stopped, it can become irreversible if present for too long. The risk of a patient developing tardive dyskinesia goes up with every year of continuous treatment. TD is specific to the use of antipsychotics (Heldt, 2017). Acute dystonia can develop within the first few hours of a patient receiving an antipsychotic. It is a sustained and painful involuntary contraction of a muscle group- usually involving the face or neck muscles. This is an easily reversible side effect and is managed with an anticholinergic drug such as Benadryl or Cogentin. This condition This study source was downloaded by 100000769192234 from CourseHero.com on 10-16-2023 17:34:58 GMT -05:00 https://www.coursehero.com/file/123197773/Discussion-7docx/ can resolve within a few minutes of proper medication and will not leave any long-term effects (Heldt, 2017). Athetosis is slow, involuntary, writhing movements of fingers, hands, toes and feet. Patients with this condition cannot maintain a stable or still position and when patients attempt to try to control the movements, symptoms can get worse. Athetosis is often a longterm symptom of continued use of first-generation antipsychotics (Holland, 2018). Tics are distinguished from EPS symptoms by the fact that tics are most commonly brief movements are able to be suppressed. Tics are sudden, rapid and repetitive movement (motor tics) or vocalizations (vocal tics). Those with tics feel the urge building up inside them before the tic appears, they these individuals report a feeling of relief after the tic is over. Although tics are involuntary, tics stop during sleep and patients can suppress the urge for short periods of time with effort (Martino, 2020). Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing Platform. Holland, K. (2018, July 18). What Is Athetosis? Healthline; Healthline Media. https://www.healthline.com/health/athetosis Martino, D. (2020). Update on the Treatment of Tics in Tourette Syndrome and Other Chronic Tic Disorders. Current Treatment Options in Neurology, 22(4). https://doi.org/10.1007/s11940-020-0620-z Stahl, S., Muntner, N., & Grady, M. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and clinical applications (5th ed.). Cambridge University Press. Stroup, T. S., McEvoy, J. P., Swartz, M. S., Byerly, M. J., Glick, I. D., Canive, J. M., McGee, M. F., Simpson, G. M., Stevens, M. C., & Lieberman, J. A. (2003). The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)

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List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

When assessing this patient, it's important to ask questions that will help the provider understand the underlying causes and potential treatment options. Given the patient's recent loss and significant life changes, it's crucial to approach the assessment with sensitivity. Here are three questions I'd like to ask, along with their rationales:

1. Have you observed any changes in your sleep pattern, mood, or feelings since your husband passed away?

Rationale: This question allows the patient to provide insight into the nature and duration of her sleep disturbances and changes in her mood or feelings. Understanding the onset and progression of depression symptoms can related to her recent bereavement following her husband's passing.

2. Could you describe your emotions and have you ever experienced thoughts of self-harm or suicide?

Rationale: This question aims to comprehend a person's emotional state and evaluate the presence of suicidal thoughts or self-harm ideation. It's important to ask such questions without delay in treatment. Since the patient has a history of major depressive disorder (MDD), and her depression has worsened, it's crucial to explore her emotional state.

3. How have you been coping with the loss of your husband, and have you sought support or counseling to help you through this difficult time?

Rationale: Inquiring about coping strategies and support systems is essential for assessing the patient's resilience and identifying potential sources of assistance. Grief counseling or therapy can be invaluable in helping individuals navigate the complex emotions associated with loss. Additionally, it's important to assess whether the patient has been utilizing any resources to manage her depression.

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Identify people in the patient's life you would need to speak to or get feedback from to further assess the patient's situation. Include specific questions you might ask these people and why.

To gain a more comprehensive understanding of the patient's situation and evaluate her social support network, I would identify individuals in the patient's life, such as family members or close friends. Engaging in conversations with these individuals can be beneficial because they may have insights into the patient's emotional well-being and daily functioning. I would ask Questions like: “Could you please share any observations regarding alterations you may have noticed in the patient's behavior, mood, or sleep patterns following her husband's passing?” Family members and close friends are often the first to detect significant shifts in a person's behavior and emotional state. Their observations can offer valuable insights into the patient's emotional condition and the way the loss of her husband has affected her daily life.

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Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

In evaluating a 75-year-old patient with a chief complaint of insomnia and depression, diabetes (DM), and hypertension (HTN), a thorough assessment should include both physical exams and diagnostic tests: A physical examination should include checking blood pressure, heart rate, heart sounds, peripheral pulses, respiratory rate, and temperature. It should also involve assessing the patient's overall appearance and evaluating their general health.  In addition, assessing mental status, cognitive function, and neurological signs can help identify any neurological issues that may be contributing to sleep disturbances. Consider arranging a sleep study, also known as polysomnography (PSG). This medical test monitors various physiological functions while a person sleeps.

Diagnostic Tests include the following Blood Tests: Complete Blood Count (CBC) will check for anemia or other blood-related issues that can affect sleep and overall health; a Comprehensive Metabolic Panel (CMP), assess kidney and liver function, electrolytes, and glucose levels; The HbA1c (Glycated Hemoglobin) test can monitor her long-term blood glucose control, can provide valuable insights into her diabetes management. The results of these exams and tests will inform a comprehensive treatment plan tailored to the patient's specific needs.

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List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

When assessing a patient with insomnia, along with chronic medical conditions like diabetes and hypertension, this patient likely has Major Depressive Disorder (MDD). She had no history of MDD before her husband's passing, and the current worsening of her depression may be attributed to his death. Although anxiety can cause insomnia problems, MDD with Bereavement seems most likely. However, we need to ensure there aren't other underlying causes, such as sleep problems or medical issues. To do that, we should conduct thorough assessments and laboratory tests. She needs to seek help from both her regular doctor and a mental health professional to find the right treatment and support.

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List two pharmacologic agents and their dosing that would be appropriate for the patient's antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

When selecting pharmacologic agents for this 75-year-old patient, the choice of antidepressant therapy should consider pharmacokinetics and pharmacodynamics. Reduced kidney and liver function in elderly individuals can potentially affect both pharmacokinetics and pharmacodynamics.

SSRIs, such as sertraline (Zoloft) and escitalopram (Lexapro), are two preferred for elderly patients. They are generally well-tolerated and have a lower risk of certain side effects, such as sedation or anticholinergic effects, which can be problematic for older adults. Sertraline (Zoloft) 150mg once daily or Escitalopram (Lexapro) 20 mg daily would be appropriate for this patient.

The patient has been taking Sertraline (Zoloft), her start dose was 100mg daily; increase slowly, no more than a maximum Dose of 200 mg once daily; sertraline increases serotonin levels and can be effective in treating depression. Escitalopram is considered perhaps the best-tolerated SSRI, with the fewest cytochrome P450 (CYP450)-mediated drug interactions. (Stahl, 2021). Escitalopram (Lexapro) 20 mg daily is also the appropriate choice.

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For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?

When prescribing antidepressant therapy, it's important to consider drug contraindications and alterations. For the selected antidepressant, escitalopram (Lexapro), don't use it with MAOIs or within 14 days after stopping an MAOI to prevent serotonin syndrome. This is a contraindication due to the risk of serotonin syndrome, a potentially life-threatening condition characterized by agitation, confusion, rapid heart rate, and other symptoms. Escitalopram is primarily metabolized in the liver; it should be used with caution in patients with severe hepatic impairment or elderly with decreased liver function. In such cases, a lower initial dose and slower titration may be considered, as drug clearance may be reduced.

In all cases, ethical prescribing involves a thorough assessment of the patient's medical history, medication history, and potential contraindications. Dosing adjustments, when necessary, should be made to maximize therapeutic benefits while minimizing risks and adverse effects.

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Include any “checkpoints” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

In depression treatment, scheduled follow-up appointments are vital for assessing progress, managing side effects, and adjusting treatment. Common intervals are every 4 weeks. At the checkpoint, like follow-up data at weeks 4, 8, 12, etc., make treatment decisions based on the patient's response, side effects, and goals. If there's significant improvement with few side effects, stick with the current dose. If there's limited improvement or major side effects, consider increasing the dose (if not already at the maximum) or trying a different antidepressant. In cases of long-term remission with a low risk of recurrence, think about tapering or discontinuing the medication.

At Week 4 (four weeks after initiating treatment), it's the time to evaluate the patient's initial response to medication. Inquire about changes in mood, sleep patterns, energy levels, and any side effects.

At Week 8 (eight weeks after starting treatment), it's time to reassess the patient's mood and overall well-being. Keep an eye on side effects, whether they're taking the medication as prescribed, any changes in their medical conditions, and any suicidal ideation.

At Week 12 (12 weeks after starting treatment), continue monitoring the patient's mood and how they're responding to treatment. Check for any signs that their depression might be coming back or getting worse.

Ongoing Follow-up (Regularly, every 3-6 months): Continue to monitor the patient's mental health, medication adherence, and any emerging side effects. Evaluate the need for ongoing treatment.

 

Reference:

Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015 Apr;147(4):1179-1192. doi: 10.1378/chest.14-1617. PMID: 25846534; PMCID: PMC4388122.

Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

Lexapro Labeling-508; Reference ID: 4036381 https://www.fda.gov/media/135185/download

Describe the advantages and desadvantages of a Mixed Method Research Design

400 words 

APA 7 format

Citation and 2 references