PICOT is utilized by the health care community to identify and study a nursing practice problem. Consequently, PICOT examples that may provide insight into the use of the PICOT process may not be relevant to nursing practice as they are based on a medical practice problem.

Define evidence-based practice. Describe the difference between a nursing practice problem and a medical practice problem. Provide one example of each. Discuss why is it important to ensure your PICOT is based on a nursing practice problem.

• Bipolar Disorder or Major Depressive Disorder   
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• Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.

Week 5 Unit 5 Discussion Medications for Depression and Anxiety Related Disorders2 Peer Response 800w. due10-4-23

Instructions:

Please read and respond to the two peers' initial postings for week 2 below. Consider the following questions in your responses.

Compare and contrast your initial posting with those of your peers.  

1. How are they similar or how are they different?

2. What information can you add that would help support the responses of your peers?

3. Ask your peers a question for clarification about their post.

4. What most interests you about their responses? 

5. Summaries at least 1 evidence based article that supports there point.

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

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Response 1 400 words IA

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This case scenario is quite interesting since this is about a young female patient who reports multiple symptoms starting three weeks ago. This is where one researches and I believe this patient may be having an episode of major depressive disorder. I dare to come to come up with this diagnosis since she presents multiple symptoms starting about three weeks ago. Going over the multiple sections to cover this week in the “Diagnostic and Statistical Manual of Mental Disorders” I found that she presents with subjective information such as having insomnia, diminished ability to concentrate, lack of interest, weight loss due to loss of appetite, crying spells with no apparent reason. This young lady also reports feeling “tired & fatigued” and has lost interest in activities she usually enjoys. The key for me here was finding all these symptoms under the diagnostic criteria for major depressive disorder box (Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR 2022). Although she does not meet all the criteria, she presents more than five symptoms with onset about three weeks ago and according to our manual symptoms must be present at least two weeks (Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR 2022).

Regarding her headache, and according to our book this patient can be reporting somatic complaints such as pain and aches instead of reporting an actual feeling of sadness (Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR 2022).

The classification of medication that I would recommend for this patient would be antidepressants. Our prescriber's book has a long list such as sertraline, paroxetine, trazodone, and escitalopram among many (Stahl, 2021). I would focus on a common drug that I see very often, and that is sertraline. Sertraline would be a good option for her since is an SSRI (selective serotonin reuptake inhibitor) (Stahl, 2021)

and I remember Dr. Kubiak mentioning that serotonin can be the usual one to blame for depression along with norepinephrine. This drug can boost the neurotransmitter serotonin and can also block the serotonin reuptake pump (Stahl, 2021)

References:

Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th ed.). (2022). . American Psychiatric Association Publishing.

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: The Prescriber’s Guide (7th ed.). Cambridge University Press.

Response 2. 400 words sy

What diagnosis do you believe may apply to this individual?

This patient presented with symptoms of headache, fatigue, sleep disturbance, weight loss, loss of interest in activities, and frequent crying spells, all of which are indicative of major depressive disorder (MDD). Signs that a patient might be suffering from MDD include avoiding certain situations that they enjoy, inability to concentrate, and being unable to go to work due to fatigue. MDD can disrupt the patient's daily life by affecting their home, work, and social life (Salvo et al., 2022). According to the DSM-5, to be diagnosed with MDD, patients must experience 5 or more symptoms in the last week.

What classifications of medications can be used to treat this disorder? Which medication do you recommend and why?

Treatment for this patient will include antidepressants. Antidepressants are classified into different types based on their work and chemical structures. There are four main groups: monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs).

SSRIs are a broad category of antidepressant medications. Since this patient has no significant past medical or psychiatric history and takes no regular medications, my recommendation would be fluoxetine 10 mg for 4 weeks, then increasing the dose to 20 mg daily if the drug is well tolerated by the patient (Arcangelo et al., 2021). SSRIs tend to be well-tolerated and are relatively cost-effective. Patients who take SSRIs exhibit fewer side effects in comparison to those who take Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs). Therefore, SSRIs are often considered the first line and primary choice for the treatment of mood and anxiety disorders. The class of SSRIs includes Fluoxetine (Prozac), Fluvoxamine (Luvox), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), and Escitalopram (Lexapro). Side effects include weight gain, insomnia, sexual dysfunction, gastrointestinal issues, and agitation (Arcangelo & Peterson, 2021).

References

Arcangelo, V. & Peterson, A. (2021). Pharmacotherapeutics for advanced practice: A practical approach. (5th ed.). Wolters Kluwer

Imiuwa, M. E., Baynes, A., & Routledge, E. J. (2023). Understanding target-specific effects of antidepressant drug pollution on molluscs: A systematic review protocol. PLoS One, 18(6) https://doi.org/10.1371/journal.pone.0287582Links to an external site.

Salvo, G. D., Bianco, M., Teobaldi, E., Maina, G., & Rosso, G. (2022). A Psychoanalytic-Derived Brief Psychotherapeutic Approach in the Treatment of Major Depression: Monotherapy Studies. Medicina, 58(10), 1335. https://doi.org/10.3390/medicina58101335

Each week you will take a few minutes and ask 2 people about their personal coping mechanisms for dealing with the stress of working in healthcare during this unique time of Covid. Stress can be physical, emotional, spiritual, or any combination of triggers. Ask a diverse variety of people, don’t forget those in other departs at different points of hierarchy. For example, ask your unit manager, environmental services, volunteers, patients, fellow nurses, etc. Write 2-3 paragraphs on your findings and impressions while respecting the person’s identity.

1.Define psychopharmacology and pharmacodynamics and describe the neuron’s cellular structure. Include the definition of synapses as well as their significance to the nervous and psychological system. 

2.Research an article on neuron’s cellular structure works and explain what you found interesting about this topic.

Discussion should be 500 words minimum. Reply to classmates 250 words. References in APA not older than 5 years.

Post your original response by the end of Day 3. Then, by the end of Day 6, comment on at least two of your classmates’ posts.

If you copy and paste references from the course into your assignment, be sure to confirm APA formatting before submitting.

Please Note