Feb 23, 2024 NURS 6630 Assignment 1 Short Answer Assessment
NURS 6630 Assignment 1 Short Answer Assessment
In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
A combined approach of counseling and medication is usually the optimal treatment option for an individual with MDD who has a history of consuming alcohol. Because of their effectiveness and safety record, selective serotonin reuptake inhibitors (SSRIs), for example, fluoxetine are frequently recommended. Monoamine oxidase inhibitors (MAOIs) are contraindicated because of possible interactions with alcohol as well as the likelihood of hemodynamic crises (Alsheikh et al., 2020). Although there might be variations in symptom relief after four to six weeks of regular therapy, individuals frequently begin to feel better.
Short Answer Assessment
The human brain is complex in terms of structures and functions. Mental disorders are on the rise in the United States and these conditions require effective psychological and psychopharmacological therapies for optimal outcome. The pathophysiology of mental disorders is best understood by understanding how it interferes with the basic brain anatomy and physiology, since pharmacotherapy affects brain functions. It is therefore necessary for a mental health practitioner to have better understanding of the anatomy and function of the central nervous system. The purpose of this paper is to examine the basic anatomical structures and functions of the central nervous system.
Describe the Anatomy of the Neuron
Neuron the basic functional unit of the nervous system that transmits information to different parts of the body from the brain and vice versa. It is made up of different parts, namely the axon, the dendrites, nucleus, myelin sheath, soma, and the synapse. Transmission of electrical impulses through the neurons is mediated by an influx of certain positive ions such as sodium and calcium (Zhang, 2019). Electrical potential travels from one neuron to the next through the node of Ranvier and the myelin sheath assists in faster propagation of the impulse. The impulse terminates at the synapse where it conveys appropriate information. For instance, pain and heat sensation are transmitted through the efferent nerve fibers to the brain as an impulse for interpretation and the brain acts accordingly, by withdrawing from harmful stimuli.
A Sample Answer For the Assignment: NURS 6630 Assignment 1 Short Answer Assessment
In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.
According to Javaid et al. (2020), the human brain comprises over 100 billion distinct neurons. The neuron’s cell body harbors the nucleus and serves as the point of attachment for both the dendrites and axons of the neuron. The term “soma” is sometimes used to refer to the cell body, while axon clusters, commonly referred to as nerves in some contexts, can be found throughout the body in various locations. Neurons can interact with one another even when they are separated by large distances, which is made possible by the fact that they contain dendrites and axons. Furthermore, owing to the mechanism of electrical conduction intrinsic to neurons, nerve impulses can propagate at a remarkable pace, marked by a transient electrical oscillation that traverses from the neuronal soma, through its dendrites, and culminates at the terminal end of the axon.
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Answer the following (listing is acceptable for these questions):What are the major components that make up subcortical structures?Basal ganglia: Pertains to a cluster of subcortical nuclei that are primarily accountable for regulating motor control (Wilfrid Jänig, 2022). Additionally, they play a crucial role in executive functions, motor learning, and emotional and behavioral regulation.Limbic structure: The limbic system is responsible for the regulation of motivation, mood, learning, and memory through its intricate network of structures and interconnected regions(Wilfrid Jänig, 2022). The interface between the subcortical structures and the cerebral cortex is located within the limbic system. The limbic system exerts its influence on the autonomic nervous system and the endocrine systemThalamic structures: The structure in question comprises four distinct components, namely the thalamus, epithalamus, subthalamus, and hypothalamus. Each of the aforementioned structures plays a crucial role in the survival and optimal operation of the human body (Wilfrid Jänig, 2022). Therefore, it is imperative to familiarize oneself with their anatomy. Cerebellar: The cerebellum is a neuroanatomical structure situated in the posterior cranial fossa, superior and posterior to the pontomedullary junction, where the spinal cord merges with the brainstem. The aforementioned structure is a significant subcortical entity that has an impact not only on motor function but also potentially on cognitive and emotional processes (Wilfrid Jänig, 2022).
Which component plays a role in learning, memory, and addiction?
According to Wilfrid Janig (2022), the limbic structure contributes to the capacity of the human body to acquire new information and retain it. Furthermore, it assumes a crucial function in the control of cognitive attention and behaviors that are addictive.
What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?Dopamine: While the activity of dopaminergic cells cannot directly dictate movements, a recent study conducted on humans has indicated that the consistent levels of dopamine present in the dorsal striatum may contribute to the facilitation of regular motion by encoding the sensitivity to the energy expenditure of a movement (Skelin et al., 2019). This implicit signal can be interpreted as a “motor motivational” cue.
Gamma-aminobutyric acid (GABA): It is widely distributed throughout the nervous system and plays a crucial role in inhibiting the transmission of signals. It is essential for regulating movement, both in the cortex and subcortical regions of the brain.
In 3 or 4 sentences, explain how glial cells function in the central nervous system. Be specific and provide examples.
The phrase “glial cells” may refer to several different kinds of glial cells, including astrocytes, Schwann cells, oligodendrocytes, and microglial cells all of which have a unique role in ensuring that the brain continues to operate normally (Yang & Zhou, 2019). Astrocytes are responsible for controlling blood flow, as well as supplying neurons with mitochondria and the components necessary to construct neurotransmitters, which are the driving force behind neuronal metabolism. Schwann cells play an essential role in the development, maintenance, functioning, and regeneration of peripheral nerves. Oligodendrocytes are chiefly accountable for the production and upkeep of the myelin sheath that envelops axons within the nervous system while microglia are enduring brain cells that govern brain maturation, the safeguarding of neural networks, and the recuperation from injuries.
The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.
When an action potential is generated at the chemical synapse, the neuron at the presynaptic cleft is stimulated, which results in the release of neurotransmitters, which are the molecules that are responsible for transporting information being propagated from the presynaptic gap to the postsynaptic cleft, which is where it is accepted by another cell. The dendrite of the receiving neuron is the one that is responsible for receiving the message from the axon terminal of the transmitting neuron. Because one axon may create synapses on a large number of postsynaptic cells, it can interact with a large number of cells (Stadelmann et al., 2019). As a consequence of this, a single neuron may receive information from the other neurons since it is capable of receiving millions of synaptic inputs from a wide variety of neurons that are responsible for transmitting presynaptic signals.
In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples.
Neuroplasticity, commonly referred to aseither brain plasticityor neural plasticity, denotes a phenomenon wherein the brain encounters adaptive modifications in both functional and structural domains. The nervous system is capable of modifying its activity in response to both internal and external stimuli through the process of restoring its functions, pattern, or connections following events such as cerebrovascular incidents or traumatic brain injuries (Innocenti, 2022). These alterations may be helpful in that they lead to the regeneration of function after an injury, neutral in that there is no change, or pathologically detrimental with the resulting pathological consequences.The notion of neuroplasticity can be deconstructed into two primary mechanisms, which are functional reorganizationand collateral sprouting/neuronal regeneration.
References
Innocenti, G. M. (2022). Defining neuroplasticity. Handbook of Clinical Neurology, 3–18. https://doi.org/10.1016/b978-0-12-819410-2.00001-1
Javaid, M. A., Schellekens, H., Cryan, J. F., & Toulouse, A. (2020). Evaluation of Neuroanatomy Web Resources for Undergraduate Education: Educators’ and Students’ Perspectives. Anatomical sciences education, 13(2), 237-249. https://doi.org/10.1002/ase.1896
Skelin, I., Kilianski, S., & McNaughton, B. L. (2019). Hippocampal coupling with cortical and subcortical structures in the context of memory consolidation. Neurobiology of Learning and Memory, 160, 21–31. https://doi.org/10.1016/j.nlm.2018.04.004
Stadelmann, C., Timmler, S., Barrantes-Freer, A., & Simons, M. (2019). Myelin in the Central Nervous System: Structure, Function, and Pathology. Physiological Reviews, 99(3), 1381–1431. https://doi.org/10.1152/physrev.00031.2018
Wilfrid Jänig. (2022). The Integrative Action of the Autonomic Nervous System. Cambridge University Press.
Yang, Q.-Q., & Zhou, J.-W. (2019). Neuroinflammation in the central nervous system: Symphony of glial cells. Glia, 67(6), 1017–1035. https://doi.org/10.1002/glia.23571
Appropriate Drug Therapy for a Patient with MDD and a History of Alcohol Abuse
A combination of an antidepressant and a medicine that treats alcohol abuse would probably be the best pharmacological therapy for a patient with MDD and a history of alcohol consumption. As a first-line therapy for MDD, selective serotonin reuptake inhibitors like fluoxetine or sertraline are advised.
Naltrexone may also be administered to ease alcohol withdrawal symptoms and cravings. In this patient, antidepressants such as monoamine oxidase inhibitors are not advised since they raise the risk of seizures. Within six to eight weeks of beginning treatment, the patient should see a reduction in symptoms, but it’s crucial to keep up the medication for at least six to twelve months to avoid relapse (Akbar et al., 2018).
Predictors of Late Onset Generalized Anxiety Disorder
A past history of depression
Ongoing medical issues
Trauma or abuse
A family history of anxiety disorders
(Mohammadi et al., 2020).
Potential Neurobiology Causes of Psychotic Major Depression
Abnormal activity in the hypothalamic-pituitary-adrenal axis
Abnormal activity in the noradrenergic system
Abnormal activity in the serotonergic system
Abnormal activity in the dopaminergic system
(Dean et al., 2017).
Symptoms Required for Major Depression Episode to Occur
Persistent feelings of hopelessness or loss of vigor or pleasure
Exhaustion or lack of energy
Difficulty concentrating or making decisions
Changes in appetite or sleeping patterns
Feelings of guilt or inadequacy
Suicidal or death-related thoughts
(Pykel et al., 2022).
Classes of Drugs That Can Precipitate Insomnia
Beta blockers for example Propranolol
Corticosteroids for example prednisone
Antidepressant, for example
(Bonnet et al, .2021).
References
Akbar, M., Egli, M., Cho, Y. E., Song, B. J., & Noronha, A. (2018). Medications for alcohol use disorders: An overview. Pharmacology & Therapeutics, 185, 64-85. doi: 10.1016/j.pharmthera.2017.11.007.
Mohammadi, M. R., Pourdehghan, P., Mostafavi, S. A., Hooshyari, Z., Ahmadi, N., & Khaleghi, A. (2020). Generalized anxiety disorder: Prevalence, predictors, and comorbidity in children and adolescents. Journal of Anxiety Disorders, 73, 102234. Doi: 10.1016/j.janxdis.2020.102234.
Dean, J., & Keshavan, M. (2017). The neurobiology of depression: An integrated view. Asian Journal of Psychiatry, 27, 101-111. Doi: 10.1016/j.ajp.2017.01.025
Paykel, E. S. (2022). Basic concepts of depression. Dialogues in clinical neuroscience, 10(3). Doi: 10.31887/DCNS.2008.10.3/espaykel
Bonnet, M. H., & Arand, D. L. (2021). Risk factors, comorbidities, and consequences of insomnia in adults. Up-to-date, Waltham, MA.
Therapy for Patients with Sleep/Wake Disorders
In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
Care should be taken when treating patients with addiction and additional mental illness to avoid contraindications. The appropriate drug psychopharmacology for a person with major depressive disorder (MDD) and alcohol abuse is a combination of Acamprosate with escitalopram. Acamprosate reduces the effects of addiction while escitalopram is antidepressant.
The medications are safe to use together (Donoghue et al., 2022). Antidepressants such as Bupropion are contraindicated in persons with comorbid alcohol abuse and MDD because of the risk of seizure or liver damage (Li et al., 2020).
List 4 predictors of late onset generalized anxiety disorder.
Low probability of remission
Higher severity and persistence
High risk of recurrence
Presence of comorbid mental disorders
List 4 potential neurobiology causes of psychotic major depression.
Hypersensitivity to stress
Electrical stimulation in the vagus nerve
Serotonin dysfunction
Electrical stimulation of the ventral striatum (Li et al., 2021)
An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur
Depressed mood presenting in the form of sadness, hopelessness, or guilt
Diminished pleasure or interest in activities that a person once enjoyed (SAMHSA, 2020)
Weight loss or gain
Insomnia
Fatigue
Agitation
Diminished concentration
List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia.
SSRI antidepressants example fluoxetine
Statins for example Lipitor
Stimulants for example Ritalin (Stokes et al., 2020)
References
Donoghue, K., Hermann, L., Brobbin, E., & Drummond, C. (2022). The rates and measurement of adherence to acamprosate in randomised controlled clinical trials: A systematic review. PlosOne, https://doi.org/10.1371/journal.pone.0263350.
Li, J., Wang, H., Li, M., Shen, Q., Li, X., Rong, X., & Peng, Y. (2020). Efficacy of pharmacotherapeutics for patients comorbid with alcohol use disorders and depressive symptoms-A bayesian network meta-analysis. CNS Neurosci Ther, 26(11),1185-1197. https://doi.10.1111/cns.13437.
Li, Z., Ruan, M., & Chen, J. (2021). Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications. Neurosci. Bull, 37, 863–880. https://doi.org/10.1007/s12264-021-00638-3.
SAMHSA. (2020). Substance Use Disorder Treatment for People With Co-Occurring Disorders . Substance Abuse and Mental Health Services Administration.
Stokes, P., Jokinen, T., Amawi, S., Qureshi, M., Husain, M., Yatham, L., . . . Young, A. (2020). Pharmacological Treatment of Mood Disorders and Comorbid Addictions: A Systematic Review and Meta-Analysis. Can J Psychiatry, 65(11), 749-769. https://doi.10.1177/0706743720915420.
Assignment 1: Short Answer Assessment
As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being.
NURS 6630 Assignment 1 Short Answer Assessment
The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.
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To Prepare
Review the Learning Resources for this week.
Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders.
Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.
To complete:
Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.
In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
List 4 predictors of late onset generalized anxiety disorder.
List 4 potential neurobiology causes of psychotic major depression.
An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.
List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.
By Day 7
This Assignment is due.
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Submit your Week 8 Assignment 1 draft and review the originality report.
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Week 8 Assignment 1
Week 8: Therapy for Patients With Sleep/Wake Disorders
From negative changes in mood to problems concentrating, sleep/wake disorders can have a tremendous impact on patients’ lives. When patients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms.
However, many of the medications used to treat sleep/wake disorders may be addictive, making thorough patient assessments and close follow-up care essential. To prescribe appropriate therapies with patient safety in mind, you must understand not only the pathophysiology of these disorders but also the pharmacologic agents used to treat them.
This week, as you study therapies for individuals with sleep/wake disorders, you examine the assessment and treatment of patients with these disorders. You also explore ethical and legal implications of these therapies.
Learning Objectives
Students will:
Synthesize concepts related to the psychopharmacologic treatment of patients
Assess patient factors and history to develop personalized therapy plans for patients with sleep/wake disorders
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for sleep/wake disorders
Synthesize knowledge of providing care to patients presenting for sleep/wake disorders
Analyze ethical and legal implications related to prescribing therapy for patients with sleep/wake disorders
Learning Resources
Required Readings (click to expand/reduce)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/
Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf
Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470
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