ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS PAPER

ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS PAPER

ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS PAPER

1. 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 the resolution of symptoms?

ORDER A PLAGIARISM-FREE PAPER HERE

The appropriate drug therapy for a patient with major depressive disorder (MDD) and a history of alcohol abuse is selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) class of antidepressants. These drugs are effective in treating depression and have a lower risk of interactions with alcohol than other antidepressants (Sheffler & Abdijadid, 2020). Drugs contraindicated for this patient include those that fall under monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). These drugs can have severe interactions with alcohol and increase the risk of adverse events such as serotonin syndrome or a hypertensive crisis. The timeframe for the resolution of symptoms varies from patient to patient. It can depend on various factors, such as the severity of the depression, the patient’s response to medication, and their treatment adherence. The treatment always takes several weeks to months to resolve.
2. List four predictors of late-onset generalized anxiety disorder.
Late-onset generalized anxiety disorder (GAD) is defined as the onset of GAD symptoms after age 50. While the causes of late-onset GAD are not fully understood, several predictors have been identified. Firstly, the presence of medical conditions such as cardiovascular disease, diabetes, or chronic pain increases the risk of developing late-onset GAD (Welzel et al., 2021). Secondly, life stressors such as retirement, widowhood, or chronic illness can increase the risk of developing GAD later in life. Thirdly, personality traits such as neuroticism, introversion, and perfectionism have been associated with an increased risk of late-onset GAD. Finally, cognitive decline, including memory and executive function impairment, has been linked to an increased risk of developing late-onset GAD.
3. List 4 potential neurobiology causes of psychotic major depression.
The neurobiology causes of psychotic major depression are complex and involve interactions between multiple systems and pathways. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis can result in hyperactivity of the HPA axis, increased cortisol production, and a higher risk of developing depression and psychosis. Secondly, abnormalities in the serotonin system can also cause psychotic major depression. Serotonin plays a vital role in regulating mood, and abnormalities in this system have been linked to depression and psychosis (Li et al., 2021). Additionally, dysregulation of the dopamine system, particularly the mesolimbic pathway, can also lead to psychotic symptoms in depression. Finally, abnormalities in brain structure and function, particularly in regions involving the prefrontal cortex, amygdala, and hippocampus, which play critical roles in emotion regulation and memory, can lead to psychotic major depression.
4. An episode of major depression is a period lasting at least two weeks. List at least five symptoms required for the episode to occur. Be specific.
According to the DSM-5, to be diagnosed with a major depressive episode, an individual must have experienced five or more of the following symptoms during the same 2-week period, and at least one of the symptoms must be either depressed mood or loss of interest or pleasure in activities: Depressed mood, loss of interest or pleasure in activities once enjoyed, significant weight loss or gain, or changes in appetite, insomnia or hypersomnia, psychomotor agitation, fatigue or loss of energy, feelings of worthlessness or guilt nearly every day, diminished ability to think or concentrate, or indecisiveness nearly every day and suicidal thoughts (Sheffler & Abdijadid, 2020).
5. List three classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.
Various classes of medications can cause insomnia as a side effect. The first class is beta-blockers, often used to treat cardiovascular conditions, high blood pressure, and heart failure. Beta-blockers like metoprolol (Lopressor) and propranolol (Inderal) cause insomnia as a side effect. The second class is antidepressants, particularly SSRIs and SNRIs, commonly used to treat depression, anxiety, and other mental health disorders. Fluoxetine (Prozac) and venlafaxine (Effexor) are examples of antidepressants that can cause insomnia (Sheffler & Abdijadid, 2020). The third class of drugs is steroids, specifically, corticosteroids, used to treat inflammation, allergies, and autoimmune disorders. Prednisone and dexamethasone are steroids that can cause insomnia as a side effect.

References
Li, Z., Ruan, M., Chen, J., & Fang, Y. (2021). Major depressive disorder: Advances in neuroscience research and translational applications. Neuroscience Bulletin, 37(6). https://doi.org/10.1007/s12264-021-00638-3
Sheffler, Z. M., & Abdijadid, S. (2020). Antidepressants. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538182/
Welzel, F. D., Luppa, M., Pabst, A., Pentzek, M., Fuchs, A., Weeg, D., Bickel, H., Weyerer, S., Werle, J., Wiese, B., Oey, A., Brettschneider, C., König, H.-H., Heser, K., van den Bussche, H., Eisele, M., Maier, W., Scherer, M., Wagner, M., & Riedel-Heller, S. G. (2021). Incidence of anxiety in latest life and risk factors. Results of the agecode/agequalide study. International Journal of Environmental Research and Public Health, 18(23), 12786. https://doi.org/10.3390/ijerph182312786

ORDER A PLAGIARISM-FREE PAPER HERE

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.

references

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disordersLinks to an external site. (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 ReportsLinks to an external site., 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. ChestLinks to an external site., 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. SLEEPLinks to an external site., 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. SLEEPLinks to an external site., 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 MedicineLinks to an external site., 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of MedicineLinks to an external site., 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740