Assignment: NURS 6630 Psychopharmacological Approaches to Treat Psychopathology
Assignment: NURS 6630 Psychopharmacological Approaches to Treat Psychopathology
Psychopharmacological Approaches to Treat Psychopathology
Mental health problems such as insomnia affect the patient’s health and wellbeing. Patients experience reduced quality of life due to the alteration in their daily routines and lifestyles. The adoption of effective interventions to manage sleep disorders is important in nursing practice. Psychiatric mental health nurse practitioners explore the existing best practice interventions that have minimal harm and optimum benefits in ensuring patient’s recovery from their disorders
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The purpose of this paper is to examine insomnia case study involving a 31-year-old man. The patient came to the unit with complaints that his insomnia has been worsening over the last six months. The patient has problems with falling asleep. He also finds hard to maintain sleep. He reports that the problems started following the loss of his fiancé. His health problem has affected his functioning significantly. A further history obtained from him shows that he has used diphenhydramine in the past and he did not like it because of the experiences he has in the morning after its use. He also has an opiate abuse history, which has made him not being prescribed opiates over the last four years. He also reports that he uses alcohol to enhance his quality of sleep. He takes about four beers to enable his sleep. The mental status examination showed results within the normal range. The patient factors that will influence the decisions made in treating this patient include a history of opiate and alcohol abuse and experience with diphenhydramine.
Decision 1
Selected Decision
Administer Trazodone 50 mg PO at bedtime
Reason for the Selection
Trazodone is the recommended drug of choice in patients suffering from insomnia and depression. It works by antagonizing serotonin receptors, which blocks serotonin reuptake transporter. Trazodone also influences cortisol suppression to enhance sleep quality and quantity. It also has moderate low cholinergic activity and acts as an antihistamine to improve insomnia symptoms. Trazodone also enhances slow-wave sleep to reduce insomnia symptoms (Rios et al., 2019; Yi et al., 2018). It has minimal side effects such as hangovers, hence, its appropriateness for the patient.
Why others were not selected
I did not select Zolpidem 10 mg daily at bedtime for the client due to its associated risks such as hangover symptoms. Patients often experience symptoms such as feeling drugged and dizzy following Zolpidem use. The patient may not adhere to the treatment due to the above side effects, as he stopped using diphenhydramine in the past due to similar experiences (Xiang et al., 2021). Hydroxyzine 50 mg daily at bedtime was also not selected due to its associated anxiolytic side effects such as confusion, drowsiness, and fatigue that may affect treatment adherence and the overall functioning of the patient (Terada et al., 2022).
Expected Outcomes
I selected the above decision intending to improve insomnia symptoms due to the effects of Trazodone. The therapeutic effectiveness of Trazodone such as inhibiting serotonin reuptake improves the quantity and quality of sleep (Wang et al., 2020). I was also expecting minimal side effects that would enhance treatment adherence.
Ethical Considerations
Treating psychiatric conditions should entail weighing the benefits and risks of the available alternatives. The therapeutic efficacy of Trazodone is higher than that of Hydroxyzine and Zolpidem. As a result, as a psychiatric mental health nurse practitioner, a focus should be on ensuring treatments that have minimal harm and optimum benefits to the patient (Rios et al., 2019). Through it, non-maleficence and benevolence were promoted in the treatment process.
Decision 2
Selected Decision
Explain that erection lasting 15 minutes is not considered priapism and should diminish over time, continue with the current dose
Reason for the Selection
Trazodone 50 mg orally at bedtime improved moderately the symptoms of insomnia. The client reports enhanced tolerability to trazodone. However, he experiences an erection lasting for 15 minutes in the morning, which has affected his engagement in family routines. The reported complaint is a side effect of Trazodone and is expected to improve as the client tolerates the current dosage (Yi et al., 2018). Therefore, the current dose of Trazodone should be maintained to ensure safety, sustain symptom improvement, and minimize any unwanted side effects.
Why others were not selected
I did not select the decision to discontinue Trazodone and state Suvorexant 10 mg daily at bedtime because there is no indication of a change in treatment. The patient has not developed any adverse effects associated with Trazodone (Xiang et al., 2021). The patient also reports moderate symptom improvement. Discontinuing the current treatment may lead to symptom relapse. I did not decrease Trazodone dose to 25 mg daily at bedtime since the dose is lower than the recommended and initial dosage the client was initiated. There is significant improvement in insomnia symptoms with current dose. Decreasing the dosage increases the risk of insomnia symptom relapse in the patient.
Expected Outcomes
I made the above decision aiming at maintaining or improving further the symptoms of insomnia. Maintaining the dosage would have ensured the establishment of the desired therapeutic level of Trazodone (Morin et al., 2020). I also expected to reduce the side effects, as patient tolerance was anticipated to occur.
Ethical Considerations
Evidence-based practice informs the decisions that psychiatric nurses make in their practice. The existing evidence supports dosage maintenance when moderate symptom improvement has been achieved to enhance treatment adherence and minimize further side effects (Rios et al., 2019). Therefore, by considering such recommendations, I ensured safety, quality, and efficiency in treating the patient in the case study.
Decision 3
Selected Decision
Continue dose. Explain to the patient he may split the 50 mg tablet in half. The decreased dose should minimize next-day drowsiness. Follow-up in 4 weeks.
Reason for the Selection
There is significant improvement in insomnia symptoms with the decision made in step two. However, the patient experienced night awakening followed by drowsiness in the next day. Splitting the 50 mg table into two will lower Trazodone-associated side effects. As a result, the patient is least likely to experience the above complaints (Wang et al., 2020). The complaints also demonstrate that the therapeutic levels of Trazodone have been achieved. Consequently, splitting the tablet will not result in any risks such as symptom relapse.
Why others were not selected
The decision to discontinue Trazodone, initiate Sonata 10 mg at bedtime, and follow up in 4 weeks was not chosen because the client reports significant improvement in insomnia symptoms. Discontinuing and initiating another treatment would increase the risk of symptom relapse (Yi et al., 2018). I did not discontinue Trazodone and initiate Hydroxyzine 50 mg at bedtime and follow-up in 4 weeks due to the realization of the desired outcomes of treatment in insomnia management.
Expected Outcomes
It is expected that night awakening and drowsiness in the next day will reduce significantly. Symptom improvement is expected to improve patient’s adherence to treatment, hence, optimum outcomes (La et al., 2019).
Ethical Considerations
The desired treatment outcomes have been achieved in this case study. A focus should be on empowering the patient through education on the interventions to sustain the treatment outcomes. Patient education on the importance of treatment adherence and behavioral interventions to improve sleep quality should be done at this stage (Rios et al., 2019). Through it, patient autonomy in decision-making will be promoted.
Conclusion
I believe that I made the right decisions in treating the patient in the case study. The first decision demonstrated effectiveness of Trazodone 50 mg in managing insomnia symptoms. The decision was made based on the evidence that Trazodone improves insomnia symptoms as well as those associated with depressive disorders. Trazodone has more efficacy in insomnia than Zolpidem and Hydroxyzine. The anticipated outcomes for making this decision included improvement in symptoms of insomnia and enhanced treatment tolerance (Wang et al., 2020). The ethical considerations that guided the decision-making process in this stage included benevolence and non-maleficence. The psychiatric mental health nurse practitioner ensured that the adopted treatment had minimal harm and optimum benefits to the patient.
The second decision to maintain the earlier dosage was also effective. There was more than average symptom improvement when the patient was administered with Trazodone 50 mg orally daily at bedtime. The side effect of morning erection lasting 15 minutes is expected to wear off as the patient tolerates the treatment. Discontinuing Trazodone at this time and starting a new drug was not recommended since it increased the risk of symptom relapse. The ethical considerations made at this step are aimed at ensuring the optimization of treatment outcomes (Morin et al., 2020). Through it, safety in the treatment process was promoted.
The third decision to split the Trazodone tablet into two was also effective. The therapeutic levels of Trazodone had been achieved. As a result, splitting the table would not result in a reduction in symptom improvements. The ethical considerations that should be made in this stage are empowering the patient about effective symptom management. Patient education on treatment adherence and the use of psychotherapy to improve sleep quality should be considered (Rios et al., 2019).
References
La, A. L., Walsh, C. M., Neylan, T. C., Vossel, K. A., Yaffe, K., Krystal, A. D., Miller, B. L., & Karageorgiou, E. (2019). Long-Term Trazodone Use and Cognition: A Potential Therapeutic Role for Slow-Wave Sleep Enhancers. Journal of Alzheimer’s Disease, 67(3), 911–921. https://doi.org/10.3233/JAD-181145
Morin, C. M., Edinger, J. D., Beaulieu-Bonneau, S., Ivers, H., Krystal, A. D., Guay, B., Bélanger, L., Cartwright, A., Simmons, B., Lamy, M., & Busby, M. (2020). Effectiveness of Sequential Psychological and Medication Therapies for Insomnia Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 77(11), 1107–1115. https://doi.org/10.1001/jamapsychiatry.2020.1767
Rios, P., Cardoso, R., Morra, D., Nincic, V., Goodarzi, Z., Farah, B., Harricharan, S., Morin, C. M., Leech, J., Straus, S. E., & Tricco, A. C. (2019). Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: An overview of reviews. Systematic Reviews, 8(1), 281. https://doi.org/10.1186/s13643-019-1163-9
Terada, T., Hirayama, T., Sadahiro, R., Wada, S., Nakahara, R., & Matsuoka, H. (2022). Pilot Study of Lemborexant for Insomnia in Cancer Patients with Delirium. Journal of Palliative Medicine. https://doi.org/10.1089/jpm.2021.0509
Wang, J., Liu, S., Zhao, C., Han, H., Chen, X., Tao, J., & Lu, Z. (2020). Effects of Trazodone on Sleep Quality and Cognitive Function in Arteriosclerotic Cerebral Small Vessel Disease Comorbid With Chronic Insomnia. Frontiers in Psychiatry, 11. https://www.frontiersin.org/article/10.3389/fpsyt.2020.00620
Xiang, T., Cai, Y., Hong, Z., & Pan, J. (2021). Efficacy and safety of Zolpidem in the treatment of insomnia disorder for one month: A meta-analysis of a randomized controlled trial. Sleep Medicine, 87, 250–256. https://doi.org/10.1016/j.sleep.2021.09.005
Yi, X., Ni, S., Ghadami, M. R., Meng, H., Chen, M., Kuang, L., Zhang, Y., Zhang, L., & Zhou, X. (2018). Trazodone for the treatment of insomnia: A meta-analysis of randomized placebo-controlled trials. Sleep Medicine, 45, 25–32. https://doi.org/10.1016/j.sleep.2018.01.010
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NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology
Assignment: Assessing and Treating Patients With Sleep/Wake Disorders
Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.
Utilize SafeAssign Drafts for originality report, before final submission.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
*Learning resources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/
https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf
https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf
https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470
https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched.
alprazolam
amitriptyline
amoxapine
amphetamine
desipramine
diazepam
doxepin
eszopiclone
flunitrazepam
flurazepam
hydroxyzine
imipramine
lemborexant
lorazepam
melatonin
methylphenedate
modafinil armodafinil
carnitine
clomipramine
clonazepam
nortriptyline
pitolisant
ramelteon
sodium oxybate
solriamfetol
SSRI’s
temazepam
trazodone
triazolam
trimipramine
wellbutrin
zaleplon
zolpidem
The Assignment: 5 pages
Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
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