Psychiatric Assessment Essay

Psychiatric Assessment Essay

 Drug Therapy for MDD.

Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine are the recommended treatment options for major depressive disorder in individuals with a history of alcohol abuse. SSRIs are the most prescribed antidepressants that inhibit the brain’s normal absorption rate of serotonin, resulting in an extended and sustained feel-good response (Plöderl et al., 2021). It is generally safe to consume alcohol with SSRIs though a few minor side effects may be experienced.

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) are contraindicated in such a patient. SNRIs are incompatible with alcohol, especially in large amounts, resulting in worsened liver damage. Binge drinking while concurrently taking TCAs worsens depressive symptoms and increases intoxication effects (Agabio et al., 2018). MAOIs are some of the worst antidepressants to mix with alcohol. Certain chemicals present in these medications result in an elevation in blood pressure, necessitating immediate hospitalization. Resolution of symptoms is experienced within 6-8 weeks. Patients should, however, continue medication for at least 6-9 months.

Generalized Anxiety Disorder.

The predictors of late-onset generalized anxiety disorder include being female, a history of recent traumatic events, the presence of chronic physical conditions such as heart failure, and the presence of a mental disorder such as depression or a previous episode of generalized anxiety disorder (DeMartini et al., 2019).

Psychotic Major Depression.

The most implicated cause is a complex reaction involving dysfunction in serotonin, increased sensitivity to stress, and predisposition to major depressive disorder (Lynch et al., 2020). Dopamine has recently been suggested as playing a vital role in the causation of major depressive disorder.

Major Depression.

For a diagnosis of major depressive disorder to be made, the patient must experience five or more of the symptoms associated with major depression for at least two weeks. One of these symptoms should either be a low or depressed mood for the majority of the day or a decline or complete loss of interest in normal daily activities most of the time (Santini et al., 2020). These should be experienced during most days of the two-week timeframe. Other symptoms include fatigue or diminished energy levels, feelings of worthlessness or guilt, and repetitive suicidal thoughts.

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References.

Agabio, R., Trogu, E., & Pani, P. P. (2018). Antidepressants for the treatment of people with co-occurring depression and alcohol dependence. The Cochrane Database Of Systematic Reviews, 4(4), CD008581. https://doi.org/10.1002/14651858.CD008581.pub2

DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals Of Internal Medicine, 170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020

Lynch, C. J., Gunning, F. M., & Liston, C. (2020). Causes and Consequences of Diagnostic Heterogeneity in Depression: Paths to Discovering Novel Biological Depression Subtypes. Biological Psychiatry, 88(1), 83–94. https://doi.org/10.1016/j.biopsych.2020.01.012

Plöderl, M., & Hengartner, M. P. (2021). Learning about the course of suicidal behavior but not about the effects of SSRIs. Neuropsychopharmacology: Official Publication Of The American College Of Neuropsychopharmacology, 10.1038/s41386-021-01224-x. Advance online publication. https://doi.org/10.1038/s41386-021-01224-x

Santini, Z. I., Jose, P. E., York Cornwell, E., Koyanagi, A., Nielsen, L., Hinrichsen, C., Meilstrup, C., Madsen, K. R., & Koushede, V. (2020). Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. The Lancet. Public Health, 5(1), e62–e70. https://doi.org/10.1016/S2468-2667(19)30230-0

 

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