NURS 6521 Week 8 Pharmacology for Psychological Disorders
NURS 6521 Week 8 Pharmacology for Psychological Disorders
NURS 6521 Week 8 Pharmacology for Psychological Disorders
Week 9: Concepts of Psychological Disorders Knowledge Check: Psychological Disorders
Scenario 1: Schizophrenia
- What are the known characteristics of schizophrenia and relate those to this patient?
Schizophrenia is a chronic mental disorder displayed in patients who interpreted reality abnormally just like the 22-year-old patient in the provided case study. It can lead to a combination of delusion. Hallucination and extremely disordered behaviour and thinking impair the patient normal functioning (Correll et al., 2019). The patient in the provided case study reported signs of auditory and visual hallucination, unexpected rage and crying, and delusion. Additional symptoms include disorganized speech and thinking as demonstrated by the results of the mental status examination. The patient also displayed negative symptoms such as inability to make eye contact and being socially withdrawn which are significant indications of schizophrenia disorder.
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Genetics are sometimes attached to schizophrenia explains this.
Pre-molecular and molecular genetic studies have reported that genetics play a significant role in the development of schizophrenia. Consequently, the inheritance pattern of the disease demonstrates increased risk among first relatives. At the molecular level, several positional and functional genes associated with the development of schizophrenia have been identified, such as neuregulin (NRG-1, 8p12–21), proline dehydrogenase (PRODH-2, 22q11.21), dysbindin, (DTNBP1,6p22.3), catechol-O-methyltransferase (COMT, 22q11.21), G72 (13q34) / D-amino acid oxidase (DAAO,12q24),5HT2A and dopamine D3 receptor (DRD3) and regulator of G protein signaling (RGS-4) (Cleynen et al., 2021). Recent studies support schizophrenia candidate regions on chromosomes 1q, 2q, 5q, 6p, 8p, 10p, 13q,15q and 22q. Additional studies are however required to provide a precise association with the above-mentioned genetic factors concerning how they lead to the development of schizophrenia.
What roles do neurotransmitters play in the development of schizophrenia?
Neurotransmitters are chemicals responsible for conveying messages between brain cells. Studies illustrate an association between changes in the levels of neurotransmitters in the brain to the development of schizophrenia. This is evident by the mechanism of antipsychotics in relieving symptoms of schizophrenia through altering the levels of certain neurotransmitters in the brain. Recent studies have reported several biochemical alterations in schizophrenia, concerningneurotransmitter dysfunction in different systems, with the most prominent being γ-aminobutyric acid (GABA), serotonin, glutamate, and dopamine (Müller, 2018). For instance, alterations in the signaling of dopamine and hyperactivity of the D2 receptor in the limbic and subcortical region of the brain have been associated with some of the schizophrenia symptoms including delusion and hallucination. Consequently, hypodopaminergic activity in the mesocortical system is also associated with negative symptoms of schizophrenia such as flattening, lack of pleasure, withdrawal, and inability to follow through.
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Explain what structural abnormalities are seen in people with schizophrenia.
Through imaging studies, several complex patterns of structural abnormalities have been reported among patients diagnosed with schizophrenia, in addition to those who are at high risk of the disorder (Zhao et al., 2018). For example, MRI studies have reported a reduced volume of grey matter in the prefrontal, superior temporal, and medial temporal areas of the brain. These regions of the brain are involved in several functions such as short-term memory/decision making, processing of auditory information, and episodic memory respectively. Postmortem studies on the other hand report that a reduction in the cortical grey matter does not indicate loss of cell bodies but instead, reflects a reduction in synaptic density and dendritic complexity which may impair intraneuronal integration and communication leading to cognitive changes among other associated symptoms. Disruptions in the integrity of the white matter have also been implicated in schizophrenia, given that it forms the structural connections between different regions of the brain.
Scenario 2: Bipolar Disorder
How does genetics play in the development of bipolar 2 disorders?
Bipolar disorder (BD) is characterized by extreme shifts in the patient’s mood, behaviour, and energy levels. The patient in the provided case study is however diagnosed with bipolar 2 disorder, which is characterized by hypomanic and depressive episodes. The inheritance pattern of bipolar 2 disorder is quite unclear. Studies however report greater risks among first-degree relatives, with genetic factors accounting for approximately 80% of the causes of this mental disorder (Gordovez& McMahon, 2020). Genome-wide association studies (GWASs) have associated increased risk of bipolar 2 disorder with several genetic factors such as alpha-1 subunit of the L-type voltage-gated calcium channel (CACNA1C), teneurin transmembrane protein 4 (ODZ4), ankyrin G node of Ranvier (ANK3), nesprin-1 (SYNE1) and diacylglycerol kinase eta (DGKH).For instance, the DGKH is involved in diacylglycerol (DAG) phosphorylation in the phosphoinositol pathway sensitive to lithium, which contributes to the development of the bipolar disorder.
References
Cleynen, I., Engchuan, W., Hestand, M. S., Heung, T., Holleman, A. M., Johnston, H. R., … & Bassett, A. S. (2021). Genetic contributors to the risk of schizophrenia in the presence of a 22q11. 2 deletion. Molecular psychiatry, 26(8), 4496-4510. https://doi.org/10.1038/s41380-020-0654-3
Correll, C. U., Brevig, T., & Brain, C. (2019). Patient characteristics, burden, and pharmacotherapy of treatment-resistant schizophrenia: results from a survey of 204 US psychiatrists. BMC psychiatry, 19(1), 1-12. https://doi.org/10.1186/s12888-019-2318-x
Gordovez, F. J. A., & McMahon, F. J. (2020). The genetics of bipolar disorder. Molecular psychiatry, 25(3), 544-559.https://doi.org/10.1038/s41380-019-0634-7
Müller, N. (2018). Inflammation in schizophrenia: pathogenetic aspects and therapeutic considerations. Schizophrenia bulletin, 44(5), 973-982. https://doi.org/10.1093/schbul/sby024
Zhao, C., Zhu, J., Liu, X., Pu, C., Lai, Y., Chen, L., … & Hong, N. (2018). Structural and functional brain abnormalities in schizophrenia: a cross-sectional study at different stages of the disease. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 83, 27-32. https://doi.org/10.1016/j.pnpbp.2017.12.017.
How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?
Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care.
This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.
Learning Objectives
Students will:
- Evaluate patients for treatment of psychological disorders
- Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders
- Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology
- Evaluate patients for treatment of neurological and musculoskeletal disorders
- Analyze decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders
- Justify decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders
Learning Resources
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
- Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
- Chapter 27, “Antidepressants” (pp. 214–226)
- Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
- Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
- Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
- Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)
Required Media (click to expand/reduce)
Discussion: Decision Making When Treating Psychological Disorders
Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.
Photo Credit: Getty Images/iStockphoto
For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.
To Prepare
- Review this week’s interactive media pieces and select one to focus on for this Discussion.
- Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.
By Day 3 of Week 8
Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.
By Day 6 of Week 8
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 8 Discussion Rubric
Post by Day 3 of Week 8 and Respond by Day 6 of Week 8
To Participate in this Discussion:
Week 8 Discussion
Assignment: Decision Tree for Neurological and Musculoskeletal
By Day 7 of Week 8
Submit your Assignment, started in Week 6.
Reminder: The Collegeof Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
Photo Credit: KATERYNA KON/SCIENCE PHOTO LIBRARY / Science Photo Library / Getty Images
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
- Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Week 8 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 8 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 8 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 8
To participate in this Assignment:
Week 8 Assignment
What’s Coming Up in Module 7?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In the next module, you will examine types of drugs prescribed to address women’s and men’s health, infections, and disorders of the hematologic system.
Next Week