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Nur641PsychopharmacologydiscussionReplies.docxNur 641 Psychopharmacology Replies
Please reply this students Jacqueline, Juliet, Roseline and Heidi discussion each in a paragraph of 170 – 200 words with APA and References. One reply for each student for a total of 4 replies.
1. Juliet Nwanna
Week 7/8 DB
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Substance Use Disorder
The excessive and harmful use of psychoactive substances characterizes substance abuse. It is a significant public health concern affecting millions worldwide (Amin et al., 2023). According to Amin et al. (2023), substance abuse entails the misuse of substances such as alcohol, stimulants, opioids, and sedatives. Their use has adverse psychological, social, and physical consequences. Substance use disorders are complex conditions influenced by biological, psychological, and social factors. Hence, a comprehensive treatment approach is required for successful management.
Case Study
In the case study, the patient is Mr. F., a 45-year-old male who presents with a substance use disorder involving opioids (heroine). He has a medical history of chronic back pain and hypertension that contributed to his opioid misuse. Mr. F has a psychiatric history of depression and anxiety, which implies potential co-occurring mental health conditions. He is divorced, unemployed, and lives with his adult son. Also, social factors and psychiatric and medical history might have contributed to his substance use disorder. It is vital to address his mental health concerns, social support system, and physical pain management. It will be part of his comprehensive treatment plan. By addressing these correlated factors, he can receive holistic care addressing the primary causes of his opioid misuse and enhance his overall well-being.
Diagnosis
· Substance Use Disorder, Opioid Type
· Major Depressive Disorder
· Generalized Anxiety Disorder
This case was very pathetic; a man with chronic pain issues is making an effort to obtain help and becoming opioid-dependent in the process. Also, he verbalized that he has been judged and ill treated by people in the past which made him feel extreme sadness and depressed.
Pharmacological Treatment/Concern/Ethical dilemma
Treatment involves buprenorphine/naloxone (Suboxone) for opioid use disorder. The starting dose is 4/1 mg of sublingual (SL) film once daily (Poliwoda et al., 2022). The plans for titration are based on his response and withdrawal symptoms. The patient is to follow up in a week, and if there is no improvement in craving, the Suboxone dose will be increased to 8/2mg sublingual film daily; it may be taken at one time or maybe taken in two doses: 4/1mg sublingual two times a day. Buprenorphine acts as a partial agonist at the mu-opioid receptor, reducing cravings and withdrawal symptoms. While naloxone helps deter misuse by precipitating withdrawal if the medication is injected. My concern is that some people are quick at judging other people without empathizing with them and understanding that some medical conditions that are related to pain issues and medication for pain can result in opiod dependence. Also, Mr. F. verbalized that people has told him to his face that a lot of people from his race/ethnic group are drug addicts.
Non-pharmacological Treatment
Mr. F. will be referred to a substance abuse treatment program that comprises of group and individual therapy sessions. Cognitive-behavioral therapy (CBT) will help in addressing his anxiety and depressive symptoms (Fullen et al., 2020). Additionally, it assists in developing coping strategies for managing triggers and cravings for substance use.
Neurotransmitters and CYP-450 Enzymes Affected and Medication to Address it
The use of opioids affects different neurotransmitter systems, for example, the endorphin and dopamine pathways (Voicu et al., 2023). They are likely to lead to withdrawal and dependence symptoms upon termination. Buprenorphine, a partial agonist at the mu-opioid receptor, stabilizes these pathways. It lessens cravings and withdrawal symptoms, while naloxone prevents misuse.
Patient Teaching Considerations, Including Side Effects
Mr. F. will be educated on the side effects of buprenorphine/naloxone, which include nausea, constipation, headache, and dizziness. The side effects are mild and transient but need close monitoring. The duration for opioid treatment is long, and if Mr. F. decides to discontinue, it should be done under medical supervision to avoid relapse. Coping strategies are vital, and he will be equipped to manage cravings and triggers, such as stress management techniques, enrolling and attending meetings and groups, and healthy lifestyle habits.
Plans for Follow-Up
Mr. F. will be scheduled for regular follow-up appointments initially every week to monitor his response to treatment, assess for any adverse effects, and adjust the medication dosage as needed to a maximum of 24/6 mg SL daily. As he stabilizes, follow-up appointments may be spaced out to bi-weekly or monthly intervals, with ongoing monitoring of his progress in substance abuse treatment programs (Poliwoda et al., 2022).
Reference
Amin, U., Malla, A. M., Amin, I., & Jan, R. (2023). Substance abuse: A public health concern. Indian Journal of Psychiatric Nursing, 20(2), 168-178. https://doi /10.4103/iopn.iopn_25_23
Fullen, T., Jones, S. L., Emerson, L. M., & Adamou, M. (2020). Psychological treatments in adult ADHD: A systematic review. Journal of Psychopathology and Behavioral Assessment, 42(3), 500-518. https://doi.org/10.1007/s10862-020-09794-8
Poliwoda, S., Noor, N., Jenkins, J. S., Stark, C. W., Steib, M., Hasoon, J., & Kaye, A. D. (2022). Buprenorphine and its formulations: a comprehensive review. Health Psychology Research, 10(3). https://doi.org/10.52965%2F001c.37517
Voicu, V., Brehar, F. M., Toader, C., Covache-Busuioc, R. A., Corlatescu, A. D., Bordeianu, A., & Ciurea, A. V. (2023). Cannabinoids in medicine: a multifaceted exploration of types, therapeutic applications, and emerging opportunities in neurodegenerative diseases and cancer therapy. Biomolecules, 13(9), 1388. https://doi.org/10.3390/biom13091388
3 days ago
2.Jacqueline Licauco
Substance Abuse DB
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Case Scenario
Patient is a 68 y/o female who was recently in the hospital for acute onset of right upper extremity weakness and slurring of speech for one day. She has a long-standing history of hypertension maintained on Amlodipine 10 mg daily. She is a retired teacher who smokes one pack of cigarettes for 40 years.
Acute weakness and slurring of speech resolved spontaneously and neurological imaging did not show any evident or apparent stroke. Carotid duplex ultrasound showed moderate degree stenosis bilaterally. Blood tests showed elevated cholesterol levels. The patient was diagnosed with TIA and started on a high-dose statin, and was advised to quit smoking.
She started smoking in her 20s to help deal with stress and depression. She feels that smoking calms her and regards cigarettes as her “antidepressant.” She is well aware of the consequences of smoking but cannot stop since it will make her feel depressed without it. She would like to quit but has fears about it.
Medical Challenge: How to make a chronic smoker stop smoking
To assist the patient in quitting smoking, the patient must be motivated to quit. Pharmacological and nonpharmacological treatment modalities need to be incorporated together. Since she has underlying depression, she can be started on Bupropion SR 150 mg for three days initially and increased to 150 mg twice a day for 6 to 12 weeks. At the same time, she can be given nicotine patches initially 21 mg/day for four weeks, then decreased to 14 mg/day for another four weeks and 7 mg/day for the next four weeks. It has been shown that combined bupropion and nicotine patches had higher quit rates than either alone (Boland & Verduin, 2022). Findings have shown that bupropion was effective in the medium-term (< 6 months) and long-term treatment (Spanakis et al., 2020). Buproprion can be started one to two weeks before quit date and can be continued for 6 months (Boland & Verduin, 2022).
In combination with medication, psychotherapy is done through cognitive behavioral therapy and motivational enhancement therapy. This will help restructure the thinking regarding cigarette smoking and will increase the motivational drive to continue quitting.
References
Boland, R., & Verduin, M. (Eds.). (2022). Kaplan & Sadock's Synopsis of Psychiatry (12th ed.). Wolters Kluwer.
Spanakis, P., Peckham, E., Young, B., Heron, P., Bailey, D., & Gilbody, S. (2021). A systematic review of behavioural smoking cessation interventions for people with severe mental ill health—what works? Addiction, 117(6), 1526–1542. https://doi.org/10.1111/add.15724
3.
Roseline Oifoh
Management and Ethical_week 7
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Management and Ethical Challenges Case
John, who is fifty years old, has a drinking habit that he has incurred for a long time. This is the first time he knew he had cirrhosis of the liver, a disease that is usually caused by lifetime drinking habits. He was taken to the hospital due to the severe manifestation of his illness, comprising jaundice, swelling, and gastrointestinal bleeding. They took him to the hospital to give him intravenous fluids, stop the bleeding, and take care of other problems like hepatic encephalopathy.
Neurotransmitters and Medicine
Naltrexone was prescribed to John not only to minimize his addiction but also to cure his addiction to a certain degree. The action of this drug counteracts opioids on neurotransmitter systems. As a result, it can help in reducing patients’ cravings and curb relapse risk. Naltrexone has a mechanism that hits the receptors of opioids. Alcohol becomes less addictive, which is crucial to addiction. John started with 50 milligrams every day. This was modified based on his response and capacity. To avoid significant withdrawal or side effects, the team monitored him closely.
Emotional and Mental Health Challenges
The diagnosis of cirrhosis by the doctors had a far-reaching emotional impact on John. He had sadness and anxiety, which may have been made worse by the fact that he didn't want to talk about his drinking problem or think about rehab. The mental health conditions that John had gained during the war were critical for his recovery. John consulted with a counselor to discuss the emotional issues and to suggest practical solutions for John's emotion and low self-esteem. Another professional was added to the individualized team - a psychologist, who carries out the function of being a safe person with whom John could share his fears and who helps John work out his resistance to taking the treatment.
Patient Teaching and Education
John’s main area of interest in the care plan was teaching him about the side effects of medication involved in the treatment. It was pointed out that a patient using naltrexone may experience other side effects such as headache, dizziness, and fatigue. Besides that, he was also being instructed on problems that may arise from the Somatic set-up of the medication if he was taking opioids when taking it as well. He must know these risks so avoid the risk of getting sick. People learned how to transform their behaviors and stay sober. The social worker was crucial in helping John remember these lessons and connecting him with hope-filled support groups. This comprehensive approach aimed to help John create a solid support system to improve his mental and physical health.
Follow-up and Monitoring Plan
John needed to ensure his recovery would be carried out thoroughly only by introducing a strong follow-up plan. The strategy will be to have him follow up with his primary physician regularly, also Hepatology consultation to verify whether his liver function and overall health are working well. As well the plan would contain two mental health sessions per month to help him deal with his emotional challenges and one social worker session a week to gain the required interpersonal skills to be part of the family and the community. Thanks to this multidisciplinary approach, the healthcare team could change John's care plan as needed and ensure he stayed on track with his rehab goals.
Ethical Considerations
Ethical consideration was given utmost attention when John was being treated. His attitude of not talking about his addiction and the issue of whether to respect his privacy or not, of course, made the balance between the need of the patient to disclose his substance abuse and the job to keep him safe become crucial. The concerned healthcare team did everything possible for John by ensuring that he had the lead in every significant decision made on his behalf and that his rights remained inviolable.
Conclusion
John stands a better chance of being comfortable getting and keeping himself sober with a team of multifaceted personalities, a complete plan, and a strong support group. John's road to recovery is successful and largely rises from the doctor's careful watch, patient education, and moral approval.
4.Heidi Waldorf
Waldorf Wk 7 Discussion - Ethical Dilemma
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Case Discussion: Treatment Resistance and Confidentiality in Adolescent Mental Health
During my FNP pediatric clinicals, I encountered a 16-year-old Hispanic female diagnosed with depression and anxiety. This case had been particularly challenging due to her resistance to treatment and her insistence on not involving her parents, citing fears of humiliation, and misunderstanding related to mental health within her culture and family.
The ethical dilemma I faced involved the need to maintain patient confidentiality versus the need for parental involvement in her treatment. This created a management issue as involving the family is often crucial for successful adolescent mental health treatment, yet as a provider I also needed to respect her wishes, ensure I maintained her trust, and comply with legal standards for confidentiality.
Handling the Situation and Concerns
This patient’s treatment required building a strong therapeutic alliance with the patient, using motivational interviewing techniques to explore her fears and resistance towards treatment and parental involvement. My preceptor and I utilized this approach to empower her to take an active role in her recovery while also encouraging her to consider the benefits of family support. Given the patient’s age and cultural background, we started her treatment with the integration of cognitive-behavioral therapy (CBT). Due to the availability of telehealth services, the patient would be able to do therapy without having to ask for rides to/from her appointments which addressed concerns regarding access to care. The patient was resistant to the idea of medications, and more accepting of CBT as a possible treatment for her concerns.
Plans for follow-up
We provided the patient with teaching on phone applications such as the Calm app, to help her practice mindfulness and manage her anxiety and stress. We asked the patient to follow up in one week and encouraged her to include her parents in the treatment. The mother did attend the next session but was resistant to the idea of adding medication to the treatment plan. My preceptor and I were both aware that one of Latino culture’s biggest impediments to depression treatment is mental disease stigma (Washburn et al., 2022). To encourage not only the patient but also the mother’s support and involvement in her daughter’s care, we initiated biweekly appointments. The patient was also referred to a local office for therapy to allow her the opportunity for both online and in-person sessions if desired. We recommended she attend biweekly therapy initially, which could be adjusted per patient response to treatment. We followed the patient every two weeks, having her repeat her GAD-7 and PHQ-9 at each visit to help us determine the efficacy of treatment. We did provide education about the need to repeat these questionnaires, explaining that not only can these determine how severe one’s symptoms are but they can also identify any trends occurring in a patient’s treatment response (Anand et al., 2021). Throughout the treatment, the patient’s father was resistant to the diagnosis and would not participate in any of the appointments. We focused our discussions with the patient and mother on normalizing mental health concerns and treatments and maintaining open and honest communication about not needing to feel shameful for seeking help. Unfortunately, my clinical time ended at that clinic and I was unable to continue following this patient’s case.
This case stuck with me as I am of Latino descent as well and have seen the stigma towards seeking help for mental health amongst family, friends, and patients. I have also seen how this can negatively impact patient outcomes as they are often resistant to continued mental health treatment. I believe that having honest and open conversations with patients, creating a safe environment, and maintaining a non-judgmental approach can help patients feel more comfortable with mental health care. Sometimes all they need is for someone to listen to their concerns and let them know that there are options for help.
References
Anand, P., Bhurji, N., Williams, N., & Desai, N. (2021). Comparison of PHQ-9 and PHQ-2 as screening tools for depression and school related stress in inner city adolescents. Journal of primary care & community health, 12, 21501327211053750. https://doi.org/10.1177/21501327211053750
Washburn, M., Brewer, K., Gearing, R., Leal, R., Yu, M., & Torres, L. (2022). Latinos' conceptualization of depression, diabetes, and mental health-related stigma. Journal of racial and ethnic health disparities, 9(5), 1912–1922. https://doi.org/10.1007/s40615-021-01129-x
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