WK7 PRAC 6675 ASSIGN 1

Running head: DISCUSSION QUESTIONS 1

DISCUSSION QUESTION 2

SAMPLES

1 Great post Cynthia Nash

Response1 to question 1

1. Based on information presented, what medication might you have started the patient on if she was not currently on Seroquel, and why?

Lamictal would be my choice of treatment for Unspecified Mood Disorder with Anxious Distress especially because of the history of suicidal thought with and without a plan. In an exploratory study of  lamotrigine's role in mood stabilization in adolescent with BPD. It found  effective in maintaining symptom control of a broad range of manic, depressive, irritable, and aggressive symptoms in PBD. There was no increase in suicidal ideation. Lamotrigine can be added to SGAs to gain effective symptom control and maintenance at an average dose of 200 mg/day. There was no weight gain or related metabolic abnormalities (Pavuluri et al., 2009).

Since  the rate of serious rash is greater in pediatric patients than in adults, Lamictal is approved only for use in pediatric patients below the age of 16 years who have seizures associated with the Lennox-Gastaut Syndrome or in patients with partial seizures. However, when confronted with the poor prognosis and suicide risk associated with treatment-resistant depression, LTG can be considered as a 3rd-line treatment option, as the benefits may outweigh the risks. Lamotrigine in Adolescent Mood Disorders: A Retrospective Chart Review study revealed that lamotrigine might be associated with a significant risk of benign rash. No serious rash such as Stevens Johnson Syndrome, Toxic Epidermal Necrolysis has occurred.  (Carandang et al., 2007).

Carandang, C., Robbins, D., Mullany, E., Yazbek, M., & Minot, S. (2007, February). Lamotrigine in adolescent mood disorders: A retrospective chart review. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent. Retrieved July 14, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276172/

Pavuluri, M. N., Henry, D. B., Moss, M., Mohammed, T., Carbray, J. A., & Sweeney, J. A. (2009, February). Effectiveness of lamotrigine in maintaining symptom control in pediatric bipolar disorder. Journal of child and adolescent psychopharmacology. Retrieved July 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692234/

2 Response 1 question 1

1. Describe knowledge of the association between obsessive-compulsive behaviors and paraphilias.

OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are repetitive and persistent thoughts, images, impulses or urges that are intrusive and unwanted, and are commonly associated with anxiety. Compulsions are repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession according to rigid rules, or to achieve a sense of ‘completeness’.  Common sets of obsessions and compulsions in patients with OCD include concerns about contamination together with washing or cleaning, concerns about harm to self or others together with checking, intrusive aggressive or sexual thoughts together with mental rituals, and concerns about symmetry together with ordering or counting (Stein et al., 2019).

Paraphilias are persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature. A recent study focusing on neurotransmission of paraphilic disorders found evidence to suggest that central dopamine plays a key role in the pathogenesis of paraphilic disorders and the general disturbance of the conscious regulation of behavior. The results of this study revealed increased levels of serotonin and norepinephrine, with a decreased concentration of DOPAC (3,4-dihydroxyphenylacetic acid) in urine samples of the test population diagnosed with paraphilic disorders. Researchers have established a correlation between serotonin and norepinephrine with obsessive disturbances and an association of DOPAC with affective and dissociative disorders. Studies have  also shown SSRIs to be particularly useful in the adolescent population and milder paraphilias, including exhibitionism and patients suffering from comorbidities of obsessive-compulsive disorders (OCD) or depression ( Fisher; Marwaha., 2022).

A relationship has been suggested between clinical presentation of paraphilias and obsessive-compulsive disorder (OCD) with respect to the unwanted repetitive nature and insight into the irrationality of the paraphiliac behavior. This has led to speculation that paraphiliac disorders might belong to an "obsessive compulsive spectrum."  (Kruesi ;Fine ;Valladares ;Phillips ;Rapoport ;, 2021).

Fisher; Marwaha., K. A. R. (2022). Home - books - NCBI. National Center for Biotechnology Information. Retrieved July 14, 2022, from  https://www.ncbi.nlm.nih.gov/books

Kruesi ;Fine ;Valladares ;Phillips ;Rapoport ;, M. J. S. L. R. A. J. L. (2021). Paraphilias: A double-blind crossover comparison of clomipramine versus desipramine. Archives of sexual behavior. Retrieved July 14, 2022, from  https://pubmed.ncbi.nlm.nih.gov/1482282/

Stein, D. J., Costa, D. L. C., Lochner, C., Miguel, E. C., Reddy, Y. C. J., Shavitt, R. G., van den Heuvel, O. A., & Simpson, H. B. (2019, August 1). Obsessive-compulsive disorder. Nature reviews. Disease primers. Retrieved July 14, 2022, from  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370844/