Week 8: Assignment 1: Short Answer Assessment NURS 6630

Week 8: Assignment 1: Short Answer Assessment NURS 6630

A Sample Answer For the Assignment: Week 8: Assignment 1: Short Answer Assessment NURS 6630

Appropriate Drug Therapy for a Patient with MDD and a History of Alcohol Abuse

A combination of an antidepressant and a medicine that treats alcohol abuse would probably be the best pharmacological therapy for a patient with MDD and a history of alcohol consumption. As a first-line therapy for MDD, selective serotonin reuptake inhibitors like fluoxetine or sertraline are advised. Naltrexone may also be administered to ease alcohol withdrawal symptoms and cravings.

In this patient, antidepressants such as monoamine oxidase inhibitors are not advised since they raise the risk of seizures. Within six to eight weeks of beginning treatment, the patient should see a reduction in symptoms, but it’s crucial to keep up the medication for at least six to twelve months to avoid relapse (Akbar et al., 2018).

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Predictors of Late Onset Generalized Anxiety Disorder

1. A past history of depression
2. Ongoing medical issues
3. Trauma or abuse
4. A family history of anxiety disorders

 (Mohammadi et al., 2020).

Potential Neurobiology Causes of Psychotic Major Depression

1. Abnormal activity in the hypothalamic-pituitary-adrenal axis
2. Abnormal activity in the noradrenergic system
3. Abnormal activity in the serotonergic system
4. Abnormal activity in the dopaminergic system

(Dean et al., 2017).

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Symptoms Required for Major Depression Episode to Occur

1. Persistent feelings of hopelessness or loss of vigor or pleasure
2. Exhaustion or lack of energy
3. Difficulty concentrating or making decisions
4. Changes in appetite or sleeping patterns
5. Feelings of guilt or inadequacy
6. Suicidal or death-related thoughts

(Pykel et al., 2022).

Classes of Drugs That Can Precipitate Insomnia

1. Beta blockers for example Propranolol
2. Corticosteroids for example prednisone
3. Antidepressant, for example

(Bonnet et al, .2021).

References

Akbar, M., Egli, M., Cho, Y. E., Song, B. J., & Noronha, A. (2018). Medications for alcohol use disorders: An overview. Pharmacology & Therapeutics, 185, 64-85. doi:        10.1016/j.pharmthera.2017.11.007.

Mohammadi, M. R., Pourdehghan, P., Mostafavi, S. A., Hooshyari, Z., Ahmadi, N., & Khaleghi,             A. (2020). Generalized anxiety disorder: Prevalence, predictors, and comorbidity in   children and adolescents. Journal of Anxiety Disorders, 73, 102234. Doi:            10.1016/j.janxdis.2020.102234.

Dean, J., & Keshavan, M. (2017). The neurobiology of depression: An integrated view. Asian      Journal of Psychiatry, 27, 101-111. Doi: 10.1016/j.ajp.2017.01.025

Paykel, E. S. (2022). Basic concepts of depression. Dialogues in clinical neuroscience, 10(3).      Doi: 10.31887/DCNS.2008.10.3/espaykel

Bonnet, M. H., & Arand, D. L. (2021). Risk factors, comorbidities, and consequences of   insomnia in adults. Up-to-date, Waltham, MA.

Short Answer Assessment

1. 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 the resolution of symptoms?

For patients with MDD and a history of alcohol abuse, the use of antidepressant medication like nefazodone in conjunction with psychotherapeutic approaches has been proven to be effective (Thom et al., 2019). Nefazodone is a serotonin modulator that has demonstrated a desirable safety profile, high tolerance, and great effectiveness in managing depression among alcohol-dependent patients.

While SSRIs can also be considered, monoamine oxidase inhibitors like bupropion are contraindicated for such patients as alcohol increases the risks of adverse events such as the spiking of the patient’s blood pressure. With the use of nefazodone and multiple psychosocial therapies, the patient is expected to completely manage the MDD symptoms within 6 to 8 weeks.

List 4 predictors of late-onset generalized anxiety disorder.

• Female gender (Park & Zarate, 2019).
• Current phobia
• History of MDD
• Respiratory Disorder

List 4 potential neurobiology causes of psychotic major depression.

• Hypersensitivity to stress (Thom et al., 2019).
• Serotonin dysfunction
• Vulnerability to developing MDD
• Elevated dopamine levels

An episode of major depression is defined as a period lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.

• Reduced energy levels or fatigue (Mullen, 2018).
• Depressed mood
• Anhedonia
• Sleep disturbances
• Feeling of worthlessness

List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. 

• Selective serotonin reuptake inhibitors (SSRIs)- Zoloft and Prozac (Mullen, 2018)
• Psychostimulants and amphetamines- Adderall and Benzedrine
• Dopamine agonists- ropinirole and lisuride

 References

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275-283. https://doi.org/10.9740/mhc.2018.11.275

Park, L. T., & Zarate Jr, C. A. (2019). Depression in the primary care setting. New England Journal of Medicine, 380(6), 559-568. DOI: 10.1056/NEJMcp1712493

Thom, R., Silbersweig, D. A., & Boland, R. J. (2019). Major depressive disorder in medical illness: a review of assessment, prevalence, and treatment options. Psychosomatic Medicine, 81(3), 246-255. DOI: 10.1097/PSY.0000000000000678

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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 the resolution of symptoms?

The first-line treatment for major depressive disorder is usually selective serotonin reuptake inhibitors. However, studies showing the efficacy of these medications in individuals with concomitant alcohol use are limited and controversial. According to Ballesta et al. (2019), tricyclic antidepressants such as desipramine and imipramine as well as the serotonin antagonist and reuptake inhibitors such as nefazodone are more effective in treating depression in alcohol use compared to other antidepressants.

Several medications are contraindicated in individuals with alcohol use disorder. For instance, nonsteroidal anti-inflammatory drugs due to increased risk of bleeding and peptic ulcers. Additionally, drugs such as selective serotonin reuptake inhibitors, opioids, and benzodiazepines should not be used concurrently with alcohol due to the additive risk of central nervous system depression. According to Sheffler and Abdijadid (2021), patients taking antidepressants may take up to 2 to 6 weeks for an initial improvement of symptoms to be observed. However, complete resolution of symptoms may be observed after 3 to 6 months of treatment.

List 4 predictors of late-onset generalized anxiety disorder.

Generalized anxiety disorder refers to excessive and prolonged anxiety not confined to a distinct fear. According to DeMartini et al. (2019), the principal predictors of a late-onset generalized anxiety disorder include the following;

• Being female
• Recent adverse life events
• Chronic physical conditions including arrhythmias, heart failure, and respiratory disorders
• Mental health disorders including phobias, past generalized anxiety disorder, and depression.

List 4 potential neurobiology causes of psychotic major depression.

Major depression is a chronic debilitating condition whose etiology and pathophysiology are yet to be vividly explored. According to Kaltenboeck and Harmer (2018), the following neurobiological causes of depression have been postulated;

• Dysfunction of the hypothalamic-pituitary-adrenal axis with resultant excessive production of cortisol and corticotropin-releasing hormone.
• Decreased levels of monoamine neurotransmitters including serotonin and noradrenaline.
• Polymorphism in the gene that codes for brain-derived neurotrophic factor.
• Abnormal feedback in the striatal dopamine system.

An episode of major depression is defined as a period lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.

According to the DSM-5 criteria for diagnosis of major depression, at least five or more of the following nine symptoms are required with at least one of the symptoms being anhedonia or depressed mood (American Psychiatric Association, 2022).

• Depressed mood
• Anhedonia
• Sleep disturbance
• Feeling of worthlessness
• Loss of energy
• Diminished concentration, and ability to make decisions
• Changes in weight due to changes in appetite
• Psychomotor agitation
• Suicidal ideation

List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. 

Insomnia can be precipitated by several drugs. The following classes of drugs listed below may precipitate insomnia

• Selective serotonin reuptake inhibitors antidepressants for example escitalopram.
• Corticosteroids for example methylprednisolone.
• Beta blockers for example metoprolol.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787

Ballesta, A., Alén, F., Rodríguez de Fonseca, F., Gómez de Heras, R., & Orio, L. (2019). Rethinking the use of antidepressants to treat alcohol use disorders and depression comorbidity: The role of neurogenesis. In Antidepressants – Preclinical, Clinical and Translational Aspects. IntechOpen. https://doi.org/10.5772/intechopen.83743

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

Kaltenboeck, A., & Harmer, C. (2018). The neuroscience of depressive disorders: A brief review of the past and some considerations about the future. Brain and Neuroscience Advances, 2, 2398212818799269. https://doi.org/10.1177/2398212818799269

Sheffler, Z. M., & Abdijadid, S. (2021). Antidepressants. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538182/

Neurons are information messengers with three main parts namely the cell body, axon, and the dendrites (Kringelbach et al., 2020). The cell body is made up of a nucleus and cytoplasm and produces protein required to construct other parts of the neuron. The axon, on the other hand, extends from the cell body and carries signals away from the cell body while the dendrites carry signals toward the cell body and have numerous synapses to receive the signal from nearby neurons.

Upon stimulation, neurons transmit an electrical impulse that passes through the dendrite, to the cell body, axon, axon terminal, and finally, the stimulus is passed (Kringelbach et al., 2020). At the axonal terminal, the axon releases neurotransmitters that depolarize neighboring cells through synapses and by binding to the membrane of the dendrite.

Subcortical Structures

Other structures within the brain are subcortical structures that act as information hubs for the nervous system. Their main role is to relay and modulate information circulating in different areas of the brain. They include the basal ganglia, limbic structures, pituitary gland, and the diencephalon (Malinowski, 2019). 

The limbic systems play a great role in learning and memory addiction.  The systems provide the anatomical substrate for emotions and motivated behaviors, including the circulatory for reward-related events and stress responses. Specifically, the hippocampus is used to mediate a cognitive/spatial form of memory.

It controls learning and declarative memory which covers the memory of facts and events (Malinowski, 2019).  The dorsal striatum also helps in memory by mediating the stimulus-response habit memory. Addiction on the other hand is linked to the limbic system through the orbitofrontal cortex and anterior cingulate gyrus (Malinowski, 2019).

In line with motor control, the nigra striatal region offers two anatomically and functionally distinct portions knowns as the substantia nigra pars compacta and the substantia nigra pars reticulata.

Glial Cells

Other essential components in the central nervous system are the glial cells. They include the astrocytes whose role is to maintain the environment for neuronal signaling by controlling the level of neurotransmitters surrounding the synapses (Hirbec et al., 2020). Equally, oligodendrocytes wrap around the axons forming a protective layer called myelin sheath which enhances neuron signaling.

The cells also include microglia, ependymal cells, and radial glial whose roles are clearing dead cells or removing harmful toxins, maintaining homeostasis, and regenerating neurons and other glial cells like astrocytes and oligodendrocytes respectively.

Neuron Communication

Neurons communicate with each other through synaptic transmission. A chemical synapse is registered at the axon terminal of the presynaptic neuron and the dendrite of the postsynaptic neuron (Malinowski, 2019). The dendrite picks up signals and passes the signals down to the axon, into the axon terminals, and into the synapses. The role of the chemical synapse is to transform the electrical signal in the presynaptic cell’s axon into a chemical signal and back into an electrical signal in the postsynaptic cell.

Neuroplasticity

Brain plasticity denotes the ability of the brain to reorganize itself and form new neural connections in response to extrinsic or intrinsic stimuli.  Through axonal sprouting, the undamaged axons develop new nerve endings and reconnect neurons with severed or injured links (Mateos-Aparicio & Rodríguez-Moreno, 2019).

For instance, undamaged brain sites of stroke patients rewire themselves to take over functions of the damaged brain sites. Similarly, the undamaged axons sprout nerve endings that connect with other undamaged nerve cells to form new neural pathways (Mateos-Aparicio & Rodríguez-Moreno, 2019).   For example, exposing the brain to specific grammatical rules helps it process and develop language.

References

Hirbec, H., Déglon, N., Foo, L. C., Goshen, I., Grutzendler, J., Hangen, E., … & Escartin, C. (2020). Emerging technologies to study glial cells. Glia, 68(9), 1692-1728. https://doi.org/10.1002/glia.23780

Kringelbach, M. L., Cruzat, J., Cabral, J., Knudsen, G. M., Carhart-Harris, R., Whybrow, P. C., … & Deco, G. (2020). Dynamic coupling of whole-brain neuronal and neurotransmitter systems. Proceedings of the National Academy of Sciences, 117(17), 9566-9576. https://doi.org/10.1073/pnas.1921475117

Malinowski, M. N. (2019). Anatomy of the brain and brain stem. In Deer’s Treatment of Pain (pp. 49-59). Springer, Cham.

Mateos-Aparicio, P., & Rodríguez-Moreno, A. (2019). The impact of studying brain plasticity. Frontiers in cellular neuroscience, 13, 66. https://doi.org/10.3389/fncel.2019.00066