Drug Therapy for a Patient who Presents with MDD and a History of Alcohol Abuse Discussion Essay

Drug Therapy for a Patient who Presents with MDD and a History of Alcohol Abuse Discussion Essay

Assignment 1: Short Answer Assessment NURS 6630, Explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse, List 4 predictors of late-onset generalized anxiety disorder, and 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. An episode of major depression is defined as a period lasting at least two weeks. List at least five symptoms required for the episode to occur, List at least 5 symptoms required for the episode to occur, and list 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia.

Assignment 1: Short Answer Assessment

To Prepare

• Review the Learning Resources for this week.
• Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders.
• Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.

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To complete:

Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

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?
2. List 4 predictors of late-onset generalized anxiety disorder.
3. List 4 potential neurobiology causes of psychotic major depression.
4. 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.
5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. Assignment 1: Short Answer Assessment

Explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse, List 4 predictors of late-onset generalized anxiety disorder, and 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. An episode of major depression is defined as a period lasting at least two weeks. List at least five symptoms required for the episode to occur, List at least 5 symptoms required for the episode to occur, and list 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia.

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 a resolution of symptoms?

The appropriate drug therapy for a client presenting an MMD disorder and PMH of drug dependence would be an integrated treatment of Sertraline 25mg plus naltrexone 50mg orally daily. The client’s symptoms would reduce significantly after four weeks. Sertraline plus naltrexone combination have been proven to produce higher alcohol abstinence rates, longer days before relapse, and complete reduction of depressive disorder without serious adverse events (Pettinati et al., 2010). It is contraindicated that clients taking Selective serotonin reuptake inhibitors (SSRI) such as Sertraline be monitored during the early stages of medication for emergent suicide ideation, agitation, behavioral changes, or manic episodes as indications of poor response that warrants medication adjustments (The Anxiety and Depression Association of America, 2020).

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List 4 predictors of late-onset generalized anxiety disorder.

Predictors of late-onset GAD include (Zhang et al., 2015):

1. Gender, particularly being female
2. Chronic physical and mental health disorders
3. Loss of a parent through death/divorce/separation
4. Reduced affective childhood support

List 4 potential neurobiology causes of psychotic major depression.

According to Aan het Rot et al. (2009), the major neurobiological causes of psychotic MDD relate to the serotonin and dopamine system changes. This includes a complex interaction between serotonin dysfunction, stress hypersensitivity, and dopamine dysfunction. These factors include:

1. Psychosocial adversity in childhood
2. Dysfunctional regulation of the hypothalamic-pituitary-adrenal axis
3. Abnormal brain activation patterns
4. Neurobiological abnormalities underlying brain atrophy

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

According to the American Psychiatric Association, symptoms required for an episode of MDD to occur include (APA, 2013):

1. Depressed mood for the greater part of the day and almost every day
2. Minimal pleasure/interest in carrying out almost every daily routine every day
3. Substantial weight change, decrease/increase in appetite when not dieting for a significant portion of the day and almost every day
4. Fatigue/energy loss for the greater part of the day and almost every day
5. Minimal thinking/concentrating ability or inappropriate guilt for the greater part of the day and almost every day

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

There many classes of drugs recommended for the treatment of insomnia. Three of these classes include (Lie et al., 2015):

1. Sedative-Hypnotics for example, Zolpidem
2. Antidepressants, for example, Doxepin
3. Dual Orexin Receptor Antagonists, for example, Suvorexant.

References

Aan Het Rot, M., Mathew, S. J., & Charney, D. S. (2009). Neurobiological mechanisms in major depressive disorder. Cmaj, 180(3), 305-313. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630359/ 

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5 ends). American Psychiatric Association, 21. Retrieved 23 March 2021, from. https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/

Lie, J. D., Tu, K. N., Shen, D. D., & Wong, B. M. (2015). Pharmacological treatment of insomnia. Pharmacy and Therapeutics, 40(11), 759. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634348/

Explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse, List 4 predictors of late-onset generalized anxiety disorder, and 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. An episode of major depression is defined as a period lasting at least two weeks. List at least five symptoms required for the episode to occur, List at least 5 symptoms required for the episode to occur, and list 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia.

Pettinati, H. M., Oslin, D. W., Kampman, K. M., Dundon, W. D., Xie, H., Gallis, T. L., … & O’Brien, C. P. (2010). A double-blind, placebo-controlled trial combining Sertraline and naltrexone for treating co-occurring depression and alcohol dependence. American Journal of Psychiatry, 167(6), 668-675. https://doi.10.1176/appi.ajp.2009.08060852

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The Anxiety and Depression Association of America. (2020). Available at: https://adaa.org/resources-professionals/practice-guidelines-mdd#Contraindicated%20Treatment [Accessed 23 March 2021] Zhang, X., Norton, J., Carriere, I., Ritchie, K., Chaudieu, I., & Ancelin, M. L. (2015). Risk factors for a late-onset generalized anxiety disorder: results from a 12-year prospective cohort (The ESPRIT study). Translational psychiatry, 5(3), e536-e536. https://doi.10.1038/tp.2015.31