Please answer these 3 discussion posts with 1 page each with references.
Post # 1
Prescribing psychotropic medications to pregnant women should be done with caution due to the potential risk of adverse perinatal and postnatal outcomes. Due to the physiological, hormonal, and psychological changes associated with pregnancy, pregnant women are at an increased risk of mental and emotional alterations which could potentially result in depression (DiPietro, 2010). Depressive disorders amongst pregnant women can lead to the following pregnancy risks and outcomes: inadequate maternal weight, substance abuse, pre-eclampsia, preterm birth, low birth weight, and fetal distress (Creeley & Denton, 2019).(Psychotropic Drug Prescription Discussion Essay)
An FDA-approved medication for major depressive disorder (MDD) that can be utilized in pregnant women is bupropion (Wellbutrin). Wellbutrin is an FDA category B antidepressant for pregnant women, demonstrating that there is no risk identified in animal studies and that there are inadequate studies in humans (Armstrong, 2008). Boshier et al. demonstrates that Wellbutrin does not increase the rate of major malformations from the baseline (2005). Unlike selective serotonin reuptake inhibitors (SSRIs), there is little research of the impact bupropion has on fetal brain development (Gitlin et al., 2017). While Wellbutrin is less likely to cause weight gain, sedation, and sexual dysfunction, it is more likely to cause restlessness and decrease the seizure threshold (Gitlin et al., 2017)(Psychotropic Drug Prescription Discussion Essay). An off-label medication for MDD that can be utilized in pregnant women is fluvoxamine (Luvox), an SSRI. Luvox is an FDA category C antidepressant for pregnant women (Armstrong, 2008). Luvox has been FDA approved for obsessive-compulsive disorder (OCD) and social anxiety disorder (Stahl, 2005). SSRIs can cross the placenta and negatively impact the functional development of the brain and behavior of the developing fetus (Belovicova et al., 2017). Major benefits of both antidepressants include improved mood. A nonpharmacological intervention for treating pregnant females with MDD would be cognitive behavior therapy (CBT). Pregnant females receiving CBT have not only demonstrated improved emotional regulation and improved mood but also demonstrated better infant orientation and engagement (Epperson et al., 2014).(Psychotropic Drug Prescription Discussion Essay)
Treating depression amongst pregnant women is complex and requires an appropriate risk assessment to be completed prior to initiation. The FDA pregnancy categories assigned allows providers to assess the risks to benefits. The American Psychiatric Association and the American College of Obstetricians and Gynecologists have put together clinical practice guidelines (CPGs) to address and assess the risks of both depression and antidepressants and subsequently developed an algorithm for management (Chaudron et al., 2009). Based upon the guidelines, my first recommendation for a client who is pregnant with MDD would be CBT. If the patient is suicidal and/or displaying psychotic behavior pharmacological agents are required. In this case, I would initiate Wellbutrin for the client since it is listed as an FDA category B medication.(Psychotropic Drug Prescription Discussion Essay)
References
Armstrong, C. (2008). ACOG guidelines on psychiatric medication use during pregnancy and
lactation. American Family Physician, 78(6), 772-778. https://www.aafp.org/pubs/afp/issues/2008/0915/p772.htmlLinks to an external site.
Belovicova, K., Bogi, E., Csatlosova, K., & Dubovicky, M. (2017). Risks of using SSRI / SNRI(Psychotropic Drug Prescription Discussion Essay)
antidepressants during pregnancy and lactation. Interdisciplinary Toxicology, 10(1), 30–34. https://doi.org/10.1515/intox-2017-0004Links to an external site.
Boshier, A., Chun-Fai-Chan, B., Fayez, I., Kalra, S., Koren, G., Voyer-Lavigne, S. (2005). Pregnancy outcome of women exposed to bupropion during pregnancy: A prospective comparative study. American Journal of Obstetrics & Gynecology, 192(3), 932-936. https://doi.org/10.1016/j.ajog.2004.09.027Links to an external site.
Chaudron, L., Dell, D.L., Lockwood, C., Oberlander, T.F., Ramin, S., Stewart, D.E., Stotland, N., Wisner, K.L., & Yonkers, K.A. (2009). The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstetrics and Gynecology, 114(3), 703–713. https://doi.org/10.1097/AOG.0b013e3181ba0632Links to an external site.
Creeley, C.E. & Denton, L.K. (2019). Use of prescribed psychotropics during pregnancy: a systematic review of pregnancy, neonatal, and childhood outcomes. Brain Sciences, 9(9), 235. https://doi.org/10.3390/brainsci9090235Links to an external site.
DiPietro, J.A. (2010). Psychological and psychophysiological considerations regarding the maternal-fetal relationship. Infant Child Development, 19(1), 27-38. https://doi.org/10.1002/icd.651Links to an external site.(Psychotropic Drug Prescription Discussion Essay)
Epperson, C.N., Hantsoo, L., Kim, D.R., Sammel, M., & Thase, M.E. (2014). Computer-assisted cognitive behavioral therapy for pregnant women with major depressive disorder. Journal of Women’s Health, 23(10), 842–848. https://doi.org/10.1089/jwh.2014.4867Links to an external site.
Gitlin, M.J., Hendrick, V., Ortiz-Portillo, E., & Suri, R. (2017). Bupropion use during pregnancy: a systematic review. Prim Care Companion CNS Disord, 19(5). https://doi.org/10.4088/PCC.17r02160Links to an external site.
Stahl, S.M. (2005). Essential Psychopharmacology: The Prescriber’s Guide. Cambridge University Press. (7th ed.)
Post # 2
Prolonged Grief Disorder (F43. 81)
The circumstances that surround aging adults, including the inevitable, death will ensue at some point within each lifetime. Evidently, most occur in the later years of life, when individuals spend a lifetime together. This sudden loss of such a calibrated emotionally invested relationship for decade upon decade places elder adults at risk for Prolonged Grief Disorder (PGD). This diagnosis is flagged by incapacitating feelings of grief, and it occurs more often when someone close to the bereaved person died within the year Prigerson, Boelen, Xu, and Maciejewski, K. (2021). These grief reactions for the longed individual occur most of the day, nearly every day for at least a month. Clinically, a provider will see significant distress or even impairment regarding social, occupational, and other functional limitations Prigerson, Boelen, Xu, and Maciejewski, K. (2021).(Psychotropic Drug Prescription Discussion Essay)
They are at risk of:
o Identity disruption (e.g., feeling as though part of oneself has died).
o Marked sense of disbelief about the death.(Psychotropic Drug Prescription Discussion Essay)
o Avoidance of reminders that the person is dead.
o Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.
o Difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future).
o Emotional numbness.(Psychotropic Drug Prescription Discussion Essay)
o Feeling that life is meaningless.(Psychotropic Drug Prescription Discussion Essay)
o Intense loneliness (i.e., feeling alone or detached from others).
(Prigerson, Boelen, Xu, and Maciejewski, K., 2021).
Depression (MDD) is a valid and high risk of PGD, and is treatable Prigerson, Boelen, Xu, and Maciejewski, K. (2021).In a study by Prigerson, Boelen, Xu, and Maciejewski, K. (2021), prolonged grief disorder therapy (PGDT) was by far more efficacious than citalopram alone. Cognitive behavior therapy has proven effective, however, not at the rate of PGDT with using the medicine citalopram Prigerson, Boelen, Xu, and Maciejewski, K. (2021)(Psychotropic Drug Prescription Discussion Essay). Loss triggers acute grief, and most often a natural adaptive process occurs where grief is transformed and integrated. PGDT facilitates adaptation and helps with early grief maladaptive coping responses, including protest, self-blame, anger, and counterfactual thinking and avoidance (Prigerson, Boelen, Xu, and Maciejewski, K. (2021). In the study by Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021), depression symptoms combined with PGDT had more success with combined treat than treating any grief symptoms. Complicated Grief Therapy (CGT) is another 16-session psychotherapy used to facilitate a bereaved person’s natural response to loss. The underlying rationale is that bereavement is a universal life event and grief and adaptation to loss are natural innate reactions Substance Abuse and Mental Health Services Administration. [SAMHSA] (2020).(Psychotropic Drug Prescription Discussion Essay)
On the contrary, naltrexone is a rapid-acting, safe, convenient, and effective intervention for those with PGDT. Oral naltrexone, in its broadest sense, is a narcotic (opioid antagonist). Yet today, there are few studies that demonstrate the investigation into the effects of medicine alone in the treatment of PGD. Like naltrexone, tricyclic antidepressants, and SSRIs and a few newer-generation antidepressants are in early open-label trials Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). At this time, there is no evidence of solid medications until trials are closed and labeled.(Psychotropic Drug Prescription Discussion Essay)
References
Boelen, P. A., Eisma, M. C., Smid, G. E., & Lenferink, L. I. M. (2020). Prolonged grief disorder in section II of DSM-5: a commentary. European journal of psychotraumatology, 11(1), 1771008. https://doi.org/10.1080/20008198.2020.1771008
Prigerson, H. G., Boelen, P. A., Xu, J., Smith, K. V., & Maciejewski, P. K. (2021). Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World psychiatry : official journal of the World Psychiatric Association (WPA), 20(1), 96–106. https://doi.org/10.1002/wps.20823Links to an external site.(Psychotropic Drug Prescription Discussion Essay)
Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment. Retrieved from https://doi.org/10.1176/appi.focus.20200052Links to an external site.
Substance Abuse and Mental Health Services Administration (2020). Grief Loss and Bereavement Fact Sheet #5: Evidence-Based Treatments for Grief. Retrieved from chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.jber.jb.mil/Portals/144/Services-Resources/Resiliency-Resources/PDF/SelfCareTipSheets/Grief.pdf(Psychotropic Drug Prescription Discussion Essay)
Post # 3
Prescribing for Older Adults and Pregnant Women
Expectant mothers face a myriad of difficulties in the course of pregnancy, arising from the mother’s health, the fetus’s health, or both. Post-traumatic stress disorder is a common disorder (PTSD) especially in mothers who had pregnancy go wrong in the past and/or those who experienced traumatic birth or abuse (Boland et al., 2022). With safe and effective treatment, however, expectant mothers can overcome the symptoms of the disorder and proceed to have normal births.(Psychotropic Drug Prescription Discussion Essay)
There are FDA-approved and off-label drugs that can be used in pregnancy. Sertraline is an example of an FDA-approved drug recommended for the management of PTSD. It falls under a class of drugs known as SSRIs and works by increasing serotonergic activity in the brain necessary to support a mental balance (Poweleit et al., 2022). While it is not explicitly indicated for use in pregnant women, it is generally considered as a safe option for the treatment of PTSD (Poweleit et al., 2022). An example of an off-label drug recommended for use in pregnancy is Venlafaxine, an SNRI. It ensures more serotonin is available in the brain by blocking serotonin reuptake in the nerve cells (Richardson et al., 2019)(Psychotropic Drug Prescription Discussion Essay). The drug, however, should be used cautiously in pregnant women if it is necessary (Richardson et al., 2019). Still, cognitive behavioral therapy (CBT) is recommended as part of nonpharmacological interventions for the treatment of PTSD in pregnant women. The intervention works by assisting the mother to identify negative thoughts and patterns that lead to mental difficulties (Li et al., 2022). It is very safe and can be initiated at any stage of pregnancy.(Psychotropic Drug Prescription Discussion Essay)
The use of Sertraline, Venlafaxine, and CBT in expectant mothers should be informed by risk assessment. The assessment should weigh in the potential benefits of treatment against the potential risks of the drugs. This indicates consideration of the severity of PTSD symptoms, the safety profile of the interventions for both the mother and fetus, the time of pregnancy, and the side effects of drugs (APA, 2017). The strategy would help determine whether the selected drug will cause the desired outcomes with little or no adverse effects on the mother and the unborn child. Without a doubt, both FDA-approved drugs and off-label drugs present significant risks and benefits. Sertraline carries the risk of preterm delivery, low birth weight, and can affect a baby’s heart (Poweleit et al., 2022). Other symptoms such as problematic breastfeeding gladly resolve within months postpartum (National Library of Medicine, 2022). On the flip side, evidence suggests the drug can be taken during pregnancy to improve depressive symptoms without adverse effects on the child since low levels of the drugs get to the infant during pregnancy and breastfeeding (Poweleit et al., 2022). Venlafaxine carries higher chances of birth defects, stillbirth, preterm birth, low infant birth, and post-partum hemorrhage especially in the last months of pregnancy (Richardson et al., 2019). Yet it can improve depressive symptoms.(Psychotropic Drug Prescription Discussion Essay)
Finally, there exist clinical practice guidelines for PTSD that can inform the best course of action. According to APA (2017), the guidelines are based on a systematic review of scientific evidence, careful measurement of benefits versus harm of interventions, patient values and preferences, and use across different demographic groups. In the case of PTSD in pregnancy, these guidelines recommend CBT as well as other cognitive processing interventions as the first-line interventions for PTSD (APA, 2017)(Psychotropic Drug Prescription Discussion Essay). The intervention carries no side effects for both the mother and the fetus. Concerning medications, the guidelines recommend the use of sertraline, fluoxetine, paroxetine, or venlafaxine (APA, 2017). As noted above, however, venlafaxine carries more severe side effects compared to sertraline and should be used as a last resort. Sertraline should be used on an expectant mother only after cognitive behavioral therapy fails to induce the desired outcomes.(Psychotropic Drug Prescription Discussion Essay)
References
American Psychological Association [APA]. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults (2017). https://www.apa.org/ptsd-guideline/ptsd.pdfLinks to an external site.
Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Li, X., Laplante, D. P., Paquin, V., Lafortune, S., Elgbeili, G., & King, S. (2022). Effectiveness of cognitive behavioral therapy for perinatal maternal depression, anxiety and stress: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review, 92, 102129. https://doi.org/10.1016/j.cpr.2022.102129Links to an external site..
National Library of Medicine. (2022). Drugs and lactation database: Sertraline.https://www.ncbi.nlm.nih.gov/books/NBK501191/Links to an external site.
Poweleit, E. A., Cinibulk, M. A., Novotny, S. A., Wagner-Schuman, M., Ramsey, L. B., & Strawn, J. R. (2022). Selective serotonin reuptake inhibitor pharmacokinetics during pregnancy: clinical and research implications. Frontiers in Pharmacology, 13, 833217. https://doi.org/10.3389/fphar.2022.833217Links to an external site.
Richardson, J. L., Martin, F., Dunstan, H., Greenall, A., Stephens, S., Yates, L. M., & Thomas, S. H. L. (2019). Pregnancy outcomes following maternal venlafaxine use: A prospective observational comparative cohort study. Reproductive Toxicology, 84, 108-113. https://doi.org/10.1016/j.reprotox.2019.01.003Links to an external site.
Psychotropic Drug Prescription Discussion Essay-Solution
Course Analysis
The course materials were fundamental in supporting each objective. The information and course resources were articulate, far-reaching, and well organized for students to understand and follow through to achieve the course objectives. It offered exhaustive information about the effects of psychotropic drugs, including antipsychotics and antidepressants, on neurotransmitters like serotonin and dopamine. The course also provided policy actions regarding psychotropic drug prescription. Nearly all psychotropic medications, especially antidepressants, appear to elevate serotonin neurotransmission (Carvalho et al., 2016). The course materials were wholesome in providing information about psychotropic drug categories focusing on the rationale for use, mechanism of action, common side effects, and drug interactions. The materials have discussed several categories, including antidepressants, antipsychotics, stimulants, mood stabilizers, and anti-anxiety agents. Some people suffering from mental health problems benefit from complementary and alternative treatments, such as aromatherapy and acupuncture (Wemrell et al., 2020). The course materials provide supportive information on using complementary and alternative therapies to address different mental health needs, being mindful of cultural and genetic factors and patient values.(Psychotropic Drug Prescription Discussion Essay)
Collecting information to draw conclusions by observation, psychological and neurological tests entails clinical assessment. The course provides supportive information concerning clinical assessment tools, including standardized tests, rating scales, and interviews. The course includes details on standard tools like behavioral assessments, cognitive evaluation, physical exams, patient history, and neurological exams. It focuses on prescribing psychotherapeutic medications for different patients and associated supportive knowledge on factors such as current state of mental health, genetics, patient values, ethical concerns, and prescriptive authority. The course includes assignments and practices works on medication prescription to help students achieve this objective. Course materials include case studies and assignments on patient education regarding diagnostics and psychopharmacology. Materials also include supportive research resources to reinforce understanding and skills development. There are various ethical and legal concerns in mental health treatment, including confidentiality, patient vulnerability and exploitation, operational challenges, conflict of interest, and informed consent (Jain et al., 2017). Therapeutic misconceptions and controversies surrounding some treatment modalities like electroshock therapy also exist, affecting the work of mental health practitioners. The course provides information and practice assignments on these issues to help students achieve the objective. (Psychotropic Drug Prescription Discussion Essay)
Information regarding neurotransmission influence on psychotropic medication prescription, psychotropic drug categorization, complementary and alternative medications, clinical assessment tools, and psychotherapeutic medication is critical for professional development and application. Students will be more competent, knowledgeable, and skillful to work in a practice environment. Students also gain vital insights into patient education and ethical, legal, and controversial concerns surrounding mental health treatment. Students are at a better place in providing effective and safe care for mental health patients. (Psychotropic Drug Prescription Discussion Essay)
References
Carvalho, A. F., Sharma, M. S., Brunoni, A. R., Vieta, E., & Fava, G. A. (2016). The safety, tolerability, and risks associated with using newer generation antidepressant drugs: a critical review of the literature. Psychotherapy and psychosomatics, 85(5), 270-288.
Jain, S., Kuppili, P. P., Pattanayak, R. D., & Sagar, R. (2017). Ethics in psychiatric research: Issues and recommendations. Indian journal of psychological medicine, 39(5), 558-565.
Wemrell, M., Olsson, A., & Landgren, K. (2020). The use of complementary and alternative medicine (CAM) in psychiatric units in Sweden. Issues in mental health nursing, 41(10), 946-957.
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