Week 7 responses 6630 | NURS 6630 - Psychopharmacologic Approaches to Treatment of Psychopathology | Walden University - Minneapolis, MN

Question 3: “Have you had any thoughts of suicide

Rationale: Ensure that patient is safe on her own. To rate the severity of depression Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. Children or family members Question 1: “Do patient prefer to stay at home rather than going out and doing new things? What is the patient regular sleep pattern? Rationale: This question asks for a yes or no answer and recognizes that isolation and withdrawal are common signs of depression especially in the elderly.” cognitive therapy, is the recommended first-line treatment of insomnia and is more effective than medications for the long-term management of insomnia. Medications, such as benzodiazepines and antidepressants, should be avoided for the treatment of insomnia in older adults” (Brewster, Riegel, & Gehrman, 2018). physical exams, and diagnostic tests would be appropriate for the patient Lab test: CBC, CMP, cortisol level and hormone levels Screening tool: Depression screening in older adults can be accomplished with multiple instruments, including the PHQ-2, PHQ-9, and various Geriatric Depression Scales Differential diagnosis for the patient. Insomnia According to the National Institutes of Health. Insomnia is a common sleep disorder when the patient has trouble falling asleep, staying asleep, or getting good quality sleep. This happens even though you have the time and the right environment to sleep well. Insomnia interferes with your daily activities and may make you feel unrested or sleepy during the day. Short-term insomnia may be caused by stress or changes in your schedule or environment. Chronic (long-term) insomnia occurs three or more nights a week, lasts more than three months, and cannot be fully explained by another health problem or a medicine. List two pharmacologic agents.

• Zoloft 50mg daily

“Sertraline is an effective and well tolerated antidepressant for the treatment of major depressive disorder in patients aged ≥60 years. Since elderly patients are particularly prone to the anticholinergic effects of TCAs as a class, SSRIs such as sertraline are likely to be a better choice for the treatment of major depressive disorder in this age group. In addition, sertraline may have advantages over the SSRIs paroxetine, fluoxetine and fluvoxamine in elderly patients because of the drug’s comparatively low potential for drug interactions, which is of importance in patient groups such as the elderly who are likely to receive more than one drug regimen” (Muijsers, Plosker & Noble, 2002).

• Melatonin 3mg at bedtime

According to National Institutes of Health, melatonin is a hormone produced by the pineal gland that has multiple effects including somnolence, and is believed to play a role in regulation of the sleep-wake cycle. Melatonin is available over the counter and is reported to have beneficial effects on wellbeing and sleep. Melatonin has not been implicated in causing serum enzyme elevations or clinically apparent liver injury.

References

Brewster, G. S., Riegel, B., & Gehrman, P. R. (2018). Insomnia in the Older Adult. Sleep medicine clinics, 13(1), 13–19. https://doi.org/10.1016/j.jsmc.2017.09.002 Muijsers RBR, Plosker GL, & Noble S. (2002). Sertraline: a review of its use in the management of major depressive disorder in elderly patients. Drugs & Aging, 19(5), 377–392. https://doi-org.ezp.waldenulibrary.org/10.2165/00002512-200219050-00006 National Institutes of Health. Melatonin. https://pubchem.ncbi.nlm.nih.gov/compound/Melatonin The American Psychiatric Association (APA). (2021) Depression. https://www.psychiatry.org/patients-families/depression/what-is-depression. The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Insomnia. (2019) https://www.nhlbi.nih.gov/health-topics/insomnia PLS USE 3 REFERENCES ON EACH DISCUSSIONS.

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