Psychopharmacologic Approaches to Treatment of Psychopathology Assignments

Assessing and Treating Clients with Psychosis and Schizophrenia

Pakistani lady Case Study

Psychosis and Schizophrenia affect about 1% of the general population (Olper et al., 2017). There are several treatments and care options for individuals with these illnesses. Psychosis affects brain cells, which, in turn, affects individuals’ thoughts. It is essential to find the correct medication regimen that will benefit people with psychosis. This paper aims to select a treatment with the most significant benefit and the least harm for this Pakistani woman with delusions.

Psychopharmacologic Approaches to Treatment of Psychopathology

Decision Point 1: Start Invega Sustenna 234mg intramuscular x1 followed by Invega Sustenna 156mg intramuscular on day four and every thirty days after that.

It was partly because of her delusions and paranoid behavior that I made this decision. This Pakistani woman has a history of not taking her psychotropics, making this choice. Invega Sustenna is also known as Paliperidone, in the same group of medicines as antipsychotic drugs. People who have Schizophrenia and delusions that are linked to psychosis take Paliperidone because it blocks the dopamine (D2) and serotonin (5-HT2A) receptors in the brain, which means it changes the balance of chemicals in the brain that controls the mind (Rabinowitz et al., 2017). The goal of prescribing this medicine is to lower the PANNS score with little to no side effects (Rabinowitz et al., 2017). It’s been four weeks since the patient took Invega Sustenna 156mg intramuscularly. She comes back for a follow-up visit. The decision to get medicine injections every month turns out to be the right one. The PANNS score went down by 25%, and there were a lot fewer symptoms. Her support system is her husband, who goes with her to follow-up visits and makes sure she takes her Invega Sustenna every month. However, she says that she feels pain at the injection site and doesn’t like it. However, she says that she felt pain at the injection site and that her weight went up two pounds. The deltoid muscle, for example, is an excellent place to get an injection because it can help ease the pain. I will watch weight and reassess at the next follow-up visit. Due to the progress, the client has made in the last four weeks, a change in medication is not needed. The PANNS score has dropped 25%, and the symptoms have lessened. At this point, the decision to keep taking medicine the same way has been made.

Decision Point 2: Continue the same medication regimen but to change injection to the deltoid

She has been taking Invega Sustenna 156mg IM to her deltoid for four weeks. She comes in for a follow-up visit. The client’s PANNS score went up another 25%, which means the score has gone up 50% since her first visit. Her body has no more prolonged pain because the injection site has been moved to the deltoid instead. With that said, she comes in today without her husband because she is worried about her weight. Almost two pounds have been added to his weight so far. In her words, she fears that her husband might not accept her gradual weight gain. As far as I know, no one said anything about any other side effects. As shown above, Invega Sustenna is part of the group of antipsychotics called atypical antipsychotics. It can make you gain weight. If you’re taking this medicine, you’re likely to gain some weight (Stahl, 2014b). Because of this, it’s important not to write off the client’s fears about weight gain. It is encouraging and reassuring for the patient to keep taking the medication for the next eight weeks. Also, referring her to a dietician about the four pounds she’s gained in the last few months can help her make better food choices and figure out how to keep the weight off.

The hopes that a continued regimen would lead to better results turned out to be true. Because the patient has been getting better and getting better, no changes are made to the medication regimen. Continue using Invega Sustenna 156mg intramuscularly to the deltoid every month, and don’t change it. visit  an appointment in four weeks for a follow-up to see how things are going.

Decision Point 3: Continue Invega Sustenna 156mg intramuscular to deltoid monthly and follow-up appointment monthly

To keep taking medicine for this Pakistani woman is shown to be a good idea by the example in this case study. In this case, I didn’t add Abilify or Qysmia because I didn’t want to do that. To get to dopamine receptors, Abilify takes longer than Invega Sustenna, but it does it faster than the other drug (Stahl, 2014b). There must also be two weeks of Abilify taking it by mouth. Then, you can get the Abilify Maintena injection. Before the therapeutic effects of oral and injection medications can be felt, they have to be taken for 30 days together (National Alliance of Mental Illness, n.d.). It doesn’t matter right now when it comes to adding Oysmia to the medicine for weight loss.

The client looks: He is 5’5″ tall and weighs 140 pounds. He has a BMI of 23, which is average. She gained about 4 pounds. This weight gain isn’t significant enough to warrant adding a weight-loss drug to the mix. This option can be looked at again later if the person’s weight keeps increasing and their BMI is above 30. The best thing to do is to send the person to a dietician. Changing your diet and adding exercise will help you lose the four pounds you gained and keep your weight the same. People who are psychologists can help with this, as well. He will talk to her about her worries about her husband not liking her weight gain, and he will talk about what she thinks about her husband and how she feels.

Conclusion

Knowing that people react to medicines in different ways when they start treatment is essential when taking care of a patient. Some people will be happy, while others will have mild or moderate side effects. In this case, a Pakistani woman was given an injection of Invega Sustenna, and it worked great. She was lucky not to have had severe side effects like Neuroleptic Malignant Syndrome (NMS), cardiac, metabolic, or seizures. That would have led to a change in medicine, which could have been a long and painful process.

References
National Alliance of Mental Illness. (n.d.). Aripiprazole (Abilify). Retrieved October 9, 2020.

https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of Medication/Aripiprazole-(Abilify) Opler, M., Yavorsky, C., & Daniel, D. G. (2017). Positive and negative syndrome scale (PANSS) training: Challenges, Solutions, and Future Directions. Innovations in Clinical Neuroscience, 14(11-12), 77–81.

Rabinowitz, J., Schooler, N. R., Anderson, A., Ayearst, L., Daniel, D., Davidson, M., Khan, A.,
Kinon, B., Menard, F., Opler, L., Opler, M., Severe, J. B., Williamson, D., Yavorsky, C., Zhao, J. (2017). Consistency checks to improve measurement with the positive and negative syndrome scale (PANSS). Schizophrenia Research, 190, 74–76. 
https://doi.org/10.1016/j.schres.2017.03.017
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY

Psychopharmacologic Approaches to Treatment of Psychopathology Assignments

Introduction to Neuroanatomy

  1. In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.

Neurons (neurons or nerve cells) are the basic units of the brain and the nervous system. They receive sensory input, send motor commands to muscles, and transform and send electrical signals over long distances in the body (Camprodon & Roffman, 2016). A simple way to think about a neuron is to think of it as a tree. Branches, roots, and the trunk are all parts of a tree. Dendrites receive input from other cells. The spines that branch out of a dendrite are the postsynaptic contact site. The axon is the part of the neuron that sends messages (Camprodon & Roffman, 2016). A general electric impulse in the axon usually sends active signals to other neurons. You can communicate with each other by sending nerve impulses through each cell’s neuron to the axon. It causes the synapse to be filled with neurotransmitters, which allows the cells to talk to each other (Camprodon & Roffman, 2016). When the heart muscle (myocardium) sends an electrical impulse, it starts at the sinoatrial (SA) node at the top of the right atrium. Then, impulses travel down the conduction pathway through the bundle of His into the ventricles, where the bundle branches split into two (right and left) ways called the bundle branches to stimulate both ventricles: each time the ventricles contract, the heart beats.

What are the major components that make up the subcortical structures?

  • Diencephalon, pituitary gland, limbic structures, and basal ganglia (Sonne, 2020).

2. Which component plays a role in learning, memory, and addiction?

  • Dopamine

3. What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?

  • Pars compacta (SNpc) containing dopaminergic neurons and pars reticulata (SNpr) with inhibitor gamma-aminobutyric acid-containing (or GABAergic) neurons (Sonne, 2020)
  1. In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples

Glia cells are non-neuronal cells in the central nervous system (CNS) and the peripheral nervous system. They are found in both parts of the body Glia cells don’t make electricity. Their job is to keep things stable, make myelin, and protect neurons (Jäkel & Dimou, 2017). Glia cells are found in the mature CNS in three different types. These three types are called microglia, oligodendrocytes, and astrocytes. Microglial cells are the brain’s immune cells, protecting it from damage and disease (Jäkel & Dimou, 2017). Astrocytes control how much neurotransmitter is around a synapse by controlling the concentrations of ions like potassium and giving the brain energy (Jäkel & Dimou, 2017). Oligodendrocytes are the cells that help support the axons of neurons in the Central Nervous System, especially in the brain.

The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.

When electrical impulses reach presynaptic vesicles, they cause neurotransmitters to be released from the neuron. When the neuron releases positive ions (NA+, K+, Ca+) or negative ions (Cl-), the neurotransmitters carry these ions across the synaptic gap to the post-synaptic cell, binding to receptor sites. This completes the process of synaptic transmission (Jäkel & Dimou, 2017).

In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples

Neuroplasticity is about how the brain can change over time to adapt, learn, and even heal from a brain injury. It talks about how neural pathways change when a new experience is stored in the brain (Shaffer, 2016). Neuroplasticity also allows brain nerve cells to make up for damage and disease caused by a stroke, for example. When you learn and remember new things, your brain makes new neural connections. This is an example of neuroplasticity (Shaffer, 2016).

References:
Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J.F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 1–19). Elsevier.
Jäkel, S., & Dimou, L. (2017). Glial Cells and Their Function in the Adult Brain: A Journey through the History of Their Ablation. Retrieved from https://www.frontiersin.org/articles/10.3389/fncel.2017.00024/full
National Heart, Lung, and Blood Institute. (n.d.). How the Heart Works. Retrieved from https://www.nhlbi.nih.gov/health-topics/how-heart-works
Shaffer, J. (2016).Neuroplasticity and Clinical Practice: Building Brain Power for Health. Retrieved December from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960264/
Sonne, J. (2020).Neuroanatomy, Substantia Nigra. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK536995/

Psychopharmacologic Approaches to Treatment of Psychopathology Assignments

As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

Learning Objectives Students will:

  • Analyze the agonist-to-antagonist spectrum of action of psychopharmacologic agents
  • Compare the actions of g couple proteins to ion gated channels
  • Analyze the role of epigenetics in the pharmacologic action
  • Analyze the impact of foundational neuroscience on the prescription of medications

Psych Pharm week 1 discussion

Psychiatric mental health practitioners (PMHNP) need to have a strong background in neuroscience to help people. To accurately diagnose and treat psychiatric disorders, the PMHNP needs to know how medications affect these disorders and the CNS. This knowledge is essential because it allows them to understand how medications affect these disorders and how they affect the CNS. Many pharmacological agents can be either agonists or antagonists at the receptors. They also react to chemical messengers, such as neurotransmitters. Agonists connect with and activate the receptor, which causes a biological reaction or action inside the cell. This is called a “biological response” (Stahl, 2013). In this case, a pharmacologic agonist attaches to and activates specific neurotransmitter receptors in the brain, like the dopamine receptors linked to schizophrenia. This helps the brain send messages more quickly. They work by attaching to receptors and making it hard for other agonists to attach, stopping any effects (Stahl, 2013). Ion-gated channels and g-couple proteins are two of the main neurotransmitter receptors used to send signals. Ion gated channels refer to ion channels that open when a ligand is attached (Stahl, 2013). After this, the voltage-gated ion channels on the membrane also open up, making them more accessible (Stahl, 2013). As a result, more ions can move across the membrane, and the neuron’s action potential keeps going down. When this process is going on, things change quickly.

G protein receptors, on the other hand, are on the surface of the cell and share a common signaling method and construction. All G proteins connect the nucleotide guanosine triphosphate (GTP) hydrolysis to make guanine diphosphate (GDP). G proteins use a protein kinase to make a system that helps control the pathways in the body. The G protein linked to GDP isn’t working, which means that a GDP-bound G protein is still working (Stahl, 2013). Postsynaptic reactions caused by G protein stimulation happen at a slower rate than the ion-gated channels. They happen in seconds or even minutes. G protein receptors can control the shutting and opening of the ion channels indirectly. This causes the response to be a little longer (Stahl, 2013).

Epigenetics is the study of how changes in organisms are caused by changes in gene expression rather than changes in the genetic code itself (What is epigenetics, 2020). Epigenetic changes can help determine if genes are turned on or off. They can also affect the production of proteins in specific cells, making sure that only necessary proteins are made. Healthy cells need to keep their phenotypic activity, and epigenetic control of genes helps keep that from happening. For example, this helps Alzheimer’s disease and schizophrenia (Stefanska and MacEwan, 2015). The study of epigenetics has led to new drug classes that try to change the way this mechanism works to treat certain illnesses. Antipsychotic drugs, for example, can be used to treat schizophrenia. They help manage the condition by lowering the amount of dopamine in the brain, which changes epigenetic homeostasis, increasing the pharmacogenomic effects (2015).
People who have strong foundations in neuroscience will be better able to prescribe drugs because they will know more about which drugs will work best and avoid side effects that aren’t good for them. I worked with an FNP who gave Haldol to a Parkinson’s disease patient taking levodopa. This would have been bad for the patient if the pharmacy didn’t notice the mistake. Antipsychotic drugs make levodopa less practical for people with Parkinson’s disease because they block dopamine receptors in the corpus striatum. If the FNP had known this, this mistake would not have happened. Haloperidol can cause Parkinsonism, one of the most common Extrapyramidal side effects (EPS) of the drug (Lucca et al., 2015). It is important to know more than just the basics about how each drug class works and how neuroscience works as a whole.

Place an order for nursing essays and papers

References

Lucca, J. M., Ramesh, M., Parthasarathi, G., & Raman, R. (2015). An adverse drug interaction of haloperidol with
levodopa. Retrieved February 23, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418258/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th
ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x
Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. British journal of
pharmacology, 172(11), 2701-2704.
What is epigenetics? – Genetics Home Reference – NIH. (2020, February 11). Retrieved February 23, 2020, from
https://ghr.nlm.nih.gov/primer/howgeneswork/epigenome
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