Diagnostic And Statistical Manual of Mental Disorders Essay

Please give a response to those 2-discussion post with their reference separately .

#1
Joy S-Mc
Discussion Post- Insomnia
According to Abbott’s (2016) research, insomnia is frequently associated with multiple psychological disorders. Here we examine how a PMHNP might treat an elderly widow suffering from insomnia and worsening depression after her husband has passed. Effective care requires conducting an in-depth assessment, diagnosis, and personalized treatment plan tailored specifically for this patient. Diagnostic And Statistical Manual of Mental Disorders Essay
At our initial consultations, there are key questions we ask to gain a clearer understanding of a patient’s current state. I may ask, “Can you describe your sleep habits more in detail?” and “How has your husband’s death changed your daily life, particularly feelings of loneliness or isolation?” These queries may help uncover whether her insomnia has psychological roots stemming from grief; additionally, I may inquire about any changes in appetite or weight since his death, as this could provide insight into its severity.

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Gathering feedback from close family and friends of a patient could provide invaluable insight, with their input on any changes in her behavior or daily routine since her husband died, proving invaluable in painting an accurate picture. Potential questions to ask family and friends include, “Have you noticed any changes in her mood or behavior since then?”. Another pertinent question is whether they have expressions of sadness or despair. Diagnostic And Statistical Manual of Mental Disorders Essay
Physical exams and diagnostic tests play an integral role in diagnosing complex diseases like diabetes mellitus (DM), hypertension (HTN), and major depressive disorder (MDD). People with histories involving these conditions need thorough physical exams to detect any additional medical conditions as part of the evaluation process. An examination should include cardiovascular and metabolic evaluations to detect abnormalities related to her hypertension, while blood glucose monitoring could provide valuable insight into managing her diabetes effectively. Neurological assessments are also crucial, given the neurological aspects of depression and insomnia. We should perform laboratory tests to rule out metabolic or endocrine disturbances that might trigger her symptoms; additionally, conducting sleep studies such as polysomnography could provide valuable insight into whether her insomnia is psychological or related to a specific sleep disorder such as sleep apnea.
Adjustment Disorder, Major Depressive Disorder, and Insomnia Disorder may all be potential diagnoses for this patient. Adjustment Disorder may be relevant given her symptoms after experiencing such a dramatic life change as the death of her husband; however, due to the severity and persistence of symptoms, it seems more likely that Major Depressive Disorder would be the correct diagnosis.  Diagnostic And Statistical Manual of Mental Disorders Essay Additionally, Insomnia Disorder may have played a part in her worsening sleep habits after her husband’s passing; however, given the timing and progression of her symptoms, it would seem most likely that bereavement-related Major Depressive Disorder is responsible. This would account for her expressed depressive symptoms and worsening sleeping habits since his passing, with chronic insomnia being one of many features associated with major depressive disorders (Abbott 2016). Diagnostic And Statistical Manual of Mental Disorders Essay
Antidepressant medication plays an essential part in treating depressive symptoms. Bupropion may be an ideal antidepressant medication choice given its ability to effectively address these without leading to significant sleep disruptions – something especially relevant given that sleeplessness has already been an issue for the patient. However, another possible treatment option could be mirtazapine; as a noradrenergic and specific serotonergic antidepressant (NaSSA), mirtazapine has proven its ability to improve mood and sleep patterns – something this patient could especially benefit from given her insomnia. Due to her age and decreased physiological function, these medications would likely initially begin at low dosage levels and be carefully adjusted as she responded or experienced potential side effects.
Prescribed medications must consider potential contraindications and dosage adjustments when treating schizophrenia. Bupropion, for instance, should not be prescribed to individuals who have experienced seizures; given her age and possible kidney function decline, mirtazapine would require an adjusted starting dose.
Regular follow-up appointments would be essential in tracking her response and tailoring our plan to address it best. At 4, 8, and 12 weeks we would assess improvements in depressive symptoms and sleep quality, making any necessary dosage or medication changes as required. Diagnostic And Statistical Manual of Mental Disorders Essay
Given the established correlations between insomnia and mental illnesses (Abbott, 2016), we should recommend proper sleep hygiene practices, such as creating a restful environment with a regular sleeping schedule and refraining from caffeine and stimulating activities before bedtime.
This comprehensive approach recognizes the intertwining nature of insomnia and mental illness, emphasizing the significance of a patient-centric approach when treating complex cases. As PMHNPs, we must continuously integrate evidence-based practices into our treatments to promote patient health and well-being. Diagnostic And Statistical Manual of Mental Disorders Essay

References
Abott, J. (2016, March 28). What’s The Link Between Insomnia And Mental Illness? ScienceAlert. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep

#2

Rita Bou
Treatment for a Patient with a Common Condition Diagnostic And Statistical Manual of Mental Disorders Essay
The case at hand involves a 75 YO with a chief complaint of insomnia and past medical history of diabetes mellitus, hypertension, and major depressive disorders, and she has been taking five types of medication. BMI calculations show that she is obese, a crucial health factor when considering medication options. She reports developing depressive symptoms since her husband died ten months ago. She denies having depression prior to her husband’s death but insists her sleeping habits have only gotten worse. Patient also denies suicidal thought/ideation. I believe the irregular sleeping habits could have been triggered by recent events, which could be a minor problem, a major underlying concern exacerbated by recent events. I would consider asking the patient the following questions:
1. How are you feeling today and what brought you in? Diagnostic And Statistical Manual of Mental Disorders Essay

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Asking these open-ended questions would allow the patient to describe her feelings and identify her major concerns. According to Shanahan and Cunningham (2021), understanding and addressing current wants is crucial in maintaining a good relationship with the client. Also, the information would lay an excellent foundation for asking follow-up questions.
2. Please describe your sleeping patterns since the problem started.
The client’s chief complaint is insomnia, and asking this question would help understand the onset and progression of the condition over time. It would help me understand how the severity has changed, allowing me to categorize it as rapid and alarming or mild or moderate sleep irregularity.
3. When did you start taking Sertraline? Has there been any dosage adjustment? Diagnostic And Statistical Manual of Mental Disorders Essay
Client claims that her depression has only gotten worse. Hence it would be appropriate to investigate the effectiveness of the prescribed medication, considering that SSRIs usually take 4-8 weeks to show improvement.
With respect to people in the patient’s life, I would consider interviewing family members and close friends. I would inquire how the patient is coping at home and whether she has asked for any help lately. By interviewing them, I would be able to assess the level of support systems the patient has back at home to determine how it may affect the client’s mental condition. It would also aid in establishing how the situation has interfered with daily activity, including social events and gatherings.
On a different note, I would consider conducting physical exams to rule out thyroid problems that are associated with poor sleep quality. Also, it would help rule out any other medical condition or medication that may contribute to poor sleep patterns (Green et al., 2021). Another test I would consider is sleep history/habits to identify the sleep inconsistency to determine their occurrence and patterns and how they relate to the patient’s daily activity. This would be followed by an insomnia test which relies on self-reporting using a questionnaire. The insomnia test would help categorize the severity of the condition. Diagnostic And Statistical Manual of Mental Disorders Essay I would also consider performing mini mental state exam (MMSE) to assess the patient’s mental state and cognitive functioning.
The differential diagnosis for the patient includes severe major depressive disorder with insomnia, prolonged grief disorder, and situational insomnia. Considering the client is already diagnosed with MDD, this could be a severe case of MDD where insomnia is one of the symptoms (American Psychiatry Association, 2022). The patient claims to have started with the health issues after the death of her husband, who could have been her comfort or depended on, considering she has a past medical history of diabetes and hypertension. Hence, this sudden change in her life may have exacerbated her MDD (Bei et al., 2018).
With respect to pharmacologic agents and their dosing, it is crucial to note that some antidepressants may interfere with sleeping habits; some worsen it while others improve. The client is already taking Sertraline, an SSRI class of medication, and its side effect include being unable to sleep and making one feel sleepy. Hence, considering a sedative medication to treat insomnia would be prioritized in this case. I would use Doxepin, an H-1 receptor that is an FDA-approved antagonist. The dosage should be 3 mg po q.d. (Chiu et al., 2021). The other option would be Trazodone, an FDA-approved medication for depression 150 mg po q.d. It works by increasing serotonin levels in the brain, helping regulate moods, sleep, appetite, memory, and attention. A possible contraindication is that Trazodone is a serotonin inhibitor, just like the Sertraline medication the client takes. Thus, administering Trazodone may trigger serotonin syndrome due to increased serotonin levels in the brain (Bollu & Kaur, 2019). Diagnostic And Statistical Manual of Mental Disorders Essay
To avoid this, Doxepin would be the first priority considering it is FDA-approved for treating insomnia (Patel et al., 2018). On the same note, the first check-up point would be after four weeks, when the patient should be able to improve sleep and anxiety. If there is no noticeable improvement, the doctor should adjust the dosage by 3 mg and not exceed 6 mg per day. I would also consider adjusting the Sertraline medication by 10 mg per day as long as the dosage does not exceed the recommended maximum daily dosage of 50 mg to achieve even better outcomes. Diagnostic And Statistical Manual of Mental Disorders Essay

References
American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787Links to an external site.
Bollu, P.C. & Kaur, H. (2019). Sleep medicine: Insomnia and sleep. Missouri Medicine, 116(1), 68-75. https://pubmed.ncbi.nlm.nih.gov/30862990Links to an external site..
Chiu, H.Y., Lee, H.C., Liu, J.W., Hua, S.J., Chen, P.Y., Tsai, P.S., & Tu, Y.K. (2021). Comparative efficacy and safety of hypnotics for insomnia in older adults: A systematic review and network meta-analysis. Sleep, 44(5), zsaa260. https://doi.org/10.1093/sleep/zsaa260Links to an external site..
Green, M.E., Bernet, V., & Cheung, J. (2021). Thyroid Dysfunction and Sleep Disorders. Frontiers in Endocrinology (Lausanne), 12,725829. https://doi.org/10.3389/fendo.2021.725829Links to an external site..
Patel, D., Steinberg, J., & Patel P. (2018). Insomnia in the elderly: A review. Journal of Clinical Sleep Medicine. 14(6), 1017-1024. https://doi.org/10.5664/jcsm.7172Links to an external site..
Shanahan, T., & Cunningham, J. (2021). Keys to trust-building with patients. Journal of Christian Nursing, 38(2), E11-E14. https://doi.org/10.1097/cnj.0000000000000823Links to an external site.. Diagnostic And Statistical Manual of Mental Disorders Essay