Generalized Anxiety Disorder, and Insomnia-Inducing Medications Essay

Week 8: Therapy for Patients With Sleep/Wake Disorders From negative changes in mood to problems concentrating, sleep/wake disorders can have a tremendous impact on patients’ lives. When patients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. However, many of the medications used to treat sleep/wake disorders may be addictive, making thorough patient assessments and close follow-up care essential. To prescribe appropriate therapies with patient safety in mind, you must understand not only the pathophysiology of these disorders but also the pharmacologic agents used to treat them. This week, as you study therapies for individuals with sleep/wake disorders, you examine the assessment and treatment of patients with these disorders. You also explore ethical and legal implications of these therapies. Learning Objectives Students will: Synthesize concepts related to the psychopharmacologic treatment of patients Assess patient factors and history to develop personalized therapy plans for patients with sleep/wake disorders Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for sleep/wake disorders Synthesize knowledge of providing care to patients presenting for sleep/wake disorders Analyze ethical and legal implications related to prescribing therapy for patients with sleep/wake disorders Learning Resources Required Readings (click to expand/reduce) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8 Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/ Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. Generalized Anxiety Disorder, and Insomnia-Inducing Medications Essay. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470 Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740 Medication Resources (click to expand/reduce) IBM Corporation. (2020). IBM Micromedex.

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https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537 Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments. alprazolam amitriptyline amoxapine amphetamine desipramine diazepam doxepin eszopiclone flunitrazepam flurazepam hydroxyzine imipramine lemborexant lorazepam melatonin methylphenedate modafinil armodafinil carnitine clomipramine clonazepam nortriptyline pitolisant ramelteon sodium oxybate solriamfetol SSRI’s temazepam trazodone triazolam trimipramine wellbutrin zaleplon zolpidem Required Media (click to expand/reduce) Assignment 1: Short Answer Assessment As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders. Photo Credit: Getty Images/Collection Mix: Sub 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. To complete: Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week. 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 resolution of symptoms? List 4 predictors of late onset generalized anxiety disorder. 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. List at least 5 symptoms required for the episode to occur . Generalized Anxiety Disorder, and Insomnia-Inducing Medications Essay. Be specific. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific. refrec must not be more than 5yrs from now

Psychopharmacology, Symptomatology, and Neurobiology of Major Depressive Disorder (MDD), Predictors of Generalized Anxiety Disorder, and Insomnia-Inducing Medications

Question 1

Major depressive disorder (MDD) and alcohol use disorder (AUD) are two psychiatric conditions that are commonly comorbid or co-occurring (APA, 2013). Appropriate drug treatment for those with MDD and a history of alcohol abuse includes escitalopram or Lexapro (usually combined with acamprosate for AUD) and sertraline or Zoloft (usually combined with naltrexone for AUD) (McHugh & Weiss, 2019; Stahl, 2017). Two drugs contraindicated for these patients are duloxetine or Cymbalta (causes hepatotoxicity in the patient who already has hepatic dysfunction due to chronic alcohol use) and bupropion or Wellbutrin (predisposes the alcoholic patient to seizures) (Stahl, 2017). Resolution of symptoms or remission usually begins to show after 2-4 weeks as that is the time it takes for the therapeutic effects of most drugs to start showing (Stahl, 2017).

Question 2

Four predictors of late-onset generalized anxiety disorder or GAD are (Zhang et al., 2015):

1. Chronic medical conditions like heart failure, coronary artery disease, type II diabetes and dyslipidemia. There is some level of psychological stress and anxiety that accompanies the persons who have these pre-existing conditions. This predisposes them to late-onset GAD.
2. Adverse life events in the near past, such as the loss of a life-long partner. GAD affects the elderly population. Losing a lifelong partner at this stage in life will predispose the victim to GAD. Generalized Anxiety Disorder, and Insomnia-Inducing Medications Essay.
3. Being female. Elderly females have been found by research to be more vulnerable to the development of GAD (Zhang et al., 2015), maybe because of the gender being naturally emotional.
4. Suffering from chronic mental conditions like depressive disorders amongst others. These already put a mental strain on the patient lowering their threshold for psychiatric conditions.

Question 3

Four potential neurobiological causes of major psychotic depression include (Sadock et al., 2015):

1. Chemical imbalances in neurotransmitters: Alterations in the composition and expression of neurotransmitters such as dopamine and serotonin cause behavioral changes that manifest as major depression with psychosis.
2. Genetics: Inherited characteristics either in a dominant or recessive manner normally lead to phenotypic expression of disease.

• Biomarkers: Objectively observed pointers to the condition of psychotic major depression would be another of its neurobiological causes.

1. Epigenetics: Extragenetic influences on the physical structure of genes such as methylation (occurring naturally) can also cause major depression with psychosis (Sadock et al., 2015).

Question 4

Five (5) of the symptoms required for a DSM-5 diagnosis of major depression to be made are (APA, 2013):

• A sense of worthlessness together with a feeling of guilt that is inappropriate
• Inexplicable depressed mood such as sadness most of the day every other day
• Suicidal ideation or thinking about death without a specific actualization plan
• A reduction in the body mass index (BMI) or total body mass that is objectively observable.
• Unrelenting anxiety and worry for a period of not less than six months, with the client being unable to control the worry and anxiety.

Question 5

Three classes of drugs that precipitate insomnia are (Levenson et al., 2015):

1. Psychostimulants such as modafinil
2. Newer antidepressants such as fluoxetine, also known as selective serotonin reuptake inhibitors or SSRIs.

• Amphetamines such as amphetamine and methamphetamine (Stahl, 2017; Sadock et al., 2015).

References

American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author. Generalized Anxiety Disorder, and Insomnia-Inducing Medications Essay.

Levenson, J.C., Kay, D.B., Buysse, D.J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179-1192.  https://doi.org/10.1378/chest.14-1617

McHugh, R.K., & Weiss, R.D. (2019). Alcohol use disorder and depressive disorders. Alcohol Research: Current Reviews, 40(1), e1-e8. https://doi.org/10.35946/arcr.v40.1.01

Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6^th ed. Cambridge University Press.

Zhang, X., Norton, J., Carrière, I., Ritchie, K., Chaudieu, I., & Ancelin, M-L. (2015). Risk factors for late-onset generalized anxiety disorder: Results from a 12-year prospective cohort (The ESPRIT study). Translational Psychiatry, 5(e536), 1-8. http://dx.doi.org/10.1038/tp.2015.31

WK 8 ASSG 1 RUBRIC

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. Generalized Anxiety Disorder, and Insomnia-Inducing Medications Essay.  Be specific. What it is the timeframe that the patient should see resolution of symptoms?

12 (16%) – 13 (17.33%)

The response accurately and clearly explains in detail the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse.

The response accurately and clearly details which drugs are contraindicated with specific examples.

The response accurately and clearly explains in detail the timeframe that the patient should see resolution of symptoms.

2.) List four predictors of late onset generalized anxiety disorder.

12 (16%) – 13 (17.33%)

The response accurately and clearly lists in detail four predictors of late-onset generalized anxiety disorder.

3.) List four potential neurobiology causes of psychotic major depression. Generalized Anxiety Disorder, and Insomnia-Inducing Medications Essay.

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12 (16%) – 13 (17.33%)

The response accurately and clearly lists in detail four 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 five symptoms required for the episode to occur. Be specific.

12 (16%) – 13 (17.33%)

The response accurately and clearly explains in detail at least five symptoms for the episode of major depression to occur.

Specific examples provided fully support the response.

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

12 (16%) – 13 (17.33%)

The response accurately and clearly lists in detail 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia.

Examples provided fully support the response provided.

5.) Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 (6.67%) – 5 (6.67%)

Uses correct grammar, spelling, and punctuation with no errors.

6.) Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. Generalized Anxiety Disorder, and Insomnia-Inducing Medications Essay.

5 (6.67%) – 5 (6.67%)

Uses correct APA format with no errors. Generalized Anxiety Disorder, and Insomnia-Inducing Medications Essay.