Week 2: Depressive Disorders

I have no one. My wife died suddenly 4 years ago and I know it was my fault. She had been complaining she was sick for a year, but the doctors kept saying it was nothing. When they finally found the cancer, it had spread throughout her body. I should have listened to her. She might have survived and I would not be alone. I seem to cry for no reason and my children don’t understand why I don’t want to go out of the house. This is where her memories are. Why would I want to leave?

Jose, age 75

The National Institutes of Mental Health acknowledges that depression is one of the most common mental disorders in the United States. It is associated with significant disability, fiscal impact, and considerable personal suffering. It may have significant impact on the individual, their family, and their social network. The PMHNP must be capable of providing comprehensive care for depressive disorders, including both psychotherapy and psychopharmacologic approaches.

This week, you will become “captain of the ship” as you take full responsibility for a client with a depressive disorder. You will recommend psychopharmacologic treatment and psychotherapy, identify medical management needs and community support, and recommend follow-up plans. You will also explore how to obtain a DEA license and the responsibilities for safe prescribing and prescription monitoring.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 8, “Mood Disorders” (pp. 347–386)

• Chapter 12, “Psychotherapy of Mood Disorders”
• Chapter 14, “Pharmacological and Somatic Treatments for Major Depressive Disorder”

• “Depressive Disorders”
• Major Depressive Disorder
• Persistent Depressive Disorder (dysthymia)
• Premenstrual Dysphoric Disorder
• Substance/Medication-Induced Depressive Disorder
• Depressive Disorder Due to Another Medical Condition
• Other Specified Depressive Disorder
• Unspecified Depressive Disorder

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

 

Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://stahlonline.cambridge.org/

 

To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Drug Enforcement Administration. (n.d.). Drug schedules. Retrieved June 14, 2016, from https://www.dea.gov/druginfo/ds.shtml

Required Media

Note: The approximate length of this media piece is 22 minutes.

Optional Resources

• Chapter 15, “Brain Stimulation Treatments for Mood Disorders”

Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31(1), 52–72. doi:10.1037/neu0000319

Note: You will access this article from the Walden Library databases.

Anderson, N. D., Damianakis, T., Kröger, E., Wagner, L. M., Dawson, D. R., Binns, M. A., . . . Cook, S. L. (2014). The benefits associated with volunteering among seniors: A critical review and recommendations for future research. Psychological Bulletin, 140(6), 1505–1533. doi:10.1037/a0037610

Note: You will access this article from the Walden Library databases.

Inoue, J., Hoshino, R., Nojima, H., Ishida, W., & Okamoto, N. (2016). Additional donepezil treatment for patients with geriatric depression who exhibit cognitive deficit during treatment for depression. Psychogeriatrics, 16(1), 54–61. doi:10.1111/psyg.12121

Note: You will access this article from the Walden Library databases.

Sachs-Ericsson, N., Corsentino, E., Moxley, J., Hames, J. L., Rushing, N. C., Sawyer, K., . . . Steffens, D. C. (2013). A longitudinal study of differences in late- and early-onset geriatric depression: Depressive symptoms and psychosocial, cognitive, and neurological functioning. Aging & Mental Health, 17(1), 1–11. doi:10.1080/13607863.2012.717253

Note: You will access this article from the Walden Library databases.

Shallcross, A. J., Gross, J. J., Visvanathan, P. D., Kumar, N., Palfrey, A., Ford, B. Q., . . . Mauss, I. B. (2015). Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition. Journal of Consulting and Clinical Psychology, 83(5), 964–975. doi:10.1037/ccp0000050

Note: You will access this article from the Walden Library databases.

Wanklyn, S. G., Pukay-Martin, N. D., Belus, J. M., St. Cyr, K., Girard, T. A., & Monson, C. M. (2016). Trauma types as differential predictors of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and their comorbidity. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 48(4), 296–305. doi:10.1037/cbs0000056

Note: You will access this article from the Walden Library databases.

Assignment 1: “Captain of the Ship” Project – Depressive Disorder

As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role.

In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.

Students will:

• Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with depression disorders
• Recommend psychotherapy based on therapeutic endpoints for clients with depression disorders
• Identify medical management needs for clients with depression disorders
• Identify community support resources for clients with depression disorders
• Recommend follow-up plans for clients with depression disorders

To prepare for this Assignment:

• Select an adult or older adult client with a depressive disorder you have seen in your practicum.

In 3–4 pages, write a treatment plan for your client in which you do the following:

• Describe the HPI and clinical impression for the client.
• Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
• Identify medical management needs, including primary care needs, specific to this client.
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

By Day 7

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK2Assgn1+last name+first initial.(extension)” as the name.
• Click the Week 2 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 2 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 2 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 2 Assignment 1 draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:

Week 2 Assignment 1

Assignment 2: Week 2 Practicum Journal: Safe Prescribing

There is probably no greater responsibility that the psychiatric mental health nurse practitioner assumes than the responsibility of prescribing medications. While someone can be harmed by psychotherapy, the level and intensity of the harm generally does not come to the same level of harm that can occur from improper prescribing. The PMHNP must understand his/her responsibility both at a state and federal level when it comes to prescribing medications.

In this Practicum Journal Assignment, you will explore the legalities associated with prescribing controlled substances, as well as what a DEA number is, how to obtain one, and, most importantly, how to prescribe controlled substances in your state.

Students will:

• Analyze roles of the Drug Enforcement Administration
• Analyze PMHNP responsibilities when issued a DEA number
• Analyze DEA number application procedures
• Analyze state requirements for safe prescribing and prescription monitoring
• Analyze PMHNP responsibilities for safe prescribing and prescription monitoring
• Analyze Schedule II-V drug levels

** Assigned in Week 2 and submitted in Week 4.

To prepare for this Practicum Journal:

• Review the Learning Resources.

In 2-3 pages:

• Describe the role of the Drug Enforcement Administration (DEA) as it pertains to the PMHNP.
• Explain your responsibilities when having a DEA number.
• Explain how you apply for a DEA number.
• Explain your state’s requirements for a safe prescribing and prescription monitoring program. Explain your responsibility as a PMHNP to follow these requirements.
• Provide an example of a drug you may prescribe from each of the Schedule II-V drug levels.

By Day 7

Submit by Day 7 of Week 4.

Making Connections

This week, you became “captain of the ship” as you took full responsibility for a client with a depressive disorder by recommending psychopharmacologic treatment and psychotherapy, identifying medical management needs and community support, and recommending follow-up plans. You also explored how to obtain a DEA license and the responsibilities for safe prescribing and prescription monitoring.

Next week, you will explore the many personality disorders and use the DSM-5 criteria for diagnosing individuals with specific personality disorders. You will use the Decision Tree format to diagnose and treat a client with a personality disorder. You also will complete the Fitzgerald University Exit Comprehensive Exam to determine your readiness for the certification exam.

To go to the next week:

Week 3