Treatment for a Patient with a Common Condition Essay

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Treatment for a Patient with a Common Condition Essay

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs. Case: An elderly widow who just lost her spouse. Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Treatment for a Patient with a Common Condition Essay. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: Metformin 500mg BID Januvia 100mg daily Losartan 100mg daily HCTZ 25mg daily Sertraline 100mg daily Current weight: 88 kg Current height: 64 inches Temp: 98.6 degrees F BP: 132/86 By Day 3 of Week 7 Post a response to each of the following: List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions. 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. Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used. List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why. List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities? Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen. Treatment for a Patient with a Common Condition Essay. Optional Learning Resources Required Readings (click to expand/reduce) Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier. American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association.

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https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. https://doi.org/10.1093/schbul/13.2.261 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/ McClellan, J. & Stock. S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 976–990. https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649–659. https://doi.org/10.2165/00023210-200923080-00002. Treatment for a Patient with a Common Condition Essay.

This is a case analysis for a 75 years old female who complained of insomnia. She is known to have diabetes mellitus, hypertension, and major depressive disorder. The depressive disorder deteriorated since the demise of her spouse 10 months ago. He visits the primary care physician at least twice a year. She takes metformin, Januvia, losartan, and sertraline. Her vitals are blood pressure at 132/86mmHg, the temperature at 98.6F, and body mass index at 33.3kg/m2.

List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

When is the onset of insomnia? This question will explain the symptoms associated with sleeping and the patient’s sleeping habits.
Does anyone in your lineage have difficulties in sleeping? A family history of insomnia is obtained because the disorder is inherited in an autosomal dominant pattern.
What medicine are you taking currently? Some drugs are known to cause insomnia such as beta-blockers, decongestants, and antidepressants.
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.

The most reliable person to ask about the patient’s history is a home helper that spends the whole day with her because they will notice the behavior pattern (Abu‐Rumeileh, et al, 2018). I would ask them; how often does she sleep? Treatment for a Patient with a Common Condition Essay. What are her daily activities? Does she complain of general body malaise and drowsiness in the morning? These questions will enable the clinician to know other symptoms associated with insomnia, for example, somnolence and irritability.

Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

Diagnostic tests are polysomnography, actigraphy, and sleep diary. These will help in documenting sleeping patterns. Thyroid function tests and lipid profile tests are essential in determining other metabolic diseases that may cause insomnia (Hertenstein, et al, 2019). Physical findings that are probable causes of insomnia are enlarged tonsils, enlarged neck size, and low-lying soft palate.

List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

Differential diagnoses are depression, obstructive sleep apnea, and restless leg syndrome. Depression is the most probable diagnosis. This is because she has a previous medical history of depression and worsened after the demise of her husband.

List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

Citalopram 20mg once daily and amitriptyline 25mg at night; Fluoxetine is a serotonin selective reuptake inhibitor and it the drug of choice for late-onset depression. It also have sedative effects that will stop insomnia (Wichniak, et al, 2017). Treatment for a Patient with a Common Condition Essay. Amitriptyline is a tricyclic antidepressant. Fluoxetine is preferred to amitriptyline because of minimum adverse effects. Amitriptyline has adverse effects that may worsen obesity in this patient.

For the drug therapy, you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

Citalopram 20mg once daily is contraindicated in cases of hypersensitivity. It may cause an increased bone fracture, and mania/hypomania.

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Include any “checkpoints” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

The patient should be reviewed after every two weeks to monitor if the drug is well tolerated and observe the adverse effects of the drug. Treatment for a Patient with a Common Condition Essay.

References

Abu‐Rumeileh, S., Redaelli, V., Baiardi, S., Mackenzie, G., Windl, O., Ritchie, D. L., & Parchi, P. (2018). Sporadic fatal insomnia in Europe: phenotypic features and diagnostic challenges. Annals of neurology, 84(3), 347-360.

Hertenstein, E., Feige, B., Gmeiner, T., Kienzler, C., Spiegelhalder, K., Johann, A., … & Baglioni, C. (2019). Insomnia as a predictor of mental disorders: A systematic review and meta-analysis. Sleep medicine reviews, 43, 96-105.

Wichniak, A., Wierzbicka, A., Walęcka, M., & Jernajczyk, W. (2017). Effects of antidepressants on sleep. Current psychiatry reports, 19(9), 63. Treatment for a Patient with a Common Condition Essay.