Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay
Introduction
This assignment involves making three decisions regarding the treatment choices for an elderly Hispanic man diagnosed with major depressive disorder. According to Cornish (2015), it is important to always utilize evidence-based practice for better health outcomes. For this assignment, the treatment decisions will be based on the latest research evidence. the paper will also discuss ethical aspects likely to affect the treatment of the client.
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Decision Point One
The chosen first decision is for the client to begin taking Effexor XR 37.5mg orally. The reason for choosing the decision is because the efficacy of Effexor in the treatment of depressive symptoms has been demonstrated. The medication works by increasing the amount of neurotransmitters norepinephrine and serotonin in the brain; these neurotransmitters control mood, appetite, sleep, emotions, anxiety, perceptions, and aggression, which are important aspects in depression (Gitlin, 2018) Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay. Another reason why this Effexor was selected is due to its safety among the geriatric population (Higuchi et al, 2016).
By choosing this decision, the expectation was that the depressive symptoms for this client would significantly improve due to the medication’s efficacy in the treatment of depression. Another expectation was that the medication would have minimal or no side effects for this client (Li, 2017).
Nonetheless, the outcome of the decision that was chosen was different from the expected outcome as indicated by the client having no notable change in the depressive symptoms. This can be attributable to the small dose of Effexor XR 37.5mg that was not effective in improving the symptoms (Stahl, 2013).
Decision Point Two
The second decision that was chosen is to have an increased dose of Effexor to 75 mg. this decision was chosen because higher doses of Effexor have been shown to be safe, effective and well-tolerated when it comes to the treating depressive symptoms (Li, 2017).
The expectation of choosing this decision was that there would be symptom remission for this client and that he would tolerate the high dose and have minimal or no side effects. According to Stahl (2013) patients are able to well tolerate higher doses of Effexor like 75 mg per day and the higher doses are effective in treating symptoms of major depressive disorder.
As per the expectations, the client had notable symptom remission after four weeks as reported and as MADRS demonstrated 25% symptom decrease. The reason for the symptom improvement is the efficacy of a higher dose of Effexor (Higuchi et al, 2016). Secondly, just like it was hoped, the client tolerated the increased dose well because no side effects were reported.
Decision Point Three
The third decision that was chosen to have the Effexor dose increased to 112.5 mg orally per day. The reason behind choosing this decision is because evidence indicates that an increased dose of Effexor is more effective due to the increased action of the medication in inhibiting reuptake of norepinephrine and serotonin. Li (2017) performed a study that showed that a dose of 75 mg of Effexor was a selective inhibitor of 5-HT reuptake whereas a higher dose of Effexor acted as an inhibitor or both norepinephrine and serotonin.
Therefore, increase the dose of Effexor to 112.5 mg per day for the client hoped that the symptoms of major depressive disorder for the client would significantly improve and as a result, the client will have complete symptom remission. Evidence shows that an elevated dose of Effexor has better efficacy when it comes to symptom improvement (Bombardier et al, 2014). In addition, it was hoped that the client would tolerate the higher dose of Effexor and hence have no adverse effects.
Ethical Considerations
Treatment of the geriatric population involves various ethical issues. Ethical issues for this client consist of the ability to make decisions and informed consent. For the informed consent, it is important for PMHNP to explain to the client all information about the available treatment options to ensure that the client makes an informed treatment decision (Stark et al, 2018). Nonetheless, at times the older adults have problems when it comes to process and understand information especially when they have mental health problems (Stark et al, 2018). Therefore, the PMHNP should ensure that the client clearly understands the information for him to make informed and independent treatment decision.
Conclusion
The decision that was first chosen for this client is starting Effexor XR 37.5mg due to the medication efficacy in treating depression. Additionally, the medication is safe and well-tolerated among the geriatric population. Nonetheless, with Effexor XR 37.5mg the client did not manifest symptom improvement and as a result, the second decision was increasing the dose to 75 mg. With the increased dose, the client manifested symptom improvement. The last decision was to increase the dose to 112.5 mg with the aim of ensuring complete symptom remission. Ethical issues relevant during the treatment of the client are the ability to make decisions and informed consent.
References
Bombardier C, Fann J, Wilson C, Allen H, Scott R, Warren A, Brooks L, Warms C, Temkin N & Tate D. (2014). A randomized controlled trial of venlafaxine XR for major depressive disorder after spinal cord injury: Methods and lessons learned. J Spinal Cord Med. 37(3): 247–263.
Cornish F. (2015). Evidence synthesis in international development: a critique of systematic reviews and a pragmatist alternative. Anthropology & Medicine. 22(3), 263-277.
Gitlin M. (2018). Antidepressants in bipolar depression: an enduring controversy. Int J Bipolar Discord. 6(25).
Higuchi T, Kamjima K, Nakagome K, Yuko A, Rio I & Imaeda T. (2016). A randomized, double-blinded, placebo-controlled study to evaluate the efficacy and safety of venlafaxine extended-release and a long-term extension study for patients with major depressive disorder in Japan. Int Clin Psychopharmacology. 31(1), 8–19.
Li X. (2017). Short-term efficacy and tolerability of venlafaxine extended-release in adults with generalized anxiety disorder without depression: A meta-analysis. PLoS One. 12(10), e0185865.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stark A, Hanna K, Stein J, Maier W, Heser K, Wiese B, Mamone S, Hans K, Bock J, Steffi G & Martin S. (2018). A qualitative study on older primary care patients’ perspectives on depression and its treatments – potential barriers to and opportunities for managing depression. BMC Fam Pract. 19(2).
BACKGROUND INFORMATION
The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.
SUBJECTIVE
During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).
RESOURCES
§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
The Assignment
Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Assessing and Treating Adult and Geriatric Clients with Mood Disorders
Introduction
This assignment involves making three decisions regarding the treatment choices for an elderly Hispanic man diagnosed with major depressive disorder. According to Cornish (2015), it is important to always utilize evidence-based practice for better health outcomes. For this assignment, the treatment decisions will be based on the latest research evidence. the paper will also discuss ethical aspects likely to affect the treatment of the client Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.
Decision Point One
The chosen first decision is for the client to begin taking Effexor XR 37.5mg orally. The reason for choosing the decision is because the efficacy of Effexor in the treatment of depressive symptoms has been demonstrated. The medication works by increasing the amount of neurotransmitters norepinephrine and serotonin in the brain; these neurotransmitters control mood, appetite, sleep, emotions, anxiety, perceptions, and aggression, which are important aspects in depression (Gitlin, 2018). Another reason why this Effexor was selected is due to its safety among the geriatric population (Higuchi et al, 2016).
By choosing this decision, the expectation was that the depressive symptoms for this client would significantly improve due to the medication’s efficacy in the treatment of depression. Another expectation was that the medication would have minimal or no side effects for this client (Li, 2017). Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.
Nonetheless, the outcome of the decision that was chosen was different from the expected outcome as indicated by the client having no notable change in the depressive symptoms. This can be attributable to the small dose of Effexor XR 37.5mg that was not effective in improving the symptoms (Stahl, 2013).
Decision Point Two
The second decision that was chosen is to have an increased dose of Effexor to 75 mg. this decision was chosen because higher doses of Effexor have been shown to be safe, effective and well-tolerated when it comes to the treating depressive symptoms (Li, 2017).
The expectation of choosing this decision was that there would be symptom remission for this client and that he would tolerate the high dose and have minimal or no side effects. According to Stahl (2013) patients are able to well tolerate higher doses of Effexor like 75 mg per day and the higher doses are effective in treating symptoms of major depressive disorder.
As per the expectations, the client had notable symptom remission after four weeks as reported and as MADRS demonstrated 25% symptom decrease. The reason for the symptom improvement is the efficacy of a higher dose of Effexor (Higuchi et al, 2016). Secondly, just like it was hoped, the client tolerated the increased dose well because no side effects were reported. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.
Decision Point Three
The third decision that was chosen to have the Effexor dose increased to 112.5 mg orally per day. The reason behind choosing this decision is because evidence indicates that an increased dose of Effexor is more effective due to the increased action of the medication in inhibiting reuptake of norepinephrine and serotonin. Li (2017) performed a study that showed that a dose of 75 mg of Effexor was a selective inhibitor of 5-HT reuptake whereas a higher dose of Effexor acted as an inhibitor or both norepinephrine and serotonin.
Therefore, increase the dose of Effexor to 112.5 mg per day for the client hoped that the symptoms of major depressive disorder for the client would significantly improve and as a result, the client will have complete symptom remission. Evidence shows that an elevated dose of Effexor has better efficacy when it comes to symptom improvement (Bombardier et al, 2014). In addition, it was hoped that the client would tolerate the higher dose of Effexor and hence have no adverse effects.
Ethical Considerations
Treatment of the geriatric population involves various ethical issues. Ethical issues for this client consist of the ability to make decisions and informed consent. For the informed consent, it is important for PMHNP to explain to the client all information about the available treatment options to ensure that the client makes an informed treatment decision (Stark et al, 2018). Nonetheless, at times the older adults have problems when it comes to process and understand information especially when they have mental health problems (Stark et al, 2018). Therefore, the PMHNP should ensure that the client clearly understands the information for him to make informed and independent treatment decision. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.
Conclusion
The decision that was first chosen for this client is starting Effexor XR 37.5mg due to the medication efficacy in treating depression. Additionally, the medication is safe and well-tolerated among the geriatric population. Nonetheless, with Effexor XR 37.5mg the client did not manifest symptom improvement and as a result, the second decision was increasing the dose to 75 mg. With the increased dose, the client manifested symptom improvement. The last decision was to increase the dose to 112.5 mg with the aim of ensuring complete symptom remission. Ethical issues relevant during the treatment of the client are the ability to make decisions and informed consent. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.
References
Bombardier C, Fann J, Wilson C, Allen H, Scott R, Warren A, Brooks L, Warms C, Temkin N & Tate D. (2014). A randomized controlled trial of venlafaxine XR for major depressive disorder after spinal cord injury: Methods and lessons learned. J Spinal Cord Med. 37(3): 247–263.
Cornish F. (2015). Evidence synthesis in international development: a critique of systematic reviews and a pragmatist alternative. Anthropology & Medicine. 22(3), 263-277. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.
Gitlin M. (2018). Antidepressants in bipolar depression: an enduring controversy. Int J Bipolar Discord. 6(25).
Higuchi T, Kamjima K, Nakagome K, Yuko A, Rio I & Imaeda T. (2016). A randomized, double-blinded, placebo-controlled study to evaluate the efficacy and safety of venlafaxine extended-release and a long-term extension study for patients with major depressive disorder in Japan. Int Clin Psychopharmacology. 31(1), 8–19.
Li X. (2017). Short-term efficacy and tolerability of venlafaxine extended-release in adults with generalized anxiety disorder without depression: A meta-analysis. PLoS One. 12(10), e0185865.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stark A, Hanna K, Stein J, Maier W, Heser K, Wiese B, Mamone S, Hans K, Bock J, Steffi G & Martin S. (2018). A qualitative study on older primary care patients’ perspectives on depression and its treatments – potential barriers to and opportunities for managing depression. BMC Fam Pract. 19(2). Assessing and Treating Adult and Geriatric Clients With Mood Disorders Essay.