Psychopharmalogical Approaches to Treat Psychopathology

The client in this case study is a 31-year-old man who came to the facility with a complaint of insomnia. The client has never been a decent sleeper, however, he is currently having trouble falling and remaining asleep at night, according to the subjective information gathered. Sleep complications, like difficulty initiating and maintaining sleep, as well as being awake the next day, describe insomnia patients. The client also claims that his sleep disorder interferes with his capacity to do his work as a forklift operator at a chemistry firm. Narcolepsy is a sleep disorder that causes sleep attacks and drowsiness in the daytime, as well as trouble completing everyday activities including watching a film, driving, and reading (Kornum et al., 2017) Psychopharmalogical Approaches to Treat Psychopathology. While the precise trigger of narcolepsy remains unknown, genetic influences and impaired brain activity as a result of disrupted nighttime sleep are two of the most common triggers. Additionally, the patient mentions that he had used diphenhydramine to help him sleep in the past but dislikes how he feels the next morning after taking it. Nevertheless, the patient does not mention any other adverse effects of the drug, like visual impairment, constipation, or throat and mouth dryness.

ORDER YOUR PAPER HERE

According to the client’s former doctor’s medical report, he has a history of opiate dependence that started when he injured his ankle in a skiing event, and he was given acetaminophen for severe pain relief. For the last four years, he has not obtained an opiate analgesic medication. He also claims to have previously used alcohol to help him rest, claiming to have had four drinks right before sleeping Psychopharmalogical Approaches to Treat Psychopathology.

Decision #1 Trazodone: 50–100 mg daily at bedtime

Trazodone is a selective receptor antagonist and reuptake inhibitor, so this decision is based on that aspect. The category of the drug, which is an off-label remedy for insomnia, influenced the decision to use it. Notwithstanding its status as a depression medication, trazodone is deemed the best therapeutic option for insomnia. The client in the aforementioned case study exhibits insomnia as a result of his fiancé’s death, indicating depression.

Given the typical adverse effects, the dosage of zolpidem 10 mg orally at bedtime was not appropriate. zolpidem’s adverse effects are numerous and are known to lead to a variety of serious complications, such as lethargy, hallucinations, and nighttime activity (Park et al. 2016). Additionally, the hydroxyzine 50 mg at bedtime option was kept out of the pharmacotherapeutic interventions. The choice to exclude the drug was made because it has anticholinergic complications, such as xerophthalmia and xerostomia.

The insomnia was expected to decrease as a result of the prescription of trazodone 50mg daily at bedtime. Furthermore, my main target was to provide a mentally healthy client with a better disposition. After 2 weeks, the client returned to the facility complaining of priapism and trouble going to work.

Autonomy would affect this situation in terms of ethical principles since the client is a confirmed alcoholic and might have drug interactions with the prescriptions.

Decision #2: Explain that priapism is a side effect of Trazodone that should diminish over time. Continue dose

The client returns to the facility two weeks later for a consultation after taking Trazodone for two weeks. He claims that the drug works well for him; however, he has an undesirable side effect of a persistent painful erection, which occurs around 15 minutes after getting up in the morning. He also claims that the erection is preventing him from preparing for work or going downstairs to take breakfast with his partner and child. The drug has clearly accomplished the therapeutic aim of minimizing insomnia, as per the review. The healthcare practitioner explains to the patient that many antidepressants, particularly SSRIs may cause serious side effects like prolonged erection (Shah et al., 2021). Priapism is recorded in around 79 percent of psychotic-drug-induced sustained erections with trazodone treatment, according to studies (Greiner et al., 2018). Nevertheless, the client must be advised to continue taking the drug because the adverse effects would fade with time Psychopharmalogical Approaches to Treat Psychopathology

The treatment’s aim at this point is to remedy the client’s stated adverse effect.

The client states that the drug is efficient, implying that stopping it and starting a fresh treatment with suvorexant 10 mg daily at bedtime will result in additional adverse effects that would make care compliance with the medication regimen difficult.

At this point, the ethical considerations will be encouraging the client to keep taking his medication even though it triggered an adverse outcome. The client has not had any adverse effects that might lead to a reduction of the prescription dose at this time. Even so, once the client is made to realize that the medication’s adverse effect is normal and will subside with time, reaching the aim of compliance will be easier.

Decision #3: Continue dose. Explain to the patient he may split the 50 mg tablet in half. The decreased dose should minimize next-day drowsiness. Follow up in 4 weeks

The client reports to the hospital in the fourth week, claiming that the priapism has subsided with time. The reason for choosing to explain to the patient that he may split the 50 mg tablet into two to reduce next-day drowsiness is because the medication has proven effective for this patient and has a low side effect profile.

It would not be appropriate to discontinue Trazodone and prescribe sonata as it poses the risk of complex sleep behaviors. Additionally, it would not be prudent to prescribe hydroxyzine as it may cause anticholinergic side effects the following morning, including Xerostomia and Xerophthalmia. In situations where patients are experiencing so many adverse effects from Trazodone, the dose should be reduced from 50 mg to 25 mg daily. Because insomnia is not a viral ailment decreasing the dosage will have no negative consequences, like rendering the virus immune to the prescription, hence lowering the medication’s efficacy (Jaffer et al., 2017).

In terms of expected outcomes as a result of the decision, I anticipated that facilitating sleep hygiene would improve sleep activity and retain a daily sleep/wake schedule, allowing for productivity. Furthermore, it was expected that by retaining the dose, the cumulative impact on depression would be reduced, leading to de-escalation.

In terms of the ethical considerations that may concern the patient’s care, it is apparent that confidentiality would decide whether or not a sleep hygiene strategy is implemented to improve the patient’s mood Psychopharmalogical Approaches to Treat Psychopathology

Conclusion

Insomnia, described as a subjective sense of trouble initiating and maintaining sleep, is one of the most pressing issues confronting society today. Nevertheless, its appropriate treatment is dependent on the form and degree of the condition. Behavioral therapies are the most often used treatments for insomniacs. Even so, based on the intended outcome, different therapies and drug therapies can be considered in the case where pharmacotherapy is entailed. In this situation, the client’s insomnia was most definitely caused by stress and depression related to the loss of his fiancée.

Benzodiazepines are not a better substitute medication for the client since he was still an alcoholic. Furthermore, the client was engaged in work practices and was forced to wake up early enough to be at his workplace. As a result, using medications with a half-life of more than 8 hours may be inappropriate, as they may trigger daytime drowsiness. Therefore, the prescription of trazodone presented an appropriate medication option (Michael et al., 2017). Following up on the drug and changing the dosage as needed to help the patient recover is crucial in the management of insomnia. The prescription of these drugs, on the other hand, necessitates careful examination of the client’s lifestyle as well as other key literature. The type of medication prescribed to the client is determined by a number of variables, including the medication’s half-life, mechanism of action, and ideal efficiency duration Psychopharmalogical Approaches to Treat Psychopathology

References

Greiner, T., Schneider, M., Regente, J., Toto, S., Bleich, S., Grohmann, R., & Heinze, M. (2018). Priapism induced by various psychotropics: A case series. The World Journal of Biological Psychiatry, 20(6), 505-512. https://doi.org/10.1080/15622975.2018.1520396

Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., … & Ishak, W. W. (2017). Trazodone for insomnia: a systematic review. Innovations in clinical neuroscience, 14(7-8), 24. https://pubmed.ncbi.nlm.nih.gov/29552421/

Kornum, B. R., Knudsen, S., Ollila, H. M., Pizza, F., Jennum, P. J., Dauvilliers, Y., & Overeem, S. (2017). Narcolepsy. Nature Reviews Disease Primers, 3(1). https://doi.org/10.1038/nrdp.2016.100

Park, S. M., Ryu, J., Lee, D. R., Shin, D., Yun, J. M., & Lee, J. (2016). Zolpidem use and risk of fractures: a systematic review and meta-analysis. Osteoporosis International, 27(10), 2935-2944. https://doi.org/10.1007/s00198-016-3605-8

Shah, T., Deolanker, J., Luu, T., & Sadeghi-Nejad, H. (2021). Pretreatment screening and counseling on prolonged erections for patients prescribed trazodone. Investigative and Clinical Urology, 62(1), 85. https://doi.org/10.4111/icu.20200195

Yi, X. Y., Ni, S. F., Ghadami, M. R., Meng, H. Q., Chen, M. Y., Kuang, L., … & Zhou, X. Y. (2018). Trazodone for the treatment of insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep medicine, 45, 25-32. https://doi.org/10.1016/j.sleep.2018.01.010 

Decision tree instructions

The Assignment: 5 pages

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature Psychopharmalogical Approaches to Treat Psychopathology.

Introduction to the case (1 page)

  • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples Psychopharmalogical Approaches to Treat Psychopathology

    ORDER YOUR PAPER HERE

Decision #3 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

  • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

 

Link to decision tree

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_11/index.html

Decision Point One

 

Trazadone 50-100mg daily at bedtime

Decision Point Two

Select what you should do next:

Explain that priapism is a side effect of trazadone that should diminish over time. Continue dose

Decision Point Three

Select what you should do next:

Continue dose. Explain to patient he may split the 50mg tablet in half. The decreased dose should minimize next-day drowsiness. Follow up in 4 weeks Psychopharmalogical Approaches to Treat Psychopathology