This article covers a reflection about Fundamentals of neurotransmission as it relates to prescribing psychotropic medications for clients with acute and chronic mental health conditions.
Instructions
Unit 8 Discussion – Reflection
Please respond to the following questions based upon these course objectives:
- Understand and be able to articulate the fundamentals of neurotransmission as it relates to prescribing psychotropic medications for clients with acute and chronic mental health conditions.
- Discuss major categories of psychotropic drugs, their rationale for use, mechanisms of action, common side effects, and drug interactions.
- Discuss evidence to support and the appropriate use of complementary alternative medications in patients that are experiencing acute and chronic mental health conditions seeking adjunctive or monotherapy treatment while considering cultural and genetic factors as well as patient values.
- Utilize clinical assessment tools associated with diagnosing and prescribing for psychiatric disorders and begin to utilize these tools in clinical settings to assist with diagnosis and treatment of chronic mental health conditions.
- Propose psychotherapeutic medication for selected patients keeping in mind safety concerns while utilizing knowledge of current mental health, medical concerns, age, gender, cultural factors, genetic factors, ethical concerns, patient values, and prescriptive authority impact decision making.
- Utilize research and provide basic diagnostic and psychopharmacology education to your client and his/her family when prescribing.
- Understand ethical and legal considerations and controversies in the current pharmacological treatment of mental health patients.
Please answer the following questions with supporting examples and full explanations.
- For each of the learning objectives, provide an analysis of how the course supported each objective.
- Explain how the material learned in this course, based upon the objectives, will be applicable to the professional application.
Provide evidence (citations and references) to support your statements and opinions. Responses to these questions are due by Tuesday at 11:59 AM.
All references and citations should in APA format.
Solution
Unit 8 Discussion-Reflection : Fundamentals of neurotransmission as it relates to prescribing psychotropic medications for clients with acute and chronic mental health conditions
Healthcare services providers acknowledge that the prevalence mental disorders and diseases presents a major public health issue. Significant mental diseases and conditions like depression, bipolar disorder and schizophrenia consume a major budgetary allocation of the national, state and local government besides that of insurers and the patient together with their family.
The National Institute of Mental Health reports that neuropsychiatric disorders remain a major cause of disability with estimates indicating that 1 in 5 adults has some form of mental illness. Research also indicates that the Covid- 19 pandemic has pushed the prevalence to 29 % (Winkler et al., 2020). As such, we as nurses have a central role to play in promoting the health of our clients. Most importantly, one must not lose focus of the fact that a health care personnel competence is founded on one’s education and the knowledge and skills it provides.
Guided by this amongst other motivations, I enrolled in the Advanced Psychopharmacology and Health Promotion Course at Hertzing University. The other is that the enactment of the Affordable Care Act in 2010 offers millions of Americans access to healthcare. Many of us who work in the mental health profession do support the expansion on the Mental Health Parity and Addiction Equity Act of 2008 as we endeavor to provide mental health care that is of high quality and treatment.
The reflection also examines how the materials learned in this course will be applied in general psychiatry and specifically by the psychiatric nurse practitioners.
Learning Objective 1: Understand and be able to articulate the fundamentals of neurotransmission as it relates to prescribing psychotropic medications for clients with acute and chronic mental health conditions.
The topic on neuroscience with its assigned readings like Stahl’s essential psychopharmacology and memorable psychopharmacology were quite informative for me right from the beginning of the course to the very end. A host of videos that we watched and used as part of discussion like Neuroanatomy Made Ridiculously Simple to mnemonics on the stem of the brain, four lobes of the brain all the way to introduction and neurotransmitters came in handy when it comes to helping the student achieve the set objective.
The course also had requirements that necessitated one to visit websites like The Anatomy of Your Brain and Unit 1 discussion where the student is accorded the chance to interact with peers in a very engaging manner. Unit 1 assignments on synchronous learning activity, portfolio on neuroanatomy and neurotransmission chart compression sharped my research skills.
Other course topics that significantly contributed to my achieving objective one was the discussion on mood stabilizers and this reflection on the same in the eighth and last unit of this course.
Learning Objective 2: Discuss major categories of psychotropic drugs, their rationale for use, mechanisms of action, common side effects, and drug interactions.
In addition to the assigned readings of Units 1, 3, 4, 6, & 8, I had the opportunity to conduct other electronic searches that yielded scholarly articles detailing the criteria and rationale used to categorize psychotropic substances like the ATC classification (Rao & Andrade, 2016). Put simply A stands for the anatomic site of action e.g. the CNS, T represents the therapeutic indication (e.g. treatment of MDD) while C refers to the chemical class of the drug (e.g. SSRIs or SNRIs).Another is the NbN system that utilizes four supplemental dimensions past basic pharmacology like approved indications, efficacy and side effects, practical note and neurobiology.
I have to admit that I found the discussion responses and initial posts on bipolar disorder treatment of mood stabilizers versus antipsychotics refreshing as they gave the divergent stands and points of views on the psychiatric nurse practitioners. The same can be said of chronic pain and the prevalence of prescription opioids addiction.
Learning Objective 3: Discuss evidence to support and the appropriate use of complementary alternative medications in patients that are experiencing acute and chronic mental health conditions seeking adjunctive or monotherapy treatment while considering cultural and genetic factors as well as patient values.
The third objective was optimally addressed by Unit 7 where we dealt with crisis management, adverse reactions, complementary and function medicine. Completing the portfolio charts and exploring the assigned case study did more than just presenting me with a simulated like clinical scenario.
As I reflect on how the course topic reinforced and enhanced the achievement of learning objective 3, it is worth noting that literature demonstrates that tranquilizer misuse is linked to alcohol and illicit drug problems and issues on mental health in university students (Grant et al, 2020). This made me reflect on the high- stress occupation that nursing is due to excessive workloads, overtime, and rotating shifts that lead to some nurses abusing drugs and alcohol.
Learning Objective 4: Utilize clinical assessment tools associated with diagnosing and prescribing for psychiatric disorders and begin to utilize these tools in clinical settings to assist with diagnosis and treatment of chronic mental health conditions.
Comprehensively going through the assigned readings on Neuroscience (1), Mood disorders and mood stabilizers(3),depression and antidepressants(4) and chronic pain and addictions(6) was instrumental in ensuring that the advanced practitioner in PMHNP rightly helps to close the existing knowledge gap and help plug the shortage of specialist nurses who have selected psychiatry as their specialty.
There was the case study of a 47 year old woman diagnosed with depression and anxiety and having comorbidities of hypertension and diabetes. The patient also had poor lifestyles as she was smoker. Devising a suitable treatment plan also sharpened my knowledge and skills in psychiatric nursing practice (Grinchii & Dremencov, 2020).
The successful achievement of the fifth learning objective in my considered opinion could not have been possible without a thorough understanding and masterly of at least half of the course units. While these units were namely 2, 3, 5 and 6, the limited scope of this reflexive essay makes me select Unit 2 topics of psychosis, schizophrenia and antipsychotics for further exploration.
Watching the videos on a brief introduction to psychosis, antipsychotics, schizophrenia simulation and the one on schizophrenia: causes, symptoms, diagnosis, treatment and pathology left a mark in me in a major way. By watching the videos, I believe I can adequately propose psychotherapeutic medication for the patients in contexts.
Suffice it to say that the selection of the best drug to use would be informed by several other factors that include age, gender, ethical concerns, genetic factors, cultural factors and patient values (Soltis- Jarrett, 2020). Other factors that would also dictate the clinical decision that I make are the prescriptive authority of the state where I practice in so that my patients receive evidence based treatment that is patient focused.
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Learning Objective 6: Utilize research and provide basic diagnostic and psychopharmacology education to your client and his/her family when prescribing.
According to Sarikhani et al (2020) the use of existing research findings in the provision of fundamental diagnostic and psychopharmacological education provides constitutes the backbone of evidence based treatment and practice in nursing.
Therefore almost all of the course units had a component that required the student to incorporate current research findings relevant to the case in context. The nurse practitioner is reminded that patient education addressing their condition or illness holds the key to better patient outcomes and improved quality of life.
Learning Objective 7: Understand ethical and legal considerations and controversies in the current pharmacological treatment of mental health patients
The centrality of ethics in psychiatric research and the legal considerations that a psychiatric specialist nurse is underpinned by the fact that of the eight units only units 1, 3 and 4 did not explicitly address ethics in their design.
As Shobhit et al (2017) note several issues relating to psychiatric disorders call for the protection of rights of persons with mental illness. For example cultural psychiatrists use explanatory models of illness like the moral model, psychosocial stress model, magical/supernatural model, religious model, and medical model to account for variations in beliefs on causation of psychiatric disorders.
While doing the assignment on complementary and alternative medicine, the issue of ethics was paramount as the practitioner has got to factor in the ethics of prescribing say ginseng herbal medicine for depression. If it the patient’s preference, the practitioner has a responsibility of highlighting the benefits and drawbacks of herbal medicine use so that the patient makes an informed decision.
How the Materials Learned in this Course will be Applicable in PMHNP Practice
In general terms, the contents of the course are bound to have ready application in the field of the science of psychiatry and psychiatry practice. This is because all nurses are trained and taught right from their introductory courses of nursing education that for nursing practice to be relevant and beneficial to the patient it has to be holistic and individual- centered.
Subsequently, the care offered must at all times be designed in ways that meet the biological, psychological, social, and spiritual needs of the those seeking nursing and healthcare services. Most importantly, the advance practice registered who has selected psychiatric mental health regard the patient as whole being whose needs must be addressed at all levels.
Conclusion
As I bring my reflection on Advanced Psychopharmacology and Health Promotion course to a conclusion, I cannot help but settle on the contemporary movement dubbed Whole Health Care or Behavioral Health Integration in addressing the psychological, behavioral and physical health care needs of my patients.
As PMHNPs we must be prepared to not only offer independent and autonomous mental health care but also be ready to work in interprofessional health care team headed by a psychiatrist. Doing so would allow psychiatrists more time to devote to patients presenting with more complex cases and higher acuity and therefore improve the delivery of quality treatment that is patient-based in the care continuum.
References
Grant, J. E., Lust, K., & Chamberlain, S. R. (2019). Sedative/Tranquilizer Misuse is Associated with Alcohol and Illicit Drug Problems, Mental Health Issues, and Impulsivity and Compulsivity in University Students. Journal of addiction medicine, 14(3), 199.
Grinchii, D., & Dremencov, E. (2020). Mechanism of Action of Atypical Antipsychotic Drugs in Mood Disorders. International Journal of Molecular Sciences, 21(24), 9532.
Jain, S., Kuppili, P. P., Pattanayak, R. D., & Sagar, R. (2017). Ethics in psychiatric research: issues and recommendations. Indian journal of psychological medicine, 39(5), 558-565.
Rao, T. S., & Andrade, C. (2016). Classification of psychotropic drugs: Problems, solutions, and more problems. Indian journal of psychiatry, 58(2), 111.
Sarikhani, Y., Bastani, P., Rafiee, M., Kavosi, Z., & Ravangard, R. (2020). Key barriers to the provision and utilization of mental health services in low-and middle-income countries: a scope study. Community mental health journal, 1-17.
Soltis-Jarrett, V. (2020). Integrating behavioral health and substance use models for advanced PMHN practice in primary care: Progress made in the 21st century. Archives of Psychiatric Nursing, 34(5), 363-369.
Winkler, P., Formanek, T., Mlada, K., Kagstrom, A., Mohrova, Z., Mohr, P., & Csemy, L. (2020). Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys. Epidemiology and psychiatric sciences, 29.
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