For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.

Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?
2. List 4 predictors of late onset generalized anxiety disorder.
3. List 4 potential neurobiology causes of psychotic major depression.
4. An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.
5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.

Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.

I have included some of the class resources, can review for the assignment (not required).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

Week 8-solution

1. In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see the resolution of symptoms?

Although major depressive disorders and alcohol abuse frequently co-occur, the efficacy of pharmacotherapy is still not apparent (McHugh & Weiss, 2019). A study was done to see if patients with co-occurring alcohol dependence and depression responded better to naltrexone combined with citalopram than naltrexone alone. The results showed that drugs were generally well tolerated and had good adherence rates (Adamson, 2015). Whether or not additional characteristics were taken into account, there were noticeable improvements in both mood and drinking in both groups, with no discernible differences between the groups on any of the mood or drinking outcome measures. For the independent/substance-induced depression state, there was no interaction impact detected. MDD with co-occurring AUD can be treated with naltrexone alone (Adamson, 2015). Naltrexone taken orally absorbs quickly and starts working within an hour after intake. The 50-mg oral tablet’s effects can continue for 24 to 36 hours. With 100 mg lasting 48 hours and 150 mg lasting 72 hours, greater doses have a longer half-life. After dosage, naltrexone often hits its peak within an hour.(psychopharmacologic treatments Discussion Essay)

2. List four predictors of late-onset generalized anxiety disorder.

As a complex stress-related affective illness, GAD appears to be caused by both proximal and distal risk factors, some of which may be able to be altered by medical intervention. The main predictors of late-onset incident GAD are:

• Gender
• Recent traumatic life events
• Chronic physical (respiratory disorders, arrhythmia, heart failure, dyslipidemia, cognitive impairment) (Zhang et al., 2015).
• Mental (depression, phobia, and past GAD) health conditions.

Additionally, strongly and independently linked to incident GAD is:(psychopharmacologic treatments Discussion Essay)

• Poverty
• Parental death or separation
• A lack of emotional support as a kid
• A parent’s history of mental illness
• Low adequate support during childhood.

1. List 4 potential neurobiology causes of psychotic major depression.

1. 1. Individual changes in a multifaceted signaling system involve the hypothalamic-pituitary-adrenal axis (Kupfer et al., 2016).
   2. Producing growth factors and neurotrophins
   3. Synthesis of proinflammatory cytokines and miRNA expression (Kupfer et al., 2016).
   4. The aberrant administration of gastrointestinal signaling peptides.

1. An episode of major depression is a period lasting at least two weeks. List at least five symptoms required for the episode to occur. Be specific.

A major depressive episode is distinguished by a depressed mood or inability to experience pleasure (anhedonia), or both, for longer than two weeks, along with several cognitive and vegetative symptoms, the incidence of distress or impairment, and other symptoms. A person can be diagnosed with major depressive disorder if they have at least one episode of this nature, without ever having a mania attack (Bains & Abdijadid, 2022). Symptoms required for this episode include:(psychopharmacologic treatments Discussion Essay)

1. Low or depressed mood
2. Anhedonia or decreased interest in pleasurable activities
3. Feelings of guilt or worthlessness
4. Lack of energy, poor concentration
5. Appetite changes
6. Psychomotor retardation or agitation
7. sleep disturbances
8. Suicidal thoughts.

1. List three classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.

1. Selective serotonin reuptake inhibitors, examples including Prozac and Zoloft (Tsai, 2017)
2. Beta-blockers, examples including atenolol and carvedilol
3. Corticosteroid examples include cortisone and methylprednisolone

References

Adamson, S. J., Sellman, J. D., Foulds, J. A., Frampton, C. M., Deering, D., Dunn, A., Berks, J., Nixon, L., & Cape, G. (2015). A randomized trial of combined citalopram and naltrexone for non abstinent outpatients with co-occurring alcohol dependence and major depression. Journal of clinical psychopharmacology, 35(2), 143–149. https://doi.org/10.1097/JCP.0000000000000287

Bains, N., & Abdijadid, S. (2022). Major depressive disorder. In StatPearls [Internet]. StatPearls Publishing.

Kupfer, D. J., Frank, E., & Phillips, M. L. (2016). Major depressive disorder: new clinical, neurobiological, and treatment perspectives. Focus, 14(2), 266-276.

McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol research: current reviews, 40(1), arch.v40.1.01. https://doi.org/10.35946/arcr.v40.1.01

Tsai, S. (2017). Medicines That Can Cause Insomnia. National Jewish Health. https://www.nationaljewish.org/conditions/insomnia/causes/medicines-that-can-cause-insomnia

Zhang, X., Norton, J., Carriere, I., Ritchie, K., Chaudieu, I., & Ancelin, M. L. (2015). Risk factors for late-onset generalized anxiety disorder: results from a 12-year prospective cohort (The ESPRIT study). Translational psychiatry, 5(3), e536-e536.