Read a selection of your colleagues’ responses and respond to at least two of your colleagues who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

You are required to include at least two evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6th edition formatting.

Respond to this

#1

I chose the 8-year-old with ADHD.  ADHD, or attention deficit hyperactivity disorder, has three main categories: inattention, impulsiveness, and hyperactivity. The pathophysiologic basis for ADHD is thought to be abnormalities in the dopaminergic and noradrenergic neurotransmission systems.” (Block et al., 2019, p. 1). Although a person may have symptoms of ADHD, other problems must be ruled out before a diagnosis like depression, learning disabilities, undetected seizures, or hearing and vision problems. A person with ADHD is said to have ADHD in multiple settings such as school, work, home, and at play.

The first decision I made to treat this patient was to start Ritalin at a low dose.  Since this improved the patient’s performance at the beginning of the day but kind of “wore off” as the day went on, it made sense to increase it. She was tolerating it well physically and saw benefits. The medication was then increased, which she continued to tolerate. The dose was then kept there as she was much improved, and the EKG was stable, so the patient is to re-evaluate in 4 weeks.

As noted prior, abnormalities are seen in the dopaminergic and noradrenergic neurotransmission systems in those with ADHD. “Methylphenidate has both dopamine and noradrenaline transporter‐binding affinity and binds to and blocks both transporters, leading to increased availability of noradrenaline and dopamine within the synaptic cleft.” (Storebo et al., 2018, p. 9). The prefrontal cortex is responsible for function and with the increased firing rate of dopamine and noradrenaline neurotransmission the patient’s function improves and symptoms become better controlled. According to Arnsten (2006), Methylphenidate has been found to improve response inhibition, spatial working memory, set-shifting, and other prefrontal cognitive functions in both children and adults with ADHD and ‘normal’ college students. (p. 2380). There will be improved attention and focus, which in turn helps with academic learning and concentration.

Ritalin is a stimulant. This does not mean it makes the child more stimulated; rather it makes different parts of the brain work activity and better together.  Because the medication stimulates the CNS, side effects can include insomnia and decreased appetite, causing weight loss. A part of the treatment plan will be to take the medication after or within a certain amount of time of the morning meal. This medication works fast within 30-60 minutes. A protein shake can be included daily if a meal is missed due to no appetite. “Cardiovascular effects occur secondary to release of NE from the sympathetic neurons.” (Rosenthal & Burchum, 2021, p. 248). The child’s pulse should be monitored and reported if the rate is 100 beats per minute or more frequently.

Thank you,

References

Arnsten, A. (2006). Stimulants: Therapeutic Actions in ADHD. Neuropsychopharmacol. 31, p.

2376-2383. https://doi.org/10.1038/sj.npp.1301164

Block, R.W., MD, Macdonald, N.E., PhD, & Piotrowski, N.A., PhD. (2019). Attention deficit

hyperactivity disorder (ADHD). Magill’s Medical Guide (Online Edition).

Stein M., (2020). Sleep and ADHD Medication Use: A Clinician’s Guide to Mitigating Side

Effects in Children. Attitude for Professionals.

Rosenthal, L.D. & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice

nurses and physician assistants (2nd ed). St. Louis, MO: Elsevier

Storebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B.,

Moreira-Maia, C. R., Magnusson, F. L., Holmskov, M., Gerner, T., Skoog, M., Rosendal, S.,

Groth, C., Gillies, D., Buch Rasmussen, K., Gauci, D., Zwi, M., Kirubakaran, R., Håkonsen,

S. J., Aagaard, L., … Gluud, C. (2018). Methylphenidate for attention deficit hyperactivity

disorder (ADHD) in children and adolescents – assessment of adverse events in non-

randomised studies. The Cochrane database of systematic reviews, 5(5), CD012069.

https://doi.org/10.1002/14651858.CD012069.pub2

Respond to this

Great added discussion

I appreciate you discussing the many signs and symptoms of depression that may be visible in your patient.  Care must be taken when treating depression in the elderly population.  Avoiding those drug classes that would cause more harm than good in your patient is very important.  There are some antidepressants that may cause drowsiness so determining when to prescribe, morning or bedtime, is also very important especially in the elderly population as you do not want to increase their risk of falls.

Tina, another very important point to note is that often times depression may be overlooked in the elderly population because of other comorbidities that may exist.  As providers, it will be vital for you to identify those hidden diagnosis that sometimes require certain questions to be asked.  Office visits should be scheduled with enough time to have those discussions with your patients.  As well, there are many screening tools that may assist with determining the diagnosis of major depression.  There is a Geriactric Depression Scale (GDS) that is specifically designed for older adults but may be used in younger adults as well (Halverson, 2019).  The key is to listen for those sign and symptoms of depression that sometimes go unnoticed.

Tina, you did mention that you would consider using amitriptyline for your patient if they failed therapy with an SSRIs.  Why should use caution with this medication in the elderly population?  Also, could you discuss further evidence for the use of lithium as an option to treat depression in your patient?

Halverson, J. (2019). Depression. Medscape. Retrieved from  https://emedicine.medscape.com/article/286759-overview?

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