Respond to 2 posts Respond to at least two of your colleagues on two different d

Respond to 2 posts
Respond to at least two of your colleagues on two different days in one of the following ways:
If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective. Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days.
Student- Yoandra Gallardo:
Additional History
“Can you describe how your sleep habits have changed since the passing of your husband?” – This question helps to gather more specific information about the patient’s insomnia, including the onset, duration, and nature of sleep disturbances. Insomnia can present in different forms and subtypes, with each subtype having a possibly varied effect on the patient (Levenson et al., 2015).
“How has the loss of your spouse affected your overall mood and daily functioning?” – This question explores the patient’s emotional response to her husband’s death and assesses the impact on her mental well-being. The answer can help provide context and a relationship between the patient’s loss of husband, depression, and insomnia.
“Are you currently experiencing any social support or engaging in activities that bring you comfort or joy?” – This question aims to assess the patient’s social support system and coping mechanisms after the loss of her spouse. It helps determine if she has adequate emotional support and if she is participating in activities that can potentially improve her mood and overall well-being. Top of Form
Bottom of Form
Additional History from the Patient Circle
 Adult Children:
How has your mother been coping with the loss of her spouse since his passing? This question helps gather insights into the patient’s emotional well-being and adjustment.
Have you noticed any changes in her sleep patterns or insomnia symptoms? The child can provide context in the onset and patterns of insomnia and depression if they are in constant contact with their mother.
Does she frequently discuss her feelings or concerns about her emotional health with you? This question helps gauge the patient’s level of communication regarding her mental well-being.
 Siblings:
Have you observed any changes in her behavior, mood, or daily activities? Such input can help provide more details on the patient’s depressive symptoms.
Does she engage in any activities or seek support from family or friends? This question helps assess the patient’s social engagement and support network within the family.
 Neighbors:
How often do you interact with the patient, and have you noticed any changes in her behavior or mood since her husband’s passing? Positive answers can lead to whether the neighbor can be included as part of the patient’s support system.
Has she mentioned any difficulties with sleep or expressed concerns about her emotional well-being? This question aims to gather information about the patient’s self-disclosure of her symptoms to her neighbors.

Physical Exams
Vital signs: Assessing blood pressure, heart rate, and temperature would inform general health and the possible impact of insomnia and depression on the patient’s general health.
Assessment of Depression Severity: Utilize validated depression assessment scales such as the PHQ-9 (Patient Health Questionnaire-9) to evaluate the severity of depression symptoms and monitor changes over time (Levis et al., 2019).
Diagnostic Tests
Thyroid panel: Depressive symptoms can result from psychological and pathological causes. One of the notable causes is hypothyroidism. Hypothyroidism can contribute to depressive symptoms and sleep disturbances (Boland et al., 2022). This diagnostic test will be used to rule out any thyroid disorder as an underlying cause of depression.
Differential Diagnosis
Adjustment Disorder with Depressed Mood: This diagnosis involves a maladaptive reaction to a significant life stressor, such as the loss of a loved one, resulting in depressive symptoms (American Psychiatric Association, 2022). The patient’s history of no previous episodes of depression before her husband’s death supports this possibility.
Bereavement-Related Sleep Disorder: While this is not a typical diagnosis in the DSM-V manual, severe and persistent grief can cause insomnia and sleep disorder (Lancel et al., 2020). The patient’s chief complaint of insomnia following her husband’s death aligns with this diagnosis.
Possible working diagnosis
Major Depressive Disorder (MDD): The patient’s persistent depressive symptoms, lack of improvement over time, and the absence of previous depressive episodes may suggest MDD (American Psychiatric Association, 2022).
Pharmacologic Agents
Sertraline:
Dosing: The typical starting dose for sertraline in the treatment of depression is 50 mg orally once daily, which can be increased gradually as needed and tolerated, up to a maximum of 200 mg/day.
Mechanism of Action: Sertraline selectively inhibits the reuptake of serotonin (5-HT) in the brain, thereby increasing the availability of serotonin neurotransmitters (Stahl, 2021).
Venlafaxine:
Dosing: Venlafaxine’s immediate-release formulation is typically initiated at 37.5 mg orally twice daily (Stahl, 2021).
Mechanism of Action: Venlafaxine inhibits the reuptake of both serotonin and norepinephrine, resulting in increased levels of these neurotransmitters in the brain.
Most possible choice
Sertraline: According to Funk et al. (2020) Sertraline has the best cardiovascular outcomes and is not significantly associated with QT abnormalities. Furthermore, the therapeutic potency of Sertraline is better than Venlafaxine (American Psychological Association, 2019).
Contraindications
Sertraline should not be used among patients with seizures or bipolar disorder (Stahl, 2021). The drug is associated with serotonergic syndrome and hence might exacerbate seizures.
Check Points and Therapeutic Changes
Sertraline takes 2-4 weeks to begin its therapeutic effect (Stahl, 2021). Following the patient after four weeks is rational to monitor symptoms and adverse effects.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
American Psychological Association. (2019). Guideline development panel for the treatment of depressive disorders, clinical practice guideline for the treatment of depression across three age cohorts. https://www.apa.org/depression-guideline
Boland, R., Verdiun, M., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Lippincott Williams & Wilkins.
Funk, M. C., Beach, S. R., & Bostwick, J. R. (2020). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf
Lancel, M., Stroebe, M., & Eisma, M. C. (2020). Sleep disturbances in bereavement: A systematic review. Sleep Medicine Reviews 53, 101331. https://doi.org/10.1016/j.smrv.2020.101331
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179-1192. https://doi.org/10.1378%2Fchest.14-1617
Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ, 365, l1476. https://doi.org/10.1136/bmj.l1476
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.
Post 2 to respond to
Marisela Marisela Reyes
Yesterday Jul 12 at 8:18pm
Marisela Reyes
Main Discussion Post
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
I could question the client, “What brought you in this morning?” as one of my queries. This open-ended question helps build the patient-physician rapport to encourage them to speak freely about her feelings. “What is your daily caffeine consumption rate?” would be my second inquiry in the discussion. Consuming caffeine right before sleep time considerably increases the risk of sleeplessness. The final question would be, “Is there any history of (GERD) Gastro esophageal reflux disease?” In senior adults, GERD causes sleeplessness. Thus ruling out environmental factors while evaluating the patient’s condition.
Identify people in the patient’s life you would need to speak to or get feedback from to assess the patient’s situation further. Include specific questions you might ask these people and why.
Her caregivers and children are the people in the patient’s life who could offer further details and assistance. Questions like “Does she depict any recent decrease in interests, appetite, mood, or energy?” are suitable because of their constant touch before admission to the facility. The queries make it easier to obtain outside data along with further patient evaluations of anything untold.
Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
A physical examination or self-reports could follow blood tests to rule out thyroid issues, as insomnia is frequently caused by hyperthyroidism, which causes uneasiness due to this hormone’s excessive activity (Cook et al., 2018). The Hamilton Anxiety Rating Scale would gauge the patient’s level of anxiety-related insomnia, and the HAM-A scores could assist with future treatment.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
Depression was earlier confirmed for the patient as Generalized anxiety disorder (GAD), brought on by the husband’s demise. The multiple potential shifts in life dynamics include worry over money, solitude fear, the anxiety of passing away, and unexpectedly falling asleep unattended (Farazdaq et al., 2018). Persistent and excessive worry about different issues causes GAD to leave the patients. Struggle to keep their worries under control. The Patient in the scenario meets this differential diagnosis, as the observed insomnia could be due to routine changes.
List two pharmacologic agents and thier dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, explain why you might choose one agent over the other.
Temazepam and trazodone are the two suitable pharmaceuticals for the patient’s antidepressant therapy.                                                                     
For insomnia, trazodone has FDA approval for serious depression treatment and is additionally administered off-label to treat anxiety and sleeplessness (Cook et al., 2018). on the other side, Temazepam is an effective option for insomnia and is thus used off-label for catatonia, anxiety disorders, psychosis, and acute mania (Dell’Osso et al., 2015).
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
Temazepam would work best for this patient considering its shorter half-life, no active metabolites, and no pharmacological interactions, making it an ideal medicine for elderly patients (Farazdaq et al., 2018). Based on the patient’s current drug regimen, with metformin, Losartan, Januvia, Sertraline, and HCTZ, for depression, diabetes mellitus, and hypertension. Temazepam would not make other prescriptions poisonous when added to the pharmaceutical regimen since numerous genes influence sleep.
                                                                                                              References
Cook, B., Creedon, T., Wang, Y., Lu, C., Carson, N., Jules, P., Lee, E., & Alegría, M. (2018). Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse. Drug and Alcohol Dependence, 187, 29-34. https://doi.org/10.1016/j.drugalcdep.2018.02.011 Links to an external site.
Dell’Osso, B., Albert, U., Atti, A. R., Carmassi, C., Carrà, G., Cosci, F., … & Fiorillo, A. (2015). Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice. Neuropsychiatric Disease and Treatment, 1885-1909.
Farazdaq, H., Andrades, M., & Nanji, K. (2018). Insomnia and its correlates among elderly patients presenting to family medicine clinics at an academic center. Malaysian Family Physician : The Official Journal of the Academy of Family Physicians of Malaysia, 13(3), 12-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382090/ Links to an external site.