The Assignment
Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Psychopharmacologic Approaches to Treatment of Psychology Essay
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients. Psychopharmacologic Approaches to Treatment of Psychology Essay
Psychopharmacologic Approaches to Treatment of Psychology
Introduction
The case study is about Mr. Akkad, a 76-year-old Iranian man, who presented for assessment with the son. The son reported that the client was having a “strange behavior”, forgetful, speech problems, and his personality had changed drastically, and he had lost interest in religious activities and was critical of everybody. The MMSE score for this client was 18/30. The diagnosis for this client is major neurocognitive disorder due to Alzheimer’s disease (presumptive). This paper will discuss treatment decisions for this client and conclude by discussing the ethical considerations likely to influence his treatment plan.
Decision Point One
The selected decision is for the client to start Aricept 5 mg orally during BEDTIME. This decision was selected because cholinesterase inhibitors such as Aricept are the first-line treatment options for neurocognitive disorders and Alzheimer’s disease. Since Alzheimer’s disease is characterized by low levels of acetylcholine in the brain; Aricept works by improving the cholinergic function by hindering the breakdown of acetylcholine. This improves the transmission of synapses within the brain and thus improving cognitive functions such as the memory (Kandiah et al., 2017). The decision to start rivastigmine 1.5 mg orally was not selected because, for major neurocognitive disorder, rivastigmine TD patch is recommended and not oral rivastigmine. Similarly, Razadyne (galantamine) was not selected because galantamine is not recommended in major neurocognitive disorder (Cummings et al., 2015).
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By selecting Aricept for this client, it was expected that the cognitive performance, functioning, and behavior of this client would improve. This is due to the mediation’s efficacy in improving cholinergic function and thus improving both cognitive functions and normal functioning (Kandiah et al., 2017).
Nonetheless, the condition for the client remained the same as per the son’s report. The client remained disinterested in religious activities, manifested disinhibited behaviors and the MMSE score was 18/30 with deficits in memory, orientation, attention, registration, and calculation. The lack of symptom improvement can be attributed to the fact that the effect of Aricept in stabilizing symptoms is gradual and thus can take several weeks before symptom improvement (Mathys, 2018).
Decision Point Two
The second decision is to increase Aricept to 10 mg orally. This decision was chosen because studies indicate an increased dose of cholinesterase inhibitors such as Aricept results in increased efficacy during the treatment of Alzheimer’s Disease. Aricept manifests a dose-dependent effect on cognitive function, functioning, and the ability to perform daily activities (Su et al, 2015). Psychopharmacologic Approaches to Treatment of Psychology Essay
Increasing Aricept to 10 mg expected that the increased dose would lead to symptom improvement for this client. This would manifest through improved cognitive function and the ability to function normally manifested by the client resuming the religious activities and reduced disinhibited behaviors. An increased dose of Aricept is associated with increased efficacy (Su et al., 2015). The decision to discontinue Aricept and start galantamine was not selected because galantamine is indicated for mild or moderate neurocognitive disorders. On the other hand, the decision to discontinue Aricept and start memantine was not selected because memantine PO (capsules) is the recommended form in the treatment of major neurocognitive disorder (Cummings et al., 2015).
As expected, the client manifested symptom improvement as exhibited by him resuming attendance of religious activities. This demonstrates that the higher dose of Aricept was effective in improving symptoms for this client (Su et al., 2015). There were no reported side effects with the increased dose and thus the client is tolerating the increased dose.
Decision Point Three
The third decision is to continue with Aricept at 10 mg orally. This decision was chosen because the dose of Aricept 10 mg seems to be effective in symptom improvement as indicated by the client starting to attend religious services. The decision to increase Aricept to 15 mg was not selected because with the Aricept 10 mg the client is already manifesting symptom improvement, without any side effect. An increased dose Aricept could lead to the client being unable to tolerate the higher dose and thus experience side effects. According to Khoury et al (2018), higher doses of cholinesterase inhibitors like Aricept are associated with risky side effects. The decision to discontinue Aricept and start Namenda was not selected because with the choice of Aricept at 10 mg, the client is already manifesting symptom improvement and tolerating the medication as well. Psychopharmacologic Approaches to Treatment of Psychology Essay
By selecting the decision to continue with Aricept at 10 mg orally, it was hoped that the client would continue manifesting symptom improvement. This is due to the ability of Aricept to improve cognitive functions and the ability to perform daily functions in people with neurocognitive disorders (Su et al., 2015). It is also expected that the client would continue tolerating the dose and thus he will not experience side effects with the Aricept 10 mg.
Ethical Considerations
The ethical issues likely to influence the treatment of Mr. Akkad include informed consent, decision-making ability, and confidentiality issues. The cognitive impairment for this client can interfere with his ability to comprehend the available treatment options. Therefore, Mr. Akkad may not be able to make logical judgments about his treatment and thus he might not be able to give informed consent for his treatment or make treatment decisions (Fields & Calvert, 2015). Moreover, impaired cognitive functioning also necessitates the need to involve a third party such as the client’s son in his treatment plan. The PMHNP should make sure that medical information is not revealed to any unauthorized person (Fields & Calvert, 2015).
Conclusion
The first decision was to start Aricept 5 mg orally because the efficacy of this medication in improving cholinergic function and thus improving cognitive function in neurocognitive disorders has been demonstrated. With the first decision, the client did not manifest any symptom improvement and therefore the second decision was to increase the dose to Aricept 10 mg. Increased doses of Aricept have increased efficacy. The increased dose of Aricept 10 mg improved symptom for the client and thus the third decision was to maintain the current dose of Aricept 10 mg. The ethical aspects likely to influence the treatment of the client include informed consent, decision-making ability, and confidentiality issues.
References
Cummings, J. L., Isaacson, R. S., Schmitt, F. A., & Velting, D. M. (2015). A practical algorithm for managing Alzheimer’s disease: what, when, and why? Annals of clinical and translational neurology, 2(3), 307–323. https://doi.org/10.1002/acn3.166.
Fields L & Calvert J. (2015). Informed consent procedures with cognitively impaired patients: A review of ethics and best practices. Psychiatry and Clinical Neurosciences, 1(69), 462–471.
Kandiah N, Pai M, Looi I, Ampil E, Park K, Karanam A & Christopher S. (2017). Rivastigmine: the advantages of dual inhibition of acetylcholinesterase and butyrylcholinesterase and its role in subcortical vascular dementia and Parkinson’s disease dementia. Clin Interv Aging. 1(12), pp: 697–707.
Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic advances in drug safety, 9(3), 171–178. https://doi.org/10.1177/2042098617750555.
Mathys M. (2018). Pharmacologic management of behavioral and psychological symptoms of major neurocognitive disorder. The mental health clinician, 8(6), 284–293. https://doi.org/10.9740/mhc.2018.11.284.
Su J, Liu Y, Liu Y & Ren L. (2015). Long-term effectiveness of rivastigmine patch or capsule for mild-to-severe Alzheimer’s disease: a meta-analysis. Expert Rev Neurother, 15(9),1093–1103.
Psychopharmacologic Approaches to Treatment of Psychology Essay