#1 Hi LA,

Thank you for your post. Your post is exciting and highly educative.  I enjoyed reading it, and I learned a lot from it. Escitalopram (Lexapro) is an SSRIs and a good option for treating your patient. It is used to treat depression, anxiety disorder, and other mental health disorders. It works by increasing the amount of Serotonin, a natural substance in the brain. A professional must consider several factors when selecting an effective assessment tool, including the validity and reliability of the instrument, cost-effectiveness, and the device's advantages and disadvantages. (American Psychiatric Association 2013) The test's results ought to be trustworthy and precise concerning the standards they are gauging. The supplier needs to consider how good the test will be. The adverse effects of the drug should be discussed with the patient before being given to her to give her autonomy over her treatment. The beneficence principle mandates that treatment alternatives be chosen with the patient's best interests in mind (Barra, S., Turner, D., Müller, M., Hertz, P. G., Retz-Junginger, P., Tüscher, O., Huss, M., & Retz, W. 2020).

 

References

(1). American Psychiatric Association. (2013). Schizophrenia Spectrum and Other Psychotic Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: Author. https://doi-org.ezp.waldenulibrary.org/10.1176/appi.books.9780890425596.dsm02  

(2). Barra, S., Turner, D., Müller, M., Hertz, P. G., Retz-Junginger, P., Tüscher, O., Huss, M., & Retz, W. (2020). ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders. European Archives of Psychiatry and Clinical Neuroscience. https://doiorg.ezp.waldenulibrary.org/10.1007/s00406- 020-01181-4

 

#2,Hi LA,

Thank you again for participating for this week’s discussion.  The additional resources for your patient should be health promotion and patient education. The patient should avoid stress; alcohol and other drugs can help to prevent manic episodes López-Muñoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018).. Recommendations include consistent routines, a healthy diet, regular exercise, and enough rest. It can lessen mild mood swings, leading to more severe manic episodes. The patient is instructed to recognize and treat the earliest signs and symptoms of manic and depressive illness. Keeping a journal of their experiences and emotional shifts over time might be helpful for patients. Particular strategies, such as boosting one's self-worth, taking charge of one's life, and asking for help, can help to lessen stigma and improve outcomes.

References

(1). López-Muñoz, F., Shen, W. W., D’ocon, P., Romero, A., & Álamo, C. (2018). A history of the pharmacological treatment of the bipolar disorder. International journal of molecular sciences, 19(7), 2143.

(2).  Meyers, M. R., PhD. (2019). Conduct disorders. Salem Press Encyclopedia of Health

#3, Hello

Thank you for your post. I feel for your client and am glad she is seeking help. People suffering with Post Traumatic stress disorder (PTSD) it is not easy to live with as it can take a toll on all aspects of their life. I agree with your preceptor’s diagnosis and treatment options. PTSD is the most common mental health disorder that develops from sexual assault, and symptoms include intrusive thoughts, memories, flashbacks, and negative emotions (Mahoney et al., 2021). Central serotonin and its transporters are involved in mood and fear modulation after stress, and selective serotonin reuptake inhibitors (SSRIs) are used in treating depression and PTSD (Lin et al., 2016). Escitalopram (Lexapro) is commonly prescribed and FDA-approved to treat PTSD by blocking the serotonin reuptake pump/transporter, boosting the neurotransmitter serotonin, and increasing serotonergic neurotransmission to reduce symptoms of PTSD (Stahl, 2017). I wonder if F.N. can benefit from Prazosin for her nightmares; how is her sleep? Is F.N. getting enough sleep or waking up from nightmares? 

 

Reference

Lin, C.-C., Tung, C.-S., & Liu, Y.-P. (2016). Escitalopram reversed the traumatic stress-induced

depressed and anxiety-like symptoms but not the deficits of fear memory. Psychopharmacology, 233(7), 1135–1146. https://doi.org/10.1007/s00213-015-4194-5

Mahoney, C. T., Lynch, S. M., & Benight, C. C. (2021). The Indirect Effect of Coping Self-

Efficacy on the Relation Between Sexual Violence and PTSD Symptoms. Journal of Interpersonal Violence, 36(21/22), 9996–10012. 

Stahl, S. M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide (6th ed.). Cambridge University Press.

Discussion Board Reply 1 to Rasheed

#4, Hi GO,

thank you for sharing your case study about this challenging case. When managing PTSD, Escitalopram is considered an off-label use of this medication, and the efficacy may not be as high as others (Qi et al., 2017). You also mentioned that the patient did not do well on both Zoloft and Prozac, two other SSRI medications that are known for treating PTSD. Since the patient had previously failed two SSRI trials, I would consider another medication to manage the symptoms, such as Effexor. Effexor has been shown to significantly improve the signs and symptoms associated with post-traumatic stress disorder as compared to a placebo in trials (Huang et al., 2020). For, I personally would have attempted to use Effexor over Escitalopram especially considering the patient had failed previous SSRIs.

Now, this does not mean that your instructor was incorrect in prescribing this medication. There is more than one way to diagnose and treat patients. Understanding the patient's full history can help a clinician to make a better sound judgment for medication management. The use of Escitalopram for PTSD is just considered an off-label use meaning that it has not shown the same efficacy as other drugs like Effexor. I would also combine this with non-pharmacological approaches likesychotherapy with trauma-focused cognitive behavioral therapy as it is shown to have significant improvements in meeting efficacy and treatment plans for managing PTSD (Watkins et al., 2018). Bose, I wanted to thank you for sharing this case study with us; it was very informative and educational. I look forward to seeing the rest of your work throughout this semester.

 

References

Huang, Z.-D., Zhao, Y.-F., Li, S., Gu, H.-Y., Lin, L.-L., Yang, Z.-Y., Niu, Y.-M., Zhang, C., & Luo, J. (2020). Comparative efficacy and acceptability of pharmaceutical management for adults with post-traumatic stress disorder: A systematic review and meta-analysis. Frontiers in Pharmacology, 11. 

Qi, W., Gevonden, M., & Shalev, A. (2017). Efficacy and tolerability of high-dose escitalopram in posttraumatic stress disorder. Journal of Clinical Psychopharmacology, 37(1), 89–93. 

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating ptsd: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12.