Address the following Short Answer Questions. Be sure to include references to the Learning Resources below.
QUESTIONS
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.  Short Answer Questions in Psychiatry Essay Example

Short-Answer Questions in Psychiatry

Q1.

There is appropriate pharmacotherapy for those patients who present with major depressive disorder (MDD) and a history of alcohol abuse. That is those patients with co-occurring MDD and alcohol use disorder AUD (APA, 2013). The appropriate medications include sertraline (Zoloft), escitalopram (Lexapro), and citalopram (Celexa); whose timeframe for resolution of symptoms (onset of therapeutic actions) is 2-4 weeks (Stahl, 2017). According to DeVido and Weiss (2012), the contraindicated medications in this case include bupropion (Wellbutrin) because it lowers the seizure threshold; and duloxetine (Cymbalta) because of heightened hepatotoxicity in those with liver dysfunction secondary to chronic alcohol use.

Q2.

Generalized anxiety disorder or GAD is a chronic disorder that causes significant disability as well as mortality. Studies have shown that late-onset incident GAD has some specific risk factors or predictors. Four (4) predictors of late onset generalized anxiety disorder are (Zhang et al., 2015):

1. The female gender
2. Chronic physical disorders such as heart disorders, dyslipidemia, respiratory disorders, and cognitive impairment.

• Recent adverse life events such as the loss of a partner or another close family member.

1. Chronic mental disorders such as phobias, past generalized anxiety disorder, and depression amongst others.   Short Answer Questions in Psychiatry Essay Example
   

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Q3.

Psychotic major depression is depression that is accompanied by psychotic symptoms such as hallucinations and delusions (APA, 2013). Four (4) potential neurobiological causes of psychotic major depression include (Stahl, 2013; APA, 2013):

1. Genetics or heredity: The passage of a defective gene from parents to the offspring.
2. Epigenetics: The alteration of the physical structure of a gene by non-genetic influences, such as in DNA methylation or the addition of a methyl group.

• The presence of particular biomarkers for psychotic major depression: These are objectively measured signs of psychotic major depression from a neurobiological standpoint.

1. Physiology: Chemical imbalances in the brain, including that of active neurotransmitters.

Q4.

A DSM-5 diagnosis of major depression must fulfil the requirement of symptoms occurring for at least a period of two weeks. Five of these symptoms needed for the diagnostic criteria to be fulfilled are (APA, 2013):

1. A significantly reduced interest in pleasurable or day-to-day activities.
2. A mood that is depressed for a large part of the day, almost daily.
3. Weight loss that is noticeably significant.
4. Either hypersomnia (excessive sleepiness) or insomnia (lack of sleep) almost on a daily basis.
5. Having feelings of inappropriate guilt or a sense of worthlessness.

Q5.

Insomnia has been defined as getting insufficient sleep in terms of both quality and quantity (Levenson et al., 2015). Three of the classes of pharmacotherapy agents that are known to pharmacodynamically precipitate the problem of insomnia are (Stahl, 2017; Morgenthaler et al., 2007):

• Selective serotonin reuptake inhibitors or SSRIs (for instance, sertraline or Zoloft and fluoxetine or Prozac).
• Psychostimulants (for instance, modafinil or Provigil).
• Amphetamines (such as methamphetamine).

References

DeVido, J.J., & Weiss, R.D. (2012). Treatment of the depressed alcoholic patient. Current Psychiatry Reports, 14(6), 610-618. http://dx.doi.org/10.1007/s11920-012-0314-7

Levenson, J.C., Kay, D.B., Buysse, D.J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179-1192.  https://doi.org/10.1378/chest.14-1617

Morgenthaler, T.I., Kapur, V.K., Brown, T.M., Swick, T.J., Alessi, C., Aurora, R.N., Boehlecke, B., Chesson Jr., A., Friedman, L., Maganti, R., Owens, J., Pancer, J., Zak, R., and AASM (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin: An American Academy of Sleep Medicine report. SLEEP, 30(12), 1705-1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf

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

Stahl, S.M. (2013). Stahl’s essential Psychopharmacology: Neuroscientific basis and practical application, 4^th ed. Cambridge University Press.

Zhang, X., Norton, J., Carrière, 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(e536), 1-8. http://dx.doi.org/10.1038/tp.2015.31   .  Short Answer Questions in Psychiatry Essay Example