NURS 6630 Therapy for Patients With Dementia and Comorbid States

NURS 6630 Therapy for Patients With Dementia and Comorbid States

NURS 6630 Therapy for Patients With Dementia and Comorbid States

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6630 Therapy for Patients With Dementia and Comorbid States

As a psychiatric nurse practitioner, you will frequently work with patients across the life span who may also have comorbid conditions. For instance, you may treat a 16-year-old female with Down syndrome and increasing violent behaviors; a middle-aged male with schizophrenia, diabetes, and poor lung function; or an older adult with a mental disorder, Stage 1 Alzheimer’s disease, and chronic heart disease (CHD). In cases like these, you must draw from foundational knowledge of pathophysiology and collaborate with other healthcare providers to ensure optimal safety and efficacy of psychopharmacologic therapies for patients.

This week’s case discussion focuses on Major Depressive Disorder co-occurring with Alcohol Abuse. Major depressive disorder is a common type of mental illness that is currently increasing in prevalence. It is a major cause of morbidity and mortality among the population. Alcohol abuse frequently crops up for a patient to adapt to a stressful, depressing, anxious state or any other unpleasant state. Alcohol abuse is maladaptive behavior. Co-occurrence of Major Depressive Disorder and alcohol abuse poses a threat to an individual’s health and significantly increases the risk of death among these patients. The purpose of this paper is to discuss the neurobiological causes, symptomatology, drug therapy of MDD co-occurring with alcohol abuse, predictors of late-onset generalized anxiety disorder, and the classes of drugs that precipitate insomnia.

Explain the Drug Therapy of a Patient Who Presents with MDD and a history of Alcohol Abuse

The treatment of these patients ideally requires a multifaceted approach involving psychosocial treatment in conjunction with the pharmacotherapeutic approach to treatment. This kind of treatment has been deemed the most efficacious in controlling symptomatology and preventing a relapse. In the drug therapy, the Selective Serotonin Reuptake Inhibitor Sertraline at a dosage of 200mg per day and naltrexone at 100mg per day is the combination of choice. They are highly efficacious in the extinction of depression symptoms, preventing relapse, and reducing symptoms of alcohol withdrawal (McHugh, 2019). These drugs are given for fourteen weeks with regular check-ups during this period. Treatment takes as long as five years for the complete resolution of symptoms in slow responders. Acamprosate and escitalopram have also been shown to have good outcomes and can be used as an alternative.

NURS 6630 Therapy for Patients With Dementia and Comorbid StatesWhich Drugs Are Contraindicated? Be Specific.

Tricyclic antidepressants such as mirtazapine, bupropion, and nortriptyline are contraindicated in the setting of

MDD and Alcohol abuse co-occurrence as they potentiate the sedative effect of alcohol. They affect judgment and coordination. Benzodiazepines such as Lorazepam and Diazepam are contraindicated due to their sedative effect, cognitive degradation, diminished long-term efficacy, and their cross-tolerance with alcohol.

What is the Timeframe for Resolution of Symptoms?

Symptom resolution takes place from fourteen to twenty-three days. This range is mostly possible with patients who have abstained from alcohol, are adherent to medication, and receive psychological treatment. Complete symptom resolution takes as long as five years as some patients are slow responders to therapy.

List Four Predictors of Late Generalized Anxiety Disorder

The main predictors of late-onset GAD include the presence of a chronic physical disorder like HIV/AIDS, chronic bronchitis, congenital cardiac anomalies, and Cardiac arrhythmias among others (Hellwig & Domschke, 2019). The presence of a chronic mental illness like the depressive state. Female gender. The recent loss of a close person, poverty, and the presence of a mental illness among the parents.

List Four Potential Neurobiological Causes of Psychotic Major Depression

Genetic mutations on the short arm of the serotonin transporter, Monoamine oxidase A receptor, and glucocorticoid receptor gene mutations have been highly implicated in the development of Psychotic Major Depression (Dubovsky et al., 2020). Inauspicious childhood experiences cause a disturbance in the hypothalamic-pituitary axis leading to the increased production of cortisol hormone which is usually elevated in periods of stress. Hypercortisolemia is an important trigger in the structural changes in the amygdala and the prefrontal cortex. The interaction between chronic stress and genetic mutations is a major factor in psychotic depression (Croarkin, 2018). Discrepancies in the neurotransmitter dopamine in the nigrostriatal pathway are an important tenet of psychotic depression as seen in dementia and schizophrenia.

List Five Symptoms Required for an Episode of Major Depression

The criteria for diagnosis of MDD is hinged on the occurrence of all three lack of interest in things previously found interesting, anergia, and a depressed mood lasting not less than two weeks. In addition to these, the presence of any four of reduced concentration, reduced self-confidence, ideas of guilt, disturbances in sleep, reduced appetite, ideations of self-harm, and pessimism confers a diagnosis of MDD.

List three Classes of Drugs that Precipitate Insomnia with an Example from each Class

Insomnia is a common adverse effect of a myriad of drug classes. They include Selective Serotonin Reuptake Inhibitors such as paroxetine, Statins such as atorvastatin, and second-generation H1 Antagonists such as Azelastine.


The co-occurrence of Major Depressive Disorder with Alcohol Abuse is almost always associated with poor outcomes. This calls for a much closer look at the diagnostic confusion and prompt and timely management of these patients. The multifaceted approach to treatment and handling of these patients goes a long way to lower the probability of poor outcomes.


Croarkin, P. E. (2018). Indexing the neurobiology of psychotic depression with resting state connectivity: Insights from the STOP-PD study. EBioMedicine, 37, 32–33.

Dubovsky, Steven L., Ghosh, Biswarup M., Serotte, Jordan C., & Cranwell, V. (2020). Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment. Psychotherapy and Psychosomatics, 90(3), 1–18.

Hellwig, S., & Domschke, K. (2019). Anxiety in Late Life: An Update on Pathomechanisms. Gerontology, 65(5), 465–473.

McHugh, R. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol Research: Current Reviews, 40(1).