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Week 10 Discussion: Influencing Social Change

Week 10 Discussion: Influencing Social Change

Week 10 Discussion: Influencing Social Change, NURS6630

Therapy for Clients with Dementia

In so many countries, to be old is shameful; to be mentally ill as well as old is doubly shameful. In so many countries, people with elderly relatives who are also mentally ill are ashamed and try to hide what they see as a disgrace on the family.
—Dr. Nori Graham, psychiatrist and honorary vice president of Alzheimer’s Disease International

In this quote, Dr. Graham is expressing her observations and experiences in her work with numerous international organizations. Many patients and their families experience feelings of anxiety and shame upon receiving a diagnosis of dementia. Lynda Hogg, an Alzheimer’s patient, shares her feelings that “some people don’t want to be associated with someone with an illness affecting the brain” (Alzheimer’s Disease International, 2012). As a psychiatric mental health nurse practitioner providing care to clients presenting with dementia, it is critically important to consider the impact of these disorders on clients, caregivers, and their families. A thorough understanding of the health implications of these disorders, as well as each client’s personal concerns, will aid you in making effective treatment and management decisions.

This week, you explore strategies to become a social change agent for psychiatric mental health. Then, as you examine the assessment and treatment of clients with dementia, you also consider related ethical and legal implications.

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Discussion: Influencing Social Change

Individuals with psychiatric mental health disorders are frequently stigmatized not only by society as a whole, but also by their friends, family, and sometimes healthcare providers. In your role, however, you have the opportunity to become a social change agent for these individuals. For this Discussion, consider how you might make a positive impact for your clients and advocate for social change within your own community.

Learning Objectives

Students will:

  • Apply strategies to become a social change agent for psychiatric mental health
Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings
  1. Angermeyer, M. C., Matschinger, H., & Schomerus, G. (2013). Attitudes towards psychiatric treatment and people with mental illness: Changes over two decades. The British Journal of Psychiatry, 203(2), 146–151. Retrieved from http://bjp.rcpsych.org/content/203/2/146.full
  2. Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html
  3. Note: Retrieved from from the Walden Library databases.
  4. Dingfelder, S. F. (2009). Stigma: Alive and well. American Psychological Association, 40(6), 56. Retrieved from http://www.apa.org/monitor/2009/06/stigma.aspx
  5. Jenkins, J. H. (2012). The anthropology of psychopharmacology: Commentary on contributions to the analysis of pharmaceutical self and imaginary. Culture, Medicine and Psychiatry, 36(1), 78–79. doi:10.1007/s11013-012-9248-0

Note: Retrieved from from the Walden Library databases. Week 10 Discussion: Influencing Social Change

Note: Retrieved from from the Walden Library databases.

Optional Resources

  1. Bennett, T. (2015). Changing the way society understands mental health. National Alliance on Mental Illness. Retrieved from http://www.nami.org/Blogs/NAMI-Blog/April-2015/Changing-The-Way-Society-Understands-Mental-Health
  2. Mechanic, D. (2007). Mental health services then and now. Health Affairs, 26(6), 1548–1550. Retrieved from https://web.archive.org/web/20170605094514/http://content.healthaffairs.org/content/26/6/1548.full
  3. Rothman, D. J. (1994). Shiny, happy people: The problem with “cosmetic psychopharmacology.” New Republic, 210(7), 34–38.

To prepare for this Discussion:

  • Reflect on how you might influence social change for psychiatric mental health.

BY DAY 3

  • Post an explanation of how you, as a nurse practitioner, might become a social change agent for psychiatric mental health. Include how you might advocate for change within your own community.

Assignment: Assessing and Treating Clients With Dementia

The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia.

Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.Week 10 Discussion: Influencing Social Change

To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

  • For insomnia
    • donepezil
    • galantamine
    • memantine
    • rivastigmine
  • Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

  • Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf

Required Media

  • Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

  • Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.
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.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

At each decision point stop to complete the following:

Decision #1

  1. Which decision did you select?
  2. Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  3. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  4. Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

  1. Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  2. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
  3. Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

  1. Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  2. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  3. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  4. Also include how ethical considerations might impact your treatment plan and communication with clients.

Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

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