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Topic: Young Girl with Difficulties in School

The Assignment:

Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

- Decision #1: Differential Diagnosis
  - Which Decision did you select?
  - Why did you select this Decision? Support your response with evidence and references to the Learning Resources. Topic: Young Girl with Difficulties in School
  - 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: Treatment Plan for Psychotherapy
  - 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: Treatment Plan for Psychopharmacology
  - 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 and their families
- LINK FOR DECISION TREE BELOW:
- SAMPLE PAPER DOCUMENT IS ATTACHED

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Assessing and Treating Clients with Dementia

Walden University

Assessing and Treating Clients with Dementia

Alzheimer’s diseaseis a mental disorder that progressively leads to brain cells destruction and becoming non-responsive. Destruction of brain cells brings about dementia as the patient fails to think properly, control behavior, or engage in social activities. Hence, a patient undergoing Alzheimer’s experiences dementia and cannot do common human activities alone and loses control of body functions and abilities. For instance, a patient may experience similar effects of Parkinson’s disease where a person’s limbs shake (Meltzer et al.,2010).Alzheimer’s disease causes brain cells to become wasted away limiting one from cognitive activities, in turn, leading to dementia (Alzheimer’s Association, 2018). Dementia is the loss of functionality of brain activities. A patient with dementia fails to do at least two brain functions, especially in making good judgment and in retaining memory. For most patients, dementia due to Alzheimer’s disease leads to paraphasia, loss of appetite, and experiencing difficulty with skilled movement. Management of dementia due to Alzheimer’s is possible. To prove this, I will review a case of an elderly Iranian man with Alzheimer’s disease, where I applied the use of three consecutive decisions involving drug therapies. In each decision, I will illustrate the reason for choosing the decision,impact the client’s pharmacokinetic and pharmacodynamic processes, what I wanted to achieve, differences between what happened and what I wanted to achieve, and ethical considerations one makes in treating the patient with dementia due to Alzheimer’s. Topic: Young Girl with Difficulties in School

Decision 1

Decision I chose was beginning with Razadyne (galantamine) 4 mg orally BID. I chose Razadyneto assist in easing some of the symptoms the patient was experiencing. Since the patient had Alzheimer’s that constitutes dementia, treatment was meant to focus management of symptoms. Use of Razadyne was for improving nerve cells’ communication as a way of increasing functionality of neurotransmitters (Nakagawa et al., 2017). Based on pharmacokinetics of Razadyne, use of the drug is for neurotransmitters to reactivate acetylcholine. Reason for using Razadyne was to reactivate acetylcholine that deals with memory processes, learning, and thinking. Since the patient was experiencing loss of nerve cells because of Alzheimer’s destroying them, production of acetylcholine was not happening.According to Bui (2012),this explains why the patient may have a behaviorthat shows easy agitation, aggressive, lack of restraint, wandering off aimlessly, restlessness, meaninglessly talking, and change in personality. Psychologically patients experience depression, experiences, hallucinations, and paranoia (Meltzer et al.,2010). Upon patient return after four weeks, I realized that patient continues to be disinterested in attending religious practices and exhibiting disinhibited behavior. By testing his primary deficits scores, he had 18 out of 30, proving that his brain was still deteriorating. Deterioration of his brain proved why the patient could not maintain attention, make calculations recall, register, and become oriented. Worsening of patient condition could be a result of insufficient utilization of the drug. The son of the patient may have given up on administering Razadyne,leading to the persistence of his father’s condition. Therefore, indicating the difference of what I expected in four weeks from how the patient was upon return.

Decision 2

The decision I went for was discontinuing Razadyne and initiating the useof Aricept (donepezil) 10 mg orally daily. Use of the Aricept was to slow downthe deterioration of cognitive abilities (Food and Drug Administration, 2020). Since limitingthe progression of Alzheimer’s isimpossible, I focused on treating symptoms. I also used Aricept as an approved medication for treating demetia. By using Aricept, I wanted to ensure the patient does not undergo brain deterioration leaving the patient lacking ways of depending on himself. Using an acceptable dosage of 10mg orally daily meant that the half-life of Aricept was going to take three days. By taking Aricept daily, half-life would not be reached. Hence, the elderly Iranian patient would have a maintained dosage in his blood system to limit the loss of cognitive abilities. Moreover, drug clearance in his system was bound to take longer since he is male. Aricept being a cholinesterase inhibitor, the intentionfor using the drug was limitingthe destruction of acetylcholine by Alzheimer’s disease (Food and Drug Administration, 2020). Acetylcholine retention was to help in nerve cells’ communication, promoting what the patient would remember, learn, how he would behave without getting agitated or depressed.

Upon return, in four weeks,the patient was experiencingnausea, diarrhea, and vomiting, which are cholinomimetic effects. The cholinomimetic effects were side effects of using Aricept as a cholinesterase inhibitor (Food and Drug Administration, 2020). Cholinesterase being the enzyme family in central nervous system that catalyzes the hydrolysis of Cholinesterase, is a family of enzymes present in the central nervous system, particularly in nervous tissue, muscle, and red cells, which catalyze the hydrolysis of the acetylcholine to become choline and acetic acid. As a result, the reaction in the patient was to ensurethe cholinergic neuron is activated to assist in message transportation in the brain. The reason why Aricept did not work for elderly Iranian man could have been due to a lack of consistency in the use of the drug. Exposure to toxicity of the drug for an elderly man would have meant the liver was not functioning in the extraction of Aricept in the blood.Thus, exposure to cholinesterase inhibitors such as Aricept and previously Razadyne also explains why the patient underwent the side effects. Topic: Young Girl with Difficulties in School

Decision 3

Decision I selected was discontinuation from Aricept and restarting the patient onRazadyne at 4 mg orally BID. Reason behind my decision to go back to using Razadyne was based on side effects that came with use of Aricept. Also, use of Razadyneis based on limiting manifestation of dementia that was leading to a patient having impaired reasoning, being forgetful, and not interacting normally by applying social skills as indicated by Meltzer et al.(2010). By prescribing Razadyne, cognitive abilities of a patient with dementia such as confusion about time, delusion, disorientation, lack of concentration, hallucination, forgetfulness, inability to do simple arithmetic, and failure to recognize common things would be avoided. As a result, the patient would maintain their ability to make new memories from daily experiences. Going back to usingRazadyne was based on ensuring the patient maintainshis awareness of surroundings. Being aware of his surrounding means the patient would have better memories and continue being active, socially reducing speeds of brain deterioration. A difference between what I expected to achieve by the third decision and the results I got was lack of the patient not strictly adhering to taking Razadyne. Since there were many instances of the patient becoming violent and aggressive, I believe the son got frustrated in giving his dad the medication as prescribed. Not following the prescription meant that the patient would end up not maintaining required levels of Razadyne to inhibit Cholinesterase and lead to hydrolysis of the acetylcholine to become choline and acetic acid. This was the process was the one responsible for promoting message transmission in the brain.

Ethical considerations involved in the treatment plan for patient were based on preventing side effects on the patient (Bennett et al., 2017). For instance, patient undergoing cholinomimetic effects was not part of the treatment plan. Another ethical issue waslimiting how it is not affected by toxins in the drug leading to liver failure. Since Razadyne takes 70 days to undergo half-life in blood, continuous usage meant that patient was vulnerable to adapt to the drug having no effect on him.

In summary, a communication plan for the elderly Iranian man with Alzheimer’s disease would focus oncreating awareness of how the son would handle his dad’s condition.I would educate the son on how to interact with his father as a way of maintaining his father’s sanity. Also, allowing his father to engage in physical activities, listen to music, read to him, and interact with his surrounding would assist in activating the patient’s cognitive abilities.

References

Alzheimer’s Association. (2018). 2018 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 14(3), 367-429.

Bennett, B., McDonald, F., Beattie, E., Carney, T., Freckelton, I., White, B., & Willmott, L. (2017). Assistive technologies for people with dementia: ethical considerations. Bulletin of the World Health Organization, 95(11), 749.

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from

Food and Drug Administration. (2020). Clinical Pharmacology Review of Aricept. Accessdata.fda.gov. Retrieved 6 August 2020, from .

Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a Serotonin2A Receptor Inverse Agonist, for the Treatment of Parkinson’s Disease Psychosis. Nature.com. Retrieved 6 August 2020, from .

Nakagawa, R., Ohnishi, T., Kobayashi, H., Yamaoka, T., Yajima, T., Tanimura, A., Kato, T., & Yoshizawa, K. (2017). Long-term effect of galantamine on cognitive function in patients with Alzheimer’s disease versus a simulated disease trajectory: an observational study in the clinical setting. Neuropsychiatric disease and treatment, 13, 1115–1124.