w9answer2II

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respond to the topic,(Pregnant women and bipolar depresion) say I agree with what you said for this and for this. and add information that deals with the same thing but is not mentioned in that work, the answers that have an argument…

at least 3 references

Pregnant Women and Bipolar Depression

 

     In this discussion post, I will explain pregnancy in women diagnosed with bipolar disorder (BD), classified as high-risk due to various clinical and pharmacotherapeutic factors.  When giving psychiatric drugs to a pregnant woman, it is very important to carefully weigh the possible effects of psychotropic drug exposure on the unborn fetus against the chance of a bipolar disorder relapse. If bipolar disorder is not treated, it can have detrimental effects on the health of both the mother and the unborn child in the case of a relapse. Access to comprehensive and up-to-date information regarding the safety of preventive medications for bipolar disorder is essential for making informed choices (Singh & Deep, 2022).

It is crucial for healthcare providers to have discussions with patients about psychiatric drugs, including their advantages and disadvantages, both before and during pregnancy, as well as postpartum; however, we will concentrate on pharmacological interventions during pregnancy in general. Even if the patient decides not to pursue pharmacotherapy, this choice is still considered a therapeutic option. Most mental health conditions, including postpartum depression, anxiety, bipolar disorder, and schizophrenia, require therapeutic drug management during pregnancy (Creeley & Denton, 2019).

The discontinuation of antipsychotic medication in patients is well documented to increase the likelihood of return of dipolar episodes. This is a significant problem, leading to a higher risk of inadequate peripartum care, suboptimal mother and fetal nutrition, difficulties throughout pregnancy, and postpartum depression. Furthermore, there is a hypothesis suggesting that the dysregulation of the hypothalamic-pituitary-adrenal system, which is linked to untreated depression, may have detrimental impacts on the fetus's health and the child's development (Creeley & Denton, 2019). Another significant concern is that no two expectant mothers with bipolar 1 depression are identical. For example, one patient has a documented record of multiple suicide attempts, while the other has been stable. The patient with a history of suicidal attempts would undoubtedly benefit from psychotropic medication at this juncture.

There is no documented approved FDA first-line drug therapy for pregnant women who are bipolar. However, atypical antipsychotics are used off-label, according to Betcher et al. (2019). Lurasidone is deemed a preferable option for antipsychotic treatment during pregnancy due to its categorization as a Category B medication in the previous pregnant drug classification system. This classification indicates that animal tests did not indicate birth defects.   Regrettably, there is a lack of empirical data regarding the safety or potential hazards of lurasidone in human subjects during pregnancy or lactation (Betcher et al., 2019). Several clinical investigations indicate that lurasidone is tolerable, demonstrating a favorable combination of effectiveness and safety. These antipsychotics are regarded as metabolically favorable. It does not affect weight gain, lipids, or glucose levels. Additionally, it is the only atypical antipsychotic proven not to induce Qtc prolongation and one of the few atypicals that do not have a Qtc warning (Stahl's, 2021).

One thing to keep in mind with pregnant and non-pregnant patients is the metabolic issues that arise from the use of antipsychotics. The physiologic changes that occur during pregnancy, like increased metabolism and a subsequent drop in antipsychotic serum levels, are both physiological effects of pregnancy. The amount of medicine in the body decreases during pregnancy because the uridine diphosphate glucuronosyltransferase (UGT) isoenzymes and the cytochrome P450 isoenzymes CYP3A4, CYP2D6, and CYP2C9 become more active. Gaining or losing weight, increasing or decreasing plasma volume, and altering renal clearance affect medication concentrations (Betcher et al., 2019).

The non-pharmacological treatment options for bipolar disorder (BD) in pregnant women include family-focused treatment (FFT), interpersonal and social rhythm therapy, and cognitive behavioral therapy (CBT). These intense psychotherapies have substantial evidence supporting their effectiveness in treating bipolar illness (Chiang & Miklowitz, 2023).  The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study and other psychotherapy studies highlight the significance of psychoeducation as a crucial element in treating bipolar depression. Group treatment that focuses on four clinical issues provides strong evidence for the effectiveness of psychoeducation. These issues include increasing awareness of the condition, promoting adherence to treatment, detecting prodromal symptoms and recurrence early, and encouraging a consistent lifestyle. After 5 years, individuals who underwent structured group psychoeducation experienced a reduction of 75% in the duration of their depressive episodes compared to those who participated in an unstructured support group (Chiang & Miklowitz, 2023).

The presence of bipolar disorder in pregnant and lactating women poses significant hazards to both the mother and the child, necessitating the need for comprehensive management (Graham et al., 2018).  Several guidelines emphasize the importance of carefully weighing the danger of bipolar relapse against the potential harms of psychotropic drugs to the newborn when making decisions about psychotropic therapy for women with bipolar disorder throughout this period.   Still, the study showed that there was not a lot of agreement among the guidelines about how dangerous these drugs might be. This made clinical recommendations and prescribing methods less effective (Graham et al., 2018).

Lastly, the risks and outcomes linked with untreated maternal disorder are as follows if a bipolar-depressive pregnant patient chooses not to use medications: Factors such as low birth weight, small size at birth, preterm birth, and an increased risk of cesarean birth can contribute to various health complications. These complications include small head circumference, hypoglycemia, and an increased risk for long-term neurocognitive, behavioral, and social deficits. Additionally, there is a high postpartum risk for first-onset and recurrent bipolar episodes, hospitalization due to substance use, poor prenatal care, and maternal suicide (Creeley & Denton, 2019). Some antipsychotic medications have harmful effects on pregnant women. For example, Clomipramine can lead to malformations in the fetal cardiovascular system; Valproates can cause birth defects; Carbamazepine can result in spina bifida; and Lithium can be teratogenic and increase the risk of miscarriage (Gruszczyńska-Sińczak et al., 2023).

Psychopathology

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Thinking about what you’ve learned in this course about 

1-    If you had the power to change anything in this class that is assessment related, what would you change and why?

2-    How will the concepts you learned in this class help you in your career? 

The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by Thursday, 11:59 p.m. Eastern Time. Two scholarly sources references are required unless stated otherwise by your professor. 

The student provides a substantive response to the discussion question or topic on Thursday day and posts a minimum of two additional responses to peers on another day(s). The answers to classmates must be posted by Sunday, 11:59 pm Eastern Time. We expect each student to participate in the discussion board in a respectful manner. 

Remember that a new discussion rubric was approved by the professors, committee members, and a majority of the students. Please review the rubric before posting to ensure a maximum of points. 

Here are the categories of the new discussion rubric:

Initial Post relevance to the topic of discussion, applicability, and insight. (20%)

Quality of Written Communication Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)

Inclusion of APNA standards essentials explored in the discussion as well as the role-specific competencies as applicable.(10%)

Rigor, currency,  and relevance of the scholarly references. (Use articles that are below 5 years). (20%)

Peer & Professor Responses. The number of responses, quality of response posts. (20%)

Timeliness of the initial post and the answers to the peers. (10%

PN 3

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Write a 1-2 page paper about some of the Best Practices you have learned about during this course. How will these practices improve patient's outcomes? You must use APA and have at least three references less than three years old to support your choices.

Psychiatrist week 4

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Describe two cognitive techniques and two behavioral techniques. In what types of situations would you choose each?

Two scholarly sources references are required.

Initial Post relevance to the topic of discussion, applicability, and insight. 

  

Quality of Written Communication Appropriateness of   audience and words choice is specific, purposeful, dynamic, and varied.   Grammar, spelling, punctuation. 

  

Inclusion of APNA standards essentials explored in the discussion as     well as the role-specific competencies as applicable

(Use articles that are below 5 years)

Healthcare Resources

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Healthcare resources are scarce, and policy makers and health planners make choices between alternative uses of resources. Economic evaluation is important when allocating scarce resources. Cost–benefit analysis, cost effectiveness analysis, and cost utility analysis are decision-making tools that help policy makers and planners examine healthcare costs and the consequences of alternative health programs, services, and interventions.Prepare at least a 5-page overview of cost effectiveness analysis and cost–benefit analysis as decision making tools in the allocation of health resources.  

pn2 m7 diss

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 Compare and contrast risk factors, age of onset, pathophysiology and clinical manifestations of Type 1 and Type 2 Diabetes. What do you think is the most important topic that must be taught to the diabetic patient and why? 

c

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Criteria

Possible Points

Points Earned

Comments

Title Page:
no running header used,

Title accurately reflects purpose of research, follows APA format, includes your name, course name and number and Dr. Shantelle Smith in the instructor spot

2


Introduction: Identifies
nature & scope of the problem &
significance of conducting the integrated research review
to generate knowledge for nursing practice.

10


Background: Provides
background information,
explains & defines problem, explains
significance &
importance of problem,
defines terms if necessary.

10


Research Problem Statement: Indicates the
gap in knowledge needed for nursing practice &
provides a basis for the study purpose.

10


Research Purpose: Clear concise statement of the specific aim or goal of the study, one sentence.

5


Research Question: Clear, concise interrogative statement, written in present tense, using PICOT format with a nursing focus

5


Research Utilization Model:
Explains the JHNEBP model and how it fits with and can be used for your proposed EBP change.

8


Search Criteria and Results: Includes Data Research Table correctly cited in APA and search terms and results. Includes Literature Review Tables correctly attached and labeled as an Appendix and referenced in this section. General description of types of articles and level of evidence based on the Melnyk rating pyramid.

5


References: Formatted and cited correctly, obtained from Mav Library, includes DOI# or website if no DOI available

10

APA Format

free of spelling and grammatical errors

10

Total Points Earned____________ (out of 75)

This is the first assignment to introduce your PICO(T), scope and nature of the problem, background information of the problem, details regarding your research review, and the Johns Hopkins EBP approach you have taken for your research. This is a “building assignment” as part 1, then next week, part 2 will add to the Final Research Paper Assignment. You do not need to worry about self-plagiarism when continuing to part 2 and so on. If you have taken this course prior to this semester, you may not use any of your previous work from that time.

Assignment Part 1 – 75 possible points. See Assignment Part 1 Rubric and Example paper.

Instructions: Follow APA 7th ed. format and follow Assignment Part 1 Rubric (refer to example paper part 1, which also includes some part 2 components, so please pay attention to the rubric)

1. Use APA 7th ed. Manual or recommend APA template sites listed in content section to set up paper (Chapter 2, APA manual 7th ed.)

2. Write in 12pt font Times New Roman

3. This is formal writing assignment: DO NOT write in first person this means do not use: I statements. Instead, say “the writer or the author” or avoid those altogether by just referring to the components of the paper without the use of these.

4. Include a Title page (Do not use Assignment 1… as your title) The title should not be your entire PICOT but should allow the reader to understand what your Research is about *see example papers in the course You do not need to use a running head for your paper but include page # appropriately placed per APA (refer to Chapter 2 and Section 2.3, 2.4. Figure 2.2).

Example title: Comparison of Pressure Reduction Boots Versus Repositioning to Reduce Pressure Ulcers in the Elderly

5. Write about your topic in paragraph format using headings and subheadings. Use the rubric headings for the headings in each section of your assignment except “Introduction” the heading for the introduction. In 7th ed. APA this is the restatement of your paper title (see APA 7th ed. Section 2.7). I should see bold headings for the following: Background, Research Problem Statement, Research Purpose, Research Question, Research Utilization Model, Search Criteria and Results, and References

6. Here are the categories for your paper as listed on the rubric:

a. Introduction: Identifies nature & scope of the problem & significance of conducting the integrated research review to generate knowledge for nursing practice. I like to write this after I’ve completed the rest of the paper. It’s a synthesis of what you’ve written and what the reader will learn from the paper.

b. Background: Provides background information, explains & defines problem, explains significance & importance of problem, defines terms if necessary. This is the history of the PICOT. What happened prior to 2018 in relation to your PICOT? This is where you can cite “old and non-current” evidence. Go back as far as you need to. You should have literature support in this section.

c. Research Problem Statement: Indicates the gap in knowledge needed for nursing practice & provides a basis for the study purpose. This is the current state of the problem. Why did you choose this PICOT? Don’t use personal or work experiences unless you can support them in the literature. An example would be that there is a need for your PICOT based on the literature that states further research is needed in this area. Back up with literature support in this section.

d. Research Purpose: Clear concise statement of the specific aim or goal of the study, one sentence. This is only one sentence. What do you hope to accomplish in your research of your PICOT question? Typically, we don’t have one sentence paragraphs/section, but it is approved in this instance.

e. Research Question: Clear, concise interrogative statement, written in present tense, using PICOT format with a nursing focus. All you need to do is include your finalized PICOT question. Again, this is a one sentence section, but it is all I’m requiring.

f. Research Utilization Model: Explains the JHNEBP model and application to your PICOT for your proposed EBP change. Include your week 3 assignment in paragraph format. Make sure it flows with your paper. (This section is from your week 3 assignment. Please utilize feedback from me or if you achieved 100%, only revise to flow with the rest of your paper. Make sure to add the references to your Research Review Part 1 reference page.

g. Search Criteria and Results: You should have a paragraph that describes your data search including a general description of types of articles and levels of evidence based on Melnyk’s pyramid, insert the week 4 completed data search table in APA format (how you insert a table into a paper, APA 7th edition manual has instructions in Chapter 7, table 7.1), and you will also reference your week 4 literature review table in this section. The literature review table should be correctly inserted at the end of the paper, per APA formatting, labeled as an Appendix and referenced in this “search criteria and results” section in the paper as a way to guide the reader to look at the appendix. So, the data search table is inserted directly into the Search Criteria and Results section, but the Literature Review Table is inserted as an Appendix at the end of the paper. I will be grading and returning feedback by Tuesday end of day so you have ample time to revise if necessary.

h. References: formatted and cited correctly, all with the exception of 1-2 should be obtained from Mav Library or other reliable source (no .coms, blogs, etc. should be used), includes DOI# or website if no DOI available. To format an APA reference page, please see APA 7th edition manual, chapters 9-10.

Progress note #2

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I need a psychiatric progress note regarding a patient with PPH: of Depression, Anxiety and Insomnia . It cannot be similar, Thank you.

Here below I leave you a sample.

CC: “I feel better in the morning with my medicines “

 Patient is a XXXX  y/o, female with Past Psychiatric History of Depression, Anxiety and Insomnia was seen today on telehealth platform for follow up and medication treatment who alleges getting better with the last treatment of trazodone 50mg at bedtime  and mirtazapine 7.5mg at bedtime, she reports decrease symptoms of sadness ,loneliness, depression , hopelessness, as well as she expresses feeling motivated, optimistic and with more energy in the morning, improve mood, self-esteem and affect because she feels useful ,decreased anxiety and stressing over her personal problems, restlessness, nervousness, as result decreased difficulty falling asleep because sleeping better and more hours at night with her previous treatment the melatonin 5mg at bedtime, also in the morning she waking up rested after a night’s sleep. Patient denies side effects of the medications, suicidal and homicidal ideation, no visual or auditory hallucinations, agitation, psychotic symptoms or paranoia .Follow up in 4 weeks.

KWL (what do you Know, what do you Want to know, what do you want to Learn)

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KWL (what do you Know, what do you Want to know, what do you want to Learn) :

As we get started in this class take a minute to tell me: What do you already know about statistics, what did you learn about statistics, and what do you want to learn more about in statistics?