• Week 3: Problem-Focused SOAP Note

During the course, you have done a thorough analysis of a company and the health care subsector in which the company operates now is the time to look at all your findings and insights and frame the situation of the company in terms of cost, access, and quality. Specifically:

1. Are there any major cost-containment policies or practices from private insurers or the government that affect your company? Are there any internal/ competitive forces that are trying to do the same?
2. How does your company (and industry) is assessed in terms of its ability to offer access to all populations?
3. What kind of quality assessment and assurance is done? Are there any positive or negative stories about the quality of health care services of the organization?

this is in correspondence with the goals and objective of the previous work. the one you did,

Summary of strengths:

Opportunities for growth:

Now, write three to four (3–4) possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described in the Learning Resources.

I need plagiarism minimized, good references and medical words. the paper follows correct APA format, valid references (more than 4)

·

· Review your Clinical Skills Self-Assessment Form you submitted and think about areas for which you would like to gain application-level experience and/or continued growth as an advanced practice nurse. How can your experiences in the practicum help you achieve these aims?  

· Review the information related to developing objectives provided in this week’s Learning Resources. Your practicum learning objectives that you want to achieve during your practicum experience must be: 

· Specific  

· Measurable  

· Attainable  

· Results-focused  

· Time-bound

· Reflective of the higher-order domains of Bloom’s taxonomy (i.e., application level and above)  

Note: Please make sure your objectives are individualized and outlined in your Practicum Experience Plan (PEP). While you may add previous objectives to continue to work toward. You must have 3 new objectives for each class, each quarter. 

· Discuss your professional aims and your proposed practicum objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site.  

· Select one nursing theory and one counseling/psychotherapy theory to best guide your clinical practice. Explain why you selected these theories. Support your approach with evidence-based literature.

· Create a timeline of practicum activities that demonstrates how you plan to meet these goals and objectives based on your practicum requirements.

THE ASSIGNMENT

Record the required information in each area of the Practicum Experience Plan template, including 3–4 
measurable practicum learning objectives you will use to facilitate your learning during the practicum experience.  

Advanced Psychopharmacology and Health Promotion

Unit 7 Discussion
Peer Response. Medications for Psychosis and Schizophrenia Related Disorders 600W. APA. 4 references due 10-20-23.

Instructions:

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

JS1

Which antipsychotics are considered first-generation, and why are they used less often than second-generation antipsychotics? Are second-generation antipsychotics more effective?

The first-generation antipsychotic (FGA) medications include chlorpromazine, fluphenazine, droperidol, loxapine, haloperidol, pimozide, perphenazine, thioridazine, prochlorperazine, thiothixene, and trifluoperazine. FGA drugs exert their therapeutic effects by antagonizing dopamine (D2) receptors, specifically addressing the positive symptoms associated with schizophrenia. According to Chokhawala & Stevens, 2023), first-generation antipsychotics are considerably more likely to elicit extrapyramidal movements (i.e., tardive dyskinesia) than second-generation and are thus used less commonly. Second-generation antipsychotic (SGA) medicines have antagonistic effects on the D2 receptor but are often called serotonin-dopamine antagonists. There is also some evidence to suggest that antipsychotics of the second generation provide better symptom management than those of the first generation (Chokhawala & Stevens, 2023). The efficacy of second-generation antipsychotics in addressing the negative symptoms of schizophrenia surpasses that of first-generation antipsychotics, while also demonstrating use in managing the positive symptoms of the disorder.

Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics.

Tardive dyskinesia (TD) is a collection of involuntary, repeated movements resulting from disrupting or blocking dopamine receptors. Involuntary motions may range from akathisia and dystonia to buccolingual stereotypy and myoclonus to chorea and tics (Paudel et al., 2023). There is currently no therapy available for TD. However, there are a variety of therapy methods available for reducing symptoms. While other drugs may also contribute to TD, conventional antipsychotics are the most common culprits. Paudel et al. (2023) provide a cautious estimate that around 5% of individuals experience TD annually when on conventional antipsychotics. Statistically speaking, older people have a far greater incidence rate.

Tardive dyskinesia, athetosis, acute dystonia, and tics are all instances of involuntary movements, as stated by Paudel et al. (2023). Repetitive muscular contractions, known as tics, often affect only one part of the body and are sometimes suppressed. Acute dystonia is characterized by sustained, repeated muscular contractions typically triggered by an intentional activity. Slow, writhing motions are characteristic of athetosis, often affecting the arms and hands.

References

Chokhawala, K., & Stevens, L. (2023). Antipsychotic medications. In StatPearls [Internet]. StatPearls Publishing. 
https://www.ncbi.nlm.nih.gov/books/NBK519503
Links to an external site.

Paudel, S., Donovan, A. L., Petriceks, A., Vyas, C. M., Van Alphen, M. U., & Stern, T. A. (2023). Drug-Induced Abnormal Involuntary Movements: Prevalence and Treatment. The Primary Care Companion for CNS Disorders, 25(3), 47041. 
https://www.psychiatrist.com/pcc/effects/drug-induced-abnormal-involuntary-movements-prevalence-and-treatment/
Links to an external site.

SY-2

Which antipsychotics are considered first-generation and why are they used less often than second-generation antipsychotics? Are second-generation antipsychotics more effective?

Both first-generation antipsychotics and second-generation antipsychotics are used for the treatment of psychiatric disorders such as schizophrenia. First-generation antipsychotics, also known as typical antipsychotics, such as phenothiazines (perphenazine, prochlorperazine), and butyrophenones (haloperidol) are classified by their chemical structure (Chokhawala, 2023). Whereas second-generation antipsychotics also known as atypical antipsychotics such as risperidone, olanzapine, quetiapine, aripiprazole, and clozapine are classified based on pharmacological proprieties (Chokhawala, 2023).

First-generation antipsychotics tend to be used less often than second-generation antipsychotics due to their long list of adverse effects that include extrapyramidal side effects, anticholinergic side effects (dry mouth, urinary retention, constipation), prolonged QT intervals, sedation, as well as the rare but fatal neuroleptic malignancy syndrome (Chokhawala, 2023). In comparison, second-generation antipsychotics have a decreased risk of extrapyramidal side effects but are associated with weight gain and metabolic syndrome, therefore patients should be monitored for diabetes, dyslipidemia, and weight gain (Chokhawala, 2023). Although second-generation antipsychotics tend to be the drug of choice when it comes to treating psychiatric disorders, and this is mainly due to the less severe side effects, this does not necessarily indicate that it is more effective. A study done by Fabrazzo et al. (2022) showed that second-generation antipsychotics showed no clear evidence of their effectiveness on cognitive deficit, however, it did prove to be more effective than first-generation antipsychotics in treating negative symptoms, relapse-free survival, and hospitalization rate.

Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics.

 Tardive Dyskinesia 
(TD) is a disorder characterized by repetitive movement such as facial and tongue movement, tongue protrusion, facial grimacing, chewing, and quick, jerking limb movements. These movements are involuntary and can range in severity (slight tremor to full body movement) thus, making daily function difficult. Its main cause is long-term use of antipsychotics, and this disorder tends to be irreversible (Bergman & Soares-Weiser, 2018).

Acute Dystonia is a neurological symptom characterized by muscle contractions that cause repetitive movements by arms, legs, neck, face, or abnormal posture (Stahl, 2022). The cause of this reaction is due to a dopaminergic-cholinergic imbalance in the basal ganglia (Lewis, 2023). Early intervention can prevent the onset and development of dystonia and neurological damage and treatments include benzodiazepines, baclofen, muscle relaxants, and dopamine depletes (VMAT-2 inhibitors) (Bledsoe et al., 2020).

Akathisia and Tics syndromes are seen in patients treated with D2 blockers and are characterized by inner restlessness and mental unease (Stahl, 2022). Akathisia is a neuropsychiatric syndrome characterized by the inability to remain still and it typically involves the lower extremity (Patel, 2023). Tics on the other hand such as Tourette syndrome are neurodevelopmental disorders characterized by motions, noise, and words and are involuntary (Jones, 2023).

References

Bergman, H., & Soares-Weiser, K. (2018). Anticholinergic medication for antipsychotic-induced tardive dyskinesia. 
Cochrane Database of Systematic Reviews, 
2018(1). https://doi.org/10.1002/14651858.cd000204.pub2

Bledsoe, I. O., Viser, A. C., & San Luciano, M. (2020). Treatment of dystonia: Medications, neurotoxins, neuromodulation, and rehabilitation. 
Neurotherapeutics, 
17(4), 1622–1644. https://doi.org/10.1007/s13311-020-00944-0

 Chokhawala, K. (2023, February 26). 
Antipsychotic medications. StatPearls – NCBI Bookshelf. 
https://www.ncbi.nlm.nih.gov/books/NBK519503/Links to an external site.

Fabrazzo, M., Cipolla, S., Camerlengo, A., Perris, F., & Catapano, F. (2022). Second-Generation Antipsychotics’ Effectiveness and Tolerability: A Review of Real-World Studies in Patients with Schizophrenia and Related Disorders. 
Journal of Clinical Medicine, 
11(15), 4530. https://doi.org/10.3390/jcm11154530

Jones, K. S. (2023, May 8). 
Tourette syndrome and other TIC disorders. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK499958/

Lewis, K. (2023, May 1). 
Dystonic reactions. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK531466/#:~:text=An%20acute%20dystonic%20reaction%20is,to%20abnormal%20movements%20or%20postures.

Stahl, S. M. (2021). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).

Patel, J. (2023, July 24). 
Akathisia. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK519543/#:~:text=Akathisia%20is%20defined%20as%20an,usually%20involves%20the%20lower%20extremities.