NUR 631 Topic 7 DQ 1

Sample Answer for NUR 631 Topic 7 DQ 1 Included After Question

Answer the following questions for your discussion response.  Use the format displayed in the “Discussion Forum Sample.”

  1. Explain the neurotransmitter dysfunction in a patient with schizophrenia and bipolar disorders.
  2. How would you recognize symptoms and severity of suicide? What would you do if you have a patient reporting suicidal ideation? How would you handle this and what type of resources would you provide?  From a legal perspective, what are you obligated to do as a provider?

A Sample Answer For the Assignment: NUR 631 Topic 7 DQ 1

Title: NUR 631 Topic 7 DQ 1

Explain the neurotransmitter dysfunction in a patient with schizophrenia and bipolar disorders.

Schizophrenia is a mental health disorder that is characterized by two types of symptoms, positive and negative symptoms. Positive symptoms include the addition of abnormal characteristics such as delusions and hallucinations. Negative symptoms are the absence of characteristics such as amotivation, social withdrawal, and cognitive symptoms. With the clinical research during early use of antipsychotics it was learned that dopamine antagonism was central to their effectiveness. This led to the hypothesis that an over production of dopamine plays a key role in schizophrenia. To date, the first line treatment in schizophrenia operate via dopamine antagonists.

Although it was clear that dopamine played a role in schizophrenia, it did not explain all of the phenomena. Dopamine antagonist are not an effective treatment in the negative and cognitive symptoms. Research has shown that glutamate also plays a role in the pathophysiology of schizophrenia. Glutamate is the major excitatory neurotransmitter of the central nervous system. Research shows that antagonists of a specific glutamate receptor, the N-methyl-D-aspartate (NDMA) receptor, induce psychotic symptoms (McCutcheon, Krystal, & Howes, 2020). 

How would you recognize symptoms and severity of suicide? What would you do if you have a patient reporting suicidal ideation? How would you handle this and what type of resources would you provide? From a legal perspective, what are you obligated to do as a provider?

In their study Hendin, Maltsberger, Lipschitz, Haas, & Kyle (2001) evaluated data from therapists that were treating patients when they committed suicide and identified three factors as markers of suicide crisis. These three factors included: a precipitating event; one of more intense affective states other than depression; and at least one of three behavioral patterns: speech or actions suggesting suicide, deterioration in social or occupational functioning, and increased substance abuse. Precipitating events are major life events that precipitated the patient’s intensive affective response. Examples of these include loss of relationships, collapse of career, illness/loss of a child/family member.

Depression was present in all of the cases of suicide in this study. Other chronic affective states were also identified such as longstanding sense of rejection, chronic hopelessness, loneliness, and self-hatred. Behavioral warning signs were also present. These included speech or action that showed they were contemplating suicide. This is evidenced often by escalating self-mutilating or self-destructive behaviors (Hendin, et. al, 2001). Suicidal ideation requires immediate attention. Ways to decrease the rate of suicide include screening patients for ideation or behaviors, assessing the individual’s current risk of imminent harm, and creating a treatment plan with the patient and their support system.

The World Health Organization recommends that all patients over the age of 10 with any mental health disorder, epilepsy, interpersonal conflict, recent severe life event, or other risk factor for suicide be screened for thoughts or plans to self-harm or attempt suicide. If a person is deemed at risk for suicide, a safety plan should be used. A safety plan includes recognizing the warning signs, identifying and using coping strategies, use of interpersonal support, contact friends or family to help resolve the crisis, contact a mental health provider/agency, and reduce the potential use of lethal means. Evidence has shown that safety plans reduce suicide attempts, completions, depressive symptoms, anxiety, and hopelessness.

An important part of the safety strategy includes the restriction of access to lethal means. If firearms must remain in the home, they should be unloaded, locked, and stored separately from ammunition. Restriction to access to alcohol and drugs are also important and has been shown to reduce suicide rates (Weber, et. al, 2017). Not all patients who report having thoughts of suicide require inpatient admission. While being evaluated for suicidal thoughts, patients should be protected from self-harm. This includes placing the patient in a private room, without access to potentially harmful objects. Providers can then use decision support tools to aid in decision making and documenting the justification of why a mental health consultation is or is not indicated. For those patients with moderate to high suicide risk, psychiatric hospitalization is the typical disposition. Voluntary hospitalization is preferable when possible. If involuntary hospitalization is required, providers should adhere to their state laws that determine who can be committed, lengths of confinement, and other requirements (Betz & Boudreaux, 2017).

McCutcheon, R., Krystal, J., Howes, O. (2020). Dopamine and glutamate in schizophrenia: biology, symptoms and treatment. World Psychiatry, 19(1), 15-33. https://doi.org/10.1002/wps.20693

Hendin, H., Maltsberger, J., Lipschitz, A., Haas, A., Kyle, J. (2001). Recognizing and responding to suicide crisis. Suicide & Life-Threatening Behavior 31(2), 115. Retrieved on June 17, 2023, from https://d1wqtxts1xzle7.cloudfront.net/30486396/sltb_summer01-libre.pdf?1391817175=&response-content-disposition=inline%3B+filename%3DRecognizing_and_responding_to_a_suicide.pdf&Expires=1687017728&Signature=cMfpIf1tTEOJzepvZjiLnFgMTA6vYziPaI2mFCxKWImblgeaBp3AEKhC3HKCmZssjXalD9HVVv4daTDDdrbcZkV2kvJtQi6gDG585cH0yFrvXNy7JetqcVFM6mkb1jKb98rT8qOI~DUdZdLJjZNJkiGSOA9SxMEk4YDZRzqsp5Y0X9njk200MONX2Hyox7gI~TREZtC1XUoKJ8kwW01AObq2mLonMUzKHwlRtKxt2pZOqid4L7D2qM77AJekmF8~TXMF5dQ870tGwhXgnU3yuWbzEu4~f~YgBNN2xpX~p4SdmJyIeDZp38GSGQMD-dzQmCQsFEXqH0w4CdwkwY8gPw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA

Weber, A., Michail, M., Thompson, A., Fiedorowicz, J. (2017). Psychiatric emergencies: assessing and managing suicidal ideation. Medical Clinics of North America, 101(3), 533-571. https://doi.org/10.1016/j.mcna.2016.12.006

Betz, M., Boudreaux, E. (2017). Managing suicidal patients in the Emergency Department. Annals of Emergency Medicine, 67(2), 276-282. https://doi.org/10.1016/j.annemergmed.2015.09.001

A Sample Answer 2 For the Assignment: NUR 631 Topic 7 DQ 1

Title: NUR 631 Topic 7 DQ 1

Explain the neurotransmitter dysfunction in a patient with schizophrenia and bipolar disorders.

After the 20th century, bipolar disorder was recognized as a mental disorder characterized by extreme mood fluctuations and a chronic course. However, how mood episodes with polar opposite characteristics recur, or a combination of symptoms emerges in bipolar disorder patients remains unknown. Therefore, mood stabilizers are only indicated for single mood episodes, such as manic and depressive episodes, and there are currently no genuine mood-stabilizing medications that are effective for treating both manic and depressive episodes. In bipolar disorder, the brain’s neurotransmitters are abnormally regulated. Impaired biogenic amine neurotransmission in the limbic system affects sleep, appetite, alertness, sexual function, endocrine function, and the regulation of anxiety and wrath (Lee et al., 2022).

Schizophrenia is a severe disorder that impacts a person’s thoughts, emotions, and behavior. A person with schizophrenia may have difficulty differentiating between the real and the imagined, be unresponsive or withdrawn, have difficulty expressing normal feelings in social situations, and be typically non-violent (MHA, 2023).

Neurotransmitters are compounds in the brain that enable communication between nerve cells. They participate in nearly all brain functions, including mood, cognition, and behavior. Researchers believe schizophrenia and bipolar disorder are caused by genetic and environmental factors that disrupt normal neurotransmitter function. This can result in these mental disorders’ symptoms. Dopamine, serotonin, and glutamate are the neurotransmitters most commonly affected in individuals with schizophrenia and bipolar disorder. Dopamine is involved in movement, emotion, and motivation regulation. Serotonin is implicated in mood, sleep, and appetite regulation. (Lee et al., 2022) Glutamate is involved in the regulation of memory, learning, and perception. Hallucinations, delusions, paranoia, depression, hysteria, and anxiety are among the symptoms. Medications that can correct the imbalance of neurotransmitters in the brain are frequently used to treat these conditions (Lee et al., 2022).

How would you recognize the symptoms and severity of suicide?

Suicide’s symptoms and severity can differ from person to person. However, there are common warning signs that a person may be contemplating suicide, including talking about wanting to die or hurt oneself, expressing feelings of hopelessness, talking about being a burden on others, increasing alcohol or drug abuse, withdrawing from friends and activities, experiencing abnormal mood swings, and giving out treasured items. If you are concerned that someone you know may be contemplating suicide, it is imperative that you speak with them about it. You should also seek professional assistance if you’re concerned for their safety (Nelson & Adams, 2020).

What would you do if you had a patient reporting suicidal ideation?

When a patient reports suicidal thoughts, it is crucial to take this seriously and investigate the patient’s underlying thoughts and emotions. It is essential to assess the level of risk and ensure the patient has a safety plan. If the patient is determined to be at high risk for suicide, hospitalization or referral to a higher level of care is essential. Remember that suicidal ideation is common among individuals with mental disorders and that these ideas should not be disregarded. It is necessary to investigate the thoughts and emotions underlying suicidal ideation to evaluate the level of risk and develop a safety plan (Nelson & Adams, 2020).

How would you handle this, and what type of resources would you provide

 There are several approaches you may take to deal with this circumstance. With the patient, you might talk about the feelings and ideas that led to the suicide ideation. You might determine the patient’s level of risk and confirm that a safety plan is in place. You might refer the patient to a higher level of treatment or hospitalize them if it is determined that they pose a significant danger of suicide. Provide the patient with resources such as counseling, support groups, and crisis hotlines. Suicidal thoughts are frequent in persons with mental problems, so it’s crucial to keep that in mind and not discount them (Weber et al., 2017).

From a legal perspective, what is an obligation as a provider?

 When a patient reports suicidal ideation, taking this complaint seriously and investigating the patient’s underlying thoughts and emotions is essential. It is necessary to assess the level of risk and ensure the patient has a safety plan. If the patient is determined to be at high risk for suicide, hospitalization or referral to a higher level of care is essential. It is also necessary to remember that suicidal ideation is common among individuals with mental disorders and that these ideas should not be dismissed. It is necessary to investigate the thoughts and emotions underlying suicidal ideation to evaluate the level of risk and develop a safety plan (Weber et al., 2017).

Reference

Lee, J. G., Woo, Y. S., Park, S. W., Seog, H., Seo, M. K., & Bahk, M. (2022). Neuromolecular Etiology of Bipolar Disorder: Possible Therapeutic Targets of Mood Stabilizers. Clinical Psychopharmacology and Neuroscience20(2), 228-239. https://doi.org/10.9758/cpn.2022.20.2.228

Mental Health America (2023). Schizophrenia. Retrieved from https://mhanational.org/conditions/schizophrenia

Nelson, P., & Adams, S. (2020). Role of Primary Care in Suicide Prevention During the COVID-19 Pandemic. The Journal for nurse practitioners: JNP, 16(9), 654–659. https://doi.org/10.1016/j.nurpra.2020.07.015

Weber, A. N., Michail, M., Thompson, A., & Fiedorowicz, J. G. (2017). Psychiatric Emergencies: Assessing and Managing Suicidal Ideation. The Medical Clinics of North America, 101(3), 553–571. https://doi.org/10.1016/j.mcna.2016.12.006