NURS 6630 Short Answer Assessment

NURS 6630 Short Answer Assessment

NURS 6630 Short Answer Assessment

Drug Management of Major Depressive Disorder Co-occurring with Alcohol Abuse

Alcohol abuse and major depressive disorders occur commonly in the population. These disorders, from time to time occur together. When they occur together, they display a dreadful outcome (Baranyi et al., 2022). An integrated approach to the treatment of these patients is paramount. The purpose of this paper is to discuss the neurobiology, symptoms, and the appropriate drug therapy for patients with Major Depressive Disorder co-occurring with Alcohol Abuse.

Explain the Appropriate Drug therapy for Major Depressive Disorder co-occurring with Alcohol Abuse

A combination of naltrexone and sertraline has been proven ideal for the treatment of co-occurrence of alcohol abuse and major depressive disorder. This combination delays the reversion to alcohol abuse, is highly efficacious, marked improvement in mood in comparison to other drug therapies, and had fewer side effects (Stubbs et al., 2022).

Which Drugs are contraindicated

Benzodiazepines- such as diazepam- are contraindicated as they lower the seizure threshold hence the patient is at an increased risk of falls, intellectual impairment, increased risk aspiration, and low efficacy, in the long run, cross-tolerance of the benzodiazepines and alcohol hence propensity to abuse the drugs, and withdrawal effects after stoppage of the drug.

Bupropion lowers the seizure threshold. Mirtazapine and tricyclic antidepressants when used in the setting of alcohol abuse, they act synergistically to increase the sedative effects of alcohol. Duloxetine is hepatotoxic and may propel liver disease in the setting of chronic alcohol abuse.

What is the Timeframe that the Patient should see the Resolution of symptoms

• With adherence to medication and abstinence from alcohol, symptoms abate starting from two weeks post initiation of therapy (Close, 2019).

List four Predictors of Late Onset Generalized Anxiety Disorder

• They include chronic disease conditions like COPD, mental retardation, presence of other mental illnesses like depression, lack of support and affection during childhood, poverty, unpropitious events in life, and separation.

List four Potential Neurobiological causes of Psychotic Major Depression

• They include hypersensitized response to stress, serotonin dysfunction, disrupted dopamine feedback system in the nigrostriatal pathway, and noradrenaline dysfunction.

List at least five Symptoms of Major Depression

• The presence of all three of a low mood, anhedonia, and anergia plus at least any three of disturbed sleep, lack of appetite, ideations of self-harm, worthlessness, reduced self-esteem, reduced attention and pessimism about the future.

List three Classes of Drugs that Precipitate Insomnia with a corresponding example for each class, be specific

• Selective Serotonin Reuptake Inhibitors such as fluoxetine.
• Dopamine receptor agonists such as  pramipexole.
• Alpha-blockers such as alfuzosin.

References

Baranyi, G., Fazel, S., Langerfeldt, S. D., & Mundt, A. P. (2022). The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis. The Lancet Public Health, 7(6), e557–e568. https://doi.org/10.1016/s2468-2667(22)00093-7

Close, L. (2019). Depression & Substance Abuse Treatment Plans, Medication, Therapy. American Addiction Centers. https://americanaddictioncenters.org/treating-depression-substance-abuse

Stubbs, K. R., Van Bezooyen, J., & Tang, Y. (2022, January 1). Chapter 31 – Managing treatment-resistant depression with comorbid substance use disorders (J. Quevedo, P. Riva-Posse, & W. V. Bobo, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780128240670000311

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In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.

According to Javaid et al. (2020), the human brain comprises over 100 billion distinct neurons. The neuron’s cell body harbors the nucleus and serves as the point of attachment for both the dendrites and axons of the neuron. The term “soma” is sometimes used to refer to the cell body, while axon clusters, commonly referred to as nerves in some contexts, can be found throughout the body in various locations. Neurons can interact with one another even when they are separated by large distances, which is made possible by the fact that they contain dendrites and axons. Furthermore, owing to the mechanism of electrical conduction intrinsic to neurons, nerve impulses can propagate at a remarkable pace, marked by a transient electrical oscillation that traverses from the neuronal soma, through its dendrites, and culminates at the terminal end of the axon.

2. Answer the following (listing is acceptable for these questions):
   • What are the major components that make up subcortical structures?
     1. Basal ganglia: Pertains to a cluster of subcortical nuclei that are primarily accountable for regulating motor control (Wilfrid Jänig, 2022). Additionally, they play a crucial role in executive functions, motor learning, and emotional and behavioral regulation.
     2. Limbic structure: The limbic system is responsible for the regulation of motivation, mood, learning, and memory through its intricate network of structures and interconnected regions(Wilfrid Jänig, 2022). The interface between the subcortical structures and the cerebral cortex is located within the limbic system. The limbic system exerts its influence on the autonomic nervous system and the endocrine system
     3. Thalamic structures: The structure in question comprises four distinct components, namely the thalamus, epithalamus, subthalamus, and hypothalamus. Each of the aforementioned structures plays a crucial role in the survival and optimal operation of the human body (Wilfrid Jänig, 2022). Therefore, it is imperative to familiarize oneself with their anatomy. 
     4. Cerebellar: The cerebellum is a neuroanatomical structure situated in the posterior cranial fossa, superior and posterior to the pontomedullary junction, where the spinal cord merges with the brainstem. The aforementioned structure is a significant subcortical entity that has an impact not only on motor function but also potentially on cognitive and emotional processes (Wilfrid Jänig, 2022).                
   • Which component plays a role in learning, memory, and addiction?

According to Wilfrid Janig (2022), the limbic structure contributes to the capacity of the human body to acquire new information and retain it. Furthermore, it assumes a crucial function in the control of cognitive attention and behaviors that are addictive.

2. What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?
   1. Dopamine: While the activity of dopaminergic cells cannot directly dictate movements, a recent study conducted on humans has indicated that the consistent levels of dopamine present in the dorsal striatum may contribute to the facilitation of regular motion by encoding the sensitivity to the energy expenditure of a movement (Skelin et al., 2019). This implicit signal can be interpreted as a “motor motivational” cue.
   2. Gamma-aminobutyric acid (GABA): It is widely distributed throughout the nervous system and plays a crucial role in inhibiting the transmission of signals. It is essential for regulating movement, both in the cortex and subcortical regions of the brain.
3. In 3 or 4 sentences, explain how glial cells function in the central nervous system. Be specific and provide examples.

The phrase “glial cells” may refer to several different kinds of glial cells, including astrocytes, Schwann cells, oligodendrocytes, and microglial cells all of which have a unique role in ensuring that the brain continues to operate normally (Yang & Zhou, 2019). Astrocytes are responsible for controlling blood flow, as well as supplying neurons with mitochondria and the components necessary to construct neurotransmitters, which are the driving force behind neuronal metabolism. Schwann cells play an essential role in the development, maintenance, functioning, and regeneration of peripheral nerves. Oligodendrocytes are chiefly accountable for the production and upkeep of the myelin sheath that envelops axons within the nervous system while microglia are enduring brain cells that govern brain maturation, the safeguarding of neural networks, and the recuperation from injuries.

4. The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.

When an action potential is generated at the chemical synapse, the neuron at the presynaptic cleft is stimulated, which results in the release of neurotransmitters, which are the molecules that are responsible for transporting information being propagated from the presynaptic gap to the postsynaptic cleft, which is where it is accepted by another cell. The dendrite of the receiving neuron is the one that is responsible for receiving the message from the axon terminal of the transmitting neuron. Because one axon may create synapses on a large number of postsynaptic cells, it can interact with a large number of cells (Stadelmann et al., 2019). As a consequence of this, a single neuron may receive information from the other neurons since it is capable of receiving millions of synaptic inputs from a wide variety of neurons that are responsible for transmitting presynaptic signals.

5. In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples.

Neuroplasticity, commonly referred to aseither brain plasticityor neural plasticity, denotes a phenomenon wherein the brain encounters adaptive modifications in both functional and structural domains. The nervous system is capable of modifying its activity in response to both internal and external stimuli through the process of restoring its functions, pattern, or connections following events such as cerebrovascular incidents or traumatic brain injuries (Innocenti, 2022). These alterations may be helpful in that they lead to the regeneration of function after an injury, neutral in that there is no change, or pathologically detrimental with the resulting pathological consequences.The notion of neuroplasticity can be deconstructed into two primary mechanisms, which are functional reorganizationand collateral sprouting/neuronal regeneration.

References

Innocenti, G. M. (2022). Defining neuroplasticity. Handbook of Clinical Neurology, 3–18. https://doi.org/10.1016/b978-0-12-819410-2.00001-1

Javaid, M. A., Schellekens, H., Cryan, J. F., & Toulouse, A. (2020). Evaluation of Neuroanatomy Web Resources for Undergraduate Education: Educators’ and Students’ Perspectives. Anatomical sciences education, 13(2), 237-249. https://doi.org/10.1002/ase.1896

Skelin, I., Kilianski, S., & McNaughton, B. L. (2019). Hippocampal coupling with cortical and subcortical structures in the context of memory consolidation. Neurobiology of Learning and Memory, 160, 21–31. https://doi.org/10.1016/j.nlm.2018.04.004

Stadelmann, C., Timmler, S., Barrantes-Freer, A., & Simons, M. (2019). Myelin in the Central Nervous System: Structure, Function, and Pathology. Physiological Reviews, 99(3), 1381–1431. https://doi.org/10.1152/physrev.00031.2018

Wilfrid Jänig. (2022). The Integrative Action of the Autonomic Nervous System. Cambridge University Press.

Yang, Q.-Q., & Zhou, J.-W. (2019). Neuroinflammation in the central nervous system: Symphony of glial cells. Glia, 67(6), 1017–1035. https://doi.org/10.1002/glia.23571