The client has been court-ordered to take the prescribed medications and the standing order for chemical restraints is approved. The PMHNP and other staff
... [Show More] are not liable if the patient has an allergic reaction or adverse side effects.
How does reviewing the genetic makeup of a client help guide the PMHNP in selecting medication for clients? - Answer--Genetic testing can assist by providing more information on how clients may respond to certain psychotropic medications
-provides information on how a client may break down and metabolize medications based on the cytochrome P450 system.
Tanrıkulu and Erbaş (2020) investigated identical twins to determine the presence of an inherited link for schizophrenia and why one twin may develop schizophrenia when the other does not. When two people have 100% identical DNA, why don't both persons develop the exact illnesses? Studies of identical Danish twins found that if one twin had schizophrenia, the other twin had a 50% lifetime risk of developing schizophrenia (Lemvigh et al., 2020). Why is there only half the risk? - Answer-Both environmental and psychosocial stressors can impact mental health. Although twins may have identical genes, their gene expression may be different.
There may be an environmental exposure that turned a gene "on" that should have been "off" for one twin to develop schizophrenia and not the other.
central sulcus - Answer-separates the frontal lobe from the parietal lobe
frontal lobe - Answer-associated with movement, intelligence, abstract thinking
broca's area - Answer-speech production
temporal lobe - Answer-involves object identification and auditory signals
cerebellum - Answer-coordination
wernicke's area - Answer-speech comprehension
occipital lobe - Answer-primary visual area
parietal lobe - Answer-keeps us alert to what is going on around us
sensory cortex - Answer-pain, heat, and other sensations
motor cortex - Answer-movement
hippocampus - Answer-involved in both memory and anxiety
nucleus accumbens - Answer-involved in the reward process
thalamus - Answer-involved in sensory organ and motor command processing
striatum - Answer-involved in complex motor actions, also links cognition to motor actions
limbic system - Answer-includes circuits that are associated with pleasure and reward
basal ganglia - Answer-group of structures involved in voluntary motor movements
amygdala - Answer-involved in emotional regulation and perception of odors
corpus callosum - Answer-controls the communication between the two brain hemispheres
white matter - Answer-contains nerve fibers that connect neurons from different regions into functional circuits
grey matter - Answer-contains nerve cells and dendrites
brain tissue - Answer-made up of grey matter and white matter
dorsal striatum - Answer-involved in complex motor actions and linkage of cognition to motor actions
-main input area for basal ganglia
*activated when anticipating or engaging in pleasure
The field of epigenetics is rapidly growing and can help explain how gene expression is:
- Answer-influenced by environmental factors and how epigenetics contributes to the manifestation of mental illness
How does epigenetics impact a person's mental health? - Answer-internal or external factors activate portions of the genome that result in the manifestation of mental health symptoms
-activation is often a result of a stressful event, which, when combined with the genetic risk, results in the disease
-genes being on or off
-occurrence of symptoms may be the result of inheritance of an abnormal gene or of normal genes being "on" when they should be "off."
Types of epigenetic changes: - Answer-DNA Methylation Histone modification
Non-coding RNA
The potential legal and ethical issues impacting mental health treatment must also be taken into account, including: - Answer--informed consent
-competence to make healthcare decisions
-off-label prescribing
Informed consent - Answer-Clients have the right to receive enough information to make decisions about treatment.
-must also be informed about potential risks associated with medications.
-have the right to refuse treatment
-cannot be forcibly medicated in non-emergencies. However, clients can be forcibly medicated if they are violent toward themselves or others and when less restrictive methods have failed
Compliance - Answer-A court order may be issued for a client to receive treatment against their wishes if they are considered a danger to themselves or others.
-Examples: clients with schizophrenia or sex offenders
-Guardians can provide consent for clients who have limited cognitive capabilities or are incompetent to make decisions
-PMHNPs are responsible for being knowledgeable about their state laws and abiding by them.
Off-Label Prescribing - Answer-Some clients may benefit from the unapproved use of a drug for symptom management.
-Example: many SSRIs used to tx anxiety and OCD but are not FDA approved for use in this disorder.
-potentially raises ethical and legal concerns
-PMHNP must remain up to date with the latest recommendations for off-label prescribing.
Incidence of mental illness-what factors are increasing the incidence - Answer- Psychological and sociological factors
Lifestyle factors such as a client's smoking status, diet, exercise, history of medication adherence, or history of addiction should be considered when prescribing psychotropic medications
Adherence - Answer-Persistence
-taking med over intended time period Compliance
-taking med as prescribed
left hemisphere - Answer--speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
right hemisphere - Answer--prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Pharmacokinetics - Answer-the study of what happens to a drug from the time of administration until the parent drug and all metabolites leave the body
CYP450 - Answer-CYP450 enzymes in the gut wall or liver convert drug substrate into a biotransformed product in the bloodstream, responsible for degradating of a large # of psychotropic drugs
-Not all ind. have same genetic form of CYP450 enzymes, determined with pharmacogenetic testing
*Most individuals have "normal" rates of drug metabolism from the major CYP450 enzymes and are said to be "extensive metabolizers", most drug doses are set for these individuals.
*genetic variants of these enzymes can make poor metabolizers or ultra rapid metabolizers
Five of the most important:
CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4.
ultra rapid metabolizers - Answer-elevated enzyme activity subtherapeutic drug levels
poor efficacy with standard doses
genotyping - Answer-the patient for pharmacogenomic use
-genes for these CYP450 enzymes can now be readily measured and used to predict which patients might need to have dosage adjustments
-measurement of genes for drug metabolism
most common targets of [Show Less]