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1.Depressed mood most of the day.2.Diminished interest or pleasure in all or most activities3.Significant unintentional weight loss or gain4.Insomnia or sleeping too much.5.Agitation or psychomotor retardation noticed by others.6.Fatigue or loss of energy.7.Feelings of worthlessness or excessive guilt.8.Diminished ability to think or concentrate, or indecisiveness.9.Recurrent thoughts of death (APA, 2000, p. 356).As part of a safety assessment, a suicide risk assessment should also be conducted which includes assessment of suicidal thoughts, intent, plans, means, and behaviors and identification of specific psychiatric symptoms such as psychosis or severe anxiety or general medical conditions that may increase the likelihood of acting on suicidal ideas. The safety assessment should also include an evaluation of the potential for risk for others. (Treatment, 2008.) A functional assessment should be completed to assess the patient’s ability to coop with work, school, family and activities of daily life. There should be a collaboration of care between the psychiatrist and any other health care workers involved in the patients care. An individualized 6
WUT Task 1treatment plan should be develop based on the patients needs. After treatment has begun the patients psychiatric status must be closely monitored to evaluate for changes in behavior and response to medications. Section A2a- Pharmacological TreatmentsPatients who suffer from depression in my state are often treated with a variety of antidepressants. These medications are standard practice in my state and local community. The Riverside County Department of Mental Health follows the evidence- based state guidelines, which are to provide medication services using antidepressants along with psychotherapy as standard practice for the treatment of depression. The choice of medication is usually based on patient characteristics, safety and anticipated side effects. Most patients require more than one antidepressant to achieve reduction of symptoms. Most patients are treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin- norepinephrine reuptake inhibitors (SNRIs) because they are safer and have fewer side effects than other antidepressants. SSRIs act by inhibiting presynaptic serotonin reuptake and SNRIs inhibit serotonin and norepinephrine reuptake at higher doses changing the levels of natural occurring brain chemicals. Side affects of these SSRI medications include weight gain, agitation, insomnia, nausea, diarrhea and sexual dysfunction. There is also an increased risk gastrointestinal bleeding with these medications. Examples of the SSRI medications include; Paxil, Prozac, Zoloft, Celexa and Lexapro. Side effects of SNRI medications include, weight gain, nausea, dry mouth, dizziness, sweating and sexual dysfunction. Examples of the SNRI medications include Cymbalta and Effexor. If SSRIs and SNRIs are not successful in treating a patient’s depression the next choice is usually a Norepinephrine-dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) is an example of7
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Nursing, Selective serotonin reuptake inhibitor, Major depressive disorder, WUT Task