Psychopharmacology:The Impact of Ethnicity on Antidepressant Therapy

Discussion: The Impact of Ethnicity on Antidepressant Therapy
Discussions

Cases from Stephen Stahl's suite- Discussions (THIS IS VERY IMPORTANT.)
Tuck this information away so you can refer to it during the weeks that you need it. The case numbers here (1,2,3) refer to a certain case within the text. Each week will give additional information on the name of the case and the case number that coincides with the case number provided in the textbook.
For this week, you are assigned the following case in the text: Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Case 1: Volume 1, Case #1: The man whose antidepressants stopped working

Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.
To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.
Case 1: Volume 1, Case #1: The man whose antidepressants stopped working
• Review this week's Learning Resources and reflect on the insights they provide.
• Go to the Stahl Online website and examine the case study you were assigned.
• Take the pretest for the case study.
• Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
• Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
• Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
• Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
• Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
• Review the posttest for the case study.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Post a response to the following:
• Provide the case number in the subject line of the Discussion thread.
• List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
• List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
• Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
• Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber's Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:
• amitriptyline
• bupropion
• citalopram
• clomipramine
• desipramine
• desvenlafaxine
• doxepin
• duloxetine
• escitalopram
• fluoxetine
• fluvoxamine
• imipramine
• ketamine
• mirtazapine
• nortriptyline
• paroxetine
• selegiline
• sertraline
• trazodone
• venlafaxine
• vilazodone
• vortioxetine
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05
Note: Retrieved from Walden Library databases.
Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from https://web(dot)archive(dot)org/web/20170809004704/https://www(dot)fda(dot)gov/downloads/Drugs/ScienceResearch/.../UCM085502.pdf
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Rubric Detail

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Name: NURS_6630_Week3_Discussion_Rubric

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• List View
Outstanding Performance Excellent Performance Competent Performance Proficient Performance Room for Improvement
Main Posting:
Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. 44 (44%) - 44 (44%)
Thoroughly responds to the discussion question(s)
is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
supported by at least 3 current, credible sources 40 (40%) - 43 (43%)
Responds to the discussion question(s)
is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
75% of post has exceptional depth and breadth
supported by at least 3 credible references 35 (35%) - 39 (39%)
Responds to most of the discussion question(s)
is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.
50% of post has exceptional depth and breadth
supported by at least 3 credible references 31 (31%) - 34 (34%)
Responds to some of the discussion question(s)
one to two criteria are not addressed or are superficially addressed
is somewhat lacking reflection and critical analysis and synthesis
somewhat represents knowledge gained from the course readings for the module.
post is cited with fewer than 2 credible references 0 (0%) - 30 (30%)
Does not respond to the discussion question(s)
lacks depth or superficially addresses criteria
lacks reflection and critical analysis and synthesis
does not represent knowledge gained from the course readings for the module.
contains only 1 or no credible references
Main Posting:
Writing 6 (6%) - 6 (6%)
Written clearly and concisely
Contains no grammatical or spelling errors
Fully adheres to current APA manual writing rules and style 5.5 (5.5%) - 5.5 (5.5%)
Written clearly and concisely
May contain one or no grammatical or spelling error
Adheres to current APA manual writing rules and style 5 (5%) - 5 (5%)
Written concisely
May contain one to two grammatical or spelling error
Adheres to current APA manual writing rules and style 4.5 (4.5%) - 4.5 (4.5%)
Written somewhat concisely
May contain more than two spelling or grammatical errors
Contains some APA formatting errors 0 (0%) - 4 (4%)
Not written clearly or concisely
Contains more than two spelling or grammatical errors
Does not adhere to current APA manual writing rules and style
Main Posting:
Timely and full participation 10 (10%) - 10 (10%)
Meets requirements for timely and full participation
posts main discussion by due date 0 (0%) - 0 (0%)
NA 0 (0%) - 0 (0%)
NA 0 (0%) - 0 (0%)
NA 0 (0%) - 0 (0%)
Does not meet requirement for full participation
First Response:
Post to colleague's main post that is reflective and justified with credible sources. 9 (9%) - 9 (9%)
Response exhibits critical thinking and application to practice settings
responds to questions posed by faculty
the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives 8.5 (8.5%) - 8.5 (8.5%)
Response exhibits critical thinking and application to practice settings 7.5 (7.5%) - 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting 6.5 (6.5%) - 7 (7%)
Response is on topic, may have some depth 0 (0%) - 6 (6%)
Response may not be on topic, lacks depth
First Response:
Writing 6 (6%) - 6 (6%)
Communication is professional and respectful to colleagues
Response to faculty questions are fully answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English 5.5 (5.5%) - 5.5 (5.5%)
Communication is professional and respectful to colleagues
Response to faculty questions are answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English 5 (5%) - 5 (5%)
Communication is mostly professional and respectful to colleagues
Response to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible sources
Response is written in Standard Edited English 4.5 (4.5%) - 4.5 (4.5%)
Responses posted in the discussion may lack effective professional communication
Response to faculty questions are somewhat answered if posed
Few or no credible sources are cited 0 (0%) - 4 (4%)
Responses posted in the discussion lack effective
Response to faculty questions are missing
No credible sources are cited
First Response:
Timely and full participation 5 (5%) - 5 (5%)
Meets requirements for timely and full participation
posts by due date 0 (0%) - 0 (0%)
NA 0 (0%) - 0 (0%)
NA 0 (0%) - 0 (0%)
NA 0 (0%) - 0 (0%)
Does not meet requirement for full participation
Second Response:
Post to colleague's main post that is reflective and justified with credible sources. 9 (9%) - 9 (9%)
Response exhibits critical thinking and application to practice settings * responds to questions posed by faculty
the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives 8.5 (8.5%) - 8.5 (8.5%)
Response exhibits critical thinking and application to practice settings 7.5 (7.5%) - 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting 6.5 (6.5%) - 7 (7%)
Response is on topic, may have some depth 0 (0%) - 6 (6%)
Response may not be on topic, lacks depth
Second Response:
Writing 6 (6%) - 6 (6%)
Communication is professional and respectful to colleagues
Response to faculty questions are fully answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English 5.5 (5.5%) - 5.5 (5.5%)
Communication is professional and respectful to colleagues
Response to faculty questions are answered if posed
Provides clear, concise opinions and ideas that are supported by two or more credible sources
Response is effectively written in Standard Edited English 5 (5%) - 5 (5%)
Communication is mostly professional and respectful to colleagues
Response to faculty questions are mostly answered if posed
Provides opinions and ideas that are supported by few credible sources
Response is written in Standard Edited English 4.5 (4.5%) - 4.5 (4.5%)
Responses posted in the discussion may lack effective professional communication
Response to faculty questions are somewhat answered if posed
Few or no credible sources are cited 0 (0%) - 4 (4%)
Responses posted in the discussion lack effective
Response to faculty questions are missing
No credible sources are cited
Second Response:
Timely and full participation 5 (5%) - 5 (5%)
Meets requirements for timely and full participation
Posts by due date 0 (0%) - 0 (0%)
NA 0 (0%) - 0 (0%)
NA 0 (0%) - 0 (0%)
NA 0 (0%) - 0 (0%)
Does not meet requirement for full participation
Total Points: 100
Name: NURS_6630_Week3_Discussion_Rubric