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Clinical Psychopharmacology - Question 1

  1. According to Takahashi et al. (2017, pp. 185), it includes neuronal death, synaptic deterioration, intracellular neurofibrillary tangles, and extracellular amyloid plaques. The tissue has congophilic angiopathy and granulovascular degeneration in the hippocampus. Neuronal dysfunction causes cell death and the synaptic activity is interfered with by amyloid plaques.
  2. A mini-cog test would be applicable to use for Ethel because it is a recall test for memory and diagnosis of the patient’s mental and cognitive ability evaluation. It is suitable for Ethel as she is too old so while sitting she can perform this test (Albanna et al., 2017, pp. 793).
  3. The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) test – to diagnose the behavioral symptoms like aggressiveness, hallucinations, delusional and paranoid ideation, or anxiety. The Cohen-Mansfield Agitation Inventory (CMAI) test – to diagnose agitation behaviors (can be physical or verbal) and aggressive behaviors (can be physical, sexual, or verbal). The Neuropsychiatric Inventory-Questionnaire (NPI-Q) test – to diagnose the neuropsychiatric symptoms. (Liu et al., 2018, pp. 295). These tests are used for Ethel because she has Alzheimer's dementia and has impaired functioning of cognitive and memory skills, so to diagnose them these tests are used.

Clinical Psychopharmacology - Question 2

According to Kahlenberg et al. (2018, pp. 193), it is a surgical procedure also known as total knee replacement, in which the knee surface damaged by arthritis is replaced. The ends of the bones are capped by plastic and metal joint is used to form the knee joint. It is conducted for serious arthritis patients who have had a knee injury.

Clinical Psychopharmacology - Question 3

  1. The 3 risks are hitting an obstacle in the path as they have reduced cognitive abilities. The patients cannot maintain their body balances due to reduced muscle strength resulting in their fall (fall risk), if the hospital floor is wet. As they have issues with their memory as well, they forget things very soon. So, if the nurse has kept the medicines on the table they might take them or hurt themselves with any surgical instrument kept near their approach.
  2. According to Gustavsson et al. (2017, pp. 313), the patient with Alzheimer’s dementia should be provided complete and quality care. In this case, the 2 interventions are: securing the locks on the wheelchair, stretcher, and bed and keeping the bed in the lowest position. This will reduce the risk of injuries as Ethel has decreased muscle strength and poor cognitive abilities. Thereby, these mentioned interventions will reduce her injury risks from both getting hit and from falling as well. Being a patient of dementia with poor memory power, Ethel might leave the hospital room so it is necessary to secure the locks.

Clinical Psychopharmacology - Question 4

First, dementia patients often hurt themselves and others, so the patient should be closely observed for violent intentions for the patient’s safety by providing them with 24/7 care takers. Second, such patients often have false ideas or hallucinations. This can be stopped by turning their attention to music or activities they enjoy. Third, such patients have poor cognitive skills and memory abilities, so simple explanations or face-to-face interactions should be used to communicate and explain things to them (Tajeddin, 2020, pp. 564). 

Clinical Psychopharmacology - Question 5

According to Kotsis et al. (2018, pp. 1447), a patient with diabetes is at a high risk of cardiac arrest and heart stroke. The more sugar level in the blood damages the blood vessels and the heart muscles. High sugar in the blood also causes the deposition of blood clots or fats on the blood vessel walls. These deposits pill up with time and obstruct the pathways of blood flow in the neck or brain. This cuts off the supply of oxygen and blood from reaching the organs resulting in heart stroke. When the heart does receive oxygen and blood it performs abnormal rhythms and stops beating resulting in cardiac arrest.

Clinical Psychopharmacology - Question 6

Medication – medication changes the mood of the patient and might alter his eating patterns resulting in his loss of attitude and weight loss (Greaves et al., 2017, pp. 160). Poor memory – such patients have poor memory they might forget that they have eaten or not and might also forget about how to chew or swallow. Mobility – an Alzheimer’s dementia patient show increased motion like frequent wander or pace is very common, resulting in their high-calorie burning (Fuller et al., 2016, pp. 770).

Clinical Psychopharmacology - Question 7

Due to poor memory, the patient may forget to take his medicines. So, it should be ensured either by the family members or by the caretaker that they take their daily dosage.

As such patients might also forget that whether they have taken the medicine or not, resulting in an overdose. The caretaker should ensure that there is no overdosing of medicines.

Using a reminder system can help to regulate the activities of medication for a dementia patient. Such systems act as alarms to help the patient to remind the medication administration timings and many other things (Look & Stone, 2018, pp. 422).

Such patients should never be given medicines over the counter because they might ask for unprescribed medicines and intake of those unprescribed medicines will result in health harm.

Clinical Psychopharmacology - Question 8

  1. The patient should be provided with occupational and physical therapies to reduce his pain or inflammation and help preserve his/her joint. Secondly, as the joints are inflamed so the patient should rest as much as possible and should only walk under nursing assistance if needed, this reduces the chances of injuries (Peterson et al., 2019, pp. 270).
  2. The involvement of the family members of the patient can play a major role in providing quality care to dementia patients. The cognitive and memory power of such patients is very low or poor so they cannot decide for themselves. Therefore, their family members or close friends should be involved in shared decision making (Miller et al., 2016, pp. 1141). Moreover, the health care proxy can also help a lot. In this, the patient can appoint a legal agent to make health care decisions on his/her behalf, thus ensuring quality and complete care for such patients. A coordinated care plan made after effective communication among the health care professionals will result in an improved treatment plan with fewer chances of conflicting treatments in the care plan (Miller et al., 2016, pp. 1141). This is a legal document in which a specific individual gets the power assigned by the patient to make vital choices for his/her medical care including end-of-life decisions.

References for Clinical Psychopharmacology

Albanna, M., Yehya, A., Khairi, A., Dafeeah, E., Elhadi, A., Rezgui, L., & Al-Amin, H. (2017). Validation and cultural adaptation of the Arabic versions of the mini–mental status examination–2 and mini-cog test. Neuropsychiatric Disease and Treatment, 13, 793.

Fuller, M. A. (2016). Clinical psychopharmacology.In The Medical Basis of Psychiatry, pp. 707-780.

Greaves, C., Poltawski, L., Garside, R., & Briscoe, S. (2017). Understanding the challenge of weight loss maintenance: A systematic review and synthesis of qualitative research on weight loss maintenance. Health Psychology Review, 11, 145-163.

Gustavsson, A., Green, C., Jones, R. W., Förstl, H., Simsek, D., de Vulpillieres, F. D. R., &Wimo, A. (2017).Current issues and future research priorities for health economic modelling across the full continuum of Alzheimer's disease. Alzheimer's & Dementia, 13, 312-321.

Kahlenberg, C. A., Nwachukwu, B. U., McLawhorn, A. S., Cross, M. B., Cornell, C. N., & Padgett, D. E. (2018). Patient satisfaction after total knee replacement: A systematic review. HSS Journal14, 192-201.

Kotsis, V., Tsioufis, K., Antza, C., Seravalle, G., Coca, A., Sierra, C., & Redon, P. (2018). Obesity and cardiovascular risk: A call for action from the European society of hypertension working group of obesity, diabetes and the high-risk patient and European association for the study of obesity part b obesity-induced cardiovascular disease, early prevention strategies and future research directions. Journal of Hypertension, 36, 1441-1455.

Liu, M., Cheng, D., Wang, K., & Wang, Y., (2018). Multi-modality cascaded convolutional neural networks for Alzheimer’s disease diagnosis. Neuroinformatics, 16, 295-308.

Look, K. A., & Stone, J. A. (2018). Medication management activities performed by informal caregivers of older adults. Research in Social and Administrative Pharmacy, 14, 418-426.

Miller, L. M., Whitlatch, C. J., & Lyons, K. S. (2016).Shared decision-making in dementia: A review of patient and family carer involvement. Dementia, 15(5), 1141-1157.

Peterson, N. E., Osterloh, K. D., & Graff, M. N. (2019).Exercises for older adults with knee and hip pain. The Journal for Nurse Practitioners15, 263-267.

Tajeddin, M. (2020).Predicting aggressive responsive behaviour among people with dementia.In Canadian Conference on Artificial Intelligence, 562-565.

Takahashi, R. H., Nagao, T., &Gouras, G. K. (2017).Plaque formation and the intraneuronal accumulation of β‐amyloid in Alzheimer's disease. Pathology International, 67(4), 185-193.

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