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Indiana University East

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Please follow the directions. Peer reviewed articles within 5 years of publications. Attachment below. Please references peer reviewed articles within 5 years of publication.

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Reply DB 1: 200 words without references including. 2 references and apa format-5 years of publication peer-reviewed article Neuroanatomy is the study of the relationship between structure and function in the nervous system. The brain consists of macroscopic (larger structures like the folds of the brain) and microscopic structures (those at the cellular and molecular level), like the interaction between neurons and glia. (Kennedy, M., et al 2014) Three components form the foundation of the nervous system: neurons (or nerve cells), neuroglia (glial cells) and extracellular constituents. Neurons process information by sensing the environment, communicating through neurotransmitters and originating our thoughts and memories. (Kennedy, M., et al 2014). Neurons have a cell body and two types of extensions, or processes. One is called a dendrite, and the other is the axon. Dendrites receive signals which then send towards the cell body. The axon also transmits signal but over long distances. In the above diagram, the neurons are communicating with another part of the brain by sending messages through the dendrites to other parts in the brain. All neurons have a cell body known as the soma, which is the command center of the nerves and contains the nucleus of the cell. (Stahl's, S., 2013) References Kennedy-Malone, L., Fletcher, K. R., & Martin-Plank, L. (2014). Advanced Practice Nursing in the Care of Older Adults. Philadelphia, PA: F.A. Davis. Stahl, S. M. (2013). Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. Cambridge, England: Cambridge University Press. Reply DB 2: 200 words without references including. 2 references and apa format-5 years of publication peer-reviewed articles According to Stahl, understanding psychopharmacology begins with becoming knowledgeable of neuroanatomy, specifically with the principles of chemical neurotransmission (2013). Competent prescribing of psychiatric medicines requires consideration of how diseases affect the central nervous system, how drugs act on the brain, and how psychiatric medicines affect behavior (Stahl, 2013). A good example of why this understanding is important is that many neurotransmitters are affected by antidepressant medications, causing serious side effects (Edmunds & Mayhew, 2013). The slide presented for discussion helps demonstrate the process of neurotransmission. Anatomically, this slide depicts neurons. These interconnected nerve cells are responsible for carrying information throughout the body, using electrical and chemical signals to coordinate bodily functions. Simply put, neurons receive information, integrate the information to determine whether or not to pass it on, and communicate the information to target cells of other neurons. The anatomy of the neuron includes a cell body, or soma, branching processes of dendrites with dendritic spines forming the dendritic tree, and a more protracted process known as the axon. Dendrites receive information from other neurons and carry the information to the soma, the soma receives the information, and axons carry information from the soma to other neurons. The slide shows neuron-to-neuron connections. The connections are known as synapses. Information is carried from the first (presynaptic) neuron to the target (postsynaptic) neuron. The axon sends information as the axon passes by (en passant) or as the axon ends (presynaptic axon terminals) (Stahl, 2013). The box in the slide is demonstrating the transmission of information by chemical messengers called neurotransmitters from the presynaptic neuron to the postsynaptic neuron at the synaptic cleft. Receptors are present on both sides of the cleft and are essential components of chemical neurotransmission (Stahl, 2013). While this is a fundamental analysis of the concept depicted in the slide, the process of chemical neurotransmission is quite complicated. A thorough understanding of the principals of neurotransmission is needed by clinicians who evaluate, diagnose, and treat psychiatric patients because every part of chemical transmission can be targeted and influenced by psychiatric medications (Stahl, 2013). References Edmunds, M. W., & Mayhew, M. S. (2013). Pharmacology for the primary care provider, 4th edition. Elsevier. Stahl, S. M. (2013). Stahl's essential psychopharmacology: neuroscientific basis and practical applications, 4th edition. Cambridge University Press. Reply DB 3: 200 words without references including. 2 references and apa format-5 years of publication peer-reviewed articles -Differentiate between generalized anxiety disorder and panic disorder - from an assessment standpoint, please tell me how you can determine the clinical differences. Panic disorders represent more isolated acute events where the patient is overwhelmed by feelings of dread (Morrison, 2014). The patient may experience physical symptoms along with these events. The attacks can be triggered by something or not triggered and be spontaneous, can occur during sleep or when awake. It is more common with women and onset of the disorder typically occurs when people are in their 20s (Morrison, 2014). These individuals also continue to worry about additional attacks (Morrison, 2014). Generalized anxiety disorders do not include panic episodes but patients with this disorder worry about a variety of things in their life and have feelings of nervousness or anxiety, and tend to feel this way often (Morrison, 2014). In the clinical setting it would be important to ask questions around frequency of events since panic disorder involves acute episodes, this should be able to be identified. If patient states they have always been a worrier or feel nervous in majority of situations, they more than likely would have generalized anxiety. 3. How do you determine the difference between depressive disorders and anxious disorders? Can they present with the same or similar symptoms? People with major depressive disorder can feel down for long periods of time. People with anxiety can also have depressive episodes but anxiety should be able to be identified through interview with the patient. Patients with anxiety would probably talk about worry or nervousness while depression is more feeling down or fatigued and not being able to be successful in completing tasks (Keltner & Steels, 2019). Patient with depression may have a flat affect and have issues with appetite change and weight changes (Generalized Anxiety Disorder vs Major, 2017). The patient with anxiety may experience physical symptoms like irritable bowel, racing heart, chest pressure, or shaky (Generalized Anxiety Disorder vs Major, 2017). Reply DB 4: 200 words without references including. 2 references and apa format-5 years of publication peer-reviewed articles General Anxiety Disorder (GAD) is a chronic debilitating disorder where patients experience “excessive or unreasonable worry or apprehension” (Keltner and Steele, 2018). GAD is typically associated with MDD with a median onset of 30 years old. Symptoms must be present for 6 months, most days of the week. Patients experience restlessness, fatigue, difficulty concentrating, irritability, and sleep disturbances. They have great difficulty coping and develop chronic issues with functioning. On the other hand, panic disorders tend to be sudden onset and situational, accompanied with fight-or-flight symptoms. They typically present to the ED with CP, SOA, hyperventilation, choking sensation, and fear of dying. Patient with panic disorder are excessively worried about having another panic attack sometimes leading to avoidance behavior and isolation. Typical onset are patients their 20s. Symptoms must be present for 1 month (Morrison, 2014). Both GAD and panic disorder can manifest physical symptoms, as mentioned above; however, the symptoms tend to be different. Both are treated with SSRIs and SNRIs, along with CBT. Panic disorder may require benzodiazepines for short term/immediate relief; however, should be titrated off quickly due to addiction and dependency issues (Keltner and Steele, 2018). DB 5: 200 words without references including. 2 references and apa format-5 years of publication peer-reviewed articles On intake, Mary Lou would be assessed initially with the ABC's to ensure no life threatening event was occurring and then, for an immediate assessment for a stroke due to her symptoms of flaccidity of her left and left leg despite no pulling of the face due to the varying symptoms that can occur through the different regions of the brain. In addition , she has risk factors of birth control and smoking that can contribute to a stroke. Assessment of disability is determined with the National Institutes of Health Stroke Scale which will allow staff to score the severity of possible stroke from a TIA to a severe life threatening situation. History (family history, social history past medical history), HPI, ROS (which will need to include the timing of symptoms and onset, back or cervical neck injury or discomfort, loss of sensation, loss of bowel or bladder function), physical exam (including neurological and reflex testing) and medication review will contribute to differential. Non-contrast/ contrast CT will be ordered immediately to R/O stroke or tumor. If symptoms continue and indicated with a CT that is negative, MRI may be considered due to its sensitivity with minor ischemic and TIA strokes. Determination if an ischemic stroke has occurred, needs to be determined within 4.5 of initial symptoms for treatment with recombinant tissue plasminogen activators. Vital signs, lab work such as CBC, CMP, TSH, cholesterol, glucose testing, CBC, PT, PTT and CPK (rule out muscle damage) all should be ordered immediately with CT scan. (Musuka, Wilton, Traboulsi &Hill, 2015) Personally, I would also add CRP and sed rate to assist with ruling out inflammation and infectious processes. Additional testing, that maybe required ECG, EEG, and MRI of spine or CT with myelography if MRI is unavailable to R/O nerve roots or spinal cord process, CSF to R/o Guillen-Barre’ syndrome, myelitis, or demyelinating peripheral neuropathy if suspected. Testing to support differential diagnosis of denervation injuries (e.g., stroke, spinal cord injury, denervation diseases e.g., guillan Barre’ syndrome, CNS infection and myasthenia crisis. (Asimos, 2018) Asimos, A. W. (2018, September 4). Evaluation of the patient with acute weakness in the emergency department. Retrieved from https://www.uptodate.com/contents/evaluation-of-theadult-with-acute-weakness-in-the-emergency-department (Links to an external site.) Depressive disorders typically are characterized by depressed mood and lack of interest in pleasurable activities. These patients feel worthless and are high risk for SI. These patients typically present with depressed mood, significant weight loss or gain, insomnia or hypersomnia, daily psychomotor agitation or retardation, fatigue, and energy loss, diminished concentration, feelings of worthlessness, and recurrent thoughts of death. These patients may present with poor hygiene, pacing and inability to sit still, slow speech or poverty of speech, slowing of body movement, and drooping posture. They may also c/o abdominal pain, CP, N/V, and sexual dysfunction (Keltner and Steele, 2018). On the other hand, anxiety disorders are typically characterized by unreasonable worry that the patient is unable to control. Patients experience restlessness, fatigue, difficulty concentrating, irritability, and sleep disturbances. They have great difficulty coping and develop chronic issues with functioning. Patients with panic disorder can develop panic attacks which create a great deal of fear. Panic attacks are typically unexpected and situational. They manifest into physical symptoms including CP, shortness of breath, palpitations, choking sensation, and fear of dying. Most episodes peak within 10 minutes and slowly resolve. They patient feels if they are going crazy and fear that they will have another one, leading to isolation and avoidance of people and places (Keltner and Steele, 2018). Depressive disorders and anxious disorders can present the same or very similar symptoms. Depressive disorders and anxious disorders can both produce extensive physical symptoms ranging from fatigue, insomnia, and restlessness, to more severe symptoms including CP, palpitations, SOA, and sweating. Both disorders are predominantly females (2:1), and onset of disorder is 20-30. Anxiety disorders have a high genetic correlation with depressive disorders. Panic attacks occur in 15% of patients with MDD. Both can cause severe impairment of social, occupational, and interpersonal functioning (Keltner and Steele, 2018). DB 6: 200 words without references including. 2 references and apa format-5 years of publication peer-reviewed articles First, let’s take a minute to talk about somatoform disorders with special attention to conversion disorders. Patients with somatic symptoms have likely been evaluated by clinician’s multiple times for a multitude of complaints. These complaints typically require a significant medical work up, yielding negative results. In somatic disorders the patient is manifesting their psychological symptoms into physical symptoms. This is typically secondary to some sort of past trauma or stressor in their life. These patients are largely undiagnosed and once diagnosed requires CBT and psychodynamic therapy, along with possible introduction of a SSRI, SNRI, or TCA (Keltner and Steele, 2018). For starters, Mary Lou’s symptoms are NOT consistent with a typical neurological diagnosis; however due to her physical complaints in the setting of smoking and current use of birth control, I feel we must rule out an acute neurological event. This patient would need a minimum of CT head, +/- MRI/MRA, and neurological consult (if work up had not been recently done). However, please note, according to Morrison (2018), “the criteria don’t require patients to undergo laboratory or imaging tests. The requirement is only that, after a careful physical and neurological evaluation, the patient’s symptom can not be explained by a known medical or neurological disease process” (pg 263). If all medical results are negative and there is no reason for neurological deficients, I feel that it is important to rule out psychological disorders at this time. With no physical explanation of symptoms, it’s important to obtain a detailed medical history, family history, social history, a current in depth history of present illness, along with MSE. It’s also important to speak with family. Conversion disorder typically have a strong genetic link (Morrison, 2014). It is important to determine if the patient is more focused on symptoms rather than fear of disease. If so, this would rule out illness of anxiety disorder (Morrsion, 2104). Since the patient doesn’t complain of pain this would likely rule out somatic symptoms disorder. In patients with conversion disorder it is important to assess their concern or anxiety about the symptoms. If their concern is low for significant debilitating symptoms this is referred to as “la belle indifference” which is a classic sign of conversion disorder (Morrison, 2014). Lastly, it is highly important to try and find the root cause for the somatic disorder. Why are they transferring psychological issues/pain into physical symptoms? This will help complete the story and strengthen the diagnosis.
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Running head: RESPONSE TO DISCUSSION BOARDS

Response to Discussion Boards
Name
Institution Affiliation
Date

1

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RESPONSE TO DISCUSSION BOARDS
Response to DB 1

I find the discussion on neuroanatomy informative, having discussed the microscopic and
macroscopic structures of the brain and its constituents. The brain networks help in achieving
cognitive tasks. The cognitive functions completed by the structures include processing of visual
objects and formation of memory traces, among others (Maksimenko et al., 2017). I suggest you
add that active elements such as neurons in the brain are is essential for one to distinguish signals
sensed on the microscopic and macroscopic scale. This is because the processes that take place
on the microscopic level affect the properties of macroscopic signals. It is true neurons play a
significant role in the brain of transmitting signals. This means neuron pruning significantly
propagate a network of errors. Neuron pruning in one layer may have significant responses of
other neurons in subsequent layers (Yu et al., 2018). This means it is wrong to prune unimportant
neurons since they might substantially affect the functioning of the other neurons. This is
because neurons send messages to other parts of the body, maintaining a cohesive functioning of
the brain. It is true all neurons have the soma, which is the command center and have the nucleus
of the cell which directs and controls all activities of the cell.
References
Maksimenko, V. A., Lüttjohann, A., Makarov, V. V., Goremyko, M. V., Koronovskii, A. A.,
Nedaivozov, V., ... & Boccaletti, S. (2017). Macroscopic and microscopic spectral
properties of brain networks during local and global synchronization. Physical Review
E, 96(1), 012316.

3

RESPONSE TO DISCUSSION BOARDS
Yu, R., Li, A., Chen, C. F., Lai, J. H., Morariu, V. I., Han, X., ... & Davis, L. S. (2018). Nisp:
Pruning networks using neuron importance score propagation. In Proceedings of the
IEEE Conference on Computer Vision and Pattern Recognition (pp. 9194-9203).
Response to DB 2

It is correct before prescribing psychiatric medication health providers require a
comprehensive understanding of the impacts on the central nervous system. According to
Mutsatsa (2016), understanding the treatment goals and considering healthy aspects is essential
since it prevents prolonged pain and damage ...


Anonymous
Excellent! Definitely coming back for more study materials.

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