Sample Answer for NUR 631 TOPIC 7 DQ 1 Included After Question
Answer the following questions for your discussion response. Use the format displayed in the “Discussion Forum Sample.”
Explain the neurotransmitter dysfunction in a patient with schizophrenia and bipolar disorders.
How would you recognize symptoms and severity of suicide? What would you do if you have a patient reporting suicidal ideation? How would you handle this and what type of resources would you provide? From a legal perspective, what are you obligated to do as a provider?
A Sample Answer For the Assignment: NUR 631 TOPIC 7 DQ 1
Title: NUR 631 TOPIC 7 DQ 1
Explain the neurotransmitter dysfunction in a patient with schizophrenia and bipolar disorders.
Schizophrenia is a mental health disorder that is characterized by two types of symptoms, positive and negative symptoms. Positive symptoms include the addition of abnormal characteristics such as delusions and hallucinations. Negative symptoms are the absence of characteristics such as amotivation, social withdrawal, and cognitive symptoms. With the clinical research during early use of antipsychotics it was learned that dopamine antagonism was central to their effectiveness. This led to the hypothesis that an over production of dopamine plays a key role in schizophrenia. To date, the first line treatment in schizophrenia operate via dopamine antagonists. Although it was clear that dopamine played a role in schizophrenia, it did not explain all of the phenomena. Dopamine antagonist are not an effective treatment in the negative and cognitive symptoms. Research has shown that glutamate also plays a role in the pathophysiology of schizophrenia. Glutamate is the major excitatory neurotransmitter of the central nervous system. Research shows that antagonists of a specific glutamate receptor, the N-methyl-D-aspartate (NDMA) receptor, induce psychotic symptoms (McCutcheon, Krystal, & Howes, 2020).
How would you recognize symptoms and severity of suicide? What would you do if you have a patient reporting suicidal ideation? How would you handle this and what type of resources would you provide? From a legal perspective, what are you obligated to do as a provider?
In their study Hendin, Maltsberger, Lipschitz, Haas, & Kyle (2001) evaluated data from therapists that were treating patients when they committed suicide and identified three factors as markers of suicide crisis. These three factors included: a precipitating event; one of more intense affective states other than depression; and at least one of three behavioral patterns: speech or actions suggesting suicide, deterioration in social or occupational functioning, and increased substance abuse. Precipitating events are major life events that precipitated the patient’s intensive affective response. Examples of these include loss of relationships, collapse of career, illness/loss of a child/family member. Depression was present in all of the cases of suicide in this study. Other chronic affective states were also identified such as longstanding sense of rejection, chronic hopelessness, loneliness, and self-hatred. Behavioral warning signs were also present. These included speech or action that showed they were contemplating suicide. This is evidenced often by escalating self-mutilating or self-destructive behaviors (Hendin, et. al, 2001). Suicidal ideation requires immediate attention. Ways to decrease the rate of suicide include screening patients for ideation or behaviors, assessing the individual’s current risk of imminent harm, and creating a treatment plan with the patient and their support system. The World Health Organization recommends that all patients over the age of 10 with any mental health disorder, epilepsy, interpersonal conflict, recent severe life event, or other risk factor for suicide be screened for thoughts or plans to self-harm or attempt suicide. If a person is deemed at risk for suicide, a safety plan should be used. A safety plan includes recognizing the warning signs, identifying and using coping strategies, use of interpersonal support, contact friends or family to help resolve the crisis, contact a mental health provider/agency, and reduce the potential use of lethal means. Evidence has shown that safety plans reduce suicide attempts, completions, depressive symptoms, anxiety, and hopelessness. An important part of the safety strategy includes the restriction of access to lethal means. If firearms must remain in the home, they should be unloaded, locked, and stored separately from ammunition. Restriction to access to alcohol and drugs are also important and has been shown to reduce suicide rates (Weber, et. al, 2017). Not all patients who report having thoughts of suicide require inpatient admission. While being evaluated for suicidal thoughts, patients should be protected from self-harm. This includes placing the patient in a private room, without access to potentially harmful objects. Providers can then use decision support tools to aid in decision making and documenting the justification of why a mental health consultation is or is not indicated. For those patients with moderate to high suicide risk, psychiatric hospitalization is the typical disposition. Voluntary hospitalization is preferable when possible. If involuntary hospitalization is required, providers should adhere to their state laws that determine who can be committed, lengths of confinement, and other requirements (Betz & Boudreaux, 2017).
McCutcheon, R., Krystal, J., Howes, O. (2020). Dopamine and glutamate in schizophrenia: biology, symptoms and treatment. World Psychiatry, 19(1), 15-33. https://doi.org/10.1002/wps.20693
Hendin, H., Maltsberger, J., Lipschitz, A., Haas, A., Kyle, J. (2001). Recognizing and responding to suicide crisis. Suicide & Life-Threatening Behavior 31(2), 115. Retrieved on June 17, 2023, from https://d1wqtxts1xzle7.cloudfront.net/30486396/sltb_summer01-libre.pdf?1391817175=&response-content-disposition=inline%3B+filename%3DRecognizing_and_responding_to_a_suicide.pdf&Expires=1687017728&Signature=cMfpIf1tTEOJzepvZjiLnFgMTA6vYziPaI2mFCxKWImblgeaBp3AEKhC3HKCmZssjXalD9HVVv4daTDDdrbcZkV2kvJtQi6gDG585cH0yFrvXNy7JetqcVFM6mkb1jKb98rT8qOI~DUdZdLJjZNJkiGSOA9SxMEk4YDZRzqsp5Y0X9njk200MONX2Hyox7gI~TREZtC1XUoKJ8kwW01AObq2mLonMUzKHwlRtKxt2pZOqid4L7D2qM77AJekmF8~TXMF5dQ870tGwhXgnU3yuWbzEu4~f~YgBNN2xpX~p4SdmJyIeDZp38GSGQMD-dzQmCQsFEXqH0w4CdwkwY8gPw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA
Weber, A., Michail, M., Thompson, A., Fiedorowicz, J. (2017). Psychiatric emergencies: assessing and managing suicidal ideation. Medical Clinics of North America, 101(3), 533-571. https://doi.org/10.1016/j.mcna.2016.12.006
Betz, M., Boudreaux, E. (2017). Managing suicidal patients in the Emergency Department. Annals of Emergency Medicine, 67(2), 276-282. https://doi.org/10.1016/j.annemergmed.2015.09.001
