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Two Replies 1 WEEK 1 DISCUSSION 2: PRESCRIPTIVE PRACTICE IN PSYCHIATRIC NURSING 5 Week 1 Discussion 2: Prescriptive Practice in Psychiatric Nursing Student Name: Luis S. Cabrera Course Name: Adv. Psychopharmacology Course Number: NU-643-03-21PCFA Instructor’s Name: Nicole Walters Institution: Regis College Date of Submission: 09/02/2021 Week 1 Discussion 2: Prescriptive Practice in Psychiatric Nursing The Ted Talk video by Insel Thomas highlights and discusses mental diseases and the challenges associated with the detection of these diseases (Insel, 2013). Additionally, he discusses the need to improve on the early detection of these diseases to decrease their mortality rates. According to Insel (2013), individuals with mental illnesses are usually treated after developing behavioral changes and symptoms. However, the brain changes associated with these diseases occur before the development of behavioral symptoms or changes (Insel, 2013). Therefore, early detection of these diseases could help in providing the appropriate interventions to patients during the initial stages of the disease, thereby decreasing the mortality rate. On the other hand, the article (Minds Over Meds) discusses the role of psychopharmacologists in the treatment of mental diseases and the need to integrate psychopharmacology and psychotherapy in practice (Carlat, 2010). Role of psychiatric medications in the promotion of patient wellbeing Psychiatric medications play a crucial role in promoting the patient’s mental health and wellbeing. The use of psychiatric medications in patients with mental diseases helps in improving and controlling their symptoms, which assists in promoting their wellbeing (Sultan et al., 2018). Additionally, the use of these medications assists in preventing relapses and the development of complications associated with psychiatric disorders, which helps in improving the wellbeing of patients (Sultan et al., 2018). For example, there are various effective psychiatric medications that are used in improving and controlling the symptoms associated with mental conditions like anxiety, bipolar disorder, and depression, which help in enhancing the wellbeing of patients with these disorders. Advantages and disadvantages of being a psychopharmacologist versus also integrating psychotherapy in your practice A psychopharmacologist is essentially a mental health professional who focuses mainly on the treatment of the patient with mental problems using psychiatric or psychotropic medications (Burgess-Dawson & Hemingway, 2017). Some of the advantages of becoming a psychopharmacologist include; the ability to conduct a thorough assessment of patients with mental problems, diagnose mental disorders, and offer the appropriate medication treatments to patients with mental disorders (Burgess-Dawson & Hemingway, 2017). For instance, being a psychopharmacologist enables the provider to assess and diagnose patients with mental problems and offer them the appropriate medication treatment. Becoming a psychopharmacologist also helps in assessing the medication effects on the behavior of patients, which helps in modifying or adjusting their treatment plan by eliminating, decreasing, or increasing the medications (Burgess-Dawson & Hemingway, 2017). However, there are various disadvantages of becoming a psychopharmacologist that includes; overreliance on medications in the treatment of mental problems and failure to address their causes. For instance, psychopharmacologists mainly focus on the treatment of mental diseases, and in most cases, they fail to address the causes of these diseases, which may lead to their recurrence. The use of medications usually helps in relieving the symptoms associated with mental diseases but does not eliminate their causes such as habitual behavior or thought patterns (Burgess-Dawson & Hemingway, 2017). The integration of psychopharmacology and psychotherapy in practice is one of the most effective approaches that help in offering the appropriate medications and therapies to patients suffering from mental diseases, which helps in enhancing their outcomes (Baruch & Annunziato, 2017). The use of medications helps in improving and controlling the symptoms associated with mental diseases while psychotherapy helps in eliminating the causes of these diseases such as the thought patterns or habitual behavior (Burgess-Dawson & Hemingway, 2017). Integrating psychotherapy with psychopharmacology helps in identifying and addressing all the needs of patients, which results in optimal patient outcomes. Moreover, the incorporation of psychotherapy in practice helps in offering the needed support and assistance to patients with mental problems. On the other hand, there are no medications that are approved for the treatment of some mental disorders like borderline personality disorders, which necessitates the incorporation of psychotherapy in practice. The integration of psychotherapy and prescribing of medications by the same healthcare provider is supported by a sizeable amount of literature. According to Baruch & Annunziato (2017), the integration of psychotherapy and prescribing of medications by the same healthcare provider helps in offering the appropriate medication and therapy treatments to patients with mental illnesses, which helps in enhancing their outcomes. Ray et al. (2020) assert that the combination of psychotherapy with psychopharmacology is a common form of treatment in contemporary psychiatric practice and is more effective than the use of each treatment alone. References Baruch, R. L., & Annunziato, R. A. (2017). Outcomes of combined treatment: Evaluating split versus integrated treatment for depression. Professional Psychology: Research and Practice, 48(5), 361. Burgess-Dawson, R., & Hemingway, S. (2017). Basics of psychopharmacology. Fundamentals of Mental Health Nursing: An Essential Guide for Nursing and Healthcare Students. Carlat, D. (2010). Mind Over Meds. The New York Times. https://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html Insel, T. (2013). Toward a new understanding of mental illness [Video]. https://www.ted.com/talks/thomas_insel_toward_a_new_understanding_of_mental_illness Ray, L. A., Meredith, L. R., Kiluk, B. D., Walthers, J., Carroll, K. M., & Magill, M. (2020). Combined pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders: a systematic review and meta-analysis. JAMA network open, 3(6), e208279-e208279. Sultan, R. S., Correll, C. U., Schoenbaum, M., King, M., Walkup, J. T., & Olfson, M. (2018). National patterns of commonly prescribed psychotropic medications to young people. Journal of child and adolescent psychopharmacology, 28(3), 158-165. Reply separately to two of your classmates’ post (see attached classmates, post#1 and post#2) INSTRUCTIONS: Reply Posts-CBT Case Study Discussion Reply to two of your peers' approaches to the case, providing your feedback and connecting your approach to theirs. What do you agree and/or disagree with? Why? Provide your rationale. What else should your peers consider? Your response should include evidence-based research to support your statements using proper citations and APA format. Please, send me the two documents separately, for example one is the reply to my peers Post#1, and the second one is the reply to my other peer Post#2. -Minimum of 300 words per peer reply. -Turnitin Assignment. Background: I live in South Florida; I am currently enrolled in the Psych Mental Health Practitioner Program. I am a Family Nurse Practitioner working in psychiatric area. Post#1: Prescriptive Practice in Psychiatric Nursing by Olber Lacosta Both the Ted talk video on “Towards a new understanding of mental illness” and the NY Times article by Danial Carlat “Mind over Meds”, discuss how mental illness has become one of the leading causes of death in the USA. According to both researchers, mental illness has increased the number of suicide cases, especially among youths, surpassing the mortality rate of chronic diseases such as cancer or heart diseases. However, the Ted Talk video emphasizes that deaths from mental illness can be reduced through early detection and intervention of the disease (TedTalks, 2013). On the other hand, the NY Times article argues that psychiatrists should refrain from only using medication to treat patients with mental illness. According to Carlat, psychiatrists should combine both therapy and medication for more efficient and effective results in treating mental health disorders (Carlat, 2010). Personally, I view the role of psychiatric medication in the promotion of patient well-being as a vital aspect in the treatment of psychiatric disorders. First, psychiatric medication plays a significant role in balancing the chemical imbalances in an individual's brain that causes mental illness symptoms. Through medication, such symptoms are reduced or completely relieved. Secondly, psychiatric medication helps in treating co-occurring mental disorders by preventing their relapses and reducing their symptoms. Also, psychiatric medications help patients maintain abstinence and minimize cravings for addictive substances that harm their health and well-being. There are various advantages and disadvantages of being a psychopharmacologist versus integrating psychotherapy in their practice. The first advantage of being a psychopharmacologist is that pharmacology allows one to use new administration routes that are more comfortable and convenient. Besides, drug formulations used in pharmacology makes it easy for healthcare providers to improve patients’ compliance. Also, medication is cheaper compared to therapy sessions. finally, medications used in pharmacology increases patients' comfort in dealing with their mental issues, ultimately, improving their health and well-being. On the other hand, the disadvantages of being a psychopharmacologist are; first, some psychiatric medications have dangerous and unpleasant side effects such as psychosis. Besides, when some medications, i.e., stimulants, and antipsychotics, are regularly used, they can be ineffective to the human body. Third, some psychiatric medicine can easily damage an individual's brain. For example, when neurotoxic SSRIs and stimulants are used for a long time, they damage the brain cells. Other drugs such as benzodiazepines used as psychiatric medications are also addictive to some patients. However, when psychopharmacology is combined with psychotherapy it yields better results. The integration of medication and therapy decreases the cases of depressive relapses, especially in elderly patients. Furthermore, combined psychotherapy and pharmacology reduces medical dependency after treatment. Finally, literature greatly supports the integration of therapy and prescription by the same clinician. According to these literature, integration of these approaches provides an opportunity to follow up with the patient, thus, improve the quality of services. When the same clinician prescribes medication and psychotherapy, he/she is able to follow up keenly, keeping track of the patient’s progress. Besides, patients are more satisfied since unnecessary mistakes such as miscommunication between the psychotherapists and pharmacologists are eliminated by integrated care. Lastly, through integrated care, a healthcare provider can choose the best intervention for a particular disorder (Greenway et al., 2020). For example, a provider can prescribe psychiatric medications to a mental condition that is not responding to therapy References Carlat, D. (2010). Mind over meds. The New York Times. Greenway, K. T., Garel, N., Jerome, L., & Feduccia, A. A. (2020). Integrating psychotherapy and psychopharmacology: psychedelic-assisted psychotherapy and other combined treatments. Expert Review of Clinical Pharmacology, 13(6), 655-670. Ted Talks (2013). Towards a new understanding of mental illness. 2013. Post#2 Prescriptive Practice in Psychiatric Nursing by Kathryn Sutherland In this discussion board post, this author will be comparing the TED Talk on Toward a New Understanding of Mental Illness held by Thomas Insel and the NY Times Article, Mind Over Meds by Danial Carlat. I will be discussing my own viewpoint of psychiatric medication, the advantages and disadvantages of being a psychopharmacologist versus a psychotherapist, and what the research states on integrating the two. I will be utilizing evidence-based sources, in addition to my own experience, to support my ideas. Insel, a psychiatrist, and neuroscientist, delivered a very powerful message in his TED Talk regarding mental health disorders or as he would say - ‘brain disorders’. Insel described and made the link that early detection and intervention leads to optimal patient outcomes of several life-altering disorders such as leukemia, cardiovascular disease, and AIDS. Insel was alluding to a future of mental health where brain pathophysiology will be so well known that detection and intervention will have a much larger role in treatment. The main takeaway point Insel described with mental health is that the disease begins long before the behavior is often observed. He believes that the sooner debilitating diseases are discovered, such as schizophrenia, bipolar disorder, and borderline personality disorders the sooner treatment can begin and suffering can end (TED, 2013). In his NY Times Article, Mind Over Meds, Carlat describes the long evolution of psychiatric medication prescribing from the days where psychiatrists would perform therapy with their clients to now the more frequent, 20-minute med management visits. Carlat speaks to the process in which med students are trained: allow the patient to describe their problems, match a diagnosis and prescribe a medication to treat their symptoms. Rarely today, do psychiatrists have training (or are willing) to do both (​​Carlat, 2010). When comparing the TED talk to the NY Times article, both Insel and Carlat attempt to pin mental health conditions on a biological basis that are caused and subsequently “fixed” in the brain. For Insel, he believes detection of neuropathways can do this and for Carlat, he describes the fix is with medication (​​Carlat, 2010; TED, 2013). In overviewing the learning material for this week, I began to think deeply regarding the use of medication in the promotion of patient well-being. From my own experience working on an inpatient trauma unit and on a residential unit for borderline personality disorder, I think that there is certainly a place for medication and it is used best when in combination with some sort of psychotherapy. Some individuals lack the skills necessary to regulate their emotions to the point where they can begin to engage in therapy or treatment. This can become treatment interfering and subsequently detrimental to progress. In my own opinion, there is certainly a need, for medication when prescribed appropriately. It is also essential to take into consideration each and every factor for each specific care. In one interesting article, by Hadjipavlou et al., (2015) the authors reviewed the place of psychotherapy in current psychiatric practice. The largest impediment to medication prescribers engaging in psychotherapy today with clients is the time constraint put on them by insurance companies (Hadjipavlou, 2015). As Carlat had described, insurance companies want to pay, lower hourly wages to providers other than MDs for the therapy aspect of patient care. As a result of this time constraint put on by insurance companies, medication prescribers are engaging in therapy less and it is a trend we continue to see today (​​Carlat, 2010). One of the major advantages of being the sole provider who prescribes only psychopharmacological agents to patients is you get to be the expert in one specific thing. The sole focus is on only treating the symptoms and assessing for progress on this one specific intervention. However, when only prescribing medication, this individual misses being able to learn and treat the entire client. Additionally, it can be problematic if both the therapist and prescriber are not on the same page with treatment. It can also become a hazard as there may be inconsistencies in the patient reports which are influential to treatment. This phenomenon is what is known as split mental health care (Skodol, 2021). Being able to perform psychotherapy and prescribe meds also comes with its advantages and disadvantages. A disadvantage would be that need to focus both on the ins and outs of therapy and learning the specific tecnqhuies could take away from the focus of the medication prescribing. Personally, I like to talk and get to know my patients. Carlat describes the type of therapy he engages with his clients in as supportive therapy, like talking to a friend and giving encouraging problem-solving suggestions (​​Carlat, 2010). As a future psychiatric mental health nurse practitioner (PMHNP) I cannot imagine myself not being in this type of role in addition to prescribing medication. Carlat describes the importance and the need for psychotherapy and supports his claims with evidence-based research in the article. This raises the question, should medication prescribers be the ones to perform psychotherapy? Research has shown that there are major communication gaps if there is more than one provider which has led to patient dissatisfaction in care. At the present moment, however, there is no clinical research or rigorous data analyses comparing outcomes of split and integrated mental health treatment (Skodol, 2021). In my opinion, an individual who is both responsible for medication and psychotherapy is in a much better position to understand and address all aspects of the client. References ​​Carlat, D. (2010, April 23). Mind over Meds (Published 2010). The New York Times - Breaking News, US News, World News and Videos. https://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html Hadjipavlou, G., Hernandez, C. A., & Ogrodniczuk, J. S. (2015). Psychotherapy in Contemporary Psychiatric Practice. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 60(6), 294–300. https://doi.org/10.1177/070674371506000609 Skodol, A. (2021, August). Collaboration between prescribing physicians and psychotherapists in mental health care. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/collaboration-between-prescribing-physicians-and-psychotherapists-in-mental-health-care?search=Collaboration%20between%20prescribing%20physicians%20and%20psychoth erapists%20in%20mental%20health%20care&source=search_result&selectedTitle=1~150&usag e_type=default&display_rank=1 TED. (2013, April 16). Thomas Insel: Toward a new understanding of mental illness [Video]. YouTube. https://www.youtube.com/watch?v=PeZ-U0pj9LI 8/30/2021 Discussion Question Rubric https://lmscontent.embanet.com/RC/General/MSN/Rubrics/Discussion_Question_Rubric_1.html 1/3 Discussion Question Rubric Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric. Note: The value of each of the criterion on this rubric represents a point range. (example: 17-0 points) Discussion Question Rubric – 100 Points Criteria Exemplary Exceeds Expectations Advanced Meets Expectations Intermediate Needs Improvement Novice Inadequate Total Points Quality of Initial Post Provides clear examples supported by course content and references. Cites three or more references, using at least one new scholarly resource that was not provided in the course materials. All instruction requirements noted. 40 points Components are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints. Meets all requirements within the discussion instructions. Cites two references. 35 points Components are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence- based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development. Is missing one component/requirement of the discussion instructions. Cites one reference, or references do not clearly support content. Most instruction requirements are noted. 31 points Absent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial. Demonstrates incomplete understanding of content and/or inadequate preparation. No references cited. Missing several instruction requirements. Submits post late. 27 points 40 8/30/2021 Discussion Question Rubric https://lmscontent.embanet.com/RC/General/MSN/Rubrics/Discussion_Question_Rubric_1.html 2/3 Peer Response Post Offers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation. All instruction requirements noted. 40 points Evidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post. Response is supported by course content and a minimum of one scholarly reference per each peer post. All instruction requirements noted. 35 points Lacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight. Missing reference from one peer post. Partially followed instructions regarding number of reply posts. Most instruction requirements are noted. 31 points Post is primarily a summation of peer’s post without further synthesis of course content. Demonstrates incomplete understanding of content and/or inadequate preparation. Did not follow instructions regarding number of reply posts. Missing reference from peer posts. Missing several instruction requirements. Submits post late. 27 points 40 Frequency of Distribution Initial post and peer post(s) made on multiple separate days. All instruction requirements noted. 10 points Initial post and peer post(s) made on multiple separate days. 8 points Minimum of two post options (initial and/or peer) made on separate days. 7 points All posts made on same day. Submission demonstrates inadequate preparation. No post submitted. 6 points 10 8/30/2021 Discussion Question Rubric https://lmscontent.embanet.com/RC/General/MSN/Rubrics/Discussion_Question_Rubric_1.html 3/3 Organization Well-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas. 5 points Organized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow. 4 points Poor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted. 3 points Illogical flow of ideas. Prose rambles. Purpose statement is unclear or missing. Demonstrates incomplete understanding of content and/or inadequate preparation. No purpose statement. Submits assignment late. 2 points 5 APA, Grammar, and Spelling Correct APA formatting with no errors. The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately). Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions. There are no spelling, punctuation, or word- usage errors. 5 points Correct and consistent APA formatting of references and cites all references used. No more than two unique APA errors. The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability. There are minimal to no grammar, punctuation, or word-usage errors. 4 points Three to four unique APA formatting errors. The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused. Multiple grammar, punctuation, or word usage errors. 3 points Five or more unique formatting errors or no attempt to format in APA. The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language). The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented. Grammar and punctuation are consistently incorrect. Spelling errors are numerous. Submits assignment late. 2 points 5 Total Points 100