Reflect on one neurotransmitter system or receptor pathway (e.g., serotonin 5-HT₁A, dopamine D₂, or glutamate NMDA) as it relates to this case Explain this system’s role in the psychiatric symptom expression for this patient
Prepare an APA paper (maximum 5 pages, not including title and reference pages) describing medication treatment approaches for both cases by addressing the following:
- Neurobiology and Mechanisms of Action
- Reflect on one neurotransmitter system or receptor pathway (e.g., serotonin 5-HT₁A, dopamine D₂, or glutamate NMDA) as it relates to this case
- Explain this system’s role in the psychiatric symptom expression for this patient and its role in drug action in the proposed treatment for the patient.
- Describe how these insights about this system influence prescribing decisions and the ability to individualize pharmacologic care.
- Psychopharmacological Treatment Planning
- Select one class of psychotropic medication (e.g., antidepressants, mood stabilizers, antipsychotics, anxiolytics, or stimulants).
- Discuss how you would approach mechanism-based treatment selection and dose titration using evidence from Stahl’s Essential Psychopharmacology or other scholarly sources.
- Reflect on how understanding receptor binding profiles, side-effect mechanisms, and pharmacokinetic interactions relates to your clinical reasoning of this case.
- Describe one clinical principle you will use when initiating or adjusting psychotropic medications for this case
- Monitoring, Safety, and Evaluation
- Summarize how you will incorporate monitoring strategies to evaluate medication effectiveness, safety, and adherence (e.g., AIMS, PHQ-9, metabolic labs).
- Reflect how you plan to anticipate adverse effects, promote patient safety, and engage in shared decision-making.
- What strategies will you use to balance therapeutic benefit with potential risk?
- Integration and Professional Growth
- Describe how knowledge of psychopharmacology enhances clinical decision-making, critical thinking, and communication with patients and interdisciplinary teams.
- Reflect on the P.R.I.C.E. values (Professionalism, Respect, Integrity, Caring, Engagement) and how they can be demonstrated as a student and as a clinician.
Once you go through all 4 parts using Melany's case, repeat the same 4 parts using Eduardo's case.
CASE 1: MELANIE M.
Diagnosis: Major Depressive Disorder (MDD)
- Patient Name: Melany
- Age: 46
- Sex: Female
- Occupation: Corporate financial analyst
- Presenting Concern: “I feel like I’m dragging myself through every day. Nothing brings me joy anymore.”
· History of Present Illness:
Melany presents with a 3-month history of worsening mood, decreased energy, early morning awakening, impaired concentration, and a 15-pound unintentional weight loss. She describes pervasive feelings of guilt related to a recent workplace layoff he oversaw and reports frequent ruminations about being a “burden” to her family. She denies active suicidal intent but admits to daily passive thoughts such as “they’d be better off without me.” Her symptoms have led to poor work performance and social withdrawal.
She previously tried sertraline for depression five years ago with partial benefit but discontinued due to sexual side effects. She has not been on any psychotropic medication for the past four years.
· Medical History:
o Well-controlled hypertension (lisinopril)
o Hyperlipidemia (atorvastatin)
o No substance use history
· Family History:
o Mother: Major depressive disorder
o Maternal uncle: Suicide at age 51
o No known bipolar disorder or schizophrenia in family
· Mental Status Exam (MSE):
o Appearance: Tired, mildly disheveled
o Mood: “Empty and hopeless”
o Affect: Blunted
o Thought Process: Linear, slowed
o Thought Content: Passive death wishes, feelings of worthlessness
o Insight/Judgment: Limited insight; judgment intact except during rumination
o Cognition: Oriented ×3; impaired concentration
· DSM-5-TR Diagnosis:
· F33.1 – Major Depressive Disorder, Recurrent, Moderate Severity, without psychotic features
· Meets criteria:
· Depressed mood most of the day, nearly every day
· Markedly diminished interest or pleasure in activities
· Significant weight loss without dieting
· Insomnia (early morning awakening)
· Fatigue/loss of energy
· Feelings of worthlessness
· Diminished ability to think/concentrate
· Passive thoughts of death
CASE 2: EDUARDO
Diagnosis: Schizophrenia
- Name: Eduardo
- Age: 30 years
- Gender: Male
- Ethnicity: white
- Marital Status: Widowed, lives alone
- Occupation: No current employment, previously worked as a clerk
- Presenting Concerns: Eduardo’s family reports that over the past six months, he has exhibited increasingly bizarre behaviors, auditory hallucinations, and paranoid delusions. He has become socially withdrawn, neglects personal hygiene, and has difficulty maintaining his daily routines.
- History of Present Illness:
o Onset: Symptoms began approximately six months ago, gradually worsening.
o Course: Symptoms have persisted for more than six months, with some periods of better reality testing.
o Symptoms:
§ Hallucinations: Auditory voices commenting on his actions and insulting him.
§ Delusions: Belief that his neighbors are spying on him and plotting to harm him.
§ Disorganized thinking: Incoherent speech at times, difficulty concentrating.
§ Negative symptoms: Affective flattening, social withdrawal, lack of motivation.
§ Behavior: Neglect of personal hygiene, neglecting meals, sporadic agitation.
· Medical & Family History:
o No significant medical illnesses.
o Family history of schizophrenia in his mother.
· Substance Use: Denies alcohol, recreational drug use, or medication misuse.
· Past Psychiatric History: No formal diagnosis before, but family reports he had odd beliefs and social withdrawal for a few years.
· Mental Status Exam (MSE):
o Appearance: Disheveled, appears somewhat anxious.
o Behavior: Limited eye contact, socially withdrawn.
o Speech: Sparse, slow, sometimes incoherent.
o Mood/Affect: Blunted affect, appears emotionally flat.
o Thought Process: Loosened associations, tangential at times.
o Thought Content: Paranoid delusions, auditory hallucinations.
o Perceptions: Hallucinations confirmed by her responses.
o Cognition: Alert but distracted; memory appears intact.
o Insight & Judgment: Limited insight into her condition.
· DSM-5-TR Diagnosis:
o Eduardo’s symptoms – delusions, hallucinations, disorganized thinking, negative symptoms—persist over six months, significantly impairing his social functioning are consistent with DSM-5-TR criteria for schizophrenia.