Decision Making in Treating Psychological Disorders in Advanced Nursing Practice

Decision-making in treating psychological disorders such as depression, bipolar disorder, and anxiety requires advanced nursing judgment that integrates pharmacotherapeutic knowledge, patient-centered care, and cultural competence to ensure effective outcomes and compassionate mental health support across diverse populations.

WEEK 8 Discussion: Decision Making When Treating Psychological Disorders

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages.
Many patients struggle silently with symptoms that deeply affect their day-to-day functioning, making timely intervention and compassionate care essential for recovery. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends.
Emotional distress can often manifest as physical symptoms, further complicating both diagnosis and treatment. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care.
Advanced nurses must also prioritize patient education, collaboration, and evidence-based interventions to promote lasting wellness and resilience. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

Photo Credit: Getty Images/iStockphoto

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders.
Engaging with the media case allows you to apply theoretical learning to realistic, practice-based decision-making scenarios that mirror real-world challenges in mental health care. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

• Review this week’s interactive media pieces and select one to focus on for this Discussion.
• Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

Critical thinking and reflective practice will help connect pharmacological interventions with individual biological responses and psychosocial contexts.

By Day 3 of Week 8

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected.
When writing your response, connect theory to practice by referencing clinical guidelines and the latest evidence on psychopharmacological management. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology.
Include both the biochemical mechanisms and the potential side effects that could alter systemic function and emotional well-being. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

MEDIA FILE CASE

Adult/Geriatric Depression: Hispanic Male With MDD

The client is a 70-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression.
His cultural background and migration history may influence his perception of illness and willingness to engage in treatment. The client was referred by his PCP after a “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.

SUBJECTIVE

During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good,” stating “Dad did what he could for us, there were 8 of us.”
These experiences suggest long-term psychosocial stressors and possible cultural identity conflicts that could contribute to his current depressive symptoms. He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but has been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.
Symptoms of weight gain, insomnia, and concentration difficulty are consistent with major depressive disorder and warrant careful pharmacologic assessment.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression.
The subdued affect and limited eye contact may reflect emotional withdrawal typical in severe depressive states. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery-Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).
This score highlights the need for immediate pharmacological and psychotherapeutic intervention tailored to his age and cultural background.

Resource: Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

Decision Point One

1. Begin Zoloft 25 mg orally daily
2. Begin Effexor XR 37.5 mg orally daily
3. Begin Phenelzine 15 mg orally TID

Each decision carries unique pharmacodynamic and safety considerations, particularly in geriatric patients who may experience altered drug metabolism and higher sensitivity to side effects.

Rubric Detail

Follow the rubric below to guide your submission and ensure adherence to academic writing standards. Accuracy, specificity, and clarity will strengthen your analysis and demonstrate advanced-level nursing reasoning.

Decision making in psychiatric nursing involves applying pharmacological knowledge, cultural sensitivity, and evidence-based practice to manage disorders such as major depressive disorder (MDD). Using interactive media case studies strengthens clinical reasoning and patient-centered treatment planning for advanced practice nurses. Including details on pathophysiology and medication impacts boosts comprehension and academic writing performance.

Peer-Reviewed References

Cipriani, A., et al. (2021). Comparative efficacy and acceptability of antidepressants for major depressive disorder in adults. The Lancet Psychiatry, 8(7), 509–520. https://doi.org/10.1016/S2215-0366(21)00177-1

Thase, M. E., & Shelton, R. C. (2022). Advances in the treatment of major depressive disorder: Pharmacotherapy and beyond. Journal of Clinical Psychiatry, 83(3), 21r14087. https://doi.org/10.4088/JCP.21r14087

Cuijpers, P., et al. (2023). Psychological treatments for depression: A systematic review and meta-analysis. World Psychiatry, 22(1), 32–46. https://doi.org/10.1002/wps.21064

Muneer, A. (2020). The neurobiology of depression: An integrated model. Frontiers in Psychiatry, 11, 72. https://doi.org/10.3389/fpsyt.2020.00072

Han, C., et al. (2019). The use of SSRIs in elderly patients with major depressive disorder: Safety and effectiveness considerations. Drugs & Aging, 36(10), 923–935. https://doi.org/10.1007/s40266-019-00709-4

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