Treatment of Major Depressive Disorder With Psychotic Features

Challenges in the Treatment of Major Depressive Disorder With Psychotic Features | Schizophrenia Bulletin | Oxford Academic (oup.com): https://academic.oup.com/schizophreniabulletin/article/39/4/787/1918693 Please use this article as a reference to answer the 1st question. For treatment please use Sertraline and Olanzapine combination. You may mention if patient refuses Olanzapine, Olanzapine comes in Zyprexa Zydis (which disintegrating tablet). Sertraline is used for depression and Olanzapine is used for psychosis. Please use another reference to answer the second question. Leslie is a 64 year old female who presents to the acute inpatient setting with acute psychosis. She has a history of similar episodes about every ten years; in between of which she has worked successfully as a schoolteacher with no evidence of residual effects. During her last episode, her husband sought emergency guardianship and a Force Medications order. With forced medications, her symptoms slowly began to abate and she was able to reach a full state of recovery within a few weeks of her inpatient admission. There are no records of her past admission and her husband does not remember what medication she was given, only that she was given injections, and that they continued it for a few months as an outpatient before she was able to discontinue altogether. Historically, she has been given a diagnosis of severe major depression with psychotic features. She has a history of chronic back pain and elevated lipids, but is otherwise in good health. Prior to hospitalization, the only medications she took were Lipitor 20mg once daily and PRN naproxen. Leslie’s current symptoms include acute paranoia, auditory and visual hallucinations, and periods of catatonia. She has been eating and sleeping poorly. On admission, she was not able to meaningfully participate in the nurse’s admission assessment. Her most recent episode has been progressively worsening for six weeks, and the precipitant appears to be the death of her close friend Teresa from cancer, about two months ago. The nurses state that she will often stand and stare blankly at them, appears fearful, has been observed mumbling to herself, and when she speaks, she only repeatedly states the name “Teresa” (her friend’s name) and nothing else. She was hospitalized involuntarily on a temporary hold after her husband called the police when he returned home and found her naked, holding a knife, and unable to follow his directions to put down the knife.As the NP on the inpatient unit, you along with the rest of the treatment team, opted to pursue legal means to extend her hospitalization and force medications. An order was granted today for an involuntary admission for up to 90 days as well as a Force Medications order. Please answer/discuss the following questions below. There are no right or wrong answers, as long as you provide adequate rationale & explanation! Feel free to respond to your peers as you answer your questions, as this will strengthen your answers & allow you to receive feedback. 1. Given her diagnosis & Force Medications Order, what specific medications might you consider to help stabilize her symptoms? Why did you consider those particular medication choices? (HINT: Consider the ROUTE of your medication choices! Be specific — i.e. “antipsychotics” is not a sufficient answer!). 2. Leslie is now hospitalized involuntarily and is being forced medications. How might you still elicit concordance with her?

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