Indiana University East Neurotransmitters and Neuropeptides Discussion please follow the directions. Attachment below. It’s a Db response to another collea

Indiana University East Neurotransmitters and Neuropeptides Discussion please follow the directions. Attachment below. It’s a Db response to another colleague. Peer review articles within 5 years of publication in U.S.A DB1: : 200 words without references included. 2-3 references peer review articles within 5 years of
publications in the U.S.A.
According to Stahl (2013), there exists numerous neurotransmitters within our nervous system that
function to stimulate or inhibit neuronal impulse travel. Stahl, (2013) sets forth six main
neurotransmitters that are generally the focus of psychopharmacology and they are as follows:
Acetylcholine is associated with muscle functioning (Heuther and McCance, 2017). A decline is linked
with Alzheimer disease while an increase may slow the advancement of such (Heuther and McCance,
2017; Stahl, 2013)
Serotonin is associated with one’s mood, level of anxiety and sleep (Heuther and McCance, 2017).
Increased levels are associated with schizophrenia while a decrease is tied to depression (Stahl, 2013).
Dopamine is known for its role related to, among others, movement, our reward centers, and attention
(Stahl, 2013; Mandal, 2019). A decrease has been linked to Parkinsons disease while an increase is
related to schizophrenia (Heuther and McCance, 2017; Mandal, 2019). Norepinephrine is related to our
fight or flight response in addition to our ability to concentrate (Cassata, 2015). Decreased levels are
related to ADHD and depression while elevated levels can cause anxiety (Dellwo, 2019).
Glutamate is connected to promote the communication between neurons and memory creation (Adães,
2018). In excess glutamate is toxic to nerve cells and a decrease can lead to in neuronal activity (Adães,
2018).In constrast, GABA (y-aminobutyric acid) works to positively inhibit neuronal communication
activity by decreasing ones stress level thus promoting relaxation, better sleep, reduction of pain (Breus,
2019). Increasing GABA, which decreases neuronal activity, has been promising in the treatment of
epilepsy (Heuther ad McCance, 2017). However, a decrease or disruption of GABA levels could lead to
insomnia, anxiety, increase in stress, among others(Breus, 2019).
DB2: : 200 words without references included. 2-3 references peer review articles within 5 years of
publications in the U.S.A.
Describe the function and characteristics of each neurotransmitter.
What signs/symptoms and diseases occur with an increase and a decrease with each neurotransmitter?
Acetylcholine: a major neurotransmitter in the brain, spinal cord, and peripheral nerves. It also found in
RBC’s and other cells in the body. It is synthesized in the neurons and released at the nerve ending to
pass on the nervous stimuli postsynaptically. (Stahl’s, 2013) It is a part of the parasympathetic system
and released at the synapse. It exerts actions opposite that of the sympathetic system. Acetylcholine is
involved in almost all the body functions like heartbeat, respiration, digestion, excretion, reproduction.
(Stahl’s, 2013)
Dopamine: This neurotransmitter is related to the sympathetic system. It is mostly confined to the brain
and spinal cord and few nerves. It has functions of mood and sympathetic system. It has a
pharmacological action of antagonist and partial antagonist. Targets G1 and G2 protein receptors.
(Stahl’s, 2013)
Norepinephrine: This is widely distributed like acetylcholine. It covers all of the sympathetic functions
and has actions opposite to acetylcholine. It acts through receptors like ?1, ?2 and ?1, ?2. It acts as an
agonist and antagonist
Glutamate: This neurotransmitter is found predominantly in the brain and also as amino-acid in the rest
of the body. It acts through NMDA, AMPA receptors. It is involved in memory and learning. (Stahl’s,
2013)
GABA (gamma aminobenzoic acid): GABA is a neurotransmitter present predominantly in the brain. It
acts to control nerve conduction and electric potential in the brain, also muscle tone. Agonist
neurotransmitter. (Stahl’s, 2013)
Serotonin: antagonist and inverse agonist. Found in large quantities in the intestine, platelets and also
brain. It acts through 14 types of serotonin receptors like 5HT1, 5HT2, 5HT3, 5HT4, 5HT7 and their subtypes. (Stahl’s, 2013)
Histamine: This substance is widely distributed in tissues. It is called as an afferent neurotransmitter as it
initiates the sense of itch and pain at sensory nerve endings in the skin and other regions. Acts as an
antagonist. (Stahl’s, 2013)
What signs/symptoms and diseases occur with an increase and a decrease with each neurotransmitter?
Acetylcholine: Deficiency and rise in the levels of acetylcholine lead to many diseases and also toxic
effects. Examples of diseases include parkinsonism, Alzheimer’s disease, glaucoma. Excess acetylcholine
causes increased mucus production and constriction of the bronchioles within the lungs, causing
breathing difficulties, decreases the heart rate, the pupils dilate and also an increase in sweating. (Lee &
Coccaro, 2019) In Parkinson’s disease, dopamine gradually depletes causing an imbalance between the
normal interactions with dopamine and ACH. These neurotransmitters normally work together
coordinating body movements. As dopamine becomes depleted, acetylcholine increases causing the
symptoms of Parkinson’s disease such as body tremors and drooling, slurred speech and mobility
difficulty. (Lee & Coccaro, 2019)
Dopamine: Disorders due to its deficiency or rise include depression, parkinsonism. Lack of pleasure,
Lack of ability to feel love, Lack of remorse about actions, Distractability, Muscle weakness, Respiratory
diseases. (Lee & Coccaro, 2019)
Norepinephrine deficiency causes a lack of drive and initiative, inability to form memories, dysregulation
of sleep, low levels of arousal and attention and therefore lack of ability to react in the face of danger.
(Lee & Coccaro, 2019)
GABA: Its deficiency leads to epilepsy. It acts through GABA receptors. This neurotransmitter plays a key
role in epilepsy or convulsion disorder. (Lee & Coccaro, 2019)
Serotonin: Its deficiency or change is seen in disorders like depression, schizophrenia. (Lee & Coccaro,
2019)
References,
Lee, R. J., & Coccaro, E. F. (2019). Neurotransmitters and Intermittent Explosive Disorder. Intermittent
Explosive Disorder, 87-110. doi:10.1016/b978-0-12-813858-8.00005-x
Stahl, S. M. (2013). Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical
Applications. Cambridge, England: Cambridge University Press.
DB3: : 200 words without references included. 2-3 references peer review articles within 5 years of
publications in the U.S.A.
Non-Rapid Eye Movement (NREM) Sleep Arousal Disorder – sleep terror type I believe is this child’s
mental health diagnosis. Essential features of Non-Rapid Eye Movement Sleep Arousal Disorder include
awakening incompletely from sleep with sleepwalking or terror, inability to communicate during the
episode, and has no recollection of the incident the next morning (Morrison, 2014). The D’s of the fine
print include distress or disability regarding work/school, social, or personal impairment (Morrison,
2014). NREM is the repetition of partial awakening, occurring in the initial third period of sleep and
lasting usually 1-2 minutes with amnesia for the event (American Psychiatric Association, 2013). The
defining symptom of sleep terror is repeated episodes of abrupt arousal from sleep starting with an
anxious sob or scream (American Psychiatric Association, 2013). This 6-year-old awakened after 90
minutes of sleep screaming for 1-7 minutes with no memory of episode which is why I chose NREM
sleep arousal disorder.
What are the differential diagnoses?
Differential diagnoses include substance use and physical disorders, anxiety and dissociative disorders,
and other sleep disorders (Morrison, 2014). Additional differential diagnoses according to the DSM-5
include the following:
Nightmare disorder – report vivid dreams, occur during REM sleep, awaken easily and completely
Breathing-related disorders – confusion awakening with amnesia accompanied by snoring, apnea, and
daytime sleepiness
REM sleep behavior disorder – involves movement that can result in harm to the individual
Parasomnia overlap syndrome – has characterizations of both sleepwalking and REM sleep behavior
disorder
Sleep-related seizures – nighttime seizures imitate NREM sleep arousal disorders
Dissociative amnesia with dissociative fugue – nighttime dissociative fugue ensues from a period of
wakefulness during sleep; often history of childhood abuse
Panic disorders – may have precipitous arousal from deep REM sleep with complete awakening and
without confusion
Discuss how to use the DSM 5: The DSM-5 is the guideline for diagnosing mental health disorders (265
diagnoses not including the modifiers) and designed to meet the needs to delineate succinctly each
mental disorder including categorical diagnostic criterion, features supporting diagnosis, prevalence,
etiology/treatment, risk factors, culture/gender alterations, differential diagnoses, and occurrence of
other conditions(American Psychiatric Association, 2013). The intention of DSM 5 is to support educated
clinicians in the diagnosis of their client’s mental health conditions as part of a care plan to provide best
practices facilitating client assessment (American Psychiatric Association, 2013).
What are other diagnostic tools you can use? Additional diagnostic tools that I could use are Morrison’s
decision tree. The decision tree prompts the clinician by asking a series of yes or no questions to arrive
at an accurate diagnosis (Morrison, 2014). Screening tests specific for the condition I am treating could
be helpful. A thorough assessment, laboratory tests, and imaging could be diagnostic tools to confirm or
to rule out certain conditions.
How would you explain to a patient how you arrived at their diagnosis?
I would have previously if possible establish therapeutic communication by involving the client and/or
family in the individuals care. Obtain a thorough history, determine prior history, order appropriate
tests, perform a medication reconciliation, collaborate with peers as I am a novice clinician. I would sit
down and talk with the client and discuss the aforementioned items and provide my professional
opinion based on data, the condition I believe they have, or conditions that I have ruled out, or that I
was unable to make a definitive diagnosis. I would ask for acknowledgement of understanding and have
the client repeat the things discussed.
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders DSM-5
(5th ed.). Washington, DC: American Psychiatric Association.
Morrison, J. (2014). Diagnosis made easier principles and techniques for mental health clinicians (2nd
ed.). New York, NY: The Guilford Press.
Morrison, J. (2014). DSM-5 made easy the clinicians guide to diagnosis. New York, NY: The Guilford
Press.
DB4: : 200 words without references included. 2-3 references peer review articles within 5 years of
publications in the U.S.A.
or this discussion board please refer to the Case Study: (References)
What is the most likely diagnosis for this young boy?
NREM Sleep Arousal Disorders – Sleep Terror Type (also known as night terrors)
Discuss how to use the DSM 5.
According to the American Psychiatric Association (2013), DSM-5 is a classification of mental disorders
with associated criteria designed to facilitate more reliable diagnoses of these disorders. It has become
the standard reference for clinical practice. However, DSM should be used as flexible guide to organize
all the information to establish the best possible diagnosis. Clinical training and experience are needed
to use DSM to identify symptoms, behaviors, cognitive functions, personality traits, physical signs,
syndrome combinations, and durations. It’s also important that the clinician can differentiate from
normal life variations and transient responses to stress. The DSM-5 should NOT be a “one size fits all”
and every patient should be carefully assessed and be the for front of the diagnosis. DSM is harmonized
with the World Health Organization’s International Classification of Diseases (ICD) to provide a standard
coding system for the United States. However, DSM-5 does not provide guidelines for treatment of the
disorders. Further knowledge, regarding psychotherapy and psychopharmacology are needed to
complete the diagnosis and treatment plan for a patient (American Psychiatric Association, 2013).
What are other diagnostic tools you can use?
For NREM Sleep Arousal Disorders – Sleep Terror Type (also known as night terrors)
Polysomnography – obscured with movement artifact during episode. Electroencephalogram typically
shows theta or alpha frequency activity during the episode, indicating partial or incomplete arousal
(Dulcan et al, 2018)
Formal sleep study
How would you explain to a patient how you arrived at their diagnosis?
First, I would talk with the patient/parents regarding his symptoms noted in the case study, which are
typical for patient experiencing NREM sleep arousal disorders, and in his case specifically sleep terrors. It
is important to note, that sleep terrors are developmental and NOT secondary to a psychiatric disorder.
Sleep terrors typically present during the first third of sleep and are recurrent episodes of incomplete
awakening. Eyes are open during the event. Episodes last between 1-10 minutes. Usually only 1 episode
occurs per night. Abrupt arousal from sleep, with panicky scream or cry. Typically associated with
mydriasis, tachycardia, rapid breathing, and sweating during episode. Unresponsive to comfort during
episode. Difficult to awake. Amnesia of the episode and child does not recall any dreams (Dulcan et al,
2018).
Then I would discuss ways to hopefully cease or decrease the episodes. Examples that contribute to
sleep terrors include sedatives, sleep deprivation, sleep-wake schedule disruptions, fatigue, and physical
or emotional stress increase likelihood of episodes (Duncan et al, 2018). Medication (Benzodiazepines)
are always a last resort, if the episodes become frequent, episodes interfere with daytime functioning,
or the patient is in physical danger (Dulcan et al, 2018).
References
American Psychiatric Association; 5th edition (2014) Diagnostic and Statistical Manual of Mental
Disorders DSM-
DB5: : 200 words without references included. 2-3 references peer review articles within 5 years of
publications in the U.S.A.
Morrison describes components of suicide in two realms – those related to mental illness and those
related to a personal/social disposition (Morrison, 2014).
Mental Health Disorders pertinent to suicide consist of:
Mood disorders – major depression and bipolar disorders account for half of all suicides
Schizophrenia – increased risk with paranoia or depressive symptoms with 10% with death by suicide
Substance abuse – clients with substance abuse more than twice as likely to commit suicide
Personality disorder – risk increased in antisocial and borderline personality disorders
Others – Chronic conditions of PTSD or ADHD may have increased suicide risk
Individual Factors that increase the risk of suicide consist of:
Higher incidence of suicide – males; advancing age (> than 85 years old); race (Caucasian); martial status
(single or divorced); religion (Protestants); living alone
Employment – unemployed/retired persons may have low confidence/diminished resources increasing
the incidence of suicide
Family history, gun ownership, physical illness, psychiatric hospitalization, hopelessness, money woes,
and addictions
Prior suicide attempt – one of the strongest indicators and may persist for forty years
What is your responsibility as a PMHNP as their care provider?
Responsibility begins with an accurate assessment. Areas to assess for when performing a suicide
assessment include the client’s current presentation, strengths and weaknesses, history, and
psychological status from the client or family, friends, clients support system, and or community
workers (Jacobs et al., 2010). Prioritization of the assessment is essential as the client’s safety is
paramount and the clinician may be unable to obtain all the essential data initially (Jacobs et al., 2010).
Responsibilities of the clinician providing ongoing care for clients include establishing/maintaining
therapeutic communication, coordination of multidisciplinary care, evaluating client progress and
modifying treatment plan as appropriate, continuing assessment (safety, mental health status, and level
of functioning), encouraging compliance with treatment, and providing education to client (Jacobs et al.,
2010). Weekly office visits and follow-up on missed appointments are other responsibilities of mental
health care clinicians (Weber, Michail, Thompson, & Fiedorowicz, 2017). In summary, the clinician is
responsible for assessment; suicidal evaluation; determining level of risk; managing level of risk; nonpharmacological interventions (safety plan, means restriction, and psychotherapy); pharmacological
intervention; documentation; and evaluation and education (Weber et al., 2017).
What are the legal ramifications?
The family of the deceased may take legal action against the clinician’s malpractice insurance. The
clinician who had a client die by suicide may have feelings of guilt or thinking they missed a symptom or
opportunity and may benefit from support of peers, counseling services, and/or consult with an
attorney/risk management (Jacobs et al., 2010).
What are some cultural considerations?
Cultural or religious ideas may deter the client from expressing ideations of suicide Peer pressure is
strong in teenagers and the suicide of a teen may precipitate the suicide of other teens (Morrison,
2014). 13 Reasons Why on Netflix was a series where a girl committed suicide and sent recordings to the
thirteen people, she held responsible for her suicide including the topics of rape, bullying, drunk driving,
and more (Knopf, 2017). Guidance for families related to the program according to Knopf are to
determine if their child saw the show, observe for warning signs of suicide and ask if they thought about
hurting themselves, educate regarding interventions if the child sees warning signs, hear openly your
child’s concerns, and seek help if you sense your child or their friends may be unsafe (Knopf, 2017).
Firefighters, due to PTSD and substance abuse, have a high incidence and underreported rate of suicide
which is compounded by inaccurate numbers, the stigma of suicide, and inadequate research on the
mental health of firefighters (Henderson, Van Hasselt, LeDuc, & Couwels, 2016). Older European descent
men have a higher incidence of suicide believed to have an etiology in their cultural conception related
to perceived humiliation of aging and rigidity in growing older (Cannetto, 2017). Cultural considerations
examples were delineated according to age and occupation.
Collaborative care models (mental health care in a primary care provider office) may decrease suicide
ideation and is financially feasible (Weber et al., 2017).
References
Cannetto, S. S. (2017). Suicide: Why are older men so vulnerable? Men and Masculinities, 20(1), 49-70.
https://doi.org/10.1177/1097184X15613832
Henderson, S. N., Van Hasselt, V. B., LeDuc, T. J., & Couwels, J. (2016). Firefighter suicide: understanding
cultural challenges for mental health professionals. Professional Psychology: Research and Practice,
47(3), 224-230. https://doi.org/10.1037/pro0000072
Jacobs, D. G., Baldseearini, R. J., Conwell, Y., Fawcett, J. A., Horton, L., Meltzer, H., … Simon, R. I. (2010).
Practice guideline for the assessment and treatment of patients with suicidal behaviors. Retrieved
September 30, 2019, from
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf
Knopf, A. (2017). Advice for parents on 13 reasons why. Brown University Ch…
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