course materials

1. The pharmacological treatments used for dementia
The pharmacological treatments used for dementiaThe pharmacological treatments used
for dementiaDB1: 300 words without references page include. 2-3 references APA format.
Peer review articles within 5 years of publication only in U.S.A. Discuss and differentiate the
pharmacological treatments used for dementia. Are there any contraindications? There are
several subtypes of neurocognitive disorders, and depending upon the cause, these
subtypes are either applied to younger, or older populations affected. They are listed as
either mild, or major, when making a determination of proper coding, according the DSM-5.
The patient may present with certain features related to the disorder, and the practitioner
must be aware of the criteria which places the patient within the appropriate subtype.
Alzheimer’s subtle progression of diminishing memory problems, and inability to perform
normal function cognitively, and physically. Since there may be many aspects of the cause, it
will be up to the practitioner to ascertain whether diagnostic features are mild, or major.
Most likely there is a genetic component, such as family history, as well as environment,
with internal, and external factors (American Psychiatric Association, 2013). Dementia is a
global term for disorders related to a decline in memory functional, and physical decline.
Since there are many stages, obtaining a family history is crucial, due to the insidious
succession of these stages. Aside from genetics, or an inherited APOE ?4 gene,increasing age
is considered a risk factor for Alzheimer’s. A disconnection of certain neurons, or deficit
with cholinergic functioning is believed to be related to interference with memory
problems, specifically short term memory. Cholinesterase inhibitors, like Donepezil,
Rivastigmine, and Galantamine inhibit AChE in certain areas of the brain, by enhancing
access in the deficient areas of the brain. A drug such as Memantine, (an NMDA antagonist),
works as an open channel antagonist, to prevent a stream of glutamate during
neurotransmission. It should also be noted that these drugs are more effective with early
stages of Alzheimer’s (Stahl, 2013). Obtaining a family history of mental health disorders is
vital, as dementia with psychotic features requires vigilant judgement with regard to
treatment with antipsychotics. According to Jacobson (2014) “When benefits of treatment
outweigh the risks, and the decision is made to use an antipsychotic, it is critically
important to determine the probable etiology of dementia, because this determines
treatment” (p. 85). Typical and Atypical drugs have a death rate in geriatric patients which
have rendered them to come with black box warnings for this population. If a decision has
been made to place a patient on drugs, such as Quetiapine, Risperidone, or Aripiprazole,
these are started at the lowest doses. These medications should be scheduled, and not used

2. on an as needed basis, or PRN, to prevent over sedation (Jacobson, 2014). There should also
be constraint in the use of an anxiolytic with an antipsychotic. The warnings for these type
of medications to control behaviors are not taken lightly, due to increased risks of death,
and CVA events. Contraindications also include patient with cardiac, kidney, and liver
problems (Stahl, 2017). Medications which may cause dizziness, also places the patient as a
high fall risk, and closer observation is warranted in this situation. Discuss pharmacological
treatments used for Autism Spectrum Disorder. What are the target symptoms? According
to Preston, O’Neal, and Talaga (2015) “There is no effective medication specific to any of the
autism spectrum disorders” (p. 96). Treatment with certain medications are targeted at
behavioral, cognitive, and emotional regulation, so that rehabilitation might improve. SSRI’s,
stimulants, mood stabilizers, antipsychotics, beta-blockers, and opioid antagonist are
common medications for certain aspects of autism.The pharmacological treatments used for
dementiaORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSSymptoms, and
behaviors reported, or observed indicates proper treatment, and involvement of a care
team, and the family of the patient for continuity of care (Preston, O’Neal, and Talaga, 2015).
Optimal functioning is the goal for treatment, therefore; prescribing any of these
medications requires a family history, to rule out any differential diagnoses. A history of
cardiac, respiratory, sleep problems, and epilepsy should be included. Negative behaviors
that have otherwise become coping skills for patients require restoration through ongoing
therapeutic intervention. When these behaviors get in the way of psychotherapy, then this
is where medications mentioned above may be useful. A disorder, like Rett’s comes with
cardiac, and respiratory problems, therefore; prescribing any medications which might
harm, rather than help, requires careful consideration. Question for the class: For patient
with dementia with psychotic features, we understand that anxiolytics should not be used
in conjunction with antipsychotics. What are some of the ways you might have managed
behaviors where you work, while patients are being stabilized? References American
Psychiatric Association (2013). DSM-5: Diagnostic and statistical manual of mental
disorders: Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease. Arlington,
VA: American Psychiatric Publishing. Jacobson, S. A. (2014). Clinical Manual of Geriatric
Psychopharmacology (2nd ed.). Arlington, VA: American Psychiatric Publishing Preston, J.
D., O’Neal, J. H., & Talaga, M. C. (2015). Child and Adolescent Clinical Psychopharmacology
Made Simple (3rd ed.). Oakland, CA: New Harbinger Publications. Stahl, S. M. (2013) Stahl’s
Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. New York:
Cambridge University Press. DB2: 300 words without references page include. 2-3
references APA format. Peer review articles within 5 years of publication only in U.S.A.
Discuss and differentiate the pharmacological treatments used for dementia. Are there any
contraindications? Several medications are being used for dementia patients, but no
medication has been found to slow or reverse dementia. The goal of treatment for dementia
is to provide symptomatic relief. Alzheimer’s disease makes up about 60-70 percent of all
dementia and is marked usually by a loss of cholinergic neurons in the brain (Preston &
Johnson, 2014). Most medications used for Alzheimer’s disease are cholinesterase
inhibitors, which boosts acetylcholine by inhibiting the enzyme that breaks down
acetylcholine Stahl, 2017). Cholinesterase inhibitors approved for Alzheimer’s are

3. Donepezil, Galantamine, and Rivastigmine. These medications inhibit cholinesterase not
just in the brain but in other parts of the body. The pharmacological treatments used for
dementiaThe increase in acetylcholine results in cholinergic effects such as diarrhea,
nausea, gastrointestinal upset, and muscle cramps. Another medication used for
Alzheimer’s disease is Memantine, which is an NMDA receptor agonist. Memantine is
helpful for moderate and severe cases of Alzheimer’s disease (Preston & Johnson, 2014).
The side effects of Memantine include, confusion, constipation, cough, diarrhea, dizziness,
and head pain, but these occur less frequently than the side effects of cholinesterase
inhibitors (Stahl, 2017). To get additive results in patients, Memantine may be used at the
same time as cholinesterase inhibitors because the mechanism of actions of the two classes
of medication are different (Stahl, 2017). Antipsychotics such as Olanzapine, Risperidone,
Haloperidol, and Quetiapine have also been used for Alzheimer’s disease. These medications
are not anti-dementia medications but are being used to treat behavioral dysregulation
common with the disease (Preston & Johnson, 2014). Although these medications may be
partially effective in decreasing neuropsychiatric symptoms, they must be used cautiously
because they pose a safety risk to these patients. Citalopram is an antidepressant that has
been shown to be effective in reducing agitation in dementia patients (Preston & Johnson,
2014). However, the medication does carry the risk of QTC prolongation and patient’s EKG
must be closely monitored. Other types of dementia are: vascular, Lewy Bodies,
frontotemporal, and pseudo dementia. Vascular dementia is caused by several mini strokes.
Cholinesterase inhibitors and Memantine are not effective for this type of dementia. Rather,
ACE inhibitors and statins may be helpful in treating the underlying risk factors of strokes
(Preston & Johnson, 2014). Dementia with Lewy Bodies frequently manifests with recurrent
visual hallucinations and progresses more quickly than other forms of dementia.
Antipsychotics are contraindicated as they can cause severe extrapyramidal side effects,
confusion, catatonia, and neuroleptic malignant syndrome. Quetiapine is tolerated the best,
if antipsychotic medication must be used in these patients. Frontotemporal dementia is a
result of increase damage to the frontal and temporal lobes of the brain.The
pharmacological treatments used for dementiaSince this type of dementia does not involve
loss of cholinergic neurons, cholinesterase inhibitors have no effect. Frontotemporal
dementia may be managed as a last resort with SSRIs and atypical anti-psychotics. usually
contraindicated in patients with this type of dementia. In pseudo dementia, symptoms of
depression present as dementia in elderly patients. These patients can be treated like any
other patients with depression (Preston & Johnson, 2014). Discuss pharmacological
treatments used for Autism Spectrum Disorder. What are the target symptoms? Autism
Spectrum Disorder (ASD) shows dysfunction in four primary areas: social interaction,
communication, emotional regulation, and repetitive behaviors. Signs of ASD usually are
seen by age of two and each child may have a unique pattern of behavior and level of
severity, ranging from low functioning to high functioning (Mayo Clinic, 2019). There is no
cure for ASD, but there are treatment options for associated symptoms of the pervasive
neurodevelopmental disorders (PNDs) (Preston, O’Neal & Talaga, 2015). Medications that
are indicating for treating or controlling PNDs include serotonin medications,
antipsychotics, beta-blockers, alpha-2 agonists, mood stabilizers, and stimulants. SSRIs and

4. clomipramine are effective in reducing aggression, agitation, ritualistic behavior, and
anxiety (Preston, O’Neal & Talaga, 2015). Second generation antipsychotics are helpful in
decreasing aggression and agitation, and improving social relatedness(Preston, O’Neal &
Talaga, 2015). However, these must be used cautiously given that children may be more
sensitive to side effects of antipsychotics, including extrapyramidal, cardiac, and weight
gain. Beta-blockers and alpha-2 agonists have been indicated to reduce aggression,
impulsivity, and self-injurious behavior. Clonidine is indicated to provide a calming effect
(Preston, O’Neal & Talaga, 2015). Lithium, Depakote, and Tegretol may be effective in
controlling agitation, aggression, and self-harm. Stimulants may be used cautiously to treat
attention problems, but only when the distractibility is generalized and not related to some
type of ritualistic behavior (Preston, O’Neal & Talaga, 2015). Results are inconsistent in the
use of naltrexone to reduce restlessness and to improve focus (Preston, O’Neal & Talaga,
2015). References Mayo Clinic (2019. Autism spectrum disorder. Retrieved from
https://www.mayoclinic.org/diseasesconditions/autism-spectrum-disorder/symptoms-
causes/syc-20352928 Preston, J.D. & Johnson, J (2014). Clinical psychopharmacology made
ridiculously simple. 8th edition. MedMaster, Inc. Preston, J.D., O’Neal, J.H. & Talaga, M.C.
(2015) Child and adolescent clinical psychopharmacology made simple. 3rd edition. New
Harbinger Publications, Inc. Stahl, S. M. (2017). Stahl’s essential psychopharmacology: The
prescriber’s guide. 6th edition. Cambridge University Press. DB 3: 300 words without
references page include. 2-3 references APA format. Peer review articles within 5 years of
publication only in U.S.A. Discuss the difference that may appear in child therapies with
your chosen therapy style? The style of therapy that I chose was existential therapy.
Existential therapy can be used for both adults and children. There are similarities and
differences in the approaches used by providers for each age group. According to Sá Pires
(2016), an event will present itself differently in each different age group and the content
may be shared with the use of different materials. A small child may express themselves
better by using toys such as dolls, where an adolescent may express themselves or discuss
personal experiences using a collage or pictures. No matter what age a client is, the provider
usually uses the same techniques to explore the content that comes up in therapy, such as
active listening, experimental validation, experimental immediacy, or existential challenge
(Sá Pires, 2016). How would you alter your techniques when treating children? Prior to
initiating therapy with a young child, a PMHNP may suggest a current physical by a
pediatrician to rule out any unknown medical problems that may be impacting the child’s
behavior or development. When providing therapy to a child it is important to keep in mind
that the family or care giver plays a large role in the child attending therapy sessions. A
provider must actively listen to the family’s concerns about the child and must also keep the
family informed of how therapy sessions are going. Another thing to take into consideration
when providing therapy to children or adolescents is that they did not choose to attend
therapy, that decision was made by their care giver. With this being said, it can be beneficial
for the provider to take a strength-based approach by pointing out the client’s strong points
(Wheeler, 2014). The pharmacological treatments used for dementiaWhen treating
children, it is also important to not just focus on the child’s behavioral issues but to also pay
attention to the developmental level of the child and how the child organizes their

5. experiences. The provider should take note of how the child shares information, how
attentive the child is during the session, how the child uses hand gestures, and how the child
reflects on his or her ideas and feelings. When providing care to a child, it is important that
the provider collaborate with the parents and school or day care staff, as well as with the
child, in order to get consistent information about the child’s behaviors. Upon setting goals
for the child, the provider should attempt to include the family’s ideas into the treatment
goals and both the parents and the child should be involved in the setting of goals (Wheeler,
2014). Discuss the needs of senior adults and how therapy may need a different delivery
than other adults. When providing care to an older adult the provider must remember that
the patient’s general practitioner plays an important role in their health care. It is essential
to communicate with the client’s general practitioner and establish contact with the family
or residential institution as needed (Conell & Lewitzka, 2018). According to Wheeler
(2014), some important accommodations for the provider’s office to offer are wheelchair
accessibility, client materials with at least a 14-point font, and bathrooms that are easily
accessible. Some older adults may not have a good opinion of attending therapy and may
require education about the process of therapy. It is important to talk to the client about
setting appropriate goals, how therapy works to improve symptoms, how the client should
behave during sessions, the length, number, and cost of sessions, and the expected outcome
of the therapy provided (Wheeler, 2014). Common therapies provided to older adults are
Cognitive Behavioral Therapy (CBT), Relaxation Therapy,The pharmacological treatments
used for dementiaInterpersonal Psychotherapy (IPT), and Reminiscence (RT) and Life
Review (LRT). According to Wheeler (2014), when providing CBT to a senior adult,
extended sessions may be required in comparison to that of younger adults to allow the
client the time they need to process their thoughts and feelings. Other modifications that
may be required when providing CBT to a senior is changing the focus to bettering physical
and memory abilities in order to be successful with CBT. If a provider uses IPT for a senior,
it is common to make changes to therapy in order to support the client’s physical and
cognitive abilities and to center therapy on bereavement, role transitions, and role conflict.
Some modifications that may be required are allowing the client extra time to look at
materials that are provided, repeating new materials or skills from one session to the next,
and allowing extra time for the client to process information and answer questions
(Wheeler, 2014). RT and LRT are provided for senior adults and are typically not used in
younger clients. Using these forms of therapy allows the provider to take a different
approach with the elderly client. When caring for the elderly adult it is important for the
provider to review the client’s family’s origin, educational experiences, time spent in the
military, sexual development, and religious history (Wheeler, 2014). Are there senior adults
that would not benefit from therapy? I believe that all senior adults can benefit from
therapy, but the provider must know what type of therapy the client will thrive with. For
instance, not all elderly clients will benefit from group therapy, but some will enjoy meeting
new acquaintances and will gain a new meaning of life after meeting new people (Conell &
Lewitzka, 2018). Originally, I thought that clients who have Alzheimer’s Disease or
profound memory loss may not benefit from psychotherapy because it may just agitate
them if they do not understand what is going on. After reading Wheeler (2014), I became

6. further educated that these patients can benefit from attending psychotherapy when
initiated early in their diagnoses and that psychotherapy can help reduce the level of
disability that the patient acquires, therefore reducing early institutionalization. Do you
agree or disagree, that all seniors can benefit from the right form of therapy? References
Conell, J., & Lewitzka, U. (2018). Adapted psychotherapy for suicidal geriatric patients with
depression. BMC Psychiatry, 18(1), 1–5. Retrieved from
https://search.ebscohost.com/login.aspx?direct=true&db=eoah&AN=45858855&site=ehos
t-live Sá Pires, B. (2016). Therapy with Children and Adolescents in The Phenomenological-
Existential Tradition: Community-Based Clinical Interventions. Existential AnalysisThe
pharmacological treatments used for dementia