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After assessing and diagnosing a patient, PMHNPs must take into consideration special characteristics of the patient before determining an appropriate course of treatment. For pharmacological treatments that are not FDA-approved for a particular use or population, off-label use may be considered when the potential benefits could outweigh the risks.

In this Discussion, you will investigate a specific disorder and determine potential appropriate treatments for when it occurs in an older adult or pregnant woman. 


· Choose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the 
DSM-5-TR to use.

· Research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one non-pharmacological intervention for treating the disorder in that population.


· Recommend one FDA-approved drug, one off-label drug, and one non-pharmacological intervention for treating your chosen disorder in older adults or pregnant women.

· Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?

· Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.

· Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a non-pharmacological intervention for the disorder.

Weekly Resources

· American Psychiatric Association. (2016). 

The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia Links to an external site.

· Agency for Healthcare Research and Quality. (2019). 

Maternal and fetal effects of men


Respond to your colleague. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature. 

**minimum of two (2) scholarly references are required for each reply cited within the body of the reply & at the end**

Reply # 1

Lauranne Elisa Brown


Depression in the Elderly

Depression is a significant concern in the elderly population due to multiple challenges.  According to Robertson et al. (2019), the elderly is susceptible to significantly more health problems in addition to experiencing life stressors that include financial challenges, social isolation, retirement, and the death of loved ones.  Suicide rates are also high in the elderly which account for 19% of all suicides even though older adults are only 13% of the population (Robertson et al., 2019). Moreover, depression the elderly is often overlooked and frequently coexists with many general illnesses (Robertson et al., 2019).  Robertson et al. (2019) indicated that depression is also perceived as an inevitable part of the aging process by some healthcare providers, and is therefore not treated effectively; nevertheless, it is crucial for clinicians to recognize this mental illness in older adults and intervene when depression is present.  In this discussion the treatments prescribed to treat major depressive disorder in older adults will be explored.

Assessment Tool

            The structured version of the Hamilton Depression Inventory (HAM-D) would be selected to detect depression in the elderly population (Carrozzino et al., 2020).  For many years this assessment tool has been the gold standard for detecting depression with good inter-rater and test-retest reliability in addition to sufficient sensitivity and internal reliability (Carrozzino et al., 2020).  Nevertheless, Carrozzino et al. (2020) cautioned that unstructured forms of this test should be avoided due to reduced reliability and sensitivity in these versions.

FDA Approved Drug for Depression in the Elderly-SSRIs

            The first line of treatment for older adults with major depressive disorder is selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine, and fluvoxamine (Robertson et al., 2019). Although SSRIs have a lower rate of cardiotoxic and antimuscarinic side effects compared to tricyclic antidepressants which is a significant benefit, in the elderly they raise the risk of hemorrhagic strokes, insomnia, restless legs, hyponatremia, cholinergic blockade, and gastrointestinal bleeds (Robertson et al., 2019). SSRIs also increase the risk of dizziness due to hypotensive side effects that can led to falls in older adu


Respond to your colleague. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature. 

**minimum of two (2) scholarly references are required for each reply cited within the body of the reply & at the end**

Reply # 2

Myrlande Dessalines

Initial Post

FDA-Approved drug, Off-Label Drug, and Nonpharmacological Interventions

Major neurocognitive disorder due to Alzheimer’s disease (AD) with behavioral disturbance [331.0 (G30.9)] is the most common cause of dementia found in older adults. They experience evident decline in memory and learning and have a steady and progressive decline in cognition (American Psychiatric Association, 2013). Donepezil (Aricept) is FDA-approved for AD whether mild, moderate, or severe, where it inhibits acetylcholinesterase, and improves the availability of acetylcholine (Liu et al., 2022). Risperidone is utilized as an off-label drug for behavioral disturbances in dementias, where it is indicated for patients with AD receiving short-term treatment with symptoms with aggressive behavior (Oliveira et al., 2021). Nonpharmacological interventions include keeping individuals who are diagnosed with AD engaged with a set routine and schedule. It is important that they are provided with various trainings to assist with memory training utilizing memory aids, as well as music and dance therapy (Park & Cohen, 2019).

Risk Assessments to Inform Treatment Decision-Making. Risks and Benefits of FDA-Approved Medicine and Off-Label drug

Risk assessments that would be utilized in making an informed treatment plan would primarily involve the stage as to where patient is in the progression of AD. Safety is a priority when assessing patients, and ensuring that they receive adequate treatment that will assist in slowing the progression, versus promoting adverse treatments. Low doses of medications must be started and utilized with the older adults as it can eliminate harsh side effects that may be experienced. There are always risks involved when medications are prescribed—whether they are FDA-approved or used off-label. However, there is greater safety when using those which are FDA-approved as there has been extensive evidence-based research to support the benefits versus the risks. When using off-label drugs there is greater risk in harm as research has not fully developed or supported its use for disease process.

Clinical Practice Guidelines for Alzheimer’s Disease

There are clinical practice guidelines in place for Alzheimer’s disease. These guidelines have been established by the official Alzheimer’s Association which has partnered with a plethora of healthcare agencies and organizations. These clinical guidelines provide suggestions and clinical tips o