Homework help – Write a 3-page summary paper that addresses the following:
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples. 10/2/23, 10:44 AM Psychopharmacologic Approaches to Treatment of Psychopathology
Alzheimer’s Disease
76-year-old Iranian Male
BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CTscan of the head) were normal.
According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone.
They also noticed that things he used to take seriously had become a source of
“amusement” and “ridicule.”
10/2/23, 10:44 AM Psychopharmacologic Approaches to Treatment of Psychopathology
Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.
SUBJECTIVE
During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.
MENTAL STATUS EXAM
Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview.
His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no
unusual motor movements and demonstrates no tic. Self-reported mood is euthymic.
Affect however is restricted. He denies visual or auditory hallucinations. No delusional or
paranoid thought processes noted. He is alert and oriented to person, partially oriented
to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh].
Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr.
Akkad’s standing up during the clinical interview and walking towards the door. When
you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal
or homicidal ideation.
Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)
RESOURCES
§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination
(MMSE). Lutz, FL: Psychological Assessment Resources.
10/2/23, 10:44 AM Psychopharmacologic Approaches to Treatment of Psychopathology
Decision Point One
Select what you should do:
Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3
mg orally BID in 2 weeks
(1.html)
: Begin Aricept (donepezil) 5 mg orally at BEDTIME
(2.html)
Begin Razadyne (galantamine) 4 mg orally BID
(3.html)
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Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented:
The patient case study involved 76-year-old Mr. Akkad, an Iranian male who was brought to the office by his son. Over the past two years, Mr. Akkad’s family had noticed changes in his personality and behavior, including becoming more critical of others, losing interest in usual activities, and developing a flat affect. He had also begun experiencing memory issues such as forgetting things and having difficulty finding words.
During the clinical evaluation, Mr. Akkad was pleasant but demonstrated confabulation on memory testing. He scored 18/30 on the Mini-Mental State Exam, indicating moderate dementia. His mental status exam found impaired insight, judgment, and impulse control. He was diagnosed with major neurocognitive disorder due to presumptive Alzheimer’s disease.
The three treatment decisions presented were:
Begin Exelon (rivastigmine) 1.5 mg orally twice daily, increasing to 3 mg in 2 weeks
Begin Aricept (donepezil) 5 mg orally at bedtime
Begin Razadyne (galantamine) 4 mg orally twice daily
My recommendation was to begin Aricept (donepezil) 5 mg orally at bedtime (decision #2).
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Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples:
Yes, I believe my treatment recommendation of beginning Aricept (donepezil) 5 mg at bedtime for Mr. Akkad’s Alzheimer’s disease was supported by evidence-based literature. Donepezil is a first-line treatment option according to guidelines from the American Psychiatric Association and Alzheimer’s Association for mild to moderate Alzheimer’s like Mr. Akkad presented with. Numerous clinical trials have found donepezil effective at improving cognitive function and delaying symptom progression compared to placebo for 6-12 months when used for mild to moderate Alzheimer’s disease (Rogers et al., 1998; Feldman et al., 2001). The recommended starting dose of 5 mg before increasing to 10 mg, taken at bedtime, is supported to minimize side effects like nausea (Gauthier et al., 2006). Therefore, the decision to initiate donepezil for this patient’s condition and level of severity was grounded in clinical evidence and treatment guidelines.
Page 3
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources. Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples:
By recommending donepezil, my goal was to provide Mr. Akkad symptomatic relief through improved cognition and functioning based on evidence it can delay progression up to 12 months (Rogers et al., 1998; Feldman et al., 2001). However, as this was a case study exercise without long-term follow-up data on Mr. Akkad’s actual response, I do not know if my treatment decision achieved the expected results. Clinical trials have found donepezil effective in a majority but not all patients with Alzheimer’s disease. It is possible Mr. Akkad may not have had a positive individual response.
Additionally, while guidelines support donepezil as a first-line treatment (Gauthier et al., 2006), it is not curative and symptoms will continue to progress over time. The case study did not provide outcome data, so I cannot assess if donepezil maintained its efficacy long-term or if Mr. Akkad may have later required augmentation, combination therapy, or a change in treatment due to progression. Real patient care involves ongoing monitoring and adjustment based on treatment response and disease progression, which this exercise did not allow for in its limited scope. Therefore, the results achieved in actual clinical practice could differ from expectations based on average trial outcomes.
