SPECIAL CONSIDERATIONS RELATED TO VULNERABLE POPULATIONS

The psychiatric mental health nurse practitioner assumes probably no greater responsibility than the responsibility of prescribing medications. While someone can be harmed by psychotherapy, the level and intensity of the harm generally does not come to the same level of harm that can occur from improper prescribing. The PMHNP must understand his/her responsibility both at a state and federal level when it comes to prescribing medications. It is of critical importance to understand the risks and benefits of the medications prescribed and their varying potential effects on special populations such as children/adolescents, pregnant women, or older adults.

This week, you examine the special considerations when prescribing for pregnant women and older adults.

· Recommend psychopharmacological and nonpharmacological interventions for older adults and pregnant women in mental health settings

· Evaluate the risks and benefits of pharmacological treatment for older adults and pregnant women

· Justify clinical decision making related to pharmacological treatment of older adults and pregnant women in mental health settings

PRESCRIBING FOR OLDER ADULTS AND PREGNANT WOMEN
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.

· Use the Walden Library to 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 nonpharmacological intervention for treating the disorder in that population.

· Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological 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 nonpharmacological intervention for the disorder.

LEARNING RESOURCES
Required Readings
· 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. . https://doi.org/10.1176/appi.books.9780890426807

· Agency for Healthcare Research and Quality. (2019). Maternal and fetal effects of mental health treatments in pregnant and breastfeeding women: A systematic review of pharmacological interventions Links to an external site. . https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/protocol-pharm-pregnant-women_0.pdf

· Hardy, L. T., & Reichenbacker, O. L. (2019). A practical guide to the use of psychotropic medications during pregnancy and lactation Links to an external site. . Archives of Psychiatric Nursing, 33(3), 254–266. https://doi.org/10.1016/j.apnu.2019.04.001

· National Library of Medicine. (2006–2020). Drugs and lactation database Links to an external site. (LactMed). https://www.ncbi.nlm.nih.gov/books/NBK501922/

· The LactMed® database is a peer-reviewed, evidence-based resource on drugs that may be used by breastfeeding mothers. It includes possible effects on nursing infants and offers drug alternatives where possible.

· Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

· Chapter 27, “Psychiatry and Reproductive Medicine”

· Chapter 33, “Geriatric Psychiatry”

· Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.) . Jones & Bartlett Learning.

· Chapter 3, “Vulnerable Populations”

· Chapter 4, “Mental Health and Primary Care: A Critical Intersection”

· Chapter 5, “Cultural Sensitivity and Global Health”

Required Media

· American Psychiatric Association. (2020). Geriatric telepsychiatry Links to an external site. [Video]. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry

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