Psychopharmacology Case-study Assignment 1

Psychopharmacology Case-study Assignment 1

 

PSY214_2018 Assignment #2

Psychopharmacology: Case-study Assignment

Due date: Nov 26th 2018 (Monday, by 11:59PM), Submit online via D2L-turnitin link (no hardcopy)

Weight: Graded out of 25 points; worth 15% of final grade

Overview

This assignment involves applying your knowledge based on reading (textbook) materials and lectures to answer questions regarding a case study. Please read through the case story below and answer the subsequent questions. I hope that you find it an interesting assignment, a chance to apply some knowledge from the course so far, and to learn a bit more by exploring and applying some text material that goes beyond the depth and content areas that we cover during class.

Your answers only need to be brief vs. extremely long explanations, but should be sufficient to both answer the question and explain your reasoning/answer. Marks will reflect the correct content of your responses as well as your ability to clearly answer the questions and demonstrate comprehension and scholarship. If you have any questions, please ask, preferentially via a post to the class D2L discussion board to ensure that everyone is ‘on the same page’.

Note: This case is a fictional account for the purpose of this assignment and may not represent actual ‘clinic’ scenarios. Nonetheless, it is at least partially based on real clinical case reports.

CASE STUDY: ‘Pat the Wanderer’

Case Log: Visit #1 – Halloween 2018

Presentation

Pat is 68-years old, single, and of German decent. Pat arrived on time to our meeting, but appeared disheveled. An apology was made for missing last week’s initial appointment and it was admitted that a chauffeur had escorted Pat today. The flow of conversation was often interrupted and thoughts often wandered from the conversation during this intake interview. Pat reported primarily episodes of forgetting mundane things and being overly distracted. Other complaints included loss of appetite and disrupted sleep patterns. Affect varies across a broad range, but was generally appropriate to the topics discussed. Pat smelled of a strong urine as well as tobacco; it was noted through self-report that smoking seemed to help Pat feel and function better.

Psychosocial History

Pat had just returned to complete a university degree after a long hiatus playing in a band. Pat was described by family members as a wild child, who was often getting into mischief. In the past, they noted that Pat always seemed to have taken pride in dress and appearance. In contrast to previously being extremely popular, Pat had gradually alienated many friends, including long-time bandmates, over the past few months.

Initiating and maintaining conversations are a particular difficulty reported by Pat’s partner and friends. They suggest that Pat seems unable to understand a lot of what is said and wonder about hearing impairment. One of the few ways they’ve found to make a connection is to sing songs from the band. At these times Pat often becomes more engaged and seems to perk up.

Environmental History

Pat has been spending most of the time in a private room at the acute care center. There is minimal participation in any of the planned activities on the floor and on a number of occasions Pat has become irritated and agitated when among larger groups of people in the common areas. Mobility has declined significantly.  While Pat used to walk with a cane, Pat is now in a wheelchair because of a series falls.

Psychiatric History

Pat had been treated by a family physician with anti-psychotics, anti-depressants, and hypnotics, all of which were reported to provide little, if any, improvement. In fact, Pat reported that some of these, especially the anti-psychotics, actually worsened the memory problems, as well as causing a horribly dry mouth (xerostomia). Pat was hospitalized because of some delusional thinking, especially increasing paranoia, and concerns from neighbours about Pat wandering seemingly aimlessly around.

A magnetic resonance imaging (MRI) scan of Pat’s brain and neuropsychological testing were scheduled by our office prior our initially scheduled meeting. Results from these assessments revealed hemorrhagic infarcts in the basal forebrain area and confirmed difficulties with memory and attention/concentration.

QUESTIONS:

1. Consider the cholinergic system as a potential source of Pat’s problems. What examples/ pieces of information from the case report would support this conclusion? Why? (list and explain) (5 pts)
2. What are the main types of cholinergic receptors? How might they relate to some of the symptoms described in the case report? (select and explain at least 2 examples) (4 pts)
3. What type of medication might be helpful for Pat? Why? How does it act pharmacologically to increase or decrease cholinergic function? (3 pts)
4. Reconsidering the case report, is there another potential neurotransmitter system you think could explain any of the aspects described? Do you think they might better explain any symptoms for this case? Why/ why not? (select and explain at least 1 example) (3 pts)
5. Imagine that you are a healthcare worker responsible for following up to provide feedback to Pat and family. How might you explain to them what might be going on based on the case information and your responses above? (Explain in accessible / lay language using your own words, using the context of the case with supporting examples) (5 pts)

Evaluation

Responses to Qs1-5 /20

+Scholarship / 5

=Total /25

Late penalty: -1 mark/day up until the end of classes (Dec 3), after which a mark of 0 will apply

(as per course syllabus).

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