Using This Article, Complete The Following Steps: Module 3 ✓ Solved

Using this article complete the following steps: Module 3 Pa

Using this article complete the following steps: Module 3 Part 3 Step 1 (table) and Step 2 (paragraph). Article: Update on Neurodegenerative Diseases and Glutamate: A PMHNP Single Case Study Report of a Diagnostically Complex Adult Patient, Interventions, and Unexpected Outcomes. Authors: Kroll SC; Bennett CF; Klinefelter TW. Source: Journal of the American Psychiatric Nurses Association, 2021 Jul 08. Directions: Step 1: Research Analysis — Complete the table: Topic of Interest; Research Article: include full APA citation and DOI/link; Professional Practice Use; Research Analysis Matrix: Strengths; Limitations; Relevancy; Notes. Step 2: Summary of Analysis — Write 2–3 paragraphs that: describe your approach to identifying and analyzing peer-reviewed research; identify at least two effective strategies used to find peer-reviewed research; identify at least one resource you will use in the future to find peer-reviewed research.

Paper For Above Instructions

Step 1: Research Analysis

Topic of Interest: Glutamatergic dysfunction and neurodegenerative/psychiatric manifestations; treatment with glutamatergic-modulating agents (dextromethorphan/quinidine) in complex psychiatric/neurodevelopmental cases.

Research Article (APA citation):

Kroll, S. C., Bennett, C. F., & Klinefelter, T. W. (2021). Update on neurodegenerative diseases and glutamate: A PMHNP single case study report of a diagnostically complex adult patient, interventions, and unexpected outcomes. Journal of the American Psychiatric Nurses Association. Advance online publication. (Searchable via journal website; DOI as listed in the record: 10.1177/—see publisher record for full DOI) (Kroll et al., 2021).

Professional Practice Use: This article informs psychiatric mental health nurse practitioner (PMHNP) practice by: screening for pseudobulbar affect (PBA) in complex psychiatric patients; considering glutamatergic-targeted pharmacotherapy (dextromethorphan/quinidine) when PBA or excitotoxicity-related symptoms are suspected; monitoring cognitive, language, and behavioral outcomes after initiating glutamatergic agents; educating families on realistic expectations and safety planning.

Research Analysis Matrix

Element Details
Strengths of the Research
  • In-depth single-case clinical description offering real-world outcome data for a diagnostically complex patient (Kroll et al., 2021).
  • Clear documentation of screening, rationale for treatment selection, and longitudinal follow-up (2 years) showing sustained benefits.
  • Bridges neurobiological discussion (glutamate dysfunction, excitotoxicity) with practical nursing implications and safety considerations.
Limitations of the Research
  • Single-case design limits generalizability and cannot establish causality or control for confounders (patient maturation, concurrent therapies) (Kroll et al., 2021).
  • Potential reporting bias and limited objective standardized outcome measures beyond screening scores and clinical descriptions.
  • Incomplete mechanistic data; biological measures (imaging, biomarkers) were not reported to corroborate neurodegenerative or glutamatergic changes.
Relevancy to Topic of Interest
  • Directly relevant: connects glutamatergic dysfunction and neurocognitive/behavioral symptoms in psychiatric and neurodevelopmental disorders.
  • Demonstrates therapeutic potential of dextromethorphan/quinidine for PBA and unexpected cognitive/behavioral improvements, supporting further study.
Notes
  • Use as a practice-based exemplar to inform screening protocols for PBA and trial selection criteria for glutamatergic agents in PMHNP settings.
  • Recommend follow-up research employing controlled designs and objective cognitive and neurophysiological measures.

Step 2: Summary of Analysis (2–3 paragraphs)

Approach to identifying and analyzing peer-reviewed research began with defining keywords aligned with the topic of interest: "glutamate," "glutamatergic dysfunction," "pseudobulbar affect," "dextromethorphan quinidine," "neurodegeneration," and "PMHNP case study." I prioritized articles published in peer-reviewed journals within the last 10–15 years and used targeted databases—PubMed/MEDLINE, CINAHL, PsycINFO, and the publisher site for the Journal of the American Psychiatric Nurses Association—to locate both primary clinical trials (e.g., randomized controlled trials of dextromethorphan/quinidine for PBA) and mechanistic reviews on glutamate-mediated excitotoxicity. For analysis, I assessed study design, sample size, outcome measures, duration of follow-up, and translational applicability to clinical nursing practice. The Kroll et al. (2021) case report was evaluated for clinical detail, temporal association between intervention and outcomes, and its integration of neurobiological rationale with nursing implications.

Two effective strategies that emerged are: (1) Using focused keyword combinations and filters (e.g., "pseudobulbar affect" + "dextromethorphan" + "randomized") in PubMed and CINAHL to quickly surface high-quality clinical trial evidence; and (2) tracing citations from a relevant review or guideline (forward and backward citation tracking) to identify cornerstone studies and subsequent real-world reports. An additional practical tactic is to search drug approval and prescribing information (FDA label, manufacturer prescribing information) for clinically validated dosing, indications, and safety data on agents such as dextromethorphan/quinidine (Nuedexta), which complements academic literature. Going forward, I intend to consistently use PubMed and CINAHL as core resources, supplementing with clinical practice guidelines and the FDA/drug manufacturer resources for up-to-date safety and prescribing information, and utilizing citation chaining to build a robust evidence base for PMHNP decision-making (Pioro et al., 2010; Avanir Pharmaceuticals, 2018).

Implications for PMHNP practice from this analysis include incorporating routine screening for PBA in populations with neurodevelopmental or severe psychiatric disorders, considering glutamatergic modulating medications when clinically indicated and supported by evidence, and documenting objective outcome measures (standardized cognitive and behavioral scales) when initiating such therapies. The case study by Kroll et al. (2021) serves as a prompt for larger-scale investigation and for clinicians to adopt vigilant monitoring and family-centered education when prescribing glutamatergic agents.

References

  1. Kroll, S. C., Bennett, C. F., & Klinefelter, T. W. (2021). Update on neurodegenerative diseases and glutamate: A PMHNP single case study report of a diagnostically complex adult patient, interventions, and unexpected outcomes. Journal of the American Psychiatric Nurses Association. Advance online publication. (Kroll et al., 2021).
  2. Pioro, E. P., Brooks, B. R., Cummings, J., Schiffer, R., Thayer, A., ... & Study Group. (2010). Dextromethorphan plus quinidine for pseudobulbar affect: randomized, double-blind, controlled trial. (Clinical trial evidence illustrating efficacy for PBA.)
  3. Avanir Pharmaceuticals, Inc. (2018). Nuedexta (dextromethorphan hydrobromide and quinidine sulfate) prescribing information. U.S. Food and Drug Administration. (Prescribing information and safety data.)
  4. Lau, A., & Tymianski, M. (2010). Glutamate receptors, neurotoxicity and neurodegeneration. Canadian Journal of Neurological Sciences. (Review of glutamate-mediated excitotoxic mechanisms.)
  5. Hardingham, G. E., & Bading, H. (2010). Synaptic versus extrasynaptic NMDA receptor signalling: Implications for neurodegenerative disorders. Nature Reviews Neuroscience. (Mechanistic review connecting glutamate signaling to cell survival/death.)
  6. Olney, J. W. (1969). Brain lesions, obesity, and other disturbances in mice treated with monosodium glutamate. Science. (Foundational work on excitotoxicity concept.)
  7. Barker, P., et al. (2015). Clinical approaches to pseudobulbar affect: assessment and management in neurological and psychiatric practice. Journal of Neuropsychiatry. (Practice-focused review relevant to PMHNPs.)
  8. Stahl, S. M. (2013). Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (4th ed.). Cambridge University Press. (Textbook resource on neurotransmitters and psychopharmacology.)
  9. National Institute of Neurological Disorders and Stroke (NINDS). (2020). Pseudobulbar affect information page. (Patient- and clinician-oriented overview of PBA and treatments.)
  10. Rogawski, M. A., & Löscher, W. (2004). The neurobiology of antiepileptic drugs for pediatric and adult clinicians: implications for practice. Epilepsia. (Context on NMDA/glutamatergic modulation and therapeutics.)

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