| Course | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 580 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | MSN, Psychiatric-Mental Health Nurse Practitioner (PMHNP) |
| Updated | October 2026 |
Free sample paper for NR 605 Week 1
Week 1 Discussion: Initial Post
Mirtazapine Over a Second SSRI for a Night-Shift Worker With Depression, Daytime Insomnia and a Past Sertraline Trial That Ended Badly, and the Week I Would Know
Initial Post
My choice for the patient I evaluated this week is mirtazapine, 15 mg taken at the start of the daytime sleep period, with cognitive behavioral therapy alongside it. Here is the patient and why.
T.N. is 34 and supervises a warehouse night shift, 22:00 to 06:30, five nights a week. Over three months: low mood most days, loss of interest, sleeping four to five broken hours in the daytime, poor appetite with a 3-kilogram weight loss, and panic attacks about twice a week, the first of them on the loading dock. PHQ-9 is 17. T.N. had a depressive episode in 2019 treated with sertraline 100 mg; mood partly improved, but T.N. stopped after four months because of sexual side effects and has not wanted to try "that kind of pill" again.
The alternative I passed over first is escitalopram. It is an obvious first-line choice for depression with anxiety, it is well tolerated and a large network meta-analysis placed it among the more acceptable antidepressants (Cipriani et al., 2018). I set it aside for a reason belonging to T.N. rather than to the drug class: T.N. stopped the last SSRI because of sexual side effects, and escitalopram carries a similar risk. A medicine the patient expects to stop is a poor first choice, however good its average.
The second alternative is bupropion, which has little sexual side effect and is often chosen for that reason. I set it aside because it is activating and can worsen insomnia and anxiety, and T.N.'s main complaints are broken daytime sleep and panic. Bupropion also lowers the seizure threshold, and T.N. drinks three or four beers on three nights a week.
Why mirtazapine fits. It is sedating, which helps the broken daytime sleep if taken at the start of the sleep period, it tends to restore appetite and it causes sexual side effects less often than SSRIs. A Cochrane review found mirtazapine had a faster onset than SSRIs in the first weeks, though its overall effect was similar (Watanabe et al., 2011). The costs are weight gain and drowsiness, which I would watch.
Therapy is an element, not a courtesy. T.N.'s panic attacks began in one place and T.N. has started avoiding the loading dock. Medication alone will not undo that avoidance; cognitive behavioral therapy aimed at the panic and the depression will, which is why it is in the plan from the first visit rather than added later.
The week I would know by. At 2 weeks: whether daytime sleep has lengthened and whether drowsiness is tolerable. At 4 weeks: whether the PHQ-9 has fallen by at least 5 points. At 8 weeks: whether it has halved. If it has not fallen by 4 weeks at an adequate dose, I would reconsider.
Reply to Brianna
Brianna, you chose sertraline for your patient. What did you consider instead, and why did sertraline win for this person rather than for depression in general? If the patient had stopped an SSRI before, would your answer change?
Reply to Nate
Nate, your plan listed therapy in the final sentence. Which therapy, at what frequency, and aimed at what? If your patient is avoiding a place, as mine is, the therapy may matter more than the medicine.
References
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391(10128), 1357-1366. https://doi.org/10.1016/S0140-6736(17)32802-7
Watanabe, N., Omori, I. M., Nakagawa, A., Cipriani, A., Barbui, C., Churchill, R., & Furukawa, T. A. (2011). Mirtazapine versus other antidepressive agents for depression. Cochrane Database of Systematic Reviews, 2011(12), CD006528. https://doi.org/10.1002/14651858.CD006528.pub2
What the NR 605 Week 1 assignment asks for
The first discussion asks for a treatment decision, defended. Most posts will name a reasonable first-line agent and stop, which reads as recall and looks the same across a thread. A defended choice puts the obvious alternative on the page and sets it aside for a reason belonging to this patient, such as a prior trial that ended badly or a side effect this person cannot accept. Include therapy as an element with a target, not a closing sentence. Say the week by which you would know whether the choice worked. Most rubrics mark down a post that stops at diagnosis, an unargued first choice and a plan that is medication only. Keep the post short enough that classmates read the whole argument.
How this NR 605 Week 1 example is built
The sample states its choice in the first sentence. The patient is described: a 34-year-old night-shift supervisor with low mood, broken daytime sleep, weight loss, panic attacks beginning on a loading dock and a 2019 sertraline trial stopped for sexual side effects. Escitalopram is set aside because the patient would likely stop another SSRI; bupropion because it is activating and lowers the seizure threshold in someone who drinks. Mirtazapine's fit is explained with its costs, and therapy is included for the avoidance. Checkpoints at 2, 4 and 8 weeks are set. Replies follow, each with a margin note on why it presses the classmate.
NR 605 Week 1 rubric: what full points look like
The largest loss is the post that stops at the diagnosis, and this one spends almost all its length on treatment. An unargued first choice costs the next share, while two alternatives are named and set aside for patient-specific reasons. A plan that is medication only loses a row, and therapy here is aimed at a named target, avoidance of the dock. Missing checkpoints lose marks, and three are given with measures. Citing comparative evidence and a review on onset of action earns the evidence criterion. Replies earn credit by pressing classmates for alternatives and therapy targets. Pressing classmates in replies shows the writer applies the same standard to others.
NR 605 Week 1 help from the desk
Most weak NR 605 Week 1 posts describe the presentation well and only name a drug in their final line. Another is choosing a first-line agent without saying what was considered instead. Many posts add therapy as an afterthought with no target. Few say when the choice will be judged. Replies tend to agree. Name your choice first, put the obvious alternative beside it and say why it loses for this patient, then add therapy aimed at something specific and the week you will review. If your patient differs, describe the history and prior trials, and a defended-choice post can be written around them.
Get a NR 605 Week 1 example written to your instructions
Send us the Week 1 prompt exactly as your section states it, along with the condition or case you were given. A custom example gets written to that prompt and comes back within 24 to 48 hours, and the first one costs nothing. What you finally post under your own name stays your call.
More NR 605 papers and PMHNP samples
- NR 605 Week 2: Initial Evaluation Note
- NR 605 Week 3: Treatment Plan Write-up
- NR 605 Week 4: Case Analysis
- NR 605 Week 5: Psychotherapy Rationale
- NR 605 Week 6: Follow Up Note
- NR 605 Week 7: Outcome Measure Plan
- NR 605 Week 8: Management Case Paper
- NR 548 Week 1: Difficult Question Discussion
- NR 547 Week 1: Diagnostic Position Discussion
- NR 546 Week 1: Antidepressant Timing Discussion
NR 605 Week 1 questions, answered
Can a plan be to wait?
Yes, and it is often the better answer. A watchful interval is a plan when it carries a date, a person doing the watching, and a named event that would end the waiting. What loses points is waiting by default, with no review point and nothing stated that would change the decision. The defense is the same one every other element has to make.
How much diagnosis belongs in a Week 1 post?
Enough to justify the plan and no further. A sentence or two placing the presentation is normally sufficient, because the graded content sits in what follows it. Posts that argue the differential at length are answering the previous course in the sequence, and they tend to run out of room exactly where the points in this one begin.
Does every element need a citation?
Every element needs a reason, and reasons that rest on evidence or guideline claims need a source sitting against them. A choice that rests on this patient's history needs the history rather than a reference. Stacking citations at the top of a post while leaving the specific claims bare is the pattern instructors mark down in most sections.
Where can I find a free NR 605 Week 1 sample paper?
The full post choosing mirtazapine over escitalopram and bupropion, with replies to Brianna and Nate, is on this page.
Why is escitalopram set aside in the NR 605 Week 1 post?
The patient stopped sertraline in 2019 because of sexual side effects and said another similar medicine would be stopped too.