| Course | NR 606 Diagnosis & Management in Psychiatric-Mental Health II Practicum |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 520 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 606 Week 1
Week 1 Discussion: Initial Post
The Patient I Inherited: Ten Weeks on Sertraline, a PHQ-9 From 22 to 12, and Why I Will Hold One More Interval With Two Checks Rather Than Change the Medicine Now
Initial Post
D.L. is 46, an accountant, and came to me this term from a colleague who left the practice. D.L. has been on sertraline for ten weeks, at 150 mg for the last six. PHQ-9, a nine-item depression scale (Kroenke et al., 2001), has fallen from 22 to 12. My colleague's last note says "improving." I do not think improving is a result.
What moved. Depressed mood: D.L. no longer cries most days and rates mood 5 out of 10, up from 2. Suicidal thinking: gone. Guilt: much less. Appetite: back to normal.
What did not. Sleep: D.L. falls asleep but wakes three or four times a night and feels unrefreshed. Energy: "like walking through wet sand" by mid-afternoon. Concentration: errors at work that D.L. never used to make. Interest: still not enjoying the things D.L. used to, such as cycling and cooking.
So the PHQ-9 of 12 is mostly made of sleep, energy, concentration and interest. That pattern matters, because those four symptoms can come from depression that has not fully responded, but they can also come from things the antidepressant would never fix.
Act now or hold. I will hold the sertraline dose for one more four-week interval, but not passively. Two things need checking first.
Adherence. A partial response sometimes means a partial dose actually taken. Before calling this a partial response to sertraline, I want pharmacy fill dates and D.L.'s own count of missed doses.
A second problem. Unrefreshing sleep, daytime exhaustion and poor concentration in a 46-year-old who, according to the intake, snores loudly and carries a body mass index of 33 should raise obstructive sleep apnea. If it is present, raising the sertraline or adding a second agent would treat the wrong thing.
The trigger. If adherence is good and sleep apnea is ruled out, and the total remains over 10 when this interval ends, I will change the medicine, most likely by increasing sertraline before considering augmentation. Residual symptoms after partial response are linked to a higher risk of relapse, which is why holding cannot be indefinite. In STAR*D, roughly one patient in three remitted at the first step, and the rest went on to further treatment levels (Rush et al., 2006).
I am placing that evidence here because it argues against complacency, not because it decides the next step. The next step depends on what the two checks show.
Reply to Gabrielle
Gabrielle, your patient's GAD-7 went from 16 to 10 and you plan to "continue current treatment." What would make you change it? If the score is 10 again in four weeks, would that be enough, or would you need a particular symptom to persist?
Reply to Owen
Owen, you suggested adding aripiprazole for your patient's residual anhedonia. What if the patient had been taking the antidepressant only five days a week? Would the plan change if adherence were the variable rather than the drug?
References
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., Niederehe, G., Thase, M. E., Lavori, P. W., Lebowitz, B. D., McGrath, P. J., Rosenbaum, J. F., Sackeim, H. A., Kupfer, D. J., Luther, J., & Fava, M. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D report. American Journal of Psychiatry, 163(11), 1905-1917. https://doi.org/10.1176/ajp.2006.163.11.1905
What the NR 606 Week 1 assignment asks for
Nothing in this course starts with a blank patient. The opening discussion begins with someone already treated, and the useful material is the gap between better and well. Refuse to let partial improvement stand as a result. Name what moved and what did not. Then commit: either the leftover symptoms are worth acting on now, or they are worth one more interval of watching, and if you hold, say what would trigger a change. Place evidence where it argues a point. In replies, change one variable in a classmate's case and ask what follows. Most rubrics mark down a post that reports improvement without a decision, a stance with no trigger and a residual described only as a lower score.
Inside the NR 606 Week 1 example
The sample introduces a 46-year-old accountant inherited from a departing colleague whose note said improving. It sorts the PHQ-9 into what moved, mood, suicidal thinking, guilt and appetite, and what did not, sleep, energy, concentration and interest. The writer holds the dose but sets two checks, adherence and a screen for sleep apnea given snoring and body mass index. A trigger for changing the medicine is stated. STAR*D is cited to argue against complacency. Two replies follow, one asking for a trigger and one asking what changes if adherence is the variable. Margin notes explain each move. Each part carries a note on its purpose.
NR 606 Week 1 rubric: what full points look like
The costliest loss is the report, an accurate description of improvement with no decision attached; this post commits to holding with two checks. A stance with no trigger costs the next share, while this one names the score and conditions that would force a change. A residual described only as a lower score loses a row, and the four unmoved symptoms are named. Evidence parked in the opening line loses marks, while the STAR*D figure is placed where it argues against waiting indefinitely. Replies that change a variable earn the discussion criterion. Placing the trigger in writing turns holding into a plan rather than a delay.
NR 606 Week 1 help from the desk
Weak NR 606 Week 1 posts describe an improving patient and recommend continuing treatment. Others want to change something now without saying why now. Many describe residual symptoms as a lower total. Citations often sit in the first line without arguing anything. Replies tend to agree. Sort the symptoms into those that moved and those that did not, decide whether to act or hold and, if holding, state the trigger. Whatever course your inherited patient has had, sort it the same way; a post on your case can be written on request. Say what you would do if the checks come back clear. Name the symptoms that did not move.
Get a NR 606 Week 1 example written to your instructions
Send the Week 1 prompt from your classroom, plus the case you were given and the rubric if your section posts one, and a custom example is written to that prompt and returned inside 24 to 48 hours. The first one is free. The position you take on waiting stays yours to argue.
More NR 606 papers and PMHNP samples
- NR 606 Week 2: Partial Response Analysis
- NR 606 Week 3: Comorbidity Case Write-up
- NR 606 Week 4: Plan Revision Note
- NR 606 Week 5: Case Analysis
- NR 606 Week 6: Augmentation Rationale
- NR 606 Week 7: Progress Note Series
- NR 606 Week 8: Complex Case Paper
- NR 605 Week 1: Defended First Choice Post
- NR 548 Week 1: Difficult Question Discussion
- NR 546 Week 1: Antidepressant Timing Discussion
- NR 547 Week 1: Diagnostic Position Discussion
NR 606 Week 1 questions, answered
Does any of this touch practicum hours or the log?
No, and it never does. Clinical hours, the hour log, the site paperwork and your preceptor's evaluation of you stay with you, and nobody else ever writes them. What a sample covers is the written coursework: the discussion, the case write-ups and the papers built on a vignette your classroom supplies. That line is firm and it is the reason the samples take the form they do.
How is this different from the first management course?
The earlier course asks for a plan when the picture is reasonably clear. This one starts after a plan has already run, which changes the writing more than it sounds. You are no longer choosing from an open field. You are arguing against a decision somebody has already made, often your own, and explaining why the case for revising it has arrived now instead of later.
Can I write about a patient from my site?
Only within whatever de-identification your section requires, and the vignette the classroom supplies is usually the safer route anyway. Details that fix a person to a place, an employer or a date have no business in a graded post. The argument about timing works exactly the same on a composite patient, which is why most of the strongest posts use one.
Where can I find a free NR 606 Week 1 sample paper?
The full post on an inherited patient's partial response to sertraline, with replies to Gabrielle and Owen, is on this page.
What two checks come before any change in the NR 606 Week 1 post?
Whether doses are actually being taken, and whether sleep apnea explains the symptoms that did not move.