| Course | PA 536 Behavioral Medicine II |
|---|---|
| Week | 4 |
| Paper type | Treatment decision brief |
| Length | About 770 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 536 Week 4
Switch Versus Augment Brief for D.K. at Ten Weeks: Bupropion Alone or Low-Dose Aripiprazole Added to Fluoxetine, Each Laid Out as the Eight Weeks It Would Ask For
Student Name
Chamberlain University
PA 536: Behavioral Medicine II
Instructor Name
Month Day, Year
Switch Versus Augment Brief for D.K. at Ten Weeks: Bupropion Alone or Low-Dose Aripiprazole Added to Fluoxetine, Each Laid Out as the Eight Weeks It Would Ask For
Where D.K. Stands
Six weeks or more on fluoxetine at an adequate dose have taken D.K.'s PHQ-9 from 17 to 11. Sleep is better and dinner insulin is back on four evenings a week, but mornings are still heavy and the darts league has not resumed. The remaining choice is between switching to bupropion and adding a low dose of aripiprazole to fluoxetine, the two next steps D.K. was willing to consider. In the largest trial comparing these strategies, 12-week remission was 28.9 percent with aripiprazole augmentation and 22.3 percent after a switch to bupropion; aripiprazole brought more sleepiness, restlessness and weight gain, while anxiety was more common in the bupropion arms (Mohamed et al., 2017).
Road One, Switch to Bupropion, as a Calendar
Week 0: stop fluoxetine; start bupropion. Fluoxetine's long half-life means its effect fades over several weeks, so there is no clean break and no washout is needed for this pair. Week 1: nurse call about sleep, anxiety and appetite. Weeks 2 to 4: the period when fluoxetine is fading and bupropion is not yet working; the gains D.K. has made may slip. Week 4: visit with PHQ-9. Week 8: visit and decision. Between contacts, D.K. watches the sensor for lows and calls if a reading falls below 54 mg/dL, since a seizure is more likely on bupropion during a deep low, and D.K. has had one. Contacts: three. Unfamiliar stretch: about four weeks.
Road Two, Add Aripiprazole, as a Calendar
Week 0: keep fluoxetine 40 mg; add aripiprazole 2 mg daily. Baseline weight, waist, blood pressure and lipids are taken the same day, as the consensus on antipsychotic monitoring advises (American Diabetes Association et al., 2004). Week 1: nurse call asking specifically about restlessness, the urge to keep moving that patients often describe as being unable to sit through a meal. Week 2: visit or video check for restlessness and sleepiness. Week 4: visit with PHQ-9 and weight. Week 8: visit and decision. Between contacts, D.K. tells us if restlessness appears, because that is the effect most often behind stopping this drug early. Contacts: four. Unfamiliar stretch: about two weeks.
Equal Length, Equal Terms
Both roads take eight weeks to a decision and both cost about four visits or calls. Road one risks losing the partial gains while one drug fades and the other starts. Road two keeps the gains and adds a drug with new side effects that need watching in a person whose weight and lipids already carry cardiovascular risk from twenty-two years of diabetes.
Cost is close to even: both medicines are available as generics on D.K.'s plan, and neither needs prior authorization at the starting dose. The difference that remains is between the risk of losing ground and the burden of new side effects to watch.
The Unsupervised Stretch
On road one, the hardest weeks come between the week 1 call and the week 4 visit, when mood may dip with no contact scheduled. On road two, the risk comes in the first two weeks, when restlessness most often appears. D.K. works the 5:30 a.m. dispatch shift and would be alone with either problem until mid-afternoon on workdays.
Who Is Reachable, and When
Our nurse line is staffed through the working day until five; after that, calls go to the on-call clinician. D.K.'s partner is home in the mornings and has agreed to call the nurse line if D.K. seems newly restless or low. Both roads use the same contact plan.
The Recommendation
I recommend road two, adding aripiprazole. It protects the gains already made, carries no seizure concern in a person with a past severe low, and had the higher remission rate in the trial, though the difference was modest. D.K. preferred it after hearing both calendars, mainly to avoid "starting over."
What Would Flip It
If restlessness appears and does not settle within two weeks, or weight rises by 3 kg or more by week 8, road one becomes the better choice. If D.K. had no history of severe lows, the seizure concern would weigh less and the choice would be closer. A firm preference from D.K. for one medicine rather than two would also flip it.
References
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, & North American Association for the Study of Obesity. (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care, 27(2), 596-601. https://doi.org/10.2337/diacare.27.2.596
Mohamed, S., Johnson, G. R., Chen, P., Hicks, P. B., Davis, L. L., Yoon, J., Gleason, T. C., Vertrees, J. E., Weingart, K., Tal, I., Scrymgeour, A., Lawrence, D. D., Planeta, B., Thase, M. E., Huang, G. D., & Zisook, S. (2017). Effect of antidepressant switching vs augmentation on remission among patients with major depressive disorder unresponsive to antidepressant treatment: The VAST-D randomized clinical trial. JAMA, 318(2), 132-145. https://doi.org/10.1001/jama.2017.8036
PA 536 Week 4 instructions, in plain terms
Week four asks for a short brief comparing two next steps after a partial response: switching to a different medicine or adding a second one. Each option should be written as a sequence of events between now and the decision point, with the number of contacts, who starts each one, what the person handles alone in between and how long the unfamiliar period lasts. Use the same headings and roughly the same length for both, since an option given less space has been decided against in advance. Describe the stretch where the person is least supported on each road, and who can be reached when something goes wrong. Make a recommendation. Finally, name the specific events or preferences that would reverse it. Evidence comparing the strategies should be cited, and the brief should stay comparative throughout rather than becoming an argument for one drug.
How the PA 536 Week 4 example is put together
The opening section places D.K. at a PHQ-9 of 11 with sleep and dinner boluses improved and cites VAST-D for remission, sleepiness, restlessness, weight and anxiety differences (Mohamed et al., 2017). Road one, the bupropion switch, runs from week 0 to week 8 with a nurse call at week 1, a dip risk in weeks 2 to 4 while fluoxetine fades, visits at weeks 4 and 8 and a duty to report sensor lows. Road two, adding aripiprazole 2 mg, has baseline weight, waist, pressure and lipids on day one, a week 1 call about restlessness, a week 2 check and the same later visits. A comparison section puts cost and burden side by side. The unsupervised stretch is located for each road against D.K.'s early dispatch shift. Contacts include the nurse line hours and D.K.'s partner. The recommendation is augmentation, with three named reversal triggers.
PA 536 Week 4 rubric: what full points look like
The heaviest deduction in this brief goes to arguing only the medicine. A brief that reaches a sound drug choice while saying nothing about what the next eight weeks require of the person and the clinic misses the point of the week. Next, graders penalize the road rejected for what it is rather than for what it would have demanded. Points then depend on concrete timing: contacts named by week, the person's unsupported stretch identified, and who is reachable at what hours. Equal treatment of both options, under the same headings, is checked directly. A recommendation earns credit only when it follows from the comparison, and the conditions that would reverse it earn a separate share. Cited trial evidence, used for both roads rather than one, and APA mechanics finish the scoring.
PA 536 Week 4 help: mistakes that cost points
Most returned briefs here are pharmacology essays, strong on receptors and weak on the calendar. Another frequent problem is an uneven brief, with half a page for the favored road and three lines for the other. Some also stop at a recommendation without saying what would change it. If your case pairs different options, such as adding bupropion versus switching to a serotonin norepinephrine reuptake inhibitor, or a lithium augmentation your setting would not start, send the scenario; the brief we write for you would set out both roads as dated calendars under the same headings, show where the person is on their own, name who answers the phone and when, and close with a recommendation plus the events that would reverse it. Mention any limits your section places on which medicines a family practice may start, and those limits will shape the comparison.
Get a PA-536 Week 4 example written to your instructions
Send the assignment, the rubric and the case exactly as your section issued it, along with any template the brief has to be written into. A custom PA-536 Week 4 brief is written to those and returned inside 24-48h, the first one free. The person in the example is constructed for the week rather than drawn from anybody real.
More PA 536 papers and MPAS samples
- PA 536 Week 1: Treatment Target Post
- PA 536 Week 2: Antidepressant Selection Memo
- PA 536 Week 3: Antidepressant Trial Appraisal
- PA 536 Week 5: Metabolic Monitoring Schedule
- PA 536 Week 6: Therapy Modality Brief
- PA 536 Week 7: Medical Comorbidity Review
- PA 536 Week 8: Maintenance and Taper Plan
- PA 534 Week 4: Growth Trajectory Analysis
- PA 533 Week 4: Prenatal Visit Schedule Rationale
- PA 532 Week 4: Informed Consent Script
- PA 531 Week 4: Worst-First Differential Table
PA 536 Week 4 questions, answered
Does the brief have to pick one of the two?
In most sections yes, and a document that lays both out beautifully and declines to commit loses the marks the assignment exists to award. Where holding is genuinely on the table, say so and treat it as a third road with its own weeks and its own cost, which is usually time the person does not feel they have. Then still commit.
What if one road is not something this setting would start?
That is a finding, not an obstacle, and writing it plainly is worth marks. Say which road leaves what the setting handles, say what would have to be arranged instead, and keep costing it anyway, because a comparison that drops an option on those grounds has never shown the reader what was given up. One line is usually enough, unless your instructions ask for more.
How specific does the timing have to be?
Specific enough that somebody could put it in a diary. Weeks and appointments rather than soon and later, with a named point where the decision gets judged. These are academic examples showing what a finished brief covers and where marks sit; nothing in one is guidance for treating anybody, and the timing in a sample is there to demonstrate the structure the rubric rewards.
Where can I find a free PA 536 Week 4 sample paper?
A complete PA 536 Week 4 switch versus augment brief, comparing a bupropion switch with low-dose aripiprazole as two eight-week calendars, is on this page.
Which option does the PA 536 Week 4 sample recommend, and why?
It recommends adding aripiprazole, because that keeps D.K.'s partial gains, avoids bupropion's seizure concern after a severe low and had higher remission in VAST-D.