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Case Study: Assessing and Treating Clients With Psychosis and Schizophrenia 

Case Study: Assessing and Treating Clients With Psychosis and Schizophrenia

Case Study: Assessing and Treating Clients With Psychosis and Schizophrenia

For this week’s assignment, the case study consists of a woman which is 34 years old and belongs to Pakistan. She has been diagnosed with “brief psychotic disorder” and hospitalized for 21 days. She stated that, after taking the medications which were Risperdal recommended by the physician, she has stoppedto take it due to the misconceptions regarding her husband that he is going to give her poison. She further stated that she is getting the distrustful and misbelief thoughts (Laureate Education, 2016j). The client was diagnosed with schizophrenia which was paranoid type on the Positive and Negative Syndrome Scale (PANSS), the scores by the scale revealed the diagnosis (Laureate Education, 2016j). The complexity of positive and negative symptoms and also the overall psychology of schizophrenic people can be classified by the help of PANSS which is a consistent or scientific interview and rates the negative and positive symptoms schizophrenia (Depp, Loughran, Vahia, & Molinari, 2010). The main objective of this week’s assignment is to evaluate and manage the client who needs the antipsychotic therapy which depends upon the decisions regarding the drugs which have been recommended for a Pakistani woman who is 34 years old and diagnosed with schizophrenia, the impact of drugs pharmacokinetic and pharmacodynamics, and also consists of the ethical considerations which influence the strategy of the treatment and also the communication with the patient.

NURS 6630 Week 6 Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

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Assessing and treating client with psychosis and schizophrenia Sample Paper

A primary mental illness or a combination of conditions in which there is a noticeable change in an individual’s thoughts, opinions, temperament, and conduct is referred to as psychosis or the specific diagnosis of schizophrenia. Depending on their individual circumstances, those who seem psychotic or schizophrenia will have a unique combination of indicators and understandings. It is common to classify the early stages of psychosis and schizophrenia by the frequent escalation of symptoms such illusions , delusions and behavioral abnormalities. Although many patients respond to initial antipsychotic pharmaceutical treatment, over 80% of patients relapse after 5 years of treatment, primarily as a result of noncompliance. (Brown et al., 2010).

Schizophrenia is categorized by serious disturbances to reasoning and feeling which may result in an ongoing loss of self care and societal functioning of the persons. (Chien WT, 2013). Both psychosis and schizophrenia are chronic psychological disease, that is curable with antipsychotic medicines. Seeking for help is imperative to seek for help early. Numerous types of antipsychotics, are in use for varying types of psychotic symptoms. These antipsychotics work on diverse elements in the brain known as the neurotransmitters. (Stahls, 2013). Many antipsychotic medicines impact the dopamine receptor. Irrespective of their important role in the management of indications of critical psychosis response to treatment and adverse effect differ on individual basis. Therefore, the individual’s reaction to treatment is unpredictable. This paper aims to discourse the use of antipsychotic therapy based on the PMHNP decision tree, which involves the management of the individual and the moral considerations on the  care of the  patient.

Decision point one

Patient will be started with dose of Invega sustenania 234mg intramuscular XI, followed by 156mg intramuscular on day 4, and monthly thereafter.

Reason for this decision: This was done because Invega sustenania is atypical antipsychotic medication, that is approved by the FDA, for treating schizophrenia in adult. It works by altering the effects of chemicals in the brain. It is a long acting injectable anti-psychotic that prevents the necessity of taking oral daily medicines helps to improve compliance. Patient will derive more benefit from Invega sustenania, due to her history of noncompliance to Risperdal and paranoia towards her husband. (Key, S. R. 1987).  Zyprexa 10mg PO, although a second generation, atypical antipsychotic medication used in treating negative and positive symptoms of schizophrenia, it has a short acting effect when compared to intramuscular Invega sustenania and will not be the top choice for the patient, because of her paranoia of being poisoned by her with medication. Similarly Ability 10mg per oral QHS that is used for agitation that is linked with schizophrenia, is a poor choice because of history of noncompliance with oral anti-psychotics as evidenced by her verbalization of non-compliance to current treatment with  Risperdal on discharge from the hospital. The likelihood side effect such as akathesia and intolerance in most patients exists (Stahl, 2013).

Probable conclusion: It is anticipated that patient will come to the outpatient clinic in four weeks, with a substantial reduction in indicators of schizophrenia like auditory hallucinations,  delusional thoughts that “ her husband is planning to poison her”. Also, paranoia nervousness, and improvement in judgments, insights has disappeared. (Stahl, 2013).

Discrepancy on expectations and the definite outcome: The medication was tolerated by the patient medication as projected but she has gained weight of 2 pounds and she complained of discomfort on the area where she was injected.

Decision point 2

This is to continue with the present treatment and instructing the nurse on giving the injections in the deltoid muscle during the visit and subsequent ones.

Aim for taking the decision: Therapeutic blood levels is expected at the first regimen of 234 mg and 156 mg on the fourth day. Based on research, Invega sustenania is found to be effective in the management of indicators and reduction in time of relapse in those diagnosed with schizophrenia who are using other oral antipsychotic drugs. (Hough D, et al, 2010). Haldol decanoate is a long acting typical antipsychotic used for long time treatment of schizophrenia which works blocking the D2 receptors in the substantial nigra. The draw back with the medication is that it has a lot of extra pyramidal effects with long term use. Some of these side effects are movement disorders like lip smacking, tongue thrusting torticollis and unusual trunk movement. (Stahls, 2013). This may not be an excellent drug for the patient. The addition of Ability maintena 300mg injection every month including PO Ability 10mg QAM for 2 weeks, is not in consideration currently for the reason that using two long acting antipsychotic medication is likely to  raise the danger of adverse reaction and medication interactions with reduced effectiveness.

Probable consequence: The client is likely to continue having a reduction in schizophrenic indicators for the following 4 weeks checkup. A marked reduction of PANSS up to 50%, a lesser amount of discomfort at the deltoid muscle the site of injection will be noted. There will be absence of noticeable adverse reaction such as headache, sleeplessness, nervousness or exacerbation, of symptoms of schizophrenia. Patient  will express satisfaction with being on Invega sustennia with some concern on gaining weight, of almost 4.5lb within  2 months, that is the one variance with the anticipated and the actual consequence.( Laureate, 2016).

Decision point 3

The plan is to remain on the Invega Sustenna, advice client that weight gain from Invega Sustenna is far less than that of drugs with comparable effectiveness. Advice will also be giving on diet and exercise before the next PMHNP in four weeks.

Aim for the decision: The aim for the continuation of Invega sustenna is because the anticipated result is consistent with the actual outcome as patient  has continually  exhibited  a positive outcomes with noticeable reduction in schizophrenic indicators. Patient shows a positive tolerance with medication irrespective of worries with gaining weight. Maintenance of patient on existing medication and dose appears to be the preferred  choice presently. Weight loss can be achieved adjusting food consumption and increased activity. Abilify maintena is an excellent decision but may not effective for every client. Also, the necessity to create a positive result with the oral dose before the administration of  Abilify Maintena, is vital as it does not bind to the D2 receptor for a long time as the Invega sustenna. (Stahls, 2013).  Qsymia which is used for  weight lost for an obsessed patient, it is not likely the preferred choice at present for fear of drug interaction with Invega sustenna resulting in toxicity.

Probable consequence: There is anticipation of full recovery from schizophrenic indications, and reduction in weight with the assistance of the dietician and fitness instructor Patient is  anticipated to less worried with gaining weight as this will be reduced with  exercise and food  consumption. Her engrossed-on compliance with her treatment regimen and no problems with discomfort on the injection area. (Lin, Rosenheck, Sugar, & Zbrozek, 2015).

Gap amid the probable and the real outcome is therapeutically in accord with the predictable decision as shown by a noticeable reduction in signs and aptitude to make a clear judgment. Assessment for effectiveness and acceptability with the long term atypical antipsychotic should be done constantly (Murray, 2013).

Influence of Ethical deliberation on care plan

Ethical conflicts is a concern for the. PMHNP in the treatment patients with schizophrenia. The discrepancy arises because of aiding the clients and with respect to their best opinion. Nevertheless, the PMHNP should not forget the ethical consequences of nonmaleficence particularly with schizophrenic client, due to impairment of their decision-making abilities. Before obtaining consent, it is important to give a clear and accurate information about her medications. (Boyle RJ, 2015).

Conclusion

The utilization of pharmacological agents in treating schizophrenia has shown marked improvement worldwide, resulting in momentous outcomes on patients’ relapse and indicator control. Even though there exists insufficient uniformity in implementation, and restricted accessibility to diverse models of actual therapy the spreading of psychosocial interventions as usual practice within mental health services has reduced. This has brought wide differences in treatment responses amongst the clients, resultant to a failure to accurate prediction of treatment effectiveness to a specific client, and thereby creating a difficult client-focused treatment.

Reference
  1. Boyle RJ. (2015).Introduction to Clinical Ethics, Third Edition. Hagerstown, MD: University Publishing Group, Inc.; Communications, truth-telling, and disclosure.
  2. Chien WT, Yeung FK, Chan AH. (2012). Understanding shame of patients with psychiatric Illness In Hong Kong: in relation with patients’ behavior, and perspectives Of caregivers and health professionals. Adm Policy Ment Health.Epub.
  3. Hough D, Gopal S, Vijapurkar U, Lim P, Morozova M, Eerdekens M. (2010) Paliperidone Palmitate maintenance treatment in delaying the time-to-relapse in patients with Schizophrenia: a randomized, double-blind, placebo-controlled study. Schizophrenic. 116: 107-117. 10.1016/j.schres.2009.10.026.
  4. Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.
  5. Laureate Education. (2016) Case Study: Pakistani woman with delusional thought processes[Interactive Media File]. Baltimore, MD. Author
  6. Lin, L, A. Rosenheck, R, Sugar, C, & Zbrozek, a (2015). Comparing antipsychotic treatments Foe schizophrenia: A health state approach. The psychiatric quality, 86(1), 107-121. Doi: 10:1007/s 11126-0149326-2.
  7. Murray CJ, Richards MA, Newton JN, Fenton KA, Anderson HR, Atkinson C, et al. (2013). UK health performance: findings of the global burden of disease study 2010. The Lancet; 381:997–1020
  8. Stahl, S. M. (2013). Essential psychopharmacology: Neuroscientific basis and practical Applications (4th Ed.). New York, NY: Cambridge University Press.

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The Assignment – Case Study: Assessing and Treating Clients With Psychosis and Schizophrenia 

Case Study: Assessing and Treating Clients With Psychosis and Schizophrenia 

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia. Case Study: Assessing and Treating Clients With Psychosis and Schizophrenia

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 4, “Psychosis and Schizophrenia”

Chapter 5, “Antipsychotic Agents”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

  • amisulpride
  • aripiprazole
  • asenapine
  • chlorpromazine
  • clozapine
  • flupenthixol
  • fluphenazine
  • haloperidol
  • iloperidone
  • loxapine
  • lurasidone
  • olanzapine
  • paliperidone
  • perphenazine
  • quetiapine
  • risperidone
  • sulpiride
  • thioridazine
  • thiothixene
  • trifluoperazine
  • ziprasidone

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659. doi:10.2165/00023210-200923080-00002

Note: Retrieved from Walden Library databases.

Document: Midterm Exam Study Guide (PDF)

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

Note: Retrieved from Walden Library databases.

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

Required Media

Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2

To prepare for this Assignment: Case Study: Assessing and Treating Clients With Psychosis and Schizophrenia 

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

Week 6 Discussion

The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

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