instructions:
Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia
Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia.
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.
The Assignment: 5 pages
Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
Assessing and Treating Patients with Psychosis and Schizophrenia
Student Name Here
Program Name or Degree Name, Walden University
Course Number, Section, and Title
(Example: NURS 0000 Section 01, Title of Course)
Instructor Name
Month, Day, Year
(enter the date submitted to instructor)
Assessing and Treating Patients with Psychosis and Schizophrenia
Schizophrenia is a health condition that occurs due to a complex relationship among genetic, environmental factors, brain structure, and alteration of neurotransmitters. The mental disorder triggers positive effects such as hallucinations, thought disorders, and delusions (Fellner, 2017). The negative symptoms are low motivation, flat effect, poor speech, and anhedonia. Patients can experience loss of touch with reality and poor participation in daily activities (Jupe et al., 2017). The symptoms can be worrying to the family members who choose to seek medical help. The paper aims to evaluate three decision points for a Pakistani woman’s case study with a paranoid type of schizophrenia. The three decision points examine the medical history, the treatment of the signs and symptoms. The reasons for each of the decisions are considered in line with the available literature. It covers the expected outcomes and the ethical principles that healthcare workers should observe in the care provision.
Decision One
The first decision is to prescribe Invega Sustenna 234mg IM XI, followed by 156mg after four days and monthly thereafter. The purpose of selecting the long-acting injection is because the patient has a history of non-adherence to medication such as oral Risperdal. According to Canady (2019), prescribing another oral medication is risky since the patient may not comply with the treatment. Canady (2019) shows that Invega Sustenna is a mood stabilizer that works by restoring a balance in the chemical components in the brain. The second-generation antipsychotic drug blocks dopamine two receptor sites and binds to 5HT2A (Fellner, 2017). The action reduces the severity of the symptoms. The drug inhibits serotonin 2A receptors by increasing the dopamine release in the brain (Fellner, 2017). The purpose of increasing dopamine release is to enhance cognitive abilities (Stahl, 2014).
Schizophrenic patients can experience relapse and lengthy hospitalizations if they do not adhere to the treatment. One of the solutions to the problem is to prescribe long-acting injections that will counter the non-adherence problem (Stahl, 2014). It was not prudent to select the other options, Zyprexa and Abilify since they are oral medications. The client has a history of non-adherence to oral medication (Correll et al., 2019). Another reason is that the impaired judgment of the patient can increase the risk of non-adherence. Zyprexa is a second-generation atypical antipsychotic drug that is effective but increases the risk of side effects such as weight gain, diabetes type 2, and high triglyceride levels (Correll et al., 2019).
The expected outcome is that the patient will present in the next clinic with a 50 percent reduction in the symptoms. For example, the patient should reduce the positive and negative syndrome scale (PANSS) score by 50 percent. Another expectation is that the patient will tolerate the medication and experience little or no side effects.
The client comes back to the clinic after four weeks. The only complaint is that she has radiating pain at the injection site. The pain is triggering discomfort while sitting and walking. According to the PANSS score, the patient has a 25 percent improvement. Her weight has increased by 2 pounds, but she is not concerned. She is tolerating the medication effectively (Laureate Education, 2016).
Decision Two
The second decision is to maintain the drug by prescribing Invega Sustenna 156mg IM extended-release for the next four weeks. The purpose of maintaining the drug is because the patient had significant improvement and tolerance of the drug (Canady, 2019). For instance, the PANSS has improved by 25 percent while the weight is just up by 2 pounds. The only complaint is that she is experiencing pain at the injection site. Due to the complaint on the pain at the injection site, the second injection will be administered on the deltoid muscle. Pain at the injection site can increase the risk of the reluctance to adhere to the treatment (Canady, 2019). Reluctance leads to relapse and slow recovery (Fellner, 2017). Healthcare workers should administer the injection at the patient’s preferred site to ensure the patient’s comfort.
It was not prudent to choose the other options since the current medication was already functioning effectively (Fellner, 2017). The client was responding well to the medication except for the complaint of pain at the injection site. Polypharmacy is not recommended in treating mental disorders since it can trigger adverse outcomes (Tiihonen et al., 2019). The treatment goal is to ensure full recovery, improve the PANSS score, reduce the pain at the injection site, lower the side effects, and general improvement.
The patient reports to the clinic after four weeks. According to the PANNS score, the patient has a 50 percent improvement. She is not accompanied by her husband, a positive sign of progress. She reports feeling better on the long-acting injection. She only complains of 4.5-pound weight gain over the eight weeks. She requests medication that does not trigger weight gain (Laureate Education, 2016).
Decision Three
The third decision is to continue with Invega Sustenna 156mg IM. A counselor, exercise physiologist, and dietician are incorporated into the treatment to address the complaint of weight gain. The incorporation of other professionals is crucial to improve patient outcomes. The purpose of continuing with the drug is to trigger significant improvement in the symptoms (Weiden et al., 2020). She testifies of feeling better and reports no reluctance to the medication. Canady (2019) shows that patients on the long-acting injections experience significant improvement in the symptoms and quality of life. For example, the improvements are evident in a decrease in hallucinations, delusions, and dysfunctional thinking. Despite the improvements, patients should continue taking the medication for complete recovery (Weiden et al., 2019). The weight gain interventions effectively convince the patient that alternative LAIs trigger more weight gain than Invega Sustenna (Correll et al., 2019). Correll et al. (2020) argue that Zyprexa leads to more weight gain than Invega Sustenna.
Abilify is not preferable since switching medications for mental disorder patients can cause adverse reactions (Rognoni et al., 2021). Another reason is that Invega Sustenna is an injection that leads to total compliance (Rognoni et al., 2021). Despite the weight gain and BMI of 28.9 kg/M2, the patient’s condition does not warrant a weight loss regimen.
The patient should continue with the injection for another four weeks. It is expected that the patient will report better insight, thought process, and judgment. The patient should continue adhering to the treatment and tolerating the medication with little or no side effects. Due to the interventions, it is expected that the patient will reduce the weight. It is expected that the patient will have improvements in the PANSS score.
The third decision has no outcomes. The healthcare provider will follow up with the patient to evaluate the outcomes after four weeks. The practitioner will decide on the subsequent intervention based on the outcomes.
Ethical Considerations
Healthcare practitioners experience ethical dilemmas in the process of dealing with diverse patients and making different decisions. Ethical considerations are essential in providing quality, safe, and patient-centered care (Koskenvuori et al., 2019). The provision of care to the Pakistani female requires ethical values such as empathy, compassion, autonomy, beneficence, veracity, and non-maleficence. Empathy builds a trusting connection and improves communication between practitioners and patients. Compassion is necessary to understand the suffering of a Pakistani woman with a mental disorder. Compassion should be coupled with beneficence. Practitioners should maintain the autonomy of making decisions according to their professional knowledge (Mehdipour Rabori et al., 2019). During the diagnosis and treatment, it will be vital to observe veracity. Non-maleficence is crucial during the provision of care to avoid putting a patient’s health at risk (Mehdipour Rabori et al., 2019). Ethical considerations are vital in the provision of professional and efficient care.
Conclusion
Patients with psychosis and schizophrenia require critical decision-making during the care provision. A PMHNP has a responsibility to examine the medical history to determine the best medication. In the case study of a Pakistani woman with a paranoid type of schizophrenia, Invega Sustenna 234mg IM XI, followed by 156mg after four days and monthly injections, is the best medication. The medication will address the non-compliance issue noted with Risperdal. Treatment should consider the side effects such as weight gain and pain at the injection site. The incorporation of other stakeholders is vital to enhance diversity and efficiency of care. Care provision should observe ethical considerations such as empathy, compassion, autonomy, beneficence, veracity, and non-maleficence.
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References
Canady, V. A. (2019). Long‐acting injectables good option for schizophrenia patients. Mental Health Weekly, 29(15), 6-7. https://doi.org/10.1002/mhw.31861
Correll, C. U., Newcomer, J. W., Silverman, B., DiPetrillo, L., Graham, C., Jiang, Y., … & Kahn, R. S. (2020). Effects of olanzapine combined with samidorphan on weight gain in schizophrenia: a 24-week phase 3 study. American Journal of Psychiatry, 177(12), 1168-1178. https://doi.org/10.1176/appi.ajp.2020.19121279
Correll, C. U., Sliwa, J. K., Najarian, D. M., & Saklad, S. R. (2019). Practical considerations for managing breakthrough psychosis and symptomatic worsening in patients with schizophrenia on long-acting injectable antipsychotics. CNS Spectrums, 24(4), 354-370. DOI: https://doi.org/10.1017/S1092852918001098
Fellner, C. (2017). New schizophrenia treatments address unmet clinical needs. Pharmacy and Therapeutics, 42(2), 130. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265239/
Jupe, T., Elezi, F., Zenelaj, B., & Myslimi, E. (2017). The side effects of risperidone depot in patients with psychotic disorders. European Psychiatry, 41(S1), s816-s816. DOI: https://doi.org/10.1016/j.eurpsy.2017.01.1586
Koskenvuori, J., Numminen, O., & Suhonen, R. (2019). Ethical climate in nursing environment: a scoping review. Nursing Ethics, 26(2), 327-345. https://doi.org/10.1177/0969733017712081
Laureate Education (2016j). Case study: Pakistani female with delusional thought processes [interactive media file]. Baltimore, MD: Author.
Mehdipour Rabori, R., Dehghan, M., & Nematollahi, M. (2019). Nursing students’ ethical challenges in the clinical settings: a mixed-methods study. Nursing Ethics, 26(7-8), 1983-1991. https://doi.org/10.1177/0969733018810766
Rognoni, C., Bertolani, A., & Jommi, C. (2021). Second-Generation Antipsychotic Drugs for Patients with Schizophrenia: Systematic Literature Review and Meta-analysis of Metabolic and Cardiovascular Side Effects. Clinical Drug Investigation, 1-17. https://doi.org/10.1007/s40261-021-01000-1
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Tiihonen, J., Taipale, H., Mehtälä, J., Vattulainen, P., Correll, C. U., & Tanskanen, A. (2019). Association of antipsychotic polypharmacy vs monotherapy with psychiatric rehospitalization among adults with schizophrenia. JAMA Psychiatry, 76(5), 499-507. doi:10.1001/jamapsychiatry.2018.4320
Weiden, P. J., Claxton, A., Kunovac, J., Walling, D. P., Du, Y., Yao, B., … & Cash, E. (2020). Efficacy and Safety of a 2-Month Formulation of Aripiprazole Lauroxil With 1-Day Initiation in Patients Hospitalized for Acute Schizophrenia Transitioned to Outpatient Care: Phase 3, Randomized, Double-Blind, Active-Control ALPINE Study. The Journal of Clinical Psychiatry, 81(3), 1-10. https://doi.org/10.4088/JCP.19m13207
