Assessing and Treating Psychosis and Schizophrenia
Walden University
NURS 6630N
Psychosis and Schizophrenia Assessment and Treatment
Introduction
Treatment of psychosis and schizophrenia necessitates a series of decisions in order to manage the condition while minimizing side effects. Invega Sustenna 234mg IM XI is one of the best medications, followed by 156mg after four days and monthly injections (Johnston et al., 2019). In comparison to other available drugs, it has few side effects. To address urgent issues, different decisions should take into account a patient’s condition. PMHNPs should make the best decisions for their patients by selecting the best medication.
Decision#1
The patient’s condition necessitates critical decisions by the PMHNP in order to stabilize the patient’s condition. There are three options for the first decision, including Zyprexa 10mg PO bedtime and Abilify 10mg PO bedtime. Another option is Invega Sustenna 234mg IM XI, followed by 156mg four days later (Johnston et al., 2019). Following the initial treatment, a monthly injection will be required.
Invega Sustenna 234mg IM XI is the best option for decision #1, followed by 156mg after four days and monthly injections. One of the reasons for making the choice is that the patient has a history of not taking medication on a consistent basis (Hsia et al., 2017). According to subjective data, the patient stopped taking Risperdal, so prescribing an oral medication may be ineffective. The patient also believes that her husband is trying to poison her, so an oral medication is not recommended. An injection, according to Hsia et al. (2017), is effective in ensuring the patient receives the necessary medication to promote recovery and reduce the risk of readmission with similar symptoms.
Due to compliance issues, prescribing Abilify 10mg and Zyprexa 10mg to the patient is also ineffective. Zyprexa 10mg is also not a good option because it can cause serious side effects such as weight gain (Lin et al., 2019). Zyprexa 10mg, for example, contains both antihistaminic and 5HT2C antagonist components. Diabetes mellitus can be caused by the drug’s properties (Stahl, 2013). Furthermore, Abilify 10mg is not a first-choice medication because it can cause drowsiness and impulsive behavior.
The preferred medication is Invega Sustenna 234mg IM XI and its subsequent dosage. The reason for this is that the treatment’s goal is to eliminate negative symptoms and normalize paranoid schizophrenia (Salvatore et al., 2018). Another reason for prescribing the medication is that Invega binds to 5HT2A receptors more potently than D2. When compared to other antipsychotics, this ability results in fewer extrapyramidal symptoms.
Treatment is also expected to eliminate symptoms that impair a patient’s quality of life, such as delusions while watching television. Treatment also focuses on improving symptoms such as speech quality, eliminating hallucinations, and becoming agitated or ‘out of control’ (Grover et al., 2017). Another prediction is that the PANSS score will decrease by half of the negative symptoms.
After four weeks, the patient returns to the clinic for another monthly injection. The results of decision #1 show that the patient has a PANSS score of 25%. She is taking the medication and has had one injection so far, with encouragement from her husband. Given that this is the first month of treatment, the progress is commendable. She also noticed a normal 2-pound weight gain. The patient also complains of pain at the injection site and is unable to sit for an extended period of time after the injection (Carlsson et al., 2017). However, the pain is to be expected, especially given the medication. She, on the other hand, is responding favorably to the treatment.
Decision#2
In the second step, it is best to stick with the current medication. One of the reasons is that the patient is already responding favorably to the medication with few side effects (Johnston et al., 2019). The only side effect, for example, is weight gain and mild pain at the injection site. It is critical to inform the client that other drugs used to treat paranoid schizophrenia can cause worse side effects. As a result, she must deal with the current situation, even though the PMHNP will make every effort to manage the side effects. It is also not recommended to keep changing medications, particularly when treating mental disorders (Johnston et al., 2019). It may take several weeks for patients to fully recover.
There is the possibility of adding another drug to the treatment to improve patient outcomes and symptoms. However, the medications are not required because polypharmacy can have negative consequences. Hsia et al. (2017) state that other drugs should only be used if the situation is dire, but the patient’s current condition indicates that he or she is responding positively. Evidence-based practice also indicates that clinicians should not administer two drugs intramuscularly at the same time (Stahl, 2013). In some cases, drugs should be administered orally in small doses to assess the effects before administering a large dose via injection. The only change to the current dosage will be the injection site (Salvatore et al., 2018). The client’s complaint is pain and an inability to sit or walk for long periods of time. As a result, during the current injection and subsequent clinic visits, the nurse should inject the deltoid site.
The treatment is expected to result in a 60 percent improvement. Another goal for the next four weeks is to significantly suppress the symptoms and return the client to normalcy (Salvatore et al., 2018). For example, I anticipate that the patient will be pleased with her marriage and that no one wishes to poison her. I also expect the patient to watch television normally, without any delusions that Prophet Mohammed or God is speaking to her and directing her to save the world from sin. I also hope that the husband’s confidence will improve to the point where he will be able to leave the children with her in peace.
After four weeks, the patient returns to the clinic with her husband. The husband is completely supportive of a full recovery. Based on the assessment, the client has a 50% reduction in negative symptoms, according to the PANSS score. The client appreciates that the medication is more comfortable in the arm. The patient states that she is happy with her marriage and that she does not receive any strange messages while watching television. She is concerned about her weight gain and wonders if her husband would still love her if she gained weight. She wonders if there is any medication that can help her lose weight. Weight gain is normal after receiving the Invega Sustenna injection. Notably, the weight gain peaks in the second week, when the drug is also altering body processes to return a client to normalcy.
The expectations and outcomes are strikingly similar. The similarities include her marriage’s positivity, the absence of delusions, and a 50% improvement in her PANSS score. Various similarities indicate that the patient is responding favorably to the medication.
Decision#3
Because the client is already responding positively to Invega Sustenna, Decision$3 has few options. There are, however, other options, such as Abilify 10mg or Qsymia. One of the reasons for making such a move to change the drug or add another medication is to control the weight (Salvatore et al., 2018). A clinician can avoid such a decision since it can trigger adverse side effects. It is thus recommendable to send the client to an exercise physiologist or nutritionist to help manage weight (Grover et al., 2017). The reason is that weight gain is the only issue the patient raises. – Term Paper Writing Service USA
Therefore, the best decision is to continue with the medication for another four weeks. A nurse should thus help the client to take another injection. However, an issue was raised in decision$2 during the assessment. According to the patient, the weight issue is affecting her since she is worried her husband may dislike her body shape. One of the best decisions is to refer the client to a dietician, exercise physiologist, or nutritionist (Grover et al., 2017). The purpose of scheduling an appointment with the nutritionist, exercise physiologist, and dietician is to help the patient to manage her diet and weight. Recommending a consultation with a specialist will be effective in addressing the fear of the client. According to Stahl (2013), it is still essential to remind the patient that moderate weight gain is expected with the medication. For example, a nutritionist or physiologist will be essential to tackle the issue and boost the patient’s confidence to continue with the medication (Johnston et al., 2019). A nutritionist will also encourage the client to continue taking the medication since her weight is not at risk. The assessment shows the BMI is 28.9kg/m2, which shows she is below the obesity cutline, which starts at 30kg/m2.
The goal of treatment is to realize 80 percent of the decrease in negative symptoms. A significant improvement will help the woman to resume participation in daily activities (Johnston et al., 2019). For example, I expect that the woman will be responsible for her children without any overreaction. She should also be positive about her marriage and believe her husband has no intention to poison her. The woman should also be free of any delusions while watching television, which makes her believe she can be the savior of the world. However, it is not a priority of the treatment goals to reduce the weight of the patient by adding extra medication. Hsia et al. (2017) argue that polypharmacy is not recommended in the treatment of mental disorders since it can cause adverse effects. PMHNP will continue to monitor the patient every month to facilitate a full recovery.
The client reports back to the clinic after four weeks. According to the assessment, she has a PANSS score of 80 recovery. The results are similar to the expectations of decision#3. She also reports positive expectations with her marriage and no longer hearing any voice about saving the world. Her husband confirms that she is happy and at peace to leave the children with her. The significant progress was achieved due to the best selection of the medication, follow up clinics, and making the right decisions to address different outcomes.
Ethical Issues in Treatment – term paper writing service
Early treatment of paranoid schizophrenia is one of the effective strategies of overcoming the negative effects of the condition. However, a PMHNP should seek the consent of a patient or family member to begin treatment (Stahl, 2013). In some cases, family members and the patient denies there is a problem. In such a case, open, honest, and evidence-based communication will be essential. Additionally, quality management of care is necessary to ensure successful treatment (Salvatore et al., 2018). The management will require the effective education of the patient. A clinician can use various channels such as talking to a patient, recommending an appointment with a nutritionist, or providing educational materials. Treatment should involve friendly medications based on a client’s condition (Salvatore et al., 2018). A PMHNP should explain to a client about the safest medication available in the market. According to Stahl (2013), the decision is per the ethical guidelines to ‘do no harm.’ Treatment of paranoid schizophrenia requires ethical considerations to improve the welfare and well-being of a patient.
Conclusion
Treatment of psychosis and schizophrenia is a process that requires a series of decisions. PMHNP makes decisions based on medical history and a patient’s condition. Invega Sustenna 234mg IM XI, followed by 156mg after four days and monthly injections, is the best decision. It is effective since the patient has a history of non-compliance with oral medication. Treatment should also consider ethical issues to improve the well-being of a patient. PMHNP should make accurate decisions by selecting the best medication and managing the condition effectively, including side effects.
References
Carlsson, I. M., Blomqvist, M., & Jormfeldt, H. (2017). Ethical and methodological issues in qualitative studies involving people with severe and persistent mental illness such as schizophrenia and other psychotic conditions: a critical review. International Journal of Qualitative Studies on Health and Well-Being, 12(sup2), 1368323. https://doi.org/10.1080/17482631.2017.1368323
Grover, S., Chakrabarti, S., Hazari, N., & Avasthi, A. (2017). Effectiveness of electroconvulsive therapy in patients with treatment-resistant schizophrenia: a retrospective study. Psychiatry Research, 249, 349-353. https://doi.org/10.1016/j.psychres.2017.01.042
Hsia, S. L., Leckband, S. G., Rao, S., Jackson, E., & Lacro, J. P. (2017). Dosing strategies for switching from oral risperidone to paliperidone palmitate: Effects on clinical outcomes. Mental Health Clinician, 7(3), 95-100. https://doi.org/10.9740/mhc.2017.05.095
Johnston, K., Sliwa, J. K., Bossie, C. A., & Kim, E. (2019). Long-Acting Injectable Antipsychotics. Journal of Psychosocial Nursing and Mental Health Services, 57(11), 5-5. https://doi.org/10.3928/02793695-20191016-02
Lin, C., Strauss, R., Hong, J., Hamper, J. G., Hoy, E. S., Lazar, A. A., & Kroon, L. (2019). Impact of a pharmacist‐administered long‐acting injectable antipsychotic service in a supermarket‐based community pharmacy on medication adherence. Journal of the American College of Clinical Pharmacy, 2(4), 343-348. https://doi.org/10.1002/jac5.1159 – Term Paper Writing Service
Salvatore, G., Buonocore, L., Ottavi, P., Popolo, R., & Dimaggio, G. (2018). Metacognitive interpersonal therapy for treating persecutory delusions in schizophrenia. American Journal of Psychotherapy, 71(4), 164-174. https://doi.org/10.1176/appi.psychotherapy.20180039
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
