Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

Assessing and Treating Patients with Psychosis and Schizophrenia

Introduction

The provided case study is about a woman who presented with a delusional thought process. The client had been admitted for 21 days after experience a psychotic disorder whereby the symptoms had persisted for about a month. Even though she verbally denied having any auditory or visual hallucination, the husband reported that she would confess to being Allah’s prophet whose purpose was to save humanity from sin. She also self-reported being Allah’s messenger through the television during the mental status exam.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

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The husband admitted that the client would get of control due to the psychotic symptoms, and such an incident led to her being hospitalized in the psychiatric unit. During the interview, she would pause to listen to “something” and the objective data indicates that she was hostile during the interview. Both the lab findings and physical assessment did not show any abnormality. The client was also not adhering to the Risperdal treatment as indicated by the subjective data. The client is also oriented to person, place, event, and time and her speech is coherent, even though she would pause during the interview. However, both her insight and judgment were impaired and she also depicted a delusional and paranoid thought process. The mood was deemed to be euthymic and affect constricted. The subjective and objective data confirmed a diagnosis of was schizophrenia, paranoid type for the client. The paper will involve discussing and choosing the appropriate treatment options for this client.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

Decision Point One

One of the decisions is Zyprexa (olanzapine) 10 mg orally at BEDTIME. Olanzapine is an antipsychotic the help to maintain the balance of neurotransmitters in the brain in order to treat psychotic symptoms (Dzyubenko et al., 2017). The second available option is Invega Sustenna 234 mg IM X1. Invega Sustenna is also an antipsychotic medication that helps in maintaining the balance of certain brain neurotransmitters (serotonin and dopamine) in order to reduce psychotic symptoms (Greer et al., 2020).Assessing and Treating Patients With Psychosis and Schizophrenia Essay. The third available option is Abilify (aripiprazole) which is also an antipsychotic that maintains a balance of dopamine and serotonin within the brain (Schöttle et al., 2020). The mechanism of action of these medications where they rebalance serotonin and dopamine within the brain improves the thinking, mood, and behaviors of an individual with schizophrenia and hence improve the psychosis symptoms. Invega Sustenna 234 mg IM X1 was prescribed for this client, over the other treatment decisions, because the medication would be administered via IM and hence increase the client’s adherence to treatment.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

Prescription of is Invega Sustenna 234 mg IM X1 expected that she would, manifest a good response and also adhere to the treatment. This because administering medications through injection has been shown to improve adherence for people with psychotic symptoms over oral medications. Moreover, the medication’s efficacy in treating patients with schizophrenia has been illustrated in various studies (Greer et al., 2020).

After four weeks, there was a 25% symptom decrease indicating a good response. Nonetheless, the client was experiencing pain where the medication was injected and she also reported significant weight gain. The 25% symptom decrease is due to Invega Sustenna’s effectiveness as an antipsychotic, while the reported weight gain is a common side effect with this pharmacological agent (Savitz et al., 2016).Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

The client was educated about the three medications in order to obtain informed consent from her. Moreover, since her thought process was delusional, while her judgment was impaired, her ability to make treatment decisions was assessed (Corsico, 2020).

Decision Point Two

The first option in decision point two was having her continue being administered with Invega Sustenna 234 mg IM X1, but change the injection site to the deltoid. Changing the injection site will address the issue of the patient experiencing pain at the injection site (Hecker et al., 2020). The other option was for the patient to stop taking Invega Sustenna and begin haloperidol decanoate 50 mg IM. Haloperidol is also an effective antipsychotic, but there is no reason to change medication because she is already responding to Invega Sustenna. The third option is to add Abilify Maintena 300 mg IM deltoid site to the Invega Sustenna. Abilify is also an antipsychotic but associated with various side effects. Therefore, the decision to have her continue being administered with Invega Sustenna 234 mg IM X1, but change the injection site to deltoid was chosen.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

The treatment goal by continuing with Invega Sustenna 234 mg IM X1 but changing the injection site was selected to ensure the client continued demonstrating symptom reduction but adhered to treatment because the pain would be eliminated by changing the site (Hecker et al., 2020).

As expected, there was a further symptom decreased (50%) and the client did not have complaints about pain at the injection site. The further symptom decrease is due to the drug’s effectiveness in the treatment of symptoms of schizophrenia(Greer et al., 2020). Nonetheless, the client was greatly concerned about the persistent weight gain.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

Informed consent was obtained before changing the injection site and the client explained the importance of changing the medication’s injection site. Moreover, the application of the ethical principle of beneficence ensured that the selected treatment choice facilitated the best care outcomes(Corsico, 2020).

Decision Point Three

One of the treatment options in this decision point was for the client to continue being administered with Invega Sustenna, be educated about the side effects of the medication that include weight gain. Additionally, the choice involved the client being referred to a nutritionist and exercise expert and be educated about the side effects. This would enable the client to understand that the medication is effective but there is weight gain, which can be controlled by managing diet and being physically active. The other option was to have Invega Sustenna being discontinued and started Abilify 400 mg while the third treatment option involved the client continuing with Invega Sustenna but having Qsymia added to facilitate weight loss. However, while Abilify is associated with numerous side effects (Mousailidis et al., 2020), Qsymia also has numerous side effects and the medication is only recommended to treat overweight and obesity (May et al., 2020). Therefore, the decision to have the client continue with Invega Sustenna, be educated about the side effects of the medication that include weight gain and referral to a dietician and exercise expertise was chosen.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

By continuing with Invega Sustenna and educating her regarding weight gain, while at the same time referring her to a nutritionist and an exercise expert expected that the client would continue experiencing symptom decrease and have her concerns regarding weight gain fixed.

The ethical principles used while selecting the appropriate treatment decision included non-maleficence and beneficence to ensure that the client’s continued to show a good response, without any side effects (Casey, 2016).Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

Conclusion

For decision point one, Invega Sustenna 234 mg IM was prescribed to ensure her adherence to the treatment since patients with psychotic symptoms are more likely to adhere to injections when compared to oral medications. The medication is also effective in the treatment of schizophrenia. The other two options (Abilify and olanzapine) were being administered orally and hence they were not prescribed. After four months, the client responded well to Invega Sustenna as there was a 25% reduction of psychotic symptoms. The patient reported pain at the injection site and therefore it was decided that she should continue with Invega Sustenna but have the medication injection site changed. After changing the injection site, the client stopped experiencing the pain and showed a better response as there was a 50% symptom decrease. However, her concern about weight gain increased, and thus the third decision was to have the client continue with Invega Sustenna, be educated about the side effects of the medication that include weight gain, and referral to a dietician and exercise expertise was chosen. All three selected treatment decisions were guided by various ethical principles that included informed consent, decision-making ability, beneficence, and non-maleficence.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

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.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

The Assignment: 5 pages

Examine Case Study: Pakistani Woman With Delusional Thought Processes (https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_06/index.html). 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.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

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.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

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.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

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.

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Assignment: 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.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest.  The course page suggests writing 1 page per decision – my opinion is that it will be very difficult to justify your treatment decisions and provide scientific evidence in 1 page (especially for decision #1). I do not need you to tell me about the patient or the treatment options available to you – I am very familiar with the cases. Your introductory page should be an overview of the disease state you are treating along with a purpose statement for the assignment.  Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data).Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

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.Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

After writing up your rationale at each decision point, I would ask yourself the following questions:

Have I provided clinical data from a meta-analysis, case report or clinical trial to support the drug I picked being safe, efficacious and the best choice for this patient?

Have I provided clinical data, etc. to support a clear rationale as to why the other treatment options are NOT optimal?

Is the focus of my discussion on mechanism of action and receptors/neurotransmitters that the drug acts on? If the answer is YES, you should consider doing additional research to address the above two questions

Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

Also include how ethical considerations might impact your treatment plan and communication with clients.

The rubric, as I interpret it, suggests 5 references cited with every assignment for full credit on this portion (20 points).  References used for your introductory paragraph, ethical considerations or conclusion do not count towards the 5 references required.  As a general rule of thumb, I would encourage you to reference AT LEAST two sources (not including the textbook) for each decision point – this will result in 6 references total for your clinical decision making.

Assessing and Treating Patients With Psychosis and Schizophrenia Essay.

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