Schizophrenia Spectrum and Other Psychotic Disorders

“Captain of the Ship” Project – Schizophrenia Spectrum and Other Psychotic Disorders

The HPI and clinical impression for the client

Patient is a 37-year-old male with a diagnosis of Paranoid Schizophrenia, who was seen for a psychiatric follow-up. The patient was born and raised in Michigan with two younger siblings. He is single and has no children. He has not been in contact with his family since he was 19 years old. He relocated to Utah and then came to Florida in 2013. He was homeless for almost six years until when the police brought him to the emergency department after walking into traffic to kill himself. He reported feeling suicidal, hopeless, and helpless, “I was on drugs and probably drunk”. He has persistent auditory hallucination command type telling him to kill himself.Schizophrenia Spectrum and Other Psychotic Disorders

The patient’s symptoms are triggered by poor compliance with medication and treatment for schizophrenia. He was taking Aripiprazole oral daily but was not compliant with that regime. He has a history of alcohol abuse and amphetamine abuse but he states the last time he used was a year ago. He smokes a pack of cigarettes or more a day. He denies using any drugs or drinking alcohol at this time as he has been living in a “sober living”. He works part-time at a nursery near his residence, which makes it easier for him to ride his bicycle to and from. The patient is oriented to person, place, time, and situation; he has intact present immediate and remote memory tested by general information. Mood is euthymic. Affect is congruent. Thought process logical, goal oriented. No abnormal movements were noted during the interview. He denies any suicidal or homicidal ideation and denies any auditory or visual hallucinations at this time. Patient educated on the benefits of medication compliance.

Psychopharmacologic treatments and therapeutic endpoints for the psychopharmacologic agent

Atypical or second-generation antipsychotics (SGAs) with the exclusion of clozapine, are the first-line treatment for schizophrenia patients.  Clozapine has the risk of causing seizures and that is why it is not recommended. Approximately 80 to 90 percent of schizophrenia patients experience a relapse in the course of the disease. Breakthrough in psychotic episodes might occur from noncompliance with maintenance therapy, stressful life events, poorer premorbid adjustment, or persistent substance use.  Long-acting injectable (LAI) antipsychotics are often utilized to prevent relapse (Fellner, 2017).Schizophrenia Spectrum and Other Psychotic Disorders

InvegaSustenna117mg IM monthly. Invega Sustenna or Paliperidone palmitate 1 month (PP1M) is a LAI that is administered once a month. According to Savitz et al. (2016), the total or partial-nonadherence to oral antipsychotic medication is that common occurrence in schizophrenia patients significantly impacts treatment outcomes. LAI removes the need for everyday dosing, ensures continued plasma levels for numerous weeks, and assists in reliable monitoring of adherence.

Psychotherapy choices (individual, family, and group)

Adjunctive psychosocial interventions including cognitive behavioral therapy (CBT), training on social skills, and family psychosocial education improve medication adherence and prevent relapse in schizophrenia patients.  Individual CBT is the recommended psychotherapy choice for the client.  According to Candida et al. (2016), CBT for schizophrenia depends on numerous techniques to efficiently target cognitive processing preconceptions along with the basic negative and positive symptoms.  When dealing with hallucinations, the therapist considers numerous features of the patient’s voice-hearing including loudness, potential triggers, number of voices, and loudness. The therapist then carefully assesses the experience of the patient and recommends a variety of approaches to lessen distress:  diverting the patient from the voice he hears, enhancing coping skills, utilizing responding techniques, normalization techniques, and metacognitive approaches to lessen negative emotions linked to the voices. Schizophrenia Spectrum and Other Psychotic Disorders

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Medical management needs, including primary care needs, specific to this client

Schizophrenia is characterized by a wide range of emotional and cognitive abnormalities, which together with a decline in functioning connected with the disorder means that the quality of life and everyday behavior of the patient are negatively impacted.  Long –term maintenance treatment and balancing medication effectiveness and adverse effects are the medical management needs specific to the client. De Bartolomeis et al. (2016) indicate that the majority of schizophrenia patients require long-term maintenance treatment for the regulation of their symptoms. However, numerous effectual antipsychotics are available, most patients do not get adequate long-term therapy majorly as a result of poor adherence.   There is evidence that optimization of the balance between side effects and efficacy is of great significance for the improvement of adherence and maximization of quality of life.

Community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client

NAMI Broward County is a community agency that is available to assist the Client. NAMI Broward c County is a grassroots organization of mentally ill individuals, particularly individuals with serious mental illnesses, their friends, and family members. The mission of the organization is to advocate for effective diagnosis, treatment, prevention recovery, research, and support that improves the QoL of all individuals affected y mental diseases (NAMI Broward County, 2021). The organization provides support to mentally ill patients, educates consumers and families, advocates for improved opportunities for meaningful jobs, rehabilitating and housing, and supports education programs intended to assist eradicate the pervasive mental health stigmatization.Schizophrenia Spectrum and Other Psychotic Disorders

A plan for follow-up intensity and frequency and collaboration with other providers

A follow-up is essential to evaluate how the client is progressing and how he responds to treatment.  Patient follow up will occur monthly for medication management and continuation with the prescribed therapy. The client will also be monitored for possible side effects and managed accordingly.  I will collaborate with other providers including psychiatrists and therapists in the formulation of the treatment plan and decisions concerning the treatment setting. I will draw the treatment by consulting all providers involved in the patient’s care.

References

Candida, M., Campos, C., Monteiro, B., Rocha, N. R., Paes, F., Nardi, E., & Machado, S. (2016). Cognitive-behavioral therapy for schizophrenia: an overview on efficacy, recent trends and neurobiological findings.  Medical Express, 3, 5).  doi: 10.5935/. Schizophrenia Spectrum and Other Psychotic Disorders

De Bartolomeis, A., Fagiolini, A., Vaggi, M., & Vampini C. (2016). Targets, attitudes, and goals of psychiatrists treating patients with schizophrenia: key outcome drivers, role of quality of life, and place of long-acting antipsychotics. Neuropsychiatric Disease and Treatment, 12, 99-108. doi: 10.2147/NDT.S96214

Fellner, C. (2017). New Schizophrenia Treatments Address Unmet Clinical Needs. Pharmacy and Therapeutics, 42(2), 130-134.

NAMI Broward County. (2021). About NAMI Broward County. https://namibroward.org/about-nami-broward-county/

Savitz, A. J., Xu, H., Gopal, S., Nuamah, I., Ravenstijn, P., Janik, A., Schotte, A., Hough, D, & Fleischhacker, W. W. (2016). Efficacy and Safety of Paliperidone Palmitate 3-Month Formulation for Patients with Schizophrenia: A Randomized Multicenter, Double-Blind, Noniferiority Study.  International Journal of Neuropsychopharmacology, 19(7), https://doi.org/10.1093/ijnp/pyw018. Schizophrenia Spectrum and Other Psychotic Disorders