Assessing and Treating Patients With Psychosis and Schizophrenia Essay

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 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 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). Assessing and Treating Patients With Psychosis and Schizophrenia Essay. Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 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 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 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. Include introduction, purpose statement and conclusion Case study https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_06/index.html. Assessing and Treating Patients With Psychosis and Schizophrenia Essay

Introduction

Schizophrenia is a mental health disorder that affects how people perceive, think, and feel. The prevalence of the disease varies in different countries. In the United States of America, around 0.6% to 1.9% of the whole population suffers from schizophrenia. 40% of the total incidences are associated with indulging Cannabis Sativa. Other causes of schizophrenia are genetic factors, perinatal factors such as chronic illnesses, and social-environmental factors. The Symptoms of schizophrenia have four domains which are positive symptoms, negative symptoms, cognitive symptoms, and mood symptoms. Positive symptoms are hallucinations, delusions, disorganized speech, and behavior. Negative symptoms are decreased emotional range, poverty speech, loss of interest, and inertia. Cognitive symptoms are loss of memory and impaired concentration. Mood symptoms are extreme sadness alternating with cheerful moments. This paper describes a treatment plan for a 34 years old Pakistan female recently diagnosed with schizophrenia paranoid type. The author discusses three decisions concerning the patient’s pharmacological treatment; the expected outcomes of treatment, potential differences between the actual and expected treatment outcomes and the ethical considerations during treatment. A psychiatric nurse practitioner plays a major role in taking care of and following up on patients suffering from schizophrenia since their symptoms may be unrecognized by a general practitioner. Assessing and Treating Patients With Psychosis and Schizophrenia Essay

Decision One

Decision Selected

Olanzapine 10mg orally at bedtime

Reason for Selecting This Decision

Olanzapine is an FDA approved medicine used in the management of schizophrenia. It is a second-generation atypical antipsychotic medicine. It works on the dopamine and dopamine receptors (Singh,et al, 2018). The dopamine D2 receptors block dopamine from having normal neurotransmission hence decreasing the positive symptoms; hallucinations, disorganized speech, and delusions(Habtewold,et al, 2019). Similarly, it works on the serotonin 5HT2A receptors whose effects are on the negative symptoms; poor attention, inertia, and loss of interest. Olanzapine is well tolerated with minimum side effects. Good results have been achieved without initiating the injectable drugs. Invega sustenna is a first-generation antipsychotic used in the management of schizophrenia. It is still a suitable drug but it has side effects such as pain at the injection site, weight gain, bradycardia, and seizures that are unsuitable experiences for the patient (Pesa, et al, 2017). Abilify 10mg at bedtime is another alternative in the management of schizophrenia. It is used alongside hadol tablets to achieve the desired outcome. It is decreases hallucinations, improves concentration, decreases the occurrence of mood swings. The drug was not selected due to its adverse effects which are weight gain, increased risk of stroke and other cardiovascular diseases, excessive drooling, and trouble sleeping (Szota,& Araszkiewicz, 2020). The patient has a previous history of non-compliance with medication. Therefore, it is not the best choice since compliance is not warranted in both drugs. Assessing and Treating Patients With Psychosis and Schizophrenia Essay

Expected Outcome

By the next visit, it is expected that all the psychotic symptoms that manifest in this patient will gradually diminish. She will be able to function physically, socially, and occupationally well, she will be restful, the hallucinations, emotional outbursts, destructive practices, and deliriums will gradually decrease.

Difference betweenthe Expected Outcome andthe Actual Outcome

The client returned to the clinic four weeks later and reports of slight response to the medication given. Her PANSS decreases to a partial response by declining the positive symptoms by 25%. The patient has gained her weight by 5 pounds and reports that she cannot get full from her meals. According to Correll,et al, (2020) olanzapine is known to increase appetite with is associated with weight gain. Obese patients are advised to control food intake and engage in regular physical exercise to reduce weight gain.Assessing and Treating Patients With Psychosis and Schizophrenia Essay

Decision Two

Decision Selected

Change medication to Geodon (zaprasidone) 40mg orally BID with meals.

Reason for Selecting This Decision

In the previous visit, the patient showed improved progress after taking the medication. She was worried about a weight gain of 5 pounds within 4 weeks due to increased hyperphagia. Reducing the dose of the medicine would decrease the weight gain and cause a relapse of the acute symptoms of schizophrenia. Adding Wellbutrin-XL 150mg orally in the morning is an alternative that would help the patient to lose weight. It may not work well for the patient because she has a history of non-compliance with risperidone monotherapy. It also has unpleasant adverse effects such as tachycardia, pharyngitis, blurring of vision, involuntary tremors, diaphoresis, constipation, dry mouth, and nausea (Nair, &Riaz, 2018). The best option was to change the medicine to ziprasidone. Ziprasidone is an atypical antipsychotic used in the treatment of acute agitation of schizophrenia. It works on the dopamine, serotonin, adrenergic, and histaminergic receptors to effectively decrease the positive symptoms of schizophrenia; hallucinations deliriums, and disorganized speech. It also helps in stabilizing moods; mania and somnolence (Yang, et al, 2017). Comparing to olanzapine, it is more effective and efficient. It is not associated with weight gain and does not have adverse changes in cholesterol, triglycerides, and glucose control. Patients experience significant improvement after administration of the medicine. There are no adverse effects when switching from another antipsychotic. It has minimum extrapyramidal effects or postural hypotension.Assessing and Treating Patients With Psychosis and Schizophrenia Essay

Expected Outcome

The psychiatric nurse practitioner expects decreased schizophrenic symptoms due to the continuous sensitization of the disease to the family about the strange behaviors of the patient and the need for drug compliance. The PNP expects that the patient will have a positive report of weight loss since the initiation of the medicine. The patient’s spouse to report marked improvement of the patient’s symptoms.

Difference betweenthe Expected Outcome andthe Actual Outcome

Four weeks later, the client returns to the clinic and reports significant improvement. The actual results match with the expected outcome. She reports a reduction of PANSS mostly the positive symptoms by 40% since the last visit. She reports a decrease in weight by 2 pounds since the previous visit. She also says that her hunger has been curbed since the initiation of the medicine. Of note is that she has been missing the afternoon dose more often over the past month. Assessing and Treating Patients With Psychosis and Schizophrenia Essay

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Decision Three

Decision Selected

Change the Geodon to 80mg at bedtime daily and monitor for breakthrough symptoms throughout the day.

Reason for Selecting This Decision

During the previous visit, the patient reports a significant improvement in both the positive symptoms and weight gain. However, changing to another medication will not only destabilize the patient’s progress but also prevent the attainment of the required therapeutic objective. Giving the patient Risperdal thrice daily and giving start Invega sustenna both stat and maintenance dose will delay the patient’s therapeutic goals. It may difficult to ensure compliance with the medicine since it is given thrice daily. Invega sustenna stat and maintenance dose will not achieve the patient’s therapeutic goals due to its unpleasant adverse effects. The patient will always complain of pain at the injection site, constipation, tachycardia, pharyngitis, and weight gain (Preda, & Shapiro, 2020). Lurasidone 40mg is not the best option in the treatment of schizophrenia. It is a second-generation atypical antipsychotic that is approved by the FDA to treat bipolar and depression (Pompili,et al, 2018). However, it works on dopamine and serotonin hence decreasing the positive symptoms of schizophrenia. It has undesirable effects such as hypercholesterolemia, hyperglycemia, weight gain, hyperlipidemia, somnolence, and sedation. These effects may cause non-compliance and will delay the desired therapeutic attainment. The best course of action at this point is to continuously monitor that patient’s progress. Reducing the frequency of medicine and increasing the dosage will help achieve the desired effects and promote compliance. Assessing and Treating Patients With Psychosis and Schizophrenia Essay

Expected Outcomes

The psychiatric nurse practitioner expects the patient’s outcome to have significantly improved the positive symptoms. The patient will comply with medicine and the family members will make it up to ensuring the patient complies with medicine and follow-up clinics.

The Difference betweenthe Expected Outcome andthe Actual Outcome

The client returned to the clinic four weeks later and reports significant improvement. The expected outcomes match the actual result. The drug is well tolerated and has minimal adverse effects. After a further assessment, the patient has achieved optimum therapeutic goals hence improving the patient’s outcome.

Ethical Considerations

When initiating the treatment plan of a patient, the psychiatric nurse practitioner needs to know the ethical principles. These principles guide nursing practice and protect patients. These principles are informed consent, confidentiality, respect for autonomy, beneficence, non-maleficence, and justice (Jacobson, et al, 2020). Before starting the medicine, the nurse should seek fully informed consent by ensuring a better understanding of the patient. The PNP should prioritize the patient’s needs and preferences despite them having a psychiatric condition. The nurse should not overlook the patient’s inability to make decisions. Therefore they should implement advance directives in the best interest to treat the patient and protect from harm. In the cases of mild cognitive deficiency, the nurse should respect the patient’s autonomy and help them in making decisions. The nurse should ensure that the information shared by the patient should be private and confidential unless the patient permits to share the information. This prevents instances of social stigma at home and place of work. Assessing and Treating Patients With Psychosis and Schizophrenia Essay

Conclusion

Schizophrenia is a public health issue in the United States of America. Mostly, it is associated with the indulgence of drugs and other substances. The psychiatric nurse practitioner is the main contact of patients with schizophrenia and psychosis. The role of a psychiatric nurse practitioner is to make the diagnosis, initiate treatment, and monitor the patients through the follow-up clinics. The best choice of drug used in the management of schizophrenia approved by the FDA is ziprasidone. It has shown improvement of the positive symptoms by 40% within four weeks after administration. It does not have metabolic disturbance, unlike olanzapine. To minimize frequent missing of the afternoon dose and to achieve the desired therapeutic goal, the psychiatric nurse practitioner increased the dosage to 80mg and reduced the frequency to once a day. The psychiatric nurse practitioner ensured strict ethical consideration throughout treatment. This positively impacted the pharmacodynamics, pharmacokinetics, and therapeutic outcome. Assessing and Treating Patients With Psychosis and Schizophrenia Essay

References

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.

Habtewold, T. D., Rodijk, L. H., Liemburg, E. J., Sidorenkov, G., Boezen, H. M., Bruggeman, R., & Alizadeh, B. Z. (2020). A systematic review and narrative synthesis of data-driven studies in schizophrenia symptoms and cognitive deficits. Translational psychiatry, 10(1), 1-24.

Jacobson, N. C., Bentley, K. H., Walton, A., Wang, S. B., Fortgang, R. G., Millner, A. J., … & Coppersmith, D. D. (2020). Ethical dilemmas posed by mobile health and machine learning in psychiatry research. Bulletin of the World Health Organization, 98(4), 270. Assessing and Treating Patients With Psychosis and Schizophrenia Essay

Nair, &Riaz, (2018) Major Depressive Disorder and the “Leaky Gut” Post Cholecystectomy. Clin Case Rep Int. 2018; 2, 1069.

Pesa, J. A., Doshi, D., Wang, L., Yuce, H., & Baser, O. (2017). Health care resource utilization and costs of California Medicaid patients with schizophrenia treated with paliperidone palmitate once monthly or atypical oral antipsychotic treatment. Current Medical Research and Opinion, 33(4), 723-731.

Pompili, M., Verzura, C., Trovini, G., Buscajoni, A., Falcone, G., Naim, S., … & Girardi, P. (2018). Lurasidone: Efficacy and safety in the treatment of psychotic and mood disorders. Expert opinion on drug safety, 17(2), 197-205.

Preda, & Shapiro, (2020). A safety evaluation of aripiprazole in the treatment of schizophrenia. Expert Opinion on Drug Safety, 19(12), 1529-1538.

Singh, A., Beniwal, R. P., Kukshal, P., Bhatia, T., Thelma, B. K., & Deshpande, S. N. (2018). A preliminary study of association of genetic variants with early response to olanzapine in schizophrenia. Indian journal of psychiatry, 60(1), 10.

Szota,& Araszkiewicz, (2020). The effectiveness of long-term aripiprazole injections to a patient with paranoid schizophrenia: a case report. Current Problems of Psychiatry, 1(ahead-of-print).

Yang, H. L., Zheng, J. G., Li, B., Zhao, S., & Zheng, W. (2017). Aripiprazole versus ziprasidone for schizophrenia. The Cochrane Database of Systematic Reviews, 2017(9). Assessing and Treating Patients With Psychosis and Schizophrenia Essay