Assessment and Treatment of Psychosis and Schizophrenia Essay

PLEASE I WILL PREFER WRITER 1747 TO COMPLETE THIS ASSIGNMENT. PLEASE FOCUS ON THE RUBRIC. COPY AND PASTE THE LINK BELOW FOR THE CASE STUDY https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_06/index.html 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. Assessment and Treatment of Psychosis and Schizophrenia Essay.  Be sure to research each option using the primary literature. RUBRICS 1) 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. 2)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. 3) 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. Assessment and Treatment of Psychosis and Schizophrenia Essay.Be specific and provide examples. 4)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. 5) 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. Optional Learning Resources Required Readings (click to expand/reduce) Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier. American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association.

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https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. https://doi.org/10.1093/schbul/13.2.261 Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. Assessment and Treatment of Psychosis and Schizophrenia Essay. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/ McClellan, J. & Stock. S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 976–990. https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649–659. https://doi.org/10.2165/00023210-200923080-00002

Psychosis and schizophrenia are major mental disorders that signify outright modifications in a person’s conduct, feelings, insight, and general views. Individuals diagnosed with psychosis and/or schizophrenia display exclusive behaviors and indicators. Studies have established that schizophrenia has become more common compared to psychosis. The assessment and evaluation of these mental disorders is dependent on various examinations, including the clinical presentation, how the patient is affected, and how they are adapting to the condition. On the other hand, treatment is achieved by the use of antipsychotic drugs, which are perhaps the most explored treatment in healthcare organizations. Medical research has established the efficacy of these treatments in treating psychotic disorders and preventing relapse as well (Gire et al., 2017). According to the American Psychiatric Association (2020), patients have to face routine social stigmatization besides the various adverse effects antipsychotic treatment confers, including excessive weight gain and sedation.

The case study presents a 34-year-old Pakistani female with delusional thought processes. The client is in an arranged marriage. She has been hospitalized for 21 days following diagnosis with a brief psychotic disorder. She narrates that she had visions of Allah in the recent past and that she was the chosen prophet. She had gone out of control when the husband called the cops on her, expressing his lack of trust for her with the kids. However, she is presently calm, claiming that the narrations are outright exaggerations that stem from her husband’s desires for a white rather than Pakistani wife. The client is in a good mood and does not admit to any hallucinations, although she states that the TV is a symbol of Allah and can communicate with her. Since discontinued her medication, she displays slow speech with interruptions of silence and reports a euthymic mood.

The Decision Tree

There are three decisions in this case study.

Decision #1

Having diagnosed paranoid schizophrenia following the patient’s delusions and hallucinations, I have resorted to prescribing intramuscular 234 mg Invega Sustenna X1, and subsequent intramuscular injection 156mg on the 4^th day, and a monthly basis thereafter. Assessment and Treatment of Psychosis and Schizophrenia Essay. The USA FDA recommends the antipsychotic drug for the treatment of paranoid schizophrenia (Keepers et al., 2020). The drug’s mechanism entails blocking dopamine and serotonin receptors in the brain, thus combating delusional thoughts and hallucinations and enhancing the patient’s capacity to focus. Since the patient appears to be categorical about discontinuing her Risperdal medication following her discharge from the hospital, it is clear that prescribing oral medications is not reasonable. Lack of compliance to medications is a common issue among schizophrenic people. It can be attributed to a symptom medically referred to as anosognosia, which lacks awareness and insight into a prevailing condition (Gire et al., 2017). Besides, injections work better in the long-term management of such mental conditions.

The pharmacodynamics and pharmacokinetics of Invega Sustenna begin with the intramuscular introduction of the drug into the system, followed by conversion to the active substance, Paliperidone. The active substance is an atypical antipsychotic whose active metabolite is risperidone. The active metabolite is often converted to 9-hydroxy-risperidone upon absorption with the aid of the CYP2D6 enzyme in the Central nervous system. The drug is administered differentially, with an initial dosage of 234 mg, and then 156 mg ensures the optimal therapeutic plasma levels for Invega Sustenna (Keepers et al., 2020). Establishing the patient’s EHG analysis is an essential step in the pre-prescription stages. It steers clear of raising the risk for heart disease, lipid abnormalities, and drastic weight gain.

Decision #2

Maintaining the initial prescription of Invega Sustenna would be prudent since the patient did not report any cases of intolerance or adverse effects. Clinical research has also established significant tolerance of the intramuscular drug among people of Asian descent (American Psychiatric Association 2020). There are several challenges in managing and treating psychosis and schizophrenia, including non-compliance to medications and subsequent risk of relapse. Assessment and Treatment of Psychosis and Schizophrenia Essay. Getting an alternative for oral medications in the first step is thus a prudent clinical decision. The patient’s significantly high Positive and Negative Syndrome Scale(PANSS) score is seemingly decreasing, an illustration of the efficacy of the Invega Sustenna prescription (Keepers et al., 2020). I did not anticipate any changes beyond the observations made at this stage. However, the client reported a remarkable increase in weight (4.5 pounds within a period of 2 months). This weight gain infers the need for intensive patient education to enhance adherence and promote health and wellness.

Observations at this stage may also necessitate a change in the site of administration, perhaps to cut down on patient discomfort. My decision to maintain the Invega Sustenna prescription is also informed by various clinical studies, which revealed that the drug is far more tolerable compared to other drugs used in the long-term treatment of psychosis and schizophrenia (Rus-Calafell et al., 2018). It is important to note that there is no need to switch from the prescription in the patient’s case. It could be essential to discuss the information on the suitability of the drug with the patient or their caregivers. Also, changing the prescription could result in a drastic adverse effect hence the need to maintain Invega Sustenna.

Decision #3

My decision to maintain my initial prescription still holds since I have made no major observations in the patient’s case. Also, the patient has exhibited remarkable progress in her condition, as demonstrated in the PANSS score. Her change in behavior and thinking patterns is an illustration of the efficacy of Invega Sustenna. The stage had no set intentions besides the significant improvement in behaviors and thought process. Another goal for the third decision was perhaps to prevent a case of relapse. Patient education on her condition, medication prescription, and foreseen adverse effects is also crucial in this phase. There is also a need to extend the patient-provider conversations to the need for achieving overall wellness through sustained diet and physical activity (Rus-Calafell et al., 2018). It is also important to note that Invega Sustenna has more tolerable side effects compared to other antipsychotic drugs. Assessment and Treatment of Psychosis and Schizophrenia Essay.

Considering the consistency displayed in the patient’s progress, I feel confident about the clinical decision made. The observations are also consistent with my expectations for the treatment. The need for thorough patient education is, however, constant, even in post-hospitalization care. Other alternatives for Invega Sustenna, such as Abilify 10mg, would not have conferred any better patient outcomes since the former has been proven to be more efficacious (Rus-Calafell et al., 2018). Besides, these alternatives are laden with notorious, adverse effects and contraindications. Some of these alternatives, the likes of Qsymia, would pre-expose the patient to health complications, like those related to heart issues (Rus-Calafell et al., 2018). Throughout the treatment, my focus was to maintain a simple protocol while ensuring the patient’s best outcome.

Ethical Considerations

The assessment and treatment of patients with psychosis and schizophrenia introduce concerns over physical issues in the patient that could be unattended. The client is also not in the mental space to speak about their condition conclusively hence leading to incomplete or in some cases, inaccurate diagnosis and treatment (Edens, Petrila, & Kelley, 2018). In this case study, it may be impossible to establish a relationship between the patient’s feelings and those of the health worker, thus creating a gap in healthcare. The patient also makes serious allegations concerning their personal life, which may be difficult to ascertain (Edens, Petrila, & Kelley, 2018). With these in mind, it can be challenging to find a definitive solution to ensure treatment and prevent relapse.

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Conclusion

Complex mental issues such as psychosis and schizophrenia represent utter shifts in cognitive, behavior, feelings, and views. According to medical research, people who have such mental conditions behave distinctively, often exhibiting unique characteristics. For a mental health practitioner to diagnose these conditions, they have to put into consideration various factors, including behavioral patterns, the patient’s expression, several physical examinations, the symptoms exhibited, and any behaviors adopted during the period.  The treatment of psychosis and schizophrenia often entails the use of antipsychotic drugs. These drugs have been proved efficacious and are the most common medications for these mental conditions. People with psychosis and schizophrenia are often discriminated against instilling the societal fear of diagnosis. Assessment and Treatment of Psychosis and Schizophrenia Essay.  The drugs also have significant side effects such as sedation and remarkable weight gain.

In this case, the patient is a middle-aged female of Asian descent suffering from delusional thought processes. She has a medical history of a brief psychotic disorder, which led to her hospitalization for about 21 days. Although she exudes calmness, her husband reports cases of delusion as she narrates past visions of Allah and her account of being the prophet Mohamed. She emphasizes the television’s capacity to communicate with her as Allah’s way to talk to her. The mental health practitioner’s diagnosis reveals paranoid schizophrenia, a condition in which the patient is laden with imaginations and presumes that people are plotting evil against her. Invega Sustenna, my medical prescription goes a long way in reducing the patient’s PANSS score, facilitating her resumption to normalcy. The drug is ideal and confers minimal adverse effects, including weight gain.

References

American Psychiatric Association. (2020). The American psychiatric association practice guideline for the treatment of patients with schizophrenia. American Psychiatric Pub

Edens, J. F., Petrila, J., & Kelley, S. E. (2018). Legal and ethical issues in the assessment and treatment of psychopathy

Gire, N., Farooq, S., Naeem, F., Duxbury, J., McKeown, M., Kundi, P. S., & Husain, N. (2017). mHealth based interventions for the assessment and treatment of psychotic disorders: a systematic review. Mhealth, 3.

Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., & (Systematic Review). (2020). The American psychiatric association practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry, 177(9), 868-872.

Rus-Calafell, M., Garety, P., Sason, E., Craig, T. J., & Valmaggia, L. R. (2018). Virtual reality in the assessment and treatment of psychosis: a systematic review of its utility, acceptability and effectiveness. Psychological medicine, 48(3), 362-391. Assessment and Treatment of Psychosis and Schizophrenia Essay.