Assessing and Treating Patients with Psychosis and Schizophrenia

Assessing and Treating Patients with Psychosis and Schizophrenia

It was determined that the patient, a 34-year-old Pakistani woman, had a brief psychotic episode and was hospitalized for 14 days. She was prescribed Risperdal, which she used for a brief amount of time until she discontinued it, claiming that her delusional thinking was getting serious as she feared her husband was going to poison. In addition, she believed she was a prophet and had received disclosures from Allah, which she revealed to her spouse. She was eventually confirmed to have paranoid schizophrenia based on her PANSS scores. The degree of both pleasant and unpleasant indications of psychosis or schizophrenia is assessed using the PANSS scale, which is similar to a clinical evaluation. It has a logical structure. In this paper, we will focus on the assessment and choosing of the most appropriate psychiatric drugs for the treatment of clinical conditions, bearing in mind the pharmacokinetic and pharmacokinetic properties of the medications in order to perform meaningful response for positive health outcomes for patients Assessing and Treating Patients with Psychosis and Schizophrenia.

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Decision #1: Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day four and monthly thereafter

As an antipsychotic drug with an extended release, Invega Sustenna was my first option since it is a conventional extended-release form. People diagnosed with schizophrenia have been prescribed this medication because of its effectiveness in reestablishing the balance of neurotransmitters essential in controlling mental processes. As justification for selecting Invega, the fact that it is the first-line treatment for schizophrenia and has fewer side effects than alternative medications was considered.  This drug blocks both serotonin 5HT2A and central dopamine D2-receptor activation (Sullivan et al., 2015).

Considering the client is concerned that her husband would poison her and marry an American woman, starting her on Zyprexa 10 mg daily would not have been an acceptable alternative. This is due to the fact that the patient has earlier demonstrated poor conformity to oral medication. I did not chose Abilify since, contrary to the Invega medication, it does not connect to the dopamine receptor for an extended period of time, making it less effective in the management of schizophrenia. When compared to Invega Sustenna, the negative impacts of Abilify and Zyprexa are significantly more pronounced than those of Invega Sustenna, which is associated with just a minor rise in bodyweight that can be controlled with lifestyle changes (Levenson et al., 2015).

It was my expectation that by choosing this decision, I would be able to restore balance to the patient’s serotonin and dopamine concentrations, resulting in stable patient’s behaviors, disposition, and cognitive ability, and a restoring of her mental wellbeing. Among client’s ethical considerations is the participation of the patient and the family in her therapy. According to the client, she is having problems with her husband. With her beliefs that he is intending to kill her and marry an American lady, obtaining her approval to include him in the treatment plan would be difficult to get.

Decision #2: Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward

Because my treatment reduced the patient’s PANSS scores by 25% in symptomatology, I made this choice for her benefit. The medication.  The medication also seemed to be tolerated by the patient. Additional aim in selecting intravenous treatment was to improve compliance with prescription regimens. Patient’s husband persuaded her to attend the scheduled visits at the healthcare center for injections, which made it simpler for her to complete the process. Although it had been predicted that the patient would have negative side effects from the medication, this did occur. A sensible decision on whether to continue with the medicine and at what dose would be made after an examination of the outcomes following 4 weeks of therapy. Meanwhile, the patient has put on weight and is feeling soreness at the injection spot as a result of the treatment. Taking into consideration that the client is not troubled by her weight gain and that it has not significantly affected her Body mass index or increased her risks of becoming obese, it would be okay to continue the medication and check her weight at the next session. A change in the injection location for pain management to the deltoid would be beneficial for this patient since the deltoid has a substantial circulation of the blood and can accommodate a range of medication dosage forms.

At this juncture, it would be unwise to initiate an augmentation medicine, such as Abilify, or to withdraw the medication in order to swap decanoate. The undesired consequences of taking two psychotropic drugs at the same time may be increased. Fever, flushes, vision problems, dry mouth, and lethargy are some of the negative impacts that can occur (McClellan & Stock. 2013)Assessing and Treating Patients with Psychosis and Schizophrenia. Because of this, mixing the medications might lead to overdosing.

Through this choice, I hoped to achieve pain reduction at the prior injection site and also obtain a great degree of tolerance at the current injection spot.   The client’s schizophrenia symptoms were also expected to be substantially less severe by the time she returned for her next appointment, as I had anticipated.

It is ethically appropriate to assess the client’s moral and religious stance at this stage in the therapeutic process.

Decision 3: Continue with the Invega Sustenna. Counsel client that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make an appointment with a dietician and an exercise physiologist. Follow up in one month

Because the patient has indicated significant improvement in the clinical symptoms following the commencement of therapy, Invega Sustenna was selected.  Upon shifting the injection area to her arm, she additionally reports that she is having substantially less pain at the current injection area. However after she started taking medication, she’s gained 4.5 pounds on Invega Sustenna, and this seems to be troubling her. In light of her increased weight, she has become more worried that her partner does not like her.

The patient wants to know whether another medication will not cause her to put on weight, despite the fact that she is feeling much better as an outcome of the medication. Prior to beginning treatment with a weight-loss drug, she should be urged to consult with a dietician and a fitness professional to help her stabilize her weight. Fortunately, this side effect may be managed without the need of pharmacological treatments (McClellan & Stock. 2013).

Due to the fact that it doesn’t keep the D2 receptors active for a long amount of time, Abilify was not an option. Qsymia was also left out because, while it may be beneficial in some circumstances for weight loss management, it is only recommended in extreme circumstances when the advantages outweigh the hazards of using the medicine (Gazewood & Barry, 2014)Assessing and Treating Patients with Psychosis and Schizophrenia.

I was hoping that by making this decision, the patient would be capable of sustaining  her weight and prevent the one side effect that Invega Sustenna has demonstrated, which is increase in weight.. In addition, it is projected that her PANSS score will continue to decline in the foreseeable future.

Ethical considerations at this stage revolve on the client’s ability to accept nonpharmacological approaches to treatment along with her partner’s enthusiasm for her losing weight. In the event that she continues to put on weight, she might be required to stop taking her medication.

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Conclusion

The Pakistani woman comes to the institution after being hospitalized for a 21-day hospitalization for a brief psychotic episode. Clinical judgments on how to manage her paranoid schizophrenia need to consider her medical and psychological history, and the history of her symptoms. After undergoing an examination, it was discovered that the patient is suffering from delusions and has gotten detached from real world.

Because of this, the choice to give Invega is driven by the desire to diminish favorable sensations while simultaneously boosting therapeutic adherence to the medication. Follow-up visits reveal that the patient has maintained outstanding adherence to the treatment. While she did suffer weight increase and soreness at the injection site, it is possible that these symptoms might be eased by relocating the injection site to the deltoid muscle and adhering to a routine physical activity plan and a good nutrition. Alternative medication choices accessible to the patient in this specific setting might worsen undesirable effects and make adherence more difficult since their mechanisms involved are transitory and require frequent usage.

References

Delusional Disorders. (2017). Delusional DisordersPakistani Female With Delusional Thought Processes. Delusional Disorders. https://mym.cdn.laureatemedia.com/2dett4d/Walden/NURS/6630/06/mm/delusional_disorders/index.html

Gazewood, J. D., & Barry, K. (2014). Phentermine/Topiramate (Qsymia) for Chronic Weight Management. American Family Physician, 90(8), 576-578. https://www.aafp.org/afp/2014/1015/p576.html

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. 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 & Adolescent Psychiatry, 52(9), 976-990. https://doi.org/10.1016/j.jaac.2013.02.008

Sullivan, L., Clarke, W., & Berg, K. (2015). Atypical antipsychotics and inverse agonism at 5-HT₂ receptors. Current Pharmaceutical Design, 21(26), 3732-3738. https://doi.org/10.2174/1381612821666150605111236 Assessing and Treating Patients with Psychosis and Schizophrenia