Psychopharmacology: Pakistani Female with Delusional Thought Processes

Week 6-Psychopharmacologic Treatment of Psychopathology
Examine Case Study: Pakistani Female with Delusional Thought Processes
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Background –Pakistani Female with Delusional Thought Processes
The Positive and Negative Syndrome Scale (PANSS) has been administered to assess the severity of schizophrenia symptoms and subsequently she was diagnosed with schizophrenia, paranoid type. The 34-year old patient was hostile to the psychiatric-mental health nurse practitioner (PMHNP), and this is a concern as it affects how interventions are carried out. The patient had been prescribed Risperdal, but stopped taking the medication believing that her husband wanted to poison her.
One of the major factors likely to affect the patient’s pharmacokinetic and pharmacodynamic processes is her behavior, specifically medication non adherence in the past and delusions abut God and her husband’. If the client does not follow the guidelines, this will affect the drugs absorption and efficacy of the drugs. While the mechanism of action of paliperidone is unknown it is believed to have the similar pathway to risperidone, where paliperidone locks dopamine 2 receptors and blocks serotonin 2A receptors.
Decision Point One
In decision point one, the choice made is “Start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter”. The recommended initial dose of Invega Sustenna (paliperidone) is 234 mg and the medication is FDA approved for schizophrenia (ages 12 and older), maintaining response in schizophrenia and schizoaffective disorder (Stahl, 2014).
Invega Sustenna was chosen as it is an atypical antipsychotic, which improves the severity of schizophrenia symptoms. I hoped to improve the symptoms by choosing an effective drug that is well tolerated. There was a 25% decrease in PANSS score and it was expected that the score would reduce. The other two options were “Start Zyprexa (Olanzapine)10 mg orally at BEDTIME” and “Start Abilify 10 mg orally at BEDTIME”- Aripiprazole. Zyprexa may result in higher weight gain and was chosen while abilify may also cause drowsiness and sleep problems, without necessarily improving symptoms for the patient.
Invega Sustenna “ blocks dopamine 2 receptors, which is associated with positive symptoms of psychosi...