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Topic:

Decision Making, Assessing and Treating Patients with Psychosis and Schizophrenia

Coursework Instructions:

BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control,” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.
During today’s assessment, she appears quite calm and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She says she knows this because the television is telling her so.
She currently weighs 140 lbs., and she is 5’ 5.
SUBJECTIVE
Client reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.
A review of her hospital records shows that she received a medical workup from a physician, who reported her to be in overall good health. Lab studies were all within normal limits.
Client admits that she was tolerating her Risperdal well but stopped taking about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.
MENTAL STATUS EXAM
The client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.
You administer the PANSS which reveals the following scores:
-40 for the positive symptoms scale
-20 for the negative symptom scale
-60 for general psychopathology scale
Diagnosis: Schizophrenia, paranoid type
RESOURCES
PANSS Scale. Available at: http://egret(dot)psychol(dot)cam(dot)ac(dot)uk/medicine/scales/PANSS
§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. doi:10.1093/schbul/13.2.261
https://www(dot)clozapinerems(dot)com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf
§ Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from https://www(dot)clozapinerems(dot)com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf
http://www(dot)ima(dot)org(dot)il/FilesUpload/IMAJ/0/40/20149.pdf
§ Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625–629. Retrieved from http://www(dot)ima(dot)org(dot)il/FilesUpload/IMAJ/0/40/20149.pdf
Decision Point One
Select what you should do:
Start Zyprexa (olanzapine) 10 mg orally at BEDTIME
Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter
Start Abilify (aripiprazole) 10 mg orally at BEDTIME
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 (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.
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. Be specific and provide examples.
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.
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.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Coursework Sample Content Preview:

Assessing and Treating Patients with Psychosis and Schizophrenia
Name
Department
Course
Instructor
Due Date
Assessing and Treating Patients with Psychosis and Schizophrenia
Introduction 
The case study focuses on a 34-year-old Pakistani female who has been in the US since her late teens and 20s and is suffering delusional disorders and delusional thought processes. Paranoid schizophrenia is mainly associated with positive symptoms such as hallucinations and delusions and distorted thoughts, emotions, and language. Furthermore, disturbing thoughts and abnormal behavior negatively affect how the client relates with others. Based on the Positive and Negative Syndrome Scale (PANSS), the client had schizophrenia, paranoid type. Some of the medications for treating schizophrenia worsen weight gain and trafficking changes in BMI during and after treatment is necessary to manage weight.
After medication, there sought to be a change in the domains of positive negative symptoms through a reduction in positive symptoms in schizophrenia and improved negative symptoms. The three decisions are beginning with starting Invega Sustenna 234 mg followed by 156 mg IM, then continuing the same decision made but instructing the administering nurse to begin injections into the deltoid at this visit and moving forward. The third decision is to continue with the Invega Sustenna and counsel the client on weight gain.
Decision #1 
In decision point one, the preferred option is to “start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day four and monthly after that.” Invega Sustenna (paliperidone palmitate) is an atypical antipsychotic or mood stabilizer FDA-approved for schizophrenia ages 12 and older and maintains response in schizophrenia (Stahl, 2014). Using Invega Sustenna in treating schizophrenia has been shown to reduce hospitalization rates, which is associated with better health outcomes.  
I chose not to “begin Zyprexa (olanzapine) 10 mg orally at BEDTIME. Zyprexa (olanzapine) is FDA approved for schizophrenia (ages 13 and older) and maintains response in schizophrenia (Stahl, 2014). However, one of the main side effects is weight gain, and InvegaSustenna 234 is associated with a modest weight gain. If the option was chosen, there would be partial repose because 25% PANSS decreases and eating more throughout the day (Laureate Education, 2016).
I also did not choose to “start Abilify (aripiprazole) 10 mg orally at BEDTIME.” Abilify (aripiprazole) is an atypical antipsychotic that may affect sleeping patterns. In a study by Bossie et al. (2017), the researchers found that early intervention using long-acting antipsychotics such as Invega Sustenna effectively improved schizoaffective disorder symptoms.
I expected symptoms reduction, and the medication is well tolerated where there is a reduction in positive symptoms and improvement in symptoms, resulting in a better quality of life. Even if there is no total remission of symptoms, the continuous treatment enhances improvement.
The ethical considerations in the decisions are how to ensure adherence and patient education to improve health outcomes and overall wellbeing. Non-adherence linked to concerns on we...
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