W4 Psychosis Case Study

1. What information, if any, would you like to know that was not included in the case?

During the assessment of patients, it is necessary to obtain all the relevant information that could be helpful and used in the diagnosis process. This also helps in understanding the cause of the patient’s problems and the risk factors associated with the problem. 

As such, some of the information that was not included in this case that might be helpful include; the patient’s psychosocial history and family history. For instance, it would be necessary to determine whether the patient has a family history of any psychiatric problem or disorder since it would help in identifying the likely cause of his problem or the factors that might have contributed to the development of this problem. Moreover, it would be necessary to assess the patient’s psychosocial history since it would also help in identifying the factors that might have contributed to the patient’s problem. 

2. Which psychiatric symptoms are a treatment priority for this case?

Among the psychiatric symptoms that are treatment priority for this case include; hallucinations and delusions. The patient exhibits symptoms of hallucinations and delusions that seem to interfere with his daily functioning. Thus, it is necessary to include the symptoms as a treatment priority since the alleviation of these symptoms would help in improving the patient’s functioning. 

3. What are the non-pharmacologic issues in this case (problems/complaints that cannot be addressed by medication)?

Some of the non-pharmacologic issues present in this case include; social isolation, ineffective coping, and patient denial that he has a psychiatric problem. 

Medication Choice 1

4. List one medication that would be appropriate for this case. Include the name and starting dose.

Aripiprazole (Abilify) is one of the most appropriate medications for this case that would help in improving the patient’s symptoms. Abilify is essentially a second-generation antipsychotic that would help in improving the patient’s symptoms (Preda, & Shapiro, 2020). The starting dose of this medication is 10 mg per day (Preda, & Shapiro, 2020). 

5. Describe your clinical decision-making. What is your rationale for choosing this medication? Also, include the mechanism of action for this medication choice, and the neurotransmitters and areas of the brain on which the medication is proposed to act on.

The assessment information and the symptoms exhibited by the patient are suggestive of schizophrenia as the most probable diagnosis for this patient. The patient presents with complaints of persecutory delusions as well as auditory hallucinations, which are among the classical symptoms of schizophrenia (Meltzer, 2017). For instance, the patient reports that his housemates are working for the MI5 and they want to harm him by poisoning his food which is indicative of persecutory delusion. Additionally, he states that he usually hears the voices of his housemates when they are talking about him, which is indicative of auditory hallucinations. Thus, the patient would be started on Abilify that would help in improving his symptoms. Abilify is essentially a second-generation antipsychotic used in the treatment of schizophrenia (Preda, & Shapiro, 2020). Second-generation antipsychotics like Ability are usually preferred in the treatment of patients with schizophrenia because they are associated with a lower side effect profile as compared to the other antipsychotics, hence the selection of this medication.

The mechanism of action (MOA) for this medication involves minimizing the dopaminergic neurotransmission via the D2 partial agonism (Preda, & Shapiro, 2020). As such, the use of this medication helps in controlling the symptoms associated with schizophrenia and psychosis by affecting the dopamine neurotransmitter in the brain (Preda, & Shapiro, 2020).   

6. What laboratory testing/monitoring is needed for safely prescribing this medication?

The laboratory testing/monitoring that might be required for safe prescription of this medication include; a hemoglobin A1C, WBC (White blood cells) count, and blood pressure test (Meltzer, 2017). The use of this medication is contraindicated in patients who have certain conditions like diabetes and hypertension since it might increase their risk of developing blood vessel or heart diseases (Meltzer, 2017). Additionally, the use of this medication in patients who have low WBC count may increase their likelihood of infections (Meltzer, 2017). Thus, it is necessary to conduct these tests to ensure the safe prescription of this medication and avoid the risk of these complications. 

7. Are there any contraindications or safety issues associated with this medication?

This medication is contraindicated in patients who have certain conditions like diabetes, hypertension, and high cholesterol since it might increase their risk of developing blood vessels or heart diseases (Meltzer, 2017). The use of this medication is also contraindicated in patients who have low WBC count since it may increase their risk for infections (Meltzer, 2017). Thus, it is necessary to determine whether the patient has any of these conditions to ensure the safe use of this medication. 

Non pharmacologic Interventions

8. What non-pharmacologic interventions do you recommend? Do you recommend including but not limited to psychotherapy, complementary and holistic therapies?

Some of the non-pharmacological interventions that may be recommended to this patient include; family therapy, individual therapy as well as social skills training (Ganguly, Soliman & Moustafa, 2018). For instance, the use of individual therapy would assist in normalizing his thought patterns and help him to learn and acquire the coping skills that would help him to effectively cope and deal with stress (Ganguly, Soliman & Moustafa, 2018). Additionally, the involvement of the patient in social skills training would help in enhancing his social interactions and communication skills thereby enhancing his ability to engage in daily activities (Ganguly, Soliman & Moustafa, 2018). On the other hand, the involvement of the family therapy would enable the family member to offer the patient the needed support and assistance that would help him in dealing with his condition (Ganguly, Soliman & Moustafa, 2018). 

Safety Risk Assessment

9. What are the safety concerns, if any, associated with this case? How will you address safety?

  Some of the safety concerns associated with this case include; the risk of overmedication, suicide, and physical injury. The patient reports having suicidal thoughts and states that he was thinking of taking an overdose of medications to kill himself. Thus, it is necessary to address these safety concerns by keeping him safe and minimizing his access to weapons or tablets. For instance, it would be necessary to inform his mother of the need to remove all the tablets and weapons in his room to minimize his risk for self-inflicted injury or suicide. The patient’s mother ought to be informed on the need to monitor the use of the prescribed medications to avoid the risk of overmedication. More importantly, it would be necessary to educate the patient on the need to stay connected and consider joining a support group.

10. When would you follow up with this patient?

The follow-up care of this patient would include; a clinical appointment scheduled in two weeks and conversations made over the telephone. 

Ganguly, P., Soliman, A., & Moustafa, A. A. (2018). Holistic management of schizophrenia symptoms using pharmacological and non-pharmacological treatment. Frontiers in public health, 6, 166.

Meltzer, H. Y. (2017). New trends in the treatment of schizophrenia. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 16(8), 900-906.