Assignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction

Running head: ASSESSING AND TESTING CLIENTS WITH PSYCHOSIS AND SCHIZOPHRENIA 1

ASSESSING AND TESTING CLIENTS WITH PSYCHOSIS AND SCHIZOPHRENIA

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Assessing and Testing Clients with Psychosis and Schizophrenia

National Alliance on Mental Illness reports that there are about 100,000 individuals that have been diagnosed with psychosis in the United State almost every year. The symptoms associated with psychosis include delusions, hallucinations, disorganized thoughts, abnormal motor behavior, and the adverse symptoms which can make the situation to be worse for the patients. Other symptoms presented by these patients can include depression, bipolar disorders, and disorders on the schizophrenia.

The case study is a patient who is thirty-four-year-old Pakistani female that moved to the United States in her early teens or early twenties. She has a pre-arranged marriage when she was nine years old. She visited to the clinic after twenty-one days hospitalization. Her symptoms persist for one month and was diagnosed with brief psychotic disorder.

Before hospitalization, she reports seeing visions of Allah, and that she believed she prophet Mohammad. Patient husband became very concerned about her behavior has she get out of control with result calling the ambulance and was taking to the hospital for psychic evaluation.

She denies what she said and instead stated that the television is speaking to her and that she is receiving messages through the television. Patient is alert and oriented x4.

There will be three decisions based on the appropriate medications to the client (Lin, Rosenheck, Sugar, & Zbrozek, 2015).

Decision #1 Prescribing Invega Sustenna 234 mg IM followed by 156 mg IM on day 4 and monthly thereafter

The reason for the decision: this drug is having reduced side effects as compared to other optional drugs that supposed to be prescribed to this patient. This implies that it can well be tolerated as well as assists in reducing the symptoms of the patient's condition. The work of this drug is that it rebalances dopamine and the serotonin to help in the improvement of the thinking, mood, and the behavior of the patient. It also binds to the D2 receptors quicker than Abilify and Zyprexa. The Zyprexa, on the other hand, is not effective to be prescribed to the patients since the patient need immediate relief from the symptom of his condition. When Zyprexa is used, it starts to work after 1 to 2 weeks and this makes it not to help in the improvement of the patient symptoms at a faster rate. It is also possible that it can take up to six weeks for its full benefits to be realized. The action of Abilify medication does not occur at a faster rate as compared to the Invega sustenna. This is basically because it does not bid to the D2 receptors for longer thus making them less effective (Fangfang, Stock, Copeland, Zeber, Ahmedani, & Morissette, 2014).

The expected outcome: the patient is expected to report an improvement in her condition, for example, the speech and judgment. The patient is also expected to have a reduction in the PANSS score thus showing an improvement in her condition.

The differences in the actual and the expected outcome: The patient returns to the facility after four weeks. There is a reduction in the PANSS score by 25 percent and the patient is tolerating the medication. Nevertheless, the patient has noted an increase in the weight by 2 pounds, but it does not seem to bother her. She also complains of the pain at the injection site that leads to difficult sitting down.

Decision#2 continue with the same medication but instruct state the injections into the deltoid at this visit going forward

Reason for the decision: The patient appears to have tolerated the medication even though there is a slight increase in the weight. It is not possible to discontinue the Invega Sustenna and start or add Abilify Maintena 300 mg IM monthly with the oral Abilify 10 mg in the morning. This is because there will be a poor reduction in the rate of the PANNS and other complications associated with the unusual movement of the trunk. The prescription of the Zyprexa might also cause more problem specially to gain in weight. Zyprexa is increasing the glucose and cholesterol levels at a higher rate as compared to the Invega Sustenna. The use of Abilify causes a slight reduction in the PANNS scores thus indicating no improvement in the condition of the patient.

The expected outcome: the patient is expected to record further reduction in the score of the PANNS. The weight of the patient is expected to reduce to normal with no further weight gain. The patient is expected not to complain of pain from the injection site.

These differences in the expected outcome and the actual outcome: the patient return to the clinic after two weeks. There is a 50 percent reduction in the PANSS score from the previous use of the Invega Sustenna. The patient stated that she feels much better in her arm and denies no pain in the injected site. Meanwhile the patient has gain two.five pounds, making a total of four.five pound within the last two month. The patient is worried about the weight gain and is afraid that her husband might not like it. She feels that the drug should be changed so that the weight could not increase further.

Decision #3 Maintain the medication but introduce suitable counseling about the weight gain from the Invega sustenna

Reason for the decision above: it appears that there is further weight gain from the medication even though she has tolerated it and had experience improvement in the symptom. The patient can be advised to take other medication since Abilify, and Zyprexa have more adverse impacts concerning weight gain as compared to the rate of weight gain caused by the use of the Invega sustenna. Therefore, an appointment is made with the dietitian and the exercise physiologist to help in ensuring that the patient is involved in regular exercise and watch a healthy diet. Abilify is not binding to the D2 receptors for longer as compared to Invega sustenna thus making it less effective (Lin, Rosenheck, Sugar, & Zbrozek, 2015).

The expected results: the patient is expected to have fully recovered with a reduction in the score of PANSS. The patient is expected to have a reduced weight following the nutritional and exercise counseling program.

The differences in the actual and the expected outcome: there is no further difference since the patient has fully recovered. However, the weight of the patient is expected to return to normal and healthy one after the initiation of the nutritional and exercise program.

Ethical considerations

While taking care for the patients with the delusional thought process, the psychiatric mental health nurse practitioner needs to know about the neurobiology of the symptoms to help in the selection of the recommended and appropriate treatment therapies and improvement of the healthcare outcome of the patient (Fangfang, Stock, Copeland, Zeber, Ahmedani, & Morissette, 2014).

References

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71 (9), 728-738. Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86 (1), 107-121.