NURS 6630 Week 7 Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia
BACKGROUND
NURS 6630 Week 7. 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 physician, who reported her to be in overall good health. Lab studies were all within normal limits.
Client admits that she stopped taking her Risperdal 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
Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia.
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.
The Assignment: 5 pages
Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
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. NURS 6630 Week 7
NURS 6630 Week 7 Answer
Introduction
Psychosis is a psychiatric term used to describe a mental condition in which individuals lose contact with reality. It is not an infectious disease but rather a behavioral disorder. Delusions and hallucinations are experienced by 8 to 30% of the general population during their lifetime (Kesby, Eyles, McGrath, & Scott, 2018). Common symptoms of psychotic disorders include sleep disturbances, depression, anxiety, social withdrawal, difficulty sleeping, impaired motivation, and a decline in overall functioning. While various symptoms may indicate psychosis, hallucinations and delusions are often the most subtle signs of this condition. Psychosis can be associated with several mental health conditions, including bipolar disorder, schizophrenia, substance abuse, and schizoaffective disorder. Schizophrenia is a critical mental condition that disrupts an individual’s thinking, decision-making, and emotional regulation. NURS 6630 Week 7
The present case concerns a 34-year-old Pakistani woman who has undergone a 21-day hospitalization. She was initially prescribed Risperdal but discontinued it, fearing that her husband might poison her. Additionally, she has experienced a series of delusional thoughts, including believing she is Allah’s prophet with a mission to save the world from sin. The patient reports an improved mood, denies auditory or visual hallucinations, but trusts the voice coming from her television. During interviews, she occasionally displays aggressiveness but eventually calms down. Previous medical records indicate that her overall health is within normal limits.
The patient remains alert and oriented in terms of time and place. However, a Positive and Negative Syndrome Scale (PANSS) assessment led to a diagnosis of paranoid schizophrenia. PANSS is a diagnostic tool that assesses the positive and negative symptoms of schizophrenia in patients. The patient reports a euthymic mood with impaired insight and judgment, and she denies any suicidal or homicidal thoughts. NURS 6630 Week 7
Decision One
The first decision involves initiating treatment with Invega Sustenna at an intramuscular dose of 234 mg as a one-time injection, followed by 156 mg intramuscular doses starting on the 4th day. Subsequent 156 mg intramuscular injections will be administered monthly. Emsley and Kilian (2018) recommend antipsychotic treatment to prevent multiple relapses associated with schizophrenia. Paliperidone (9-hydroxyrisperidone) is considered a functional metabolite of risperidone, working by blocking serotonin and dopamine receptors in the brain (McNeil, Gibbons, Cogburn, Risperidone, 2021). The monthly injections aim to maintain a stable mood, enhance thinking, and stabilize behavior.NURS 6630 Week 7
Although Abilify and Zyprexa are effective options, they are not suitable for the current case. Combining these medications may lead to increased adverse events, including blurred vision, drowsiness, flushing, abdominal cramping, and memory-related issues (Johnsen et al., 2020). The primary goal is to reduce schizophrenia symptoms with minimal side effects. Long-acting injectables (LAIs), like Paliperidone, are known to reduce the number of relapses and emergency room visits for schizophrenia patients compared to oral medications, making them a preferable choice for maintaining adherence, tolerability, and efficacy (Emsley & Kilian, 2018).
The primary objective of this therapy is to ensure that the patient adheres to the prescribed treatment regimen and experiences a reduction in symptoms by the next visit. Additionally, the expectation is to observe a decrease in the PANSS score during the follow-up visit. Antipsychotic medications may result in symptom improvement within the first 7 days, but the full efficacy of the current therapy may take up to 6 weeks to become apparent.
Fortunately, the patient returns for a follow-up and reports a 25% reduction in the PANSS score after 4 weeks. She also mentions having a high tolerance for the medications and a slight increase in weight.NURS 6630 Week 7
Decision Two
The second decision involves continuing with the same treatment but changing the injection site to the deltoid muscle. This decision is based on the patient’s reported 25% reduction in the PANSS score. However, it is essential to have a discussion with the patient about this decision to ensure she understands the benefits, potential risks, and effects of the prescribed medication. I would refrain from initiating Haldol Decanoate (haloperidol decanoate) at this stage as the current treatment with Invega Sustenna has shown promising results in symptom reduction and patient tolerance. The adjustment to deltoid injections aims to improve patient comfort and minimize discomfort at the injection site, thus enhancing her overall treatment experience and adherence. It is essential to maintain open communication with the patient to address any concerns and ensure that the prescribed therapy continues to be effective and well-tolerated.NURS 6630 Week 7
