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 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.

Solution:

Introduction

Psychosis is a psychiatric term used to describe the mental condition in which the victims lose contact with reality. It is not an infection but rather a behavioral condition. About 8 to 30 % of the general population experiences delusional or hallucination in their lifetime (Kesby, Eyles, McGrath, & Scott, 2018). The common symptoms ofthe psychotic disease include sleep problems, depression, anxiety, social withdrawal, difficultysleeping, impaired motivation, and decline in function. Psychosis may be ruled out using the various symptoms but hallucinations and delusions remain the most subtle signs of psychosis. Psychosis is attributed to several mental health conditions including bipolar disorder, schizophrenia, substance abuse, schizoaffective disorder among others. Schizophrenia is a critical mental condition that interferes with the individual’s way of thinking, making decisions and managing emotions.

The current case involves a patient with a Pakistan woman aged 34 years following a 21-day follow-up hospitalization. The client has been prescribed Risperdal but stopped citing that her husband might poison her. This is in addition to a series of other delusional thoughts including the vision of her being Allah’s prophet with a mission to rescue the world from sin. She reports improved mood. She denies auditory/visual hallucinations although she trusts the voice from her television. She is sometimes aggressive during the interview but calms down with time. A previous medical report shows normal overall health with normal limits.

The patient is alert and in place and time. However, upon undergoing a Positive and Negative Syndrome Scale (PANSS), the client is diagnosed with a paranoid type of schizophrenia. PANSS is a diagnostic tool that consists of various interview items to determine the positive or negative progression of patients with schizophrenia. She reportseuthymic mood with impaired insights and judgment. The patient denies any suicidal and homicidal thoughts.

Decision One

The first decision involved starting Invega Sustenna 234 mg intramuscular (IM) X1 and continue with 156 mg intramuscular from the 4th day. After administering the 156 mg intramuscular, the next thing would be to administer the same dose on a monthly interval. According to Emsley and Kilian (2018), antipsychotic treatment is recommended in preventing multiple relapses associated with schizophrenia. Paliperidone (9-hydroxyrisperidone) is regarded as a functioning metabolite of risperidone. It has an element of receptor building. It works by blocking the serotonin and dopamine receptors of the brain (McNeil, Gibbons, Cogburn, Risperidone,2021). The drug is administered on monthly basis through injections to ensure a normal mood, enhanced thinking, and stabilizing behaviors.

Abilify and Zyprexa would be greater choices however not suitable for the current case. The combination is likely to increase adverse events such as blurred vision, drowsiness, flushing, abdominal cramping, and memory-related issues (Johnsen et al., 2020). The goal is to reduce schizophrenia symptoms with the minimum side effects possible. Therefore, long-acting injectables (LAIs) like Paliperidone are known to reduce the number of relapses and ER visits for schizophrenia patients compared to other forms of oral medications. As a result, a therapy involvingLATs is associated with a high rate of adherence tolerability and efficacy due to its intramuscular injection element.

The primary aim of this therapy was to help the client adhere to the treatment and experience reduced symptoms before making the next visit. Another expectation was to see a reduced PANSS score during the next visit. With antipsychotic drugs, the symptoms may improve within the first 7 days however, it may take as long as 6 weeks to determine the efficacy of the current therapy.

Fortunately, the client returns and report a drop in PANSS to score upto 25 % after 4 weeks.She also reports high tolerance to the medications, along with a slight addition of weight.

Decision 2

The second decision involves continuing with the same decision but ordering deltoid injection from this visit onward. I would make such a decision since the patient reported a 25% fall in the PANSS score. I would change the injection site to prevent avoid further complaints of pain and inability to sit down. However, I would be considered discussing with the client my decision to change the regime. This would help her understand the benefits, risks, and effects of the prescribed medication. I would not consider starting t Haldol Decanoate (haloperidol…….Please click the icon below to purchase full answer at only $15