What is the treatment for schizophrenia?

Anonymous
timer Asked: Jul 2nd, 2018
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Question description

make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.


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 since she was 9 years old). She presents to your office today 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 tells you that she knows this because the television is telling her so. She currently weighs 140 lbs, and is 5’ 5” SUBJECTIVE Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down. You reviewed her hospital records and find that she has been medically worked up by a 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, 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 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. The PMHNP administers 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 § Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276. § Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_ for_Healthcare_Providers.pdf § Paz, Z., Nalls, M. & Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal. 13. 625-629. Select what the PMHNP should do: -Start Zyprexa 10mg orally at bedtime -Start Invega sustenna 234mg IM X1 followed by 156mg IM on day 4 and monthly thereafter. -Start Abilify 10mg orally at bedtime Decision tree to use. Decision Point One start Zyprexa (Olanzapine) 10mg po orally at BEDTIME RESULTS OF DECISION POINT ONE • • • Client returns to clinic in four weeks Client's PANSS decreases to a partial response (25%) Client comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get full from her meals so she is snacking constantly throughout the day. Decision Point Two Change medication to Geodon 40 mg orally BID with meals RESULTS OF DECISION POINT TWO • • • • Client returns to clinic in four weeks Client has a significant reduction in her PANSS (reduction of 40%) Client notices her weight is down slightly from the previous visit (lost 2 pounds) and that her hunger has been curbed since starting this med Client does complain that it is difficult to remember the second dose and admits to missing afternoon doses on several occasions over the past month Decision Point Three Change the Geodon to 80 MG orally at bedtime daily and monitor for breakthrough symptoms throughout the day Guidance to Student Changing to Risperdal oral therapy to test for side effects and then switching to Invega Sustenna is a good option in a patient who has problems with compliance and who shows good effect from oral therapy. The manufacturer advertises that patients can be switched from an entirely different medication to Invega Sustenna if tolerability can be shown through oral therapy. From a clinical standpoint, the patient may or may not respond to the medication and therefore this could be a waste of time. Remember, manufacturers have a product to sell and there information should always be verified before implementing into clinical practice. Although Geodon is recommended twice daily with meals, some providers will choose to give the dose once a day and monitor for efficacy in patients who have compliance issues with BID dosing regimens. Latuda is a medication that behaves much like Geodon but is taken only once daily. This makes it a good option for someone who responds to Geodon but has compliance problems with the twice daily dosing. Tolerability can be an issue as doses are escalated. Particularly, nausea, vomiting and extrapyramidal side effects can be problematic and therefore good counseling is recommended for clients. Patients usually tolerate lower doses (40 mg) but significant GI distress and movement disorders can occur when doses are pushed upward toward the daily max of 160 mg.

Tutor Answer

nkostas
School: New York University

Attached.

Running Head: TREATMENT OF SCHIZOPHRENIA

Treatment of Schizophrenia
Name
Institution Affiliation
Date

1

TREATMENT OF SCHIZOPHRENIA

2

Treatment of Schizophrenia
Schizophrenia is a mental health disorder that is complex and chronic, characterized by
many symptoms to include hallucinations, delusions, disorganized behavior or speech and
cognitive ability that is impaired. The disease is a disabling disorder to many patients and their
families due to its early onset and the chronic course that it takes. The disability is usually as a
result of both the negative symptoms characterized by deficits or loss and the cognitive
symptoms like attention impairments, executive function or working memory. Additionally, the
disorder is likely to occur due to positive symptoms like delusions, hallucinations, and
suspiciousness. The disorder also affects the emotions of affected individuals, which results in
progressive self-care loss and social functioning loss (Patel et al., 2014).
Despite psychopharmacological treatment being essential and is considered the mainstay
in achieving better cognitive and physical functioning in schizophrenia, there are several
limitations in adopting it. These limitations include adverse effects that are unavoidable like
neurocognitive impairments when drugs are used for a long period and extrapyramidal
symptoms. Other limitations which reduce the efficacy of the drugs in pharmacological approach
are the refusal of medications and non-compliance. Psychosocial interventions used as an adjunct
to medications for individuals with schizophrenia has been found to improve patients’ long-term
outcomes like remission, recovery and illness progression (Chien et al., 2013).
The patient in question is a 34-year-old female of Pakistan origin who has recently been
diagnosed with a brief psychotic disorder as her symptoms persisted for less than a month and
hospitalized for 21 days. However, upon more history and examination, a diagnosis of paranoid
type schizophrenia was made. She is in an arranged marriage since her early 20s and has four

TREATMENT OF SCHIZOPHRENIA

3

children. Prior to her admission, she had religious delusions where she reported having visions of
Allah, and she also believed that she would deliver the world from sin and that she was Prophet
Mohammad. During the assessment on this particular day, she is calm and says that the incident
was blown out of proportion and denies of having had religious delusions. She, however,
believes that her husband wanted to get her out so that he could marry an American wife which
she strongly beli...

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Anonymous
Outstanding Job!!!!

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