Treating Patients With A Delusional Thought Process essay
Treating Patients With A Delusional Thought Process essay
Introduction
Case Overview
A 34years old female comes to the clinic with her husband due to hallucinations, delirium, and paranoia. She experiences visions of Allah, believes that she is Prophet Mohammed, and would deliver people from sin. Her husband reports that her moods shifted to extremes and out of control. The patient had a previous diagnosis of brief psychotic disorder one month ago. She has been responding well to risperidone though she became non-compliant. The positive findings in the mental state examination are slow speech interrupted by periods of silence, constricted affect, euthymic mood, auditory hallucinations, impaired insight and judgment, delusional and paranoid thought processes. PANSS scores -40 for positive symptoms, -20for negative symptoms, and -60 for general psychopathological scale. Her actual diagnosis is paranoid schizophrenia. Treating Patients With A Delusional Thought Process essay
Paranoid schizophrenia is a mental disorder presenting with auditory hallucinations and delirium. The patient also has impaired cognitive function or impaired information processing. Causes of schizophrenia are anatomic abnormalities where-by the ventricles in the brain appear to be larger. The dopaminergic system imbalance causes positive and negative symptoms. The prevalence rate of schizophrenia is 1% worldwide. Its onset is in the mid-30s. It is more common in males compared to females. The DSM-5 criteria for schizophrenia state that the patient must have symptoms persisting over one month. These symptoms are delusions, hallucinations, disorganized speech, catatonic behavior, and negative symptoms (Stępnicki, et al, 2018). This paper describes the treatment given to a patient with schizophrenia. The treatment will be in three decisions. Each decision chosen should be evidence-based and should impact ethical consideration. The author describes the expected outcome after each choice. Treating Patients With A Delusional Thought Process essay
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Decision 1#
Decision Selected
Start Invega Sustenna 234mg IM X1 followed by 156mg IM on day 4 and monthly thereafter.
Reason For Making This Decision
Invega Sustenna is also paliperidone palmitate. It undergoes hydrolysis to paliperidone, the active metabolite in risperidone. It shows its efficiency in schizophrenia is through serotonin and dopamine antagonist (Kverno, K., & Rozenberg, I. 2021). It is a first-generation long-acting antipsychotic injection given once a month. It has minimal cases of disease relapse or re-hospitalization. Invega Sustenna is the best selection for this patient because it has minimum side effects such as headache, weight gain, injection site pain, and somnolence. Invega Sustenna injection is easy to comply with because it is a single dose every month. Compared to other oral antipsychotics, Invega Sustenna has shown positive effects in terms of effectiveness and safety.
Reason For Excluding The Other Two Options
Zyprexa (olanzapine) is a second-generation antipsychotic FDA approved for psychosis, schizophrenia, post-traumatic stress disorder, and bipolar. Olanzapine is a selective serotonin receptor inhibitor that antagonizes the dopamine and serotonin receptors. Olanzapine works well on the positive symptoms of schizophrenia-like hallucination and delirium. Its side effects include poor concentration, avolition, flat affect, weight gain, and extrapyramidal effects (Fellner, C. 2017). Zyprexa (olanzapine) 10mg at bedtime is not a good selection for the patient because of the previous history of no-compliance, undesirable extrapyramidal effects, and weight gain. In addition, it works well on the positive symptoms leaving the negative symptoms.
Abilify is a third-generation antipsychotic, FDA approved for psychotic disorders such as schizophrenia, bipolar, and mania. Its effectiveness is in its inhibitory effects at the dopamine neurotransmission that relieves the psychotic symptoms. It works well on the negative symptoms of schizophrenia. However, it is not the drug of choice in patients with acute agitation. In addition, its effectiveness is determined 4-8weeks after treatment initiation (Mustafa, et al, 2019). I did not select Abilify 10mg orally at bedtime for this patient because it takes a long to achieve its effectiveness. It is an add-on therapy for patients with a partial response to antipsychotics.
Expected Outcome
After administration of Invega Sustenna, the expected outcomes are injection site pain, mild weight gain, improvement of the PANSS scale, and relief of patient’s symptoms (hallucination, deliriums, and agitation).
Ethical Consideration
Ethical principles in psychiatric practice enable the PNP to do good to the patients and practice patient safety. However, some principles or values conflict to ensure patient safety. Values such as consent, confidentiality, and respect of autonomy conflict when treating a patient with psychosis because of their impaired cognitive function. Consent is seeking permission to initiate treatment in a patient. Respect for autonomy is letting the patient make informed healthcare decisions. These two values conflict to ensure patients’ well-being.
Decision 2#
Decision Selected
Continue same made but instruct administering nurse to begin injections into the deltoid at this visit moving forward.
Reason For Selecting This Decision
The patient has been responding well to Invega Sustenna. After four weeks, she reports a decrease in the PANSS score by 25%. The patient has been tolerating the medication well. Invega Sustenna is easy to comply with, safe for all patients, and has minimal side effects (Kverno, K., & Rozenberg, I. 2021). Injecting at the deltoid region minimizes the pain and enhances the patient’s comfort when sitting. Treating Patients With A Delusional Thought Process essay
Reason For Excluding The Other Two Options
Haloperidol is a first-generation antipsychotic in form of injection and oral tablets. Oral haloperidol is relatively slow and reaches its plasma peak at 6hours. Injectable haloperidol is a slow-release long-acting treatment that relieves the symptom by antagonizing the dopamine receptors. Haloperidol is effective in both positive and negative symptoms. However, it has unpleasant side effects such as weight gain, extrapyramidal symptoms, sedation, and orthostatic problems (Ostinelli, et al, 2017). Therefore, starting hadol 50mg IM q2weeks with oral hadol 5mg BID for the next three months is not a good choice for this patient because of its unpleasant adverse effects.
Abilify antenna 300mg IM Qmonthly with oral ability 10mg in the morning for two weeks is not a good choice because the patient already responded well to Invega Sustenna. Abilify is a recommended add-on therapy for patients with a partial response to antipsychotics.
Expected Outcome
After four weeks, the expected outcome is; the decrease of the PANSS score to 50%. The gluteal pain should reduce due to the change of injection site to the deltoid region. The patient should be comfortable sitting. Symptoms such as auditory hallucinations should be relieved. The patient will slightly gain weight.
Ethical Consideration
During this visit, the patient’s cognitive function has partially improved. It is appropriate to consider the conflicting principles such as respect for autonomy and consent. However, the PNP should practice beneficence and non-maleficence. Beneficence is having the best interest at heart towards a patient by doing good. Non-maleficence is the principle that protects the patient from medication-associated errors.
Decision 3#
Decision Selected
Continue with Invega Sustenna. Counsel the client on the fact that the weight gain from Invega Sustenna is not as much as that of other drugs with similar efficacy can cause. Make an appointment with a dietician and exercise physiologist. Follow up in one month.
Reason For Selecting This Decision
Continuing with Invega Sustenna is the best option for this patient because of its efficiency throughout the treatment. The symptoms have been gradually decreasing. However, the persisting adverse effect is weight gain that makes the patient uncomfortable. Invega Sustenna induces hyperphagia and slows down metabolism resulting in weight gain and insulin resistance. Involving a dietician and exercise physiologist helps the patient lose weight to her comfortable size. Treating Patients With A Delusional Thought Process essay
Reason For Excluding The Other Two Options
Abilify maintena 400mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10mg in the morning is not a good choice because the patient has been responding well to Invega Sustenna. Abilify is a recommended add-on therapy for patients with a partial response to antipsychotics.
Adding on qsymia for weight loss on this patient will cause more severe problems like diabetes mellitus, cardiovascular diseases, and hypertension (Dalai, et al, 2018). Therefore, it is not a good selection because of the undesirable effects.
Expected Outcome
The patient should report a decrease in PANSS score. She should lose weight because of a change in diet and physical exercise.
Ethical Principles
At this point, the patient can make decisions and ask questions about her health. The PNP can now instill values such as respect for autonomy and consent. The PNP educates the patient about her disease process and asks them to make a health-related decision. The PNP keeps this information confidential to avoid the stigma associated with mental illnesses Treating Patients With A Delusional Thought Process essay
Conclusion
Schizophrenia is a psychotic disorder presenting with hallucinations and delirium. Its diagnosis is through the DSM-5 criteria. Treatment methods in schizophrenia are both psychotherapeutic and pharmacotherapy. Antipsychotics are the best treatment options for schizophrenia. However, before initiating treatment, the PNP should consider ethical principles such as confidentiality, consent, respect for autonomy, and beneficence. However, there are conflicts of some principles due to the patient’s cognitive function impairment. The PNP should ensure that the drugs prescribed are safe for the patient and bring out the best result. For this patient, Invega Sustenna is effective, safe, and has minimum side effects. Patient education enables the patient to comply and minimize the side effects.
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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. Treating Patients With A Delusional Thought Process essay
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.
References
Dalai, S. S., Adler, S., Najarian, T., & Safer, D. L. (2018). The study protocol and rationale for a randomized double-blinded crossover trial of phentermine-topiramate ER versus placebo to treat binge eating disorder and bulimia nervosa. Contemporary clinical trials, 64, 173-178.
Fellner, C. (2017). New schizophrenia treatments address unmet clinical needs. Pharmacy and Therapeutics, 42(2), 130.
Kverno, K., & Rozenberg, I. (2021). Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia: Practical Considerations. Journal of psychosocial nursing and mental health services, 59(7), 7-12. Treating Patients With A Delusional Thought Process essay
Mustafa, S., Bougie, J., Miguelez, M., Clerzius, G., Rampakakis, E., Proulx, J., & Malla, A. (2019). Real-life assessment of aripiprazole monthly (Abilify Maintena) in schizophrenia: a Canadian naturalistic non-interventional prospective cohort study. BMC psychiatry, 19(1), 1-9.
Ostinelli, E. G., Brooke‐Powney, M. J., Li, X., & Adams, C. E. (2017). Haloperidol for psychosis‐induced aggression or agitation (rapid tranquillization). Cochrane database of systematic reviews, (7).
Stępnicki, P., Kondej, M., & Kaczor, A. A. (2018). Current concepts and treatments of schizophrenia. Molecules, 23(8), 2087. Treating Patients With A Delusional Thought Process essay
