Case Study: Pakistani Woman With Delusional Thought Processes

Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia

Case Study: Pakistani Woman With Delusional Thought Processes, Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

Introduction to the Case

The case is on a 34-year-old Pakistani woman living in the USA since she was about 19/20. She presents a brief psychotic disorder diagnosis from persistent symptoms following a 21-day hospitalization. Her medical history indicates that the client had Allah visions from which she was convinced she was Prophet Mohammad. She was confident that she was destined to deliver the world from sin. These visions had her husband concerned that he was afraid of leaving their four children in her care. One evening, her husband perceives her as being out of control to the extent of calling the police on her, and she is subsequently admitted into a psychiatric unit.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

During the assessment, she showed calmness, insisting that the incident in which the police were called was not as significant as it was. She denies believing that she was Prophet Mohammad. She is convinced that her husband is only determined to tame her because the television tells her the husband does not love her and instead needs an American wife.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

Subjectively, the client reports that she is in a good mood and has no audio or visual hallucinations. She believes that Allah is sending her message through television. She shows hostility towards the primary mental health practitioner (PMHP), then calms down. Her medical workup indicates her health is generally good, while previous medical test results are within the normal limits. She admits to stopping taking Risperdal because she fears her husband will poison her and get married to an American woman. (Pakistani Woman With Delusional Thought Processes)(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

Mental examination reveals she is psychologically aware of the people around her, her surroundings, time, and the occasion. Her dressing is appropriate. She does not behave appropriately with her gestures, manners, and tics. She has slow and interrupted speech. She appears undisturbed. She also shows the constricted effect and appears to listen to something despite denying visual and auditory hallucinations. She has a delusional and paranoid thought process; her intuition and judgment are impaired. She also denies being homicidal and suicidal. The PANSS score reveals her paranoia and schizophrenia (Kay et al., 1987). A higher negative PANSS score reflects a greater dominance of one syndrome over another and the general severity of schizophrenia (Kay et al., 1987). (Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

Decision One

I started Invega Sustenna (Paliperidone palmitate) 234 mg intramuscular X1 followed by 156 mg intramuscular on day four and monthly.  Paliperidone is an atypical antipsychotic drug that helps restore dopamine balance in the brain (Stevens et al., 2016). Stevens et al. (2016) place paliperidone as a significant intervention in treating the symptoms of schizophrenia, such as hallucinations and facilitating straightforward thought processes and positive self-perception. Besides, the medication reduces agitation and increases the performance of daily activities.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

Case Study: Pakistani Woman With Delusional Thought Processes, Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

I did not select Zyprexa 10mg due to its significant side effects, such as increased body weakness, drowsiness, appetite, extrapyramidal symptoms, and weight gain (Citrome et al., 2019). Equally, Abilify 10 mg orally at bedtime was not selected because of adverse side effects such as akathisia, insomnia, restlessness, and agitation (Mossaheb & Kaufmann, 2012). Sedation, excessive salivation, metabolic abnormalities, weight gain, granulopenia, and delirium or seizures are potential life-threatening side effects of Abilify (Mossaheb & Kaufmann, 2012).(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

The expectation for this selection was a decrease in the PANSS score and good toleration of the client’s medication. Invega Sustenna is crucial in restoring dopamine balance in the brain leading to reduced symptoms of schizophrenia (Kwon et al., 2015). Besides, Invega Sustenna is well tolerated by patients with minor side effects (Kwon et al., 2015). 

Ethical considerations influence how a practitioner interacts with their patients. It is crucial to uphold the rule of informed consent and the right to communication (Slim & Bazin, 2019; American Medical Association (AMA), 2019). In this case, the practitioner should inform the client and her husband of the health conditions, the available treatment interventions, benefits, and effects to make informed decisions while contributing to their care. Through effective communication, the practitioner should not coerce the client to accept a given treatment intervention. This would reduce trust in the client and contravene her right to informed consent.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

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Decision Point Two

The second decision was to continue the same decision to administer Invega Sustenna 234mg intramuscular X1 and 156mg intramuscular on the fourth day and monthly after that. On the other hand, the administering nurse will commence injections into the deltoid muscle. This decision was because the client was already responding well to medication save for the pain at the injection point, limiting her ability to sit for long hours. A deltoid intramuscular injection is recommended remedy for site pain injection (Fu et al., 2014). This necessitated a change in administering the selected medication to the arm’s deltoid area to allow her to sit without pain.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

I did not select the option to discontinue Invega Sustenna and start Haldol because the patient responded well to the initial medication. Schizophrenia’s treatment aims to reduce or eliminate symptoms (Samara et al., 2018); thus, there was a need to discontinue the regimen. Further, Haldon is associated with severe neurotoxicity causing an inability to walk or talk when used with other antipsychotic drugs. In contrast, I did not select the option to augment Invega Sustenna with Abilify Maintena because of its side effects, such as tardive dyskinesia and neuroleptic malignant syndrome. Equally, a combination of Abilify with Invega Sustenna is associated with increased side effects such as drowsiness, confusion, akathisia, and other significant memory problems.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

The expectation for this selection was a further decrease in the client’s symptoms and PANSS score. According to Stevens et al. (2016), paliperidone is well tolerated and significantly affects dopamine D2 neurotransmitters, leading to a positive psychological outcome. In this sense, paliperidone is also expected to have minimal side effects on the client and less injection site pain.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

It is significant to uphold the ethical value of nonmaleficence (Sorrell, 2017). As a practitioner, it is crucial to act in ways that promote positive health outcomes. In this case, the practitioner should consider all possible treatment interventions and decide on the option with the client’s best possible outcome to promote her well-being. For instance, an obligation not to cause harm is the reason for changing the injection site to the deltoid muscle.

Decision Three

I chose to have the client continue with the Invega Sustenna and counsel her that weight gain from Invega Sustenna is little compared with other drugs with similar efficacy. This decision was made because the client tolerated the initial medication and had a positive attitude. Besides, the client responded well to the initial medication, exemplified by the 50% reduction of PANNS, minimal weight gain, and better injection site pain. An appointment with a dietician and exercise physiologist was necessary to help the client eliminate additional weight.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

The option to discontinue Invega Sustenna and start Abilify Maintena was not selected because the client’s condition was already improving; thus, there was no need to change medication (Samara et al., 2018). Further, Abilify would not have been effective in this situation since it is associated with a two-week overlap following the first administration. On the other hand, the option to augment Invega Sustenna with Qysimis drug as a remedy for weight gain was not selected since the latter is recommended for obesity management (Sliwa et al., 2011). The client, in this case, is not obese as her BMI is 28.9 kg/M2.

The client is expected to continue responding well to treatment since the selected medication is associated with significant improvement of clinical symptoms (Sliwa et al., 2011). During the following appointment, the PANSS score and weight gain are expected to be significantly low.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

Case Study: Pakistani Woman With Delusional Thought Processes, Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

Ethically, it is crucial to discuss with the patient and her husband (as a representative) on potential side effects of the medication (LeFevre, 2010) since it is crucial to uphold the ethical principle of nonmaleficence (Sorrell, 2017). In this sense, a practitioner should inform the client of the need to engage a dietician since she is overweight, which predisposes her to obesity. It is ethical to communicate all about a patient’s illness confidential (AMA, 2019). This would avoid causing the patient more harm, i.e., a situation where medication results in obesity leading to risks of diabetes.

Conclusion

Invega Sustenna was selected as the first line of treatment for the case patient diagnosed with paranoia schizophrenia. Invega Sutenna has been shown to have a significant effect in balancing the brain’s dopamine neurotransmitter associated with the development of schizophrenia. Besides, the medication has a significant effect on the symptoms of schizophrenia and causes minimal weight gain and side effects. The other options, Zyprexa and Abilify, were not selected because of their significant side effects and associated weight gain. For instance, Zyprexa causes substantial side effects of extrapyramidal symptoms and weight gain. On the other hand, Abilify causes akathisia, insomnia, restlessness, and agitation.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

The second decision was to continue the same medication and administer the medication through the deltoid muscle since the client had paint that hindered her ability to sit long. The decision was made since the client responded well to medication, exemplified by a significant PANNS score reduction. The other available choices were not selected because there was a need to maintain consistency and no need to discontinue or augment the initial prescription. Further, Haldon was not chosen due to its side effect of neurotoxicity. In contrast, Abilify Maintena to the Invega Sustenna regimen was not selected because of its side effects, such as tardive dyskinesia and neuroleptic malignant syndrome. This combination is also associated with drowsiness, akathisia, and confusion. (Case Study: Pakistani Woman With Delusional Thought Processes, Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia)

Lastly, the prescription was continued with counsel on the need for dietary control of weight gain. The client responded positively to the treatment regimen and expected that client would completely recover following the prescribed medication. The associated weight gain was insignificant and could be easily controlled through professional nutritional and exercise guidance.  (Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)
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References

American Medical Association. (2019). Code of Medical Ethics: Chapter 1. Retrieved 14 April 2021 from: https://www.ama-assn.org/system/files/2019-01/code-of-medical-ethics-chapter-1_0.pdf (Accessed 14 April 2021).

Citrome, L., McEvoy, J. P., Todtenkopf, M. S., McDonnell, D., & Weiden, P. J. (2019). A commentary on the efficacy of olanzapine for treating schizophrenia: the past, present, and future. Neuropsychiatric disease and treatment, 15, 2559. https://doi.10.2147/NDT.S209284

Fu, D. J., Bossie, C. A., Sliwa, J. K., Ma, Y. W., & Alphs, L. (2014). Paliperidone palmitate versus risperidone long-acting injection in markedly-to-severely ill schizophrenia subjects: onset of efficacy with recommended initiation regimens. Clinical schizophrenia & related psychoses, 8(2), 101-109A. https://doi.10.3371/CSRP.FUBO.022213

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

Kwon, J. S., Kim, S. N., Han, J., Lee, S. I., Chang, J. S., Choi, J. S., … & Lee, E. (2015). Satisfaction of immediate or delayed switch to paliperidone palmitate in patients unsatisfied with current oral atypical antipsychotics. International clinical psychopharmacology, 30(6), 320. https://doi.10.1097/YIC.0000000000000093

Laureate Education. (2016). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author

LeFevre, M. (2010). Discussing Treatment Options with Patients. American family physician, 81(5), 645. https://www.aafp.org/afp/2010/0301/p645.html(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

Mossaheb, N., & Kaufmann, R. M. (2012). Role of aripiprazole in treatment-resistant schizophrenia. Neuropsychiatric disease and treatment, 8, 235. https://doi.10.2147/NDT.S13830

Samara, M. T., Klupp, E., Helfer, B., Rothe, P. H., Schneider‐Thoma, J., & Leucht, S. (2018). Increasing antipsychotic dose for non-response in schizophrenia. Cochrane Database of Systematic Reviews, (5). https://doi.org/10.1002/14651858.CD011883.pub2

Slim, K., & Bazin, J. E. (2019). From informed consent to shared decision-making in surgery. https://doi.10.1016/j.jviscsurg.2019.04.014

Case Study: Pakistani Woman With Delusional Thought Processes, Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

Sliwa, J. K., Bossie, C. A., Ma, Y. W., & Alphs, L. (2011). Effects of acute paliperidone palmitate treatment in subjects with schizophrenia recently treated with oral risperidone. Schizophrenia research.

Sorrell, J. M. (2017). Ethics: ethical issues with medical errors: shaping a safety culture in healthcare. OJIN: The Online Journal of Issues in Nursing, 22(2). https://doi.10.3912/OJIN.Vol22No02EthCol01 

Stevens, J.R, Fava M, & Rosenbaum, J.R. (2016). Psychopharmacology in the Medical Setting. In T. A. Stern, G.L. Fricchione, N.H. Cassem, M. Jelinek, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital Handbook of General Hospital Psychiatry. Elsevier.

Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

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.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

Case Study: Pakistani Woman With Delusional Thought Processes, Assignment: Assessing and Treating Patients 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.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

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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.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

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.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

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).(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)
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.(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)
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)(Comprehensive Essay on Assessing and Treating Patients With Psychosis and Schizophrenia)

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.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

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