Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample

Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample

List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

The three crucial questions that I might ask the patient are as follows:

  1. Do you think your husband’s death has affected you through having to live without him?

Thoughts of loss fill one’s mind during bereavement, making it difficult to calm and fall asleep (Lancel et al., 2020). Grieving people sometimes wake up from dreams about a dead loved one as their brain processes the loss. Talking about the husband would enable the client to relax.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

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  1. Can you please describe the details about your past relationship with your husband?

Having the client talk about her past relationship with the deceased husband would enable her to achieve closure. According to Keyes et al. (2014), grief increases the risks of heart failure, suicide ideation, and other psychosomatic and psychiatric disorders. Therefore, there is a need to help the client achieve closure cantered on the husband’s death. (Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

  1. How do you cope when you are feeling stressed or anxious?

I believe that a patient’s coping mechanism determines how they respond to prescribed medication. Since the patient has diabetes and hypertension, which necessitates effective self-management (Lewinski et al., 2019), it is crucial to know how they manage their conditions. This can help the practitioner determine whether the patient can adhere to additional treatment intervention.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

The PMH does not reveal any close person. However, since the husband is dead, the immediate person to interview would be her son/daughter. The questions are as follows:(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

  1. What are some of the changes in your mother’s behavior in the recent past?

In this case, having more information on the client’s change in daily routine will be crucial to understanding her psychosis. For instance, the psychiatrist can identify the triggers of the client’s psychosis, e.g., loneliness.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

  1. What are some external stressors for your mother’s condition?

Identifying the client’s sources of stress could help in determining an appropriate treatment plan. Stress often comes from multiple sources occurring at once. Discussing with the client’s family could reveal which aspects of the client’s physical, mental, and environmental health that triggers.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

  1. Does your mother comply with the medical regimen?

According to Kay et al. (1987), an interview of a client’s family member is an indispensable source of information on their social impairment, e.g., emotional regulation, hostility, withdrawal, and social avoidance. Therefore, getting information from the patient’s daughter/son, who is the client’s closest social support, will give the clinician another perspective on the client’s anxiety and stress triggers.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

There are no special laboratory tests to detect Schizophrenia. Therefore, psychiatrists use developed interview and evaluation techniques to determine a person’s symptoms and rule out other disorders (American Psychiatric Association, 2020). For example, physical examinations are performed to rule out other issues that may be causing symptoms and check for any associated complications. Further testing and screenings, such as MRI and CT scans, may be used to rule out other conditions with comparable symptoms, such as the effects of alcohol or drug misuse.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

A psychiatrist conducts a psychiatric assessment to ascertain a patient’s mental status by observing and questioning a client’s appearance and posture, as well as their emotions, moods, delusions, hallucinations, substance abuse, and the likelihood of violence or suicide (American Psychiatric Association, 2020). The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia, for example, is a valuable interview tool for people with Schizophrenia. PANSS ratings are founded on data from a certain period, typically a week before an appointment (Kay et al. 1987). The data comes from clinical interviews and reports from primary care personnel (if the patient is institutionalized) or family members. PANSS is a semi-structured psychiatric interview that enables researchers to track affective, psychological, perceptual, sustained attention, motor, and other body functions in real-time. The interview can be thought of as having four stages.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

A discussion of family and personal history is also included. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association also has diagnostic criteria for Schizophrenia that can be used to reconcile subjective and objective data from the client. The psychiatrist then makes a diagnosis based on the patient’s symptoms and observations of his or her attitude and behavior as explained in the DSM-5.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

A diagnosis of Schizophrenia is made if a person has two or more core symptoms for at least one month, one of which must be hallucinations, delusions, or disorganized speech, according to the DSM-5 (Tandon et al., 2013). Gross disorganization and a lack of emotional expression are the two main symptoms. Other DSM-5 criteria for a schizophrenia diagnosis include: Work productivity, interpersonal relationships, and self-care are all substantially lower than before the onset of symptoms. Disturbances that have been present for at least six months.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

Bipolar Disorder: According to the National Institute of Mental Health, the main symptoms of bipolar disorder are conflicting occurrences of high and low mood (NIMH, 2020).Changes in sleeping habits, energy levels, concentration, and other behaviors may profoundly impact a person’s behavior, work, relationships, denial, refusal to accept that something is wrong, and insomnia and sleeping problems.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

List two pharmacologic agents and their dosing appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

  1. Asenapine

I would recommend 5mg sublingually two times a day, which can be titrated to a max of 20mg daily, depending on the client’s tolerance. Asenapine is an atypical antipsychotic and works by restoring the balance of dopamine and serotonin neurotransmitters. Asenapine inhibits dopamine D2 and serotonin 5-HT2A receptors reuptake (Plosker et al., 2016). According to Patel et al. (2014), Asenapine alleviates the positive and negative schizophrenic symptoms by blocking dopamine and serotonin receptors in the brain, controlling chemical messengers’ regulation. Moreover, Asenapine tablets are taken sublingually because the drug undergoes comprehensive presystemic metabolism after being taken orally (Plosker et al., 2016).(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

Clozapine

I would recommend an initial dose of 12.5mg orally twice a day for the client, which can then be titrated to 25mg per day up to 300mg, an average dose for women (Haidary & Padhy, 2020), depending on the client’s tolerance. Clozapine is an FDA-approved antipsychotic (Haidary & Padhy, 2020) and effectively treats resistant and non-resistant clients (Bryan, 2014; Kane & Correll, 2010). Clozapine lowers suicide risks, tardive dyskinesia, and relapse.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

Clozapine works as an antagonist to dopamine and serotonin receptors and a partial 5-HT1A agonist, reducing negative symptoms and extrapyramidal symptoms (Haidary & Padhy, 2020). It blocks receptors in the brain for dopamine and serotonin neurotransmitter associated with Schizophrenia, thereby rebalances their proportion in the brain to improve thinking, mood, and behavior. Clozapine tablets are administered orally and metabolized to nor clozapine and other metabolites by the cytochrome P450 enzymes.  (Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

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For the drug therapy, you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

The efficacy of Asenapine is not affected by ethnicity. However, according to the United States’ prescription information, Asenapine exposure is 30 to 40% higher in the elderly. However, it is not recommended to adjust dosage as long as the patient responds well to medication (Plosker & Deeks, 2016) to avoid weight gain (Durgam et al., 2017). Moreover, Asenapine cannot be used together with hypersensitive drugs, leading to hypotension (Plosker & Deeks, 2016).(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

The efficacy of clozapine is not affected by a client’s ethnicity. According to Horvitz-Lennon et al. (2013), the superiority of Clozapine olds across racial-ethnic groups. On the contrary, clozapine can be used together with other antipsychotic medicines for treatment‐resistant Schizophrenia.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

Include any “checkpoints” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

Since the drugs have been regarded as effective for the treatment of Schizophrenia by the FDA, there are no significant side effected. However, there is a minimal effect in the event. Asenapine can be adjusted to 10mg per day after one week. It is also recommended that no water is taken within 2 and 5 minutes of administration of Asenapine to avoid a decrease in its bioactivity (Plosker & Deeks, 2016).(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

On the other hand, clozapine can be adjusted to 25mg per day after two weeks when the client reports no side effects yet minimal response. The slow titration of clozapine is essential for reducing side effects. Therefore, augmentation with Electroconvulsive therapy (ECT) is recommended for a partial response to increasing Clozapine efficacy (Bryan, 2014).(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

                                                                  References                  

American Psychiatric Association. (2020). The American psychiatric association practice guideline for the treatment of patients with Schizophrenia. American Psychiatric Pub.(Therapy for Patients with Schizophrenia Comprehensive Nursing Paper Sample)

Bryan, J. (2014). After 30 years, clozapine is still best for treatment-resistant patients. Pharm. J292, 58. https://doi.10.1211/PJ.2021.1.65553   

Durgam, S., Landbloom, R. P., Mackle, M., Wu, X., Mathews, M., & Nasrallah, H. A. (2017). Exploring the long-term safety of Asenapine in adults with Schizophrenia in a double-blind, fixed-dose, and extension study. Neuropsychiatric disease and treatment13, 2021. https://doi.10.2147/NDT.S130211

Haidary, H. A., & Padhy, R. K. (2020). Clozapine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK535399/

Kane, J. M., & Correll, C. U. (2010). Pharmacologic treatment of Schizophrenia. Dialogues in clinical neuroscience12(3), 345. https://doi.10.31887/DCNS.2010.12.3/jkane

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for Schizophrenia. Schizophrenia Bulletin13(2), 261.

Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: the unexpected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry171(8), 864-871. https://10.1176/appi.ajp.2014.13081132

Lancel, M., Stroebe, M., & Eisma, M. C. (2020). Sleep disturbances in bereavement: A systematic review. Sleep Medicine Reviews, 101331. https://doi.org/10.1016/j.smrv.2020.101331

Lewinski, A. A., Patel, U. D., Diamantidis, C. J., Oakes, M., Baloch, K., Crowley, M. J., … & Bosworth, H. B. (2019). Addressing diabetes and poorly controlled hypertension: pragmatic health self-management intervention. Journal of medical Internet research21(4), e12541. https://doi.0.2196/12541

National Institute of Mental Health. (2020). Bipolar Disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. Pharmacy and Therapeutics39(9), 638. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/  

Plosker, G. L., & Deeks, E. D. (2016). Asenapine: a review in Schizophrenia. CNS drugs30(7), 655-666. https://doi.org/10.1007/s40263-016-0363-2

Tandon, R., Gaebel, W., Barch, D. M., Bustillo, J., Gur, R. E., Heckers, S., … & Carpenter, W. (2013). Definition and description of Schizophrenia in the DSM-5. Schizophrenia Research150(1), 3-10. https://doi.org/10.1016/j.schres.2013.05.028

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