Assessing and Treating Clients With Psychosis and Schizophrenia

Assessing and Treating Clients With Psychosis and Schizophrenia

Mental health problems that include schizophrenia affect negatively the patient’s health. Schizophrenia affects the patient’s quality of life by increasing dependence on medications, lowering productivity, and predisposing them to premature mortality. Psychiatric mental health nurse practitioners play essential roles in providing appropriate treatments that minimize the worsening and progression of schizophrenia symptoms. In doing this, they consider the legal and ethical principles of their practice in the process of patient care. Therefore, this paper is a case analysis of a patient diagnosed with schizophrenia, paranoid type.

The patient in the case study is a 34-year-old Pakistani female who has been brought to the unit for psychiatric assessment. She is currently in an arranged marriage. She has a history of 21-day hospitalization due to a brief psychotic disorder since the symptoms persisted for less than a month. The client also has a history of seeing Allah, and false belief of herself, as she considers that she is Prophet Mohammad. She also beliefs that her husband wants to marry an American wife since the television tells her so. Subjective data shows that she stopped taking Risperdal a week ago because she thinks her husband will poison her so that he can marry an American woman.

PANSS was administered, which showed that the client scored 40 for the positive symptoms scale, 20 for the negative symptoms scale, and 60 for the general psychopathology scale. As a result, she was diagnosed with schizophrenia, paranoid type. The patient information that would be crucial for use in decision making includes her PANSS score, history of Risperdal use, obesity, illusions, and family social support systems available to her, as they influence the care outcomes.

Decision 1

Start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter.

Reason for Selection

Studies have demonstrated that Invega Sustenna is highly effective in managing schizophrenia symptoms. The effectiveness can be seen in Patel et al. (2020) study where Invega Sustenna reduced patient claims for psychoses diagnoses, hypertension, depression, substance-related and addictive disorders, bipolar disorder, anxiety, and sleep-wake disorders. The authors also found a significant reduction in the need for hospital visits, hospitalizations, and costs when patients were initiated on Invega Sustenna rather than Risperidone (Patel et al., 2020). Early treatment of schizophrenia with Invega Sustenna also results in enhanced treatment adherence and social functioning (Cassidy & Miles, 2021). According to Emsley and Kilian (2018), Invega Sustenna provides benefits that include its availability in long-acting injectable formulations and dose initiation, which causes rapid onset of action compared to other antipsychotics.

Why The Other Options Were Not Selected

Zyprexa 10 mg orally at bedtime was not selected because of the increased risk of poor adherence by the patient due to side effects that include memory loss, metabolic deregulation, and changes in the menstrual cycle. The safety risks associated with Zyprexa have made it a second choice of drug in schizophrenia (Citrome et al., 2019). Starting the patient on Abilify 10 mg orally at bedtime was not selected because studies have shown that psychotic symptoms worsen in the patient when switched from other antipsychotics to Abilify. In addition, case studies report the increased risk of adverse events and lack of efficacy with the use of Abilify in schizophrenia patients (Takeuchi et al., 2018).

Expected Outcomes

Invega Sustenna improves schizophrenia symptoms. As a result, I was expecting to witness symptom improvement, as evidenced by improvement in PANSS score, social functioning, and treatment adherence. I also expected minimal side effects associated with Invega Sustenna (Cassidy & Miles, 2021).

Ethical Considerations

            Psychiatric mental health nurse practitioners should weigh the benefits and risks associated with the available treatments for mental health disorders. While the given antipsychotics have comparable effectiveness in schizophrenia, priority should be placed on treatment safety. Invega Sustenna demonstrated enhanced efficacy over Zyprexa and Abilify due to its safety in symptom management (Patel et al., 2020).

Psychosis and schizophrenia greatly impact the brain’s
normal processes, which interferes with the ability to think clearly. When
symptoms of these disorders are uncontrolled, clients may struggle to function
in daily life. However, clients often thrive when properly diagnosed and
treated under the close supervision of a psychiatric mental health
practitioner. For this Assignment, as you examine the client case study in this
week’s Learning Resources, consider how you might assess and treat clients
presenting with psychosis and schizophrenia.

Learning Objectives

Students will:

Assess client factors and history to develop personalized
plans of antipsychotic therapy for clients

Analyze factors that influence pharmacokinetic and
pharmacodynamic processes in clients requiring antipsychotic therapy

Evaluate efficacy of treatment plans

Analyze ethical and legal implications related to
prescribing antipsychotic therapy to clients across the lifespan

Learning Resources

Note: To access this week’s required library resources,
please click on the link to the Course Readings List, found in the Course
Materials section of your Syllabus.

Required Readings

Note: All Stahl
resources can be accessed through the Walden Library using this link. This link
will take you to a log-in page for the Walden Library. Once you log into the
library, the Stahl website will appear.

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Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the
appropriate chapter. Be sure to read all sections on the left navigation bar
for each chapter.

Chapter 4, “Psychosis and Schizophrenia”

Chapter 5, “Antipsychotic Agents”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New
York, NY: Cambridge University Press.

To access information on the following medications, click on
The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the
appropriate medication.

Review the following medications:

amisulpride

aripiprazole

asenapine

chlorpromazine

clozapine

flupenthixol

fluphenazine

haloperidol

iloperidone

loxapine

lurasidone

olanzapine

paliperidone

perphenazine

quetiapine

risperidone

sulpiride

thioridazine

thiothixene

trifluoperazine

ziprasidone

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS
studies in schizophrenia: Results and implications for clinicians. CNS Drugs,
23(8), 649-659. doi:10.2165/00023210-200923080-00002

Note: Retrieved from Walden Library databases.

Document: Midterm
Exam Study Guide (PDF)

Kay, S. R., Fiszbein,
A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS)
for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

Note: Retrieved from Walden Library databases.

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

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from
http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

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

Note: This case study will serve as the foundation for this
week’s Assignment.

Optional Resources

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D.,
Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic
medication use during treatment of schizophrenia patients: Longitudinal results
from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3),
124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E.,
Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with
antipsychotic drugs in patients with schizophrenia: Trends in multiple health
care systems. American Journal of Health-System Pharmacy, 71(9), 728-738.
doi:10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A.
(2015). Comparing antipsychotic treatments for schizophrenia: A health state
approach. The Psychiatric Quarterly, 86(1), 107-121.
doi:10.1007/s11126-014-9326-2

To prepare for this Assignment:Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

Topic 1 DQ 1

Oct 3-5, 2022

What would spirituality be according to your own worldview? How do you believe that your conception of spirituality would influence the way in which you care for patients?

According to Hart (1994, p. 23), spirituality is the way a person lives out their beliefs in daily life and the way they “respond to the end conditions of individual existence” (Bożek, Nowak, , & Blukacz, 2020).A sense of peace and well-being are generated by spirituality, which is defined by faith, a search for life’s meaning and purpose and a feeling of belonging with one another. Through spiritual connection life satisfaction may increase or make it easier to accommodate illness or disability. Although, the idea of spirituality encompasses a huge range of personal experiences and convictions. Every individual has a unique perspective on spirituality. We may develop more comprehensive and compassionate healthcare systems by addressing the spiritual needs of our patients. 

Nurses are being required more and more to recognize and respond to spiritual issues because of the emphasis on holistic care and meeting the requirements of each individual patient. Physical healing, pain relief, and personal development might result from attending to the patient’s spiritual needs. The nurse must attend to the patient’s emotional as well as physical demands in order to meet their total needs.The way in which we provide patient care would be influenced by our personal understanding of spirituality. For example, my spiritual beliefs consist of treating everyone with respect, compassion, care and equality regardless of their health status, race, spiritual view, gender, etc.

I can take that into consideration into my practice by providing culturally competent, holistic care so I can better understand what I can do to assist the patient’s physical, spiritual, and mental wellbeing. Further, hospitals are held liable by The Joint Commission (TJC) for upholding patient rights, which includes making accommodations for cultural, religious, and spiritual values. The bodies, minds, and spirits of patients must all be taken into consideration by healthcare practitioners and systems (Swihart, Yarrarapu, & Martin, 2021).

Bożek, A., Nowak, P. F., & Blukacz, M. (2020). The Relationship Between Spirituality, Health-Related Behavior, and Psychological Well-Being. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.01997 

Swihart, D.L., Yarrarapu ,S.N.S & Martin R.L. (2021). Cultural Religious Competence In Clinical Practice. StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK493216/