Assignment: Treatment Goal Resolution of Psychotic Symptoms Questions

Assignment: Treatment Goal Resolution of Psychotic Symptoms Questions

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Case Study number 1

1) Watch the following Video

Based on the case study, answer the following questions.

Treatment goals 1. (List 2 treatment goals for this case. State goals in SMART format (Specific, Measurable, Achievable, Relevant, and have a Timeline for completion).

Goal: Resolution of psychotic symptoms

A)Objectives / Treatment goals

Patient will contract for safety with his nurse at least once per shift within the next 12 hours.

Patient will report any perceived conflict to housemates to the nurse at least once per shift within the next 12 hours.

Patient will identify two medications and states why they can be harmful to his life at least once a day within the next 24 hours.

Patient will participate in at least one complete group or activity per day including at least one housemate of his choice withing the next 7 days.

Patient will reality test (specific belief) with nurse for 10 minutes at least once per

Shift within the next 24 hours.

B)Identification of target symptoms/problems

Thoughts disorder

Fear a

Auditory hallucinations

Paranoia

Social isolation

Risk of self-arm

Risk of hurting others

Risk of dehydration

Risk of malnutrition

Delusional thoughts

2. What information, if any, would you like to know that was not included in the case?

The interview unfortunately does not address any information regarding the Patient’s strengths: this may include the ways in which the patient has cope successfully with past and current distress, accomplishment, source of inner value, friendships, work accomplishment and family support. Strengths also include bobbies that patient usually use to battle their worries

3. Which psychiatric symptoms are a treatment priority for this case?

Risk of self-arm

Risk of harming others

Risk of dehydration

Risk of malnutrition

Delusional thoughts

Auditory hallucinations

Paranoia

Social isolation

4. What are the non-pharmacologic issues in this case (problems/complaints that cannot be addressed by medication)? Medication Choice 1.

Social isolation

Risk of self-arm

Risk of hurting others

Risk of dehydration

Risk of malnutrition

5. List 1 medication that would be appropriate for this case. Include name, starting dose.

Trifluoperazine

a) Outpatient. 1-2 mg PO q12hr

b) Inpatient Initial: 2-5 mg PO q12hr. Maintenance Dose: 15-20 mg/day. Not to exceed 40mg/day

6. Describe your clinical decision making. What is your rationale for choosing this medication?

This medication is used to treat certain mental disorders (such as schizophrenia and other Psychotic disorders). Trifluoperazine helps patient to think more clearly, feel less nervous, and take part in everyday life. It can reduce aggressive behavior and the desire to hurt self or others. It may also help to decrease hallucinations (hearing/seeing things that are not there).

7. What laboratory testing/monitoring is needed for safely prescribing this medication?

The Drug is Pregnancy Category C. Pregnancy test may be requested.

8. Are there any contraindications or safety issues associated with this medication? Medication. Patients with dementia-related psychosis who are treated with antipsychotic drugs such as trifluoperazine are at an increased risk of death. The deaths appeared to be either cardiovascular (heart failure, sudden death) or infectious (pneumonia) in nature.

This drug is not therefore approved for the treatment of patients with dementia-related psychosis.

9. What is your second choice of medication for this case? Include name and starting dose.

Ariprazole (Abilify)

10. Describe your clinical decision making. What is your rationale for choosing this medication? Abilify (aripiprazole is an antipsychotic medication.

Abilify is used to treat the symptoms of psychotic conditions such as in this case. Although ability is a second-generation antipsychotic, which supposedly has to fewer side effects than the first generation once, I decided to put it as a second choice because Some young people have thoughts about suicide when taking Abilify. Considering the patient in consideration already has some suicide related thoughts, I did not want to further increase that risk.

11. What laboratory testing/monitoring is needed for safely prescribing this medication?

Animal studies have revealed evidence of developmental toxicity, including possible teratogenic effects. Congenital anomalies have been reported; however, a causal relationship has not been established. There are no controlled data in human pregnancy. Therefore, the drug is Pregnancy Category C.

Pregnancy Test may be requested.

12. Are there any contraindications or safety issues associated with this medication? Non pharmacologic Interventions.

Abilify is not approved for use in older adults with dementia-related psychosis for the same reasons listed above regarding Trifluoperazine.

13. What non-pharmacologic interventions do you recommend? Safety Risk Assessment.

a) Cognitive behavioral therapy

A talk therapy focused on modifying negative thoughts, behaviors, and emotional responses associated with psychological distress may be beneficial.

b) Psychoeducation

Education about mental health will also serve to support, validate, and empower this patient.

c) Family therapy Psychological Counseling will also help the patient’s family and help communicate more efficiently with the provider especially as the patient has stated that hi feel safe with his parents.

14. What are the safety concerns, if any, associated with this case? How will you address safety?

Risk of self-Harm and Harm others.

a) Hospitalization

A higher level of care whereby patients this patient can be closely monitored and may be given medications that would help stabilize his symptoms and prevent self-harm and harm to other is necessary.

The risk that carries this patient cannot be eliminated, but it can be rigorously assessed and managed or mitigated. For this reason, a patient’s history of violence or risk to others is vitally important. A risk assessment should identify key factors that indicate a pattern or that risk is increasing in this case patient clearly stated that he has a plan of taking lethal pills to kill himself. He also confessed that he has a knife and a baseball bat for self-defense. because Risk is dynamic and can be affected by circumstances that can change over the briefest of timeframes. The risk assessment for this patient needs to include a short-term perspective and frequent review. Also, the risk also increases for this patient because he has potential targeted victims (his housemates). The age of the patient is also a risk factor as the risk usually picked early 20s and late 20s. housemates must be warned as the risk to protect other in this case overweight the patient Confidentiality. (Retrieved from the website of the royal College of Psychiatry).

15. When would you follow up with this patient? References

According to the Ontario standards, this patient should be ideally followed up after 72 hours after the first visit (Anderson & Kurdyak, 2017)

16. List your references.

Anderson, K. K., & Kurdyak, P. (2017). Factors Associated with Timely Physician Follow-up after a First Diagnosis of Psychotic Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 62(4), 268–277. https://doi.org/10.1177/0706743716673322

https://www.rcpsych.ac.uk/members/supporting-you/assessing-and-managing-risk-of-patients-causing-harm

https://www.webmd.com/schizophrenia/medicines-to-treat-schizophrenia#1

https://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/THE%20INITIAL%20PSYCHIATRIC%20INTERVIEW.pdf

https://www.drugs.com/abilify.html

case_study_number_1_fall_

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