Delusional Disorders Essay

The client in the case study is a 34-year-old woman who is currently in an arranged married. She is a Pakistani who moved to the US during teenagehood. She presented for assessment after a 21-day admission after a diagnosis of a “brief psychotic disorder”. Before a hospitalization, she would claim that Allah was visiting her and she was the prophet Mohammed sent by Allah to deliver the world from sin. The husband was very concerned to a level he was afraid to leave the children with her. The husband reported that there was a time she was out of control and he called the police; this incident led to her admission in a psychiatric unit. She denies auditory or visual hallucinations but believes Allah talks to her through the television. Moreover, she appears to listen to something strange during the interview. She is hostile during the interview. The findings from the physical assessment and laboratory tests are within the normal limits. She admits that she discontinued her Risperdal medication a week after discharge. According to the MSE, she is oriented to person, event, time, and place. She is well-groomed.  Her mood is euthymic, affect constricted, while her speech is slow, and sometimes interrupted by moments of silence. Both judgment and insight are impaired, and she also manifests a paranoid and delusional thought process. After the comprehensive assessment, the diagnosis of schizophrenia, paranoid type was confirmed. The paper will discuss the appropriate treatment choices for the client and the ethical considerations guiding these treatment choices.

Decision Point One

Invega Sustenna is an antipsychotic that rebalances the brain’s neurotransmitters (dopamine and serotonin) and hence improves the psychotic symptoms (Fang et al, 2016). Zyprexa (Olanzapine) 10 mg and Abilify (aripiprazole) are also antipsychotics that work by rebalancing the level of dopamine and serotonin within the brain, which improves psychotic symptoms such as hallucinations and delusions (Citrome et al., 2019). The client should begin” Invega Sustenna 234 mg intramuscular X1”. Invega Sustenna was chosen due to its route of administration (IM), which will improve her efficacy to treatment and also the medication is effective in the treatment of schizophrenia and psychotic symptoms and also improves an individual’s social functioning. Zyprexa (Olanzapine) 10 mg and Abilify (aripiprazole) were not selected because the oral administration of the medication hinders the client’s adherence to the medication due to the psychotic symptoms. Intramuscular antipsychotic preparations are preferred for clients with psychosis due to better adherence (Mahone et al., 2016).

By selecting Invega Sustenna 234 mg intramuscular, it is expected that the psychotic symptoms will improve and she will experience minimal side effects. This is due to the efficacy of Invega Sustenna in the treatment of psychotic symptoms for patients with schizophrenia (Emsley & Kilian, 2018).

The treatment outcome was that the client started responded to the medication as manifested by the 25% decreased PANSS score. She also tolerated the medication but reported weight gain and pain at the injection site. Weight gain is among the most common side effects of the selected medication (Invega Sustenna).

Ethical principles that affected this decision include autonomy and informed consent. Informed consent was sought from both the client and the husband before starting the treatment. Moreover, the client’s autonomy was respected, even though the psychotic symptoms may interfere with her ability to make treatment decisions, her and the husband’s position about the treatment were respected (Lane et al., 2020).

ORDER A PLAGIARISM-FREE PAPER HERE

Decision Point Two

The treatment choices include administering Invega Sustenna but changing the injection site to deltoid site. The deltoid site is considered appropriate because the medication is administered via the middle of the deltoid muscle and hence reduced the possibility of injuring the radial nerve (Soliman et al., 2018). Haldol Decanoate is also an antipsychotic used to treat psychotic symptoms such as hallucinations and delusional thought processes. The third treatment option is adding Abilify Mainatena to Invega Sustenna. Abilify is also an antipsychotic.

The client should continue with Invega Sustenna but the medication to be administered at the deltoid site. Invega Sustenna was maintained because she is responding to the medication while the injection site was changed because the client reported pain at the injection site that made it difficult to walk or sit. Changing the injection site will facilitate the client’s adherence to treatment (Strohfus et al, 2018). Haldol Decanoate 50 mg IM was not selected because the client is already responding to Invega Sustenna. The decision to continue with Invega Sustenna IM and augment it with Abilify Maintena is because Abilify Maintena is associated with serious side effects like tardive dyskinesia, abnormal heart rhythm problem, and akathisia (Schöttle et al., 2018).

The treatment goal for this decision is that the client would continue manifesting a good response as manifested by reduced psychotic symptoms. Additionally, it is expected that she would adhere to the treatment and not experience side effects.

As expected, the client showed a good response as manifested by 50% symptom reduction. This is due to the efficacy of Invega Sustenna in improving psychotic symptoms. The client also adhered to the treatment and did not complain about the painful injection site. Nonetheless, the client still reported weight gain.

Informed consent and beneficence guided this decision. The client was educated about the medications before being prescribed and also the decision likely to bring the best treatment outcomes (Lane et al., 2020).

Decision Point Three

The choices include the client continuing with Invega Sustenna but to be counseled regarding weight gain and referred to a dietician and an exercise therapist. This choice includes ensuring that the client understands that the medication is effective but this comes with side effects like weight gain; the weight gain can be managed by following advice from the dietician and the exercise expert (Dayabandara et al., 2017). For the choice of maintaining Invega Sustenna and add-on Qsymia, Qysmia is a medication used to treat overweight and obesity (Bonamichi et al., 2018). The last choice is discontinuing the current medication and starting Abilify. Abilify is an atypical antipsychotic used to treat schizophrenia but it is associated with serious adverse effects (Schöttle et al., 2018).

The client should continue with the current medication and educate her about the weight gain. The client will also be referred to a nutritionist and an exercise expert to be educated about weight loss. This decision was selected because weight gain from the medication is manageable through an appropriate diet and being active physically. Additionally, reducing the weight will improve the client’s compliance with the treatment lower the risk for metabolic syndrome (Dayabandara et al., 2017). The choice to maintain Invega Sustenna and add-on Qsymia to facilitate weight loss was not considered because Qsymia is recommended for the treatment of obesity and it is also associated with serious side effects. Abilify was not chosen due to the associated side effects (Schöttle et al., 2018).

It is expected that with the decision the client will still show a good response, adhere to treatment, and have the weight gain controlled.

Non-maleficence and beneficence guided the treatment decision. This involved balancing the risks and benefits associated with the treatment choice and choosing the decision that would facilitate the best care outcomes (Lane et al., 2020).

Conclusion

The initial treatment decision involved the client starting Invega Sustenna 234 mg intramuscular X1. The medication is effective in treating psychotic symptoms for people with schizophrenia. An IM was selected because intramuscular medications improve treatment adherence for people with psychotic symptoms when compared to oral medications. The client manifested symptom reduction but she reported pain at the injection site and weight gain. The second decision involved maintaining Invega Sustenna but administering the medication at the deltoid site. The client manifested further symptom reduction and no longer complained about pain at the injection site. However, she still complained about the weight gain. As a result, the third decision involved maintaining Invega Sustenna and have the client referred to a nutritionist and an exercise expert. The client was referred to a nutritionist and an exercise expert to be educated about how to control the weight gain from Invega Sustenna. The ethical principles that guided the decisions about the treatment of this client included informed consent, autonomy, non-maleficence, and beneficence.

 

 

References

Bonamichi, B. D. S. F., Parente, E. B., dos Santos, R. B., Beltzhoover, R., Lee, J., & Salles, J. E. N. (2018). The challenge of obesity treatment: a review of approved drugs and new therapeutic targets. J. Obes. Eat. Disord, 4, 1-10.

Citrome, L., McEvoy, J. P., Todtenkopf, M. S., McDonnell, D., & Weiden, P. J. (2019). A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future. Neuropsychiatric disease and treatment, 15, 2559–2569. https://doi.org/10.2147/NDT.S209284

Dayabandara M, Raveen H, Suhashini R, Sudarshi S & Varuni A. (2017). Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatr Dis Treat, 1(13), 2231–2241.

Emsley, R., & Kilian, S. (2018). Efficacy and safety profile of paliperidone palmitate injections in the management of patients with schizophrenia: an evidence-based review. Neuropsychiatric disease and treatment, 14, 205–223. https://doi.org/10.2147/NDT.S139633

Fang L, Turkoz I & Fan Z. (2016). Efficacy and safety of once-monthly injection of paliperidone palmitate in hospitalized Asian patients with acute exacerbated schizophrenia: an open-label, prospective, noncomparative study. Neuropsychiatr Dis Treat, 1(12), 15–24.

Lane, N. M., Hunter, S. A., & Lawrie, S. M. (2020). The benefit of foresight? An ethical evaluation of predictive testing for psychosis in clinical practice. NeuroImage. Clinical, 26, 102228. https://doi.org/10.1016/j.nicl.2020.102228

Mahone, I. H., Maphis, C. F., & Snow, D. E. (2016). Effective Strategies for Nurses Empowering Clients with Schizophrenia: Medication Use as a Tool in Recovery. Issues in mental health nursing, 37(5), 372–379. https://doi.org/10.3109/01612840.2016.1157228

Schöttle, D., Janetzky, W., Luedecke, D., Beck, E., Correll, C. U., & Wiedemann, K. (2018). Effectiveness of aripiprazole once-monthly in schizophrenia patients pretreated with oral aripiprazole: a 6-month, real-life non-interventional study. BMC psychiatry, 18(1), 365. https://doi.org/10.1186/s12888-018-1946-x

Soliman, E., Ranjan, S., Xu, T., Gee, C., Harker, A., Barrera, A., & Geddes, J. (2018). A narrative review of the success of intramuscular gluteal injections and its impact in psychiatry. Bio-design and manufacturing, 1(3), 161–170. https://doi.org/10.1007/s42242-018-0018-x

Strohfus P, Oya P, Tindell C & Paula M. (2018). The evidence calls for practice change in intramuscular injection techniques. Journal of Nursing Education and Practice, 8(2).

ORDER A PLAGIARISM-FREE PAPER HERE

Delusional Disorders
Pakistani Female With Delusional Thought Processes
Hispanic male

BACKGROUND

The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.

Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control,” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.

During today’s assessment, she appears quite calm and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She says she knows this because the television is telling her so.

She currently weighs 140 lbs., and she is 5’ 5.

SUBJECTIVE

Client reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.

A review of her hospital records shows that she received a medical workup from physician, who reported her to be in overall good health. Lab studies were all within normal limits.

Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.

MENTAL STATUS EXAM

The client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.

You administer the PANSS which reveals the following scores:

-40 for the positive symptoms scale

-20 for the negative symptom scale

-60 for general psychopathology scale

Diagnosis: Schizophrenia, paranoid type

RESOURCES

PANSS Scale. Available at: http://egret.psychol.cam.ac.uk/medicine/scales/PANSS

§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. doi:10.1093/schbul/13.2.261

https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

§ Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

§ Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625–629. Retrieved from http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

ORDER A PLAGIARISM-FREE PAPER HERE

Decision Point One
Select what you should do:

Start Zyprexa (olanzapine) 10 mg orally at BEDTIME
Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter
Start Abilify (aripiprazole) 10 mg orally at BEDTIME

USE THE CASE STUDY ABOVE TO DO THIS WORK.

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.

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.
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. 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.
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. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

ORDER A PLAGIARISM-FREE PAPER HERE

RUBRIC

  • 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.

9 (9%) – 10 (10%)

The response accurately, clearly, and fully summarizes in detail the case for the Assignment.

The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient.

2.)

Decision #1 (1–2 pages)

  • 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.

18 (18%) – 20 (20%)

The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.

3)

Decision #2 (1–2 pages)

  • 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.

18 (18%) – 20 (20%)

The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.

4.)

Decision #3 (1–2 pages)

  • 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.

18 (18%) – 20 (20%)

The response accurately and clearly explains in detail the decision selected.

The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected.

The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response.

The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients.

Examples provided fully support the decisions and responses provided.

4.)

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.

14 (14%) – 15 (15%)

The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient.

The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided.

5.)

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

6.)

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

7.)

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 (5%) – 5 (5%)

Uses correct APA format with no errors.

× How can I help you?