(Solved) NURS 6630 Week 7 Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia; 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

(Solved) NURS 6630 Week 7 Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia; 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 Assessing and Treating Patients with Psychosis and Schizophrenia Course: NURS-6630- Psychopharmalogical Approaches to Treat Psychopathology Week 7: Assignment Walden University Introduction The provided case study is of 34 years old Pakistani woman who was diagnosed as “brief psychotic disorder” during her 21 days hospitalization. Patient is married (her husband was selected for her when she was 9 years old). Patient has 4 children. Patient got settled in United States after getting married in her 20’s. She was diagnosed as psychotic because the psychosis persisted for less than one month. Her husband reported that she believed that she is Prophet Mohammad and she gets messages from Allah through TV. He also reported that one evening she got out of control due to which he called police and as a result she got admitted as an inpatient in psych unit. She was asked about that incident but she denied by saying that “the entire incident is blown out of proportion”. She also denied about her believe that she is a prophet and stated that her husband is making these statements about her because he wants to get rid of her as he never loved her and he always wanted an American wife. She added that she knows the intentions of her husband because TV is telling her so. During hospitalization she was taking Risperdal but after getting discharged, she stopped taking Risperdal (about a week ago) because she thinks that through Risperdal her husband will poison her so that he can marry an American wife. The pertinent positive information that will impact the decision making when prescribing medication for this patient includes diagnosis of paranoid type Schizophrenia, scores of PANSS (40 for positive symptoms, 20 for negative symptoms and 60 for psychopathology), symptoms of Schizophrenia (persistent reflection of paranoid and delusional thought processes, presence of auditory hallucinations, slow speech, no demonstrations of tics, gestures and mannerism, judgment and insight is impaired), incompliant behavior towards medications, lab studies showing good health, BMI of patient is 23.29 (weight is 140 lbs and height is 5’5”) which indicates that patient is not underweight or overweight and patient denied homicidal or suicidal ideation. Assessing and Treating Patients with Psychosis and Schizophrenia Decision 1 The selected decision one is “start Invega Sustenna 234mg IM followed by 156mg IM on day 4 and monthly thereafter”. I selected this decision by considering the noncompliant behavior and scores of PANSS. Invega Sustenna is also known as Paliperidone which is recommended to schizophrenic patients in the form of injectable (Sustenna- injection administered after one month interval and Trinza- injection administered after three months interval). According to the study of Chang, Huang and Yang (2021) the major problem of schizophrenic patients is their non-compliant behavior towards the treatment. As the patient shows non-adherence to treatment therefore, achievement of desired outcomes becomes difficult. In such scenarios, it is recommended that long-acting injections should be prescribed as compared to oral antipsychotics. The study of Chang, Huang and Yang (2021) clearly indicated that those patient with schizophrenia who are treated by long-acting injections show reduced rates of re- hospitalization and noncompliance as compared to those patients with schizophrenia who are treated by oral antipsychotics. Considering this fact, the Invega Sustenna is selected for decision one because the background information of this patient has shown her noncompliant behavior towards treatment. Moreover, Invega is selected for decision one because it is an effective antipsychotic with increased safety profile. The studies of Chang, Huang & Yang (2021), Kverno & Rozenberg (2021) and Canady (2019) have briefly discussed that drugs like Invega possess superior efficacy in reducing both negative and positive symptoms of schizophrenia. This drug possess low risk of causing extrapyramidal effects. Patients treated with Invega have shown lower weight gain, lower relapse rates, lower withdrawal rate, better cost-benefit ratio and increased tolerability and safety. The other option of Zyprexa was not selected because of its mode of administration (which is oral) and reduced safety profile. According to the study of Krzystanek et al (2019) the noncompliance behavior of schizophrenic patients is associated with worsening of PANSS scores and therefore the medication should be selected on the basis of mode of administration. The study also mentioned that Olanzapine is an effective medication with good tolerability but as the schizophrenic patients show noncompliant behavior towards oral treatment regimen therefore such medications fail to produce the desired outcomes. The study of Li et al (2020) had discussed that olanzapine-induced dyslipidemia with schizophrenia is characterized by increased levels of plasma triglycerides, total cholesterol and low density lipo-proteins. This indicates that Zyprexa possess the tendency of improving cholesterol levels and therefore increases BMI of patient. Due to this side effect, Zyprexa requires continuous monitoring of cardiovascular status because increased lipid profile has reduced the safety profile of drug and has increased the risks of developing cardiovascular complications. Although the presented patient is not obese but getting obese due to Zyprexa and its oral mode of administration can cause her to withdraw from the treatment plan. Similarly, the third option of Abilify was also not selected because of its mode of administration (oral) and its side effect of sedation or sleep disturbance. The studies of Suba & Yetkin (2019) and Kobayashi & Takano (2018) have mentioned that Abilify (also known as Aripriprazole) induce sleep related eating disorder and affects the regulation of sleep-wake system. The study of Suba & Yetkin (2019) has thoroughly discussed that drugs like Abilify cause sedation by increasing the activity of systems that provide sleep or by reducing the activity of systems that provide alertness. It means that this drug is prone to develop sleep disorders. By making the decision of Invega Sustenna injectable, I was hoping that after four weeks patient will come and will show that her PANSS scores have reduced and she is responding to medication with good tolerability (Canady, 2019). Decision 2 For decision two I selected “continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward”. I selected this decision because of the results of decision one. As the patient came after four weeks and showed decreased in PANSS scores of 25% (in positive symptoms). Patient also showed good tolerability. However, patient reported 2 pounds of weight gain but it does not seem to bother her. The only complaint made by patient is injection- site pain. As the patient showed positive response towards decision one along with good tolerability therefore, the medication is not changed. Instead, the injection site is changed and the nurse is instructed to administer the injection into the deltoid muscles. According to the study of Zolezzi et al. (2021) long-acting injectable are introduced for the treatment of schizophrenia because of increased rates of noncompliant behavior showed by schizophrenic patients. The most common side effect of these injections is pain at injection site. Specifically, if the injection is administered via gluteal region, then the pain intensity is more because a significant percentage of drug shows poor absorbance within the gluteal muscles that cause pain. It means that administration of injectable via gluteal region contributes to the loss of drug and the complete dose of drug is not delivered. As a result, the complete efficacy of the treatment plan is not achieved. Therefore, deltoid region is recommended for Intramuscular (IM) injectable because deltoid muscles show increased absorbance as compared to gluteal muscles. The study of Zolezzi et al. (2021) has discussed that deltoid muscles are used for injecting long- acting injectable because it is viewed by patients as less intrusive than the gluteal injection site. The other option of “DC Invega Sustenna and start Haldol Decanoate” was not selected because the patient showed positive response towards the decision one. The other medications would be considered if the patient had failed to show reduction in symptoms. Moreover, Haldol Decanoate is reported to cause severe neuromuscular disorders and tardive dyskinesia is the prominent side effect of Haldol Decanoate. According to the study of Khelfi et al. (2018) the Anti-Poisoning Centers of Algiers have reported that Haldol (also known as Haloperiodl) is the most effective inducer of causing neuromuscular and muscular disorders among all antipsychotics. Due to poor safety profile of Haldol Decanoate, this drug was not selected for decision one. Moreover, the treatment algorithm of Schizophrenia have indicated that if one drug shows positive response without causing any side effect then it should not be changed or an alternative treatment plan should not be considered until the patient reports serious side effects. According to the study of Remington et al. (2017) if the patient shows resolution of positive symptoms then the treatment plan should be maintained with the same antipsychotic medication for 5 years or longer until the patient reports no serious issues. As the presented case study has mentioned that patient is showing resolution of symptoms (indicated by reduction in PANSS scores), therefore on the basis of pharmacotherapy guideline, the medication Invega Sustenna will not be discontinued and any other medication (including, Haldol Decanoate) would not be recommended until the patient reports any serious side effects.