Assessing and Treating Clients With Psychosis and Schizophrenia.

Posted: November 22nd, 2022

Assessing and Treating Clients With Psychosis and Schizophrenia.

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.
The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.Assessing and Treating Clients With Psychosis and Schizophrenia.

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At each decision point stop to complete the following:

Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.Assessing and Treating Clients With Psychosis and Schizophrenia.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659.Assessing and Treating Clients With Psychosis and Schizophrenia.
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

Assessing and Treating Clients with Psychosis and Schizophrenia
Introduction
The focus of this paper is on a client diagnosed with Schizophrenia, paranoid type as characterized by delusional and paranoid thought process and impaired insight and judgment. The PANSS revealed that the client has -40 for the positive symptoms; -60 for general psychopathology; and -20 for the negative symptom. Accordingly, three decisions will be made regarding the drugs to prescribe to the client and the rationale provided. Additionally, the ethical considerations likely to affect the client’s treatment plan will be discussed.
Decision Point One
Start InvegaSustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter
Rationale for Selecting the Decision
The reason for selecting InvegaSustenna is because an injection will ensure adherence to treatment because the client has already shown non-compliance with Risperdal and she has fears that she might be poisoned by her husband (delusions) (Fang et al, 2016). The client may therefore not adhere to any other oral medication making InvegaSustenna 234 mg intramuscular the most suitable option. Secondly, InvegaSustenna has been shown to be effective in the treatment of schizophrenia paranoid type and well tolerated (Helland& Olav, 2017).Assessing and Treating Clients With Psychosis and Schizophrenia.
The reason for not selecting Zyprexa 10mg and Abilify is because these two choices were oral medications and the client may not adhere to treatment regimen as indicated by non-compliance to Risperdal due to the delusions(Safaviet al, 2016). In addition, these medications are associated with side effects such as dizziness, memory problems, general weakness, constipation, among other side effects (Safaviet al, 2016).
Expected Outcomes
InvegaSustenna is an effective antipsychotic and hence the expectation is that the symptoms the client is experiencing will significantly reduce as manifested by reduced hallucinations, delusions and paranoid feelings(Fang et al, 2016). In addition, it is expected that the client will tolerate the medication and will, therefore, have no or minimum side effects.Assessing and Treating Clients With Psychosis and Schizophrenia.
Difference between Expected Outcome and Results of the Decision
Just as it was expected, there was significant symptom improvement as indicated by reduced PANSS score. This is because the medication is an effective antipsychotic (Helland& Olav, 2017). In addition, the client tolerated the medication well as she did not report any side effects. However, the client reported increased weight; this can be attributed to the side effect of InvegaSustenna. Additionally, the client reported experiencing difficultyin sitting after the injections. This can be attributed to injury to the sciatic nerve when dorsogluteal region is used for IM(Nakajima et al, 2017).

Decision Point Two
Continue same decision made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward
Rationale for Selecting the Decision
This decision was selected because InvegaSustenna is an effective antipsychotic and it is improving the client’s symptoms as indicated by the reduced PANSS score(Helland& Olav, 2017). In addition, the injection side was changed to deltoid because the client complained of being uncomfortable after injection. Administration of medication using dorsogluteal muscles is associated with likely injury to the sciatic nerve and hence the reason the site was changed to the deltoid to reduce this risk (Nakajima et al, 2017).Assessing and Treating Clients With Psychosis and Schizophrenia.
The option to discontinue InvegaSustenna and begin Haldol Decanoate was not selected because there are no clinical reasons to do so. The option to add Abilify to InvegaSustenna was not selected because there is no reason for augmenting the treatment. In addition, the client may not adhere to the treatment regimen with the other options due to her psychotic symptoms(Helland& Olav, 2017).
Expected Outcomes
This decision hoped that the client will continue indicating significant symptom improvement because the medication is an effective antipsychotic(Helland& Olav, 2017). It is also expected that the client will not experience any discomfort after administration because the deltoid side does not pose the risk of nerve injury (Nakajima et al, 2017). It is also expected that the client will tolerate the medication.
Difference between Expected Outcome and Results of the Decision
Just like expected, there was significant symptom improvement as indicated by the reduced PANNS score by 50%. This is attributable to the efficacy of the medication in treating psychotic symptoms (Fang et al, 2016). Secondly, the client did not experience significant pain at the injection site. However, the client reported significant weight gain which is attributable to the side effect of the medication (Fang et al, 2016).
Decision Point Three
Continue with the InvegaSustenna and have the client educated regarding weight gain from InvegaSustennaand make an appointment with a dietician and an exercise physiologist.Assessing and Treating Clients With Psychosis and Schizophrenia.

Rationale for Selecting the Decision
This decision was selected because other medications with the same efficacy as InvegaSustenna are associated with more weight gain than this one (Fang et al, 2016). Therefore, InvegaSustenna has minimal weight gain when compared to other medications of similar efficacy. The dietician and an exercise physiologist will help the client in weight control.
Expected Outcome
Selecting this decision hoped that the client will continue showing symptom improvement and that she will adhere to the treatment regimen (Fang et al, 2016). It is also expected that the dietician and exercise physiologist will help the client in preventing significant weight gain.
Ethical Considerations
Ethical aspects for the client include autonomy and decision-making capability. Patients with psychotic symptoms like the client may have impaired judgment and this may interfere with the ability to making decisions regarding their treatment(Noordsy, 2016). Additionally, the client has not adhered to treatment before; therefore, the client may also not adhere to the current treatment regimen and this brings in the issue of respecting the client’s autonomy to accept or refuse treatment (Noordsy, 2016).Assessing and Treating Clients With Psychosis and Schizophrenia.