Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.

Posted: December 4th, 2022

Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.

Assignment 1- Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9
In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” once again as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a schizophrenia spectrum/other psychotic disorder.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.

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Learning Objectives
Students will:
• Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with schizophrenia spectrum and other psychotic disorders
• Recommend psychotherapy based on therapeutic endpoints for clients with schizophrenia spectrum and other psychotic disorders
• Identify medical management needs for clients with schizophrenia spectrum and other psychotic disorders
• Identify community support resources for clients with schizophrenia spectrum and other psychotic disorders
• Recommend follow-up plans for clients with schizophrenia spectrum and other psychotic disorders.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
QUESTION
To prepare for this Assignment:
• Select an adult or older adult client with a schizophrenia spectrum and other psychotic disorder you have seen in your practicum.
In 3–4 pages, write a treatment plan for your client in which you do the following:
• Describe the HPI and clinical impression for the client.
• Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
• Identify medical management needs, including primary care needs, specific to this client.
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
By Day 7

NOTE
ALL REFERENCES 5 YEARS OR LESS.

Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia and other psychotic disorder are characterized by changes in behaviors, perceptions,and thoughts of an individual which are considered to be out of contact with the reality. Schizophrenic patients make up 1% of the population,and it usually presents during early adulthood(Sadock, Sadock & Ruiz, 2014). It is a psychotic illness that presents difficulties in the performance of daily activities and maintenance of social ties between people. In general, psychotic disorders including schizophrenia disconnect the affected people from the real world that they live in. The schizophrenia spectrum is associated with catatonia, delusional disorder, schizoaffective disorder, and schizophrenia (Murphy, 2011). This paper explores a client diagnosed with schizophrenia spectrum and other psychotic disorders, her treatment options, community and medical needs as well as her follow-up plan.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
HPI and Clinical Impression
The client is a 26-year-old AA woman. She claims to be followed by people even at home. She encroaches herself in the corner of her apartment and claims that they know where she is and only waiting to get her. She reports having a secret that those people are looking for and they intend to open her skull to get it from her brain. She results in hiding in the closet, behind all the clothes to protect her brain as she believes that those people won’t see her. The clientpresents abnormal thought disorder and processes associated with schizoaffective disease and delusional disorders. Her social and occupational functionality is also affected.
Physical Assessment- Objective
The client presents no physical abnormalities and she is dressed and groomed according to the time and age.
Mental Status Examination (MSE)
The client is well groomed and dressed appropriately. She has a steady gait and normal psychomotor activity. She does not make eye contact and her speech is incoherent, irrelevant, disorganized and irregular. The client’s mood is anxious and has intrusive thoughts with increases impulse. The client is fearful of death and imaginary people. She has hallucinations and delusional thoughts.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Diagnosis
According to the DSM-5 criteria, schizophrenia spectrum and other psychotic disorders cause delusions, hallucinations and thoughts that affect the client’s social and occupational aspects (American Psychiatric Association. 2013). The client exhibits such symptoms which are associated with the fear of losing her mind and her being followed by imaginary people. She also presents disorganized thoughts and speech as well as abnormal behavior associated with catatonia.

Psychopharmacologic Treatments
Schizophrenia and other psychotic disorders are primarily treated using antipsychotic medications. These medications act by blocking the dopamine D-2 receptors which results in the improvement of the patient’s disorganization and positive schizophrenic symptoms(Ferreira et al., 2016). In this case, the client will receive a prescription of clozapine, a second-generation antipsychotic drug. This is because; the medication has been reported to have high toleration effects in many individuals and also demonstrates positive outcomes due to its increased efficacy (Stahl, 2014). Multiple researches from the medical databases have shown the effectiveness of this approach to delusional disorders, schizoaffective disorders, schizophreniform and schizophrenia (American Psychiatric Association, 2013).Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Psychotherapy Choices
Schizophrenia spectrum and other psychotic disorders are also managed using psychotherapy. This involves cognitive behavior therapies which seek to improve the thoughts, emotions,and behaviors of the patient. In this case, the client will be involved in individual, family and group therapies to enhance her lifestyle and social functionality(Gabbard, 2014). Family therapies will enable the family to care for Jamie at home as well as be able to cope with the distress associated with her condition. On the other hand, individual therapy will help her in understanding and accepting the illness and work in group therapies to gain coping skills. Group activities will involve physical activities and interaction through sharing of individual experiences. This will help in reducing symptoms of the client and enhance their participation in daily routine without delusions, reduce relapses and improve mental and physical wellbeing.
Medical Management Needs
Schizophrenia spectrum and other psychotic disorders are identified by primary care healthcare providers. Thisis achieved through diagnostic reasoning which examines the pathological factors of an individual to determine their symptoms. This will follow the collaborative efforts of the primary care provider with the mental and general health practitioners in diagnoses and formulation of treatment plans for the patient. This will prevent medical gaps which could result in misdiagnosis and occurrence of medical errors (Murphy, 2011).Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9. Moreover, it will support informed decision-making through the integration of multiple experts in the formulation of an evidence-based plan of treatment for Jamie. Consequently, they will create health awareness to the family and guide them on the coping skills necessary for such diseases.
Community Support Resources and Community Agencies Available
Community support services offer social, medical, physical and emotional support to clients with schizophrenia and other psychotic disorders. These include support groups, supported employment, community mental health team visits,and drop-in centers. Online based support groups are also essential in providing medical information and support to patients,and therefore, I would recommend the client to engage in their favorite programs.
Follow-up plan
Jamie will be given appointments a four-week appointment to assess her recovery progress. However, she will be engaged by her psychiatrist for 14 days for psychological therapies. She can also contact the practitioner via email or phone in the event of a worsened situation or for consultation. Failure of improvement, the severing of symptoms and adverse side effects should be reported immediately,and the client must present to the hospital immediately.
Conclusion
Schizophrenia spectrum and other psychotic disorders disconnect patients with external reality. They experience delusions, hallucinations and other symptoms which cause distress and affect normal productivity. The treatment options available include psychotherapies and pharmacotherapies as well as community support. Follow up plans helps in monitoring the patient’s recovery progress.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Ferreira, C. D., de Souza, M. G. D., Fernández-Calvo, B., Machado-de-Sousa, J. P., Cecilio Hallak, J. E., & Torro-Alves, N. (2016). Neurocognitive functions in schizophrenia: A systematic review of the effects of typical and atypical antipsychotic drugs. Psychology & Neuroscience, 9(1), 12–31. doi:10.1037/pne0000045
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications
Murphy, L. (2011, July 21). Types of schizophrenia – A day in the life (scary) [Video file]. Retrieved from https://www.youtube.com/watch?v=LWYwckFrksg
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.)
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press

Obsessive Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a chronic and significantly impairing disorder, characterized by distressing, unwanted obsessions and time-consuming and intense, recurrent compulsions (Sadock, Sadock & Ruiz, 2014). This assignment describes a client diagnosed with OCD and the pharmacological and psychotherapy treatments for the client. It also addresses the client’s medical management needs, community support resources available to help the client. The subsequent follow-up plans and partnership with other providers and ways to manage the client’s psychiatric disorder will be examined.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
HPI and Clinical Impression
Jean is a 30- year old female client with a university education and has a 6-year old daughter. The primary symptoms of the client included an intense fear of dirt and infections, and an irrepressible desire to clean her hands or clean all things, including floor and furniture at her workplace and home. The client was not able to manage her hand cleaning and frequently disinfected everything with alcohol. These obsessions and compulsions made it hard for Jean to work, and also caused severe worry and insomnia. Jean also compelled her daughter and spouse to carry out similar ritual behavior, and when they declined to perform these rituals, she became irritable and depressed. There was not a familial or personal history of psychosis or physical illness. The client reported that the intrusive thoughts initially occurred three years ago after the death of her grandmother as a result of an infectious disease. The client reported feeling frightened by contacting such infectious disease if her environment is not clean and fear of her daughter who might easily become sick form dirt.
The client reports of no prior psychiatric treatment and has no acute or chronic medical conditions. The client reports of a regular menstrual period and is heterosexual, but with no active sexual relationship at this time. The patient also denies any abuse from drug, alcohol or domestic issue.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Physical Assessment- Objective
The client appears well groomed of her stated age and with no noted physical ill effects.
Mental Status Examination (MSE)
A mental status examination revealed that the client is dressed appropriately and well groomed, with normal psychomotor activity and steady gait. The client makes fair eye contact, and with an intact association. The client’s speech is regular, coherent and relevant, and answers questions appropriately. Mood and affect is slightly anxious and constricted. The client reports of no suicidal or homicidal thoughts or ideation. Has moderate impulse control with intrusive thoughts of having to clean her environment to avoid dirt. The insight and judgment are fair and need to comply with treatment (Sadock, Sadock & Ruiz, 2014).Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Diagnosis
The Yale-Brown Obsessive compulsive scale was utilized to evaluate the client’s behavior symptoms, and the client had a baseline score of twenty-eight points, signifying obsessive-compulsive disorder (OCD). The client also exhibited compulsions with repetitive behaviors of hand washing and checking that she is dirt free and the client rigidly applies these behavior as rules in her life. Besides, the clients find the obsessive intrusive thoughts very upsetting of not sticking to them. Moreover, the obsessions cause the client to have clinically paramount distress, and these are not attributable to physiologic effects of substance abuse. The client, therefore, met the obsessive-compulsive disorder (OCD) diagnostic criteria according to the DSM-IV with recurrent and persistent thoughts that are being experienced with uncleanliness and unable to stop them (American Psychiatric Association. 2013).
Pharmacological treatments
Selective serotonin reuptake inhibitors (SSRIs) such as fluvoxamine, paroxetine, citalopram, and fluoxetine have been confirmed to be effective in the treatment of obsessive-compulsive disorder (OCD) disorder in adults. It is argued that SSRIs are more effective as they are administered for a prolonged period and in higher doses than those used in depression. SRRIs can help to reduce the OCD symptoms in the client through adjusting and increasing levels of serotonin in the brain and reduce the frequency and severity of compulsions and obsessions (Del Casale.et al. 2018). For instance, when using Fluvoxamine for the client, the initial dose to start will be 20mg daily in the morning. The client will be required to return to the clinic in two to four weeks to check for the therapeutic effect of the medication. If not effective, then there will be an increase in dosage slowly while bearing in mind the maximum dosage of 80mg/day. It is paramount to recognize that aggressive and early treatment of the patient, with an objective of remission, is crucial for a positive result (Stahl, 2014b).Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
On the other hand, if the treatment with SSRIs is effective, it must be sustained for one to two years or indefinitely. It is also asserted that guidelines propose administration of SSRIs for not less than one to two years after achievement of remission. Discontinuation of treatment after this duration must be considered carefully based on individual patient factors, entailing residual symptoms, duration, and severity of illness, history of reversion following discontinuation, and comorbidities (Janardhan Reddy, Sundar, Narayanaswamy & Math, 2017).Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Psychotherapy choices
Individual cognitive behavioral therapy (CBT), particularly exposure and response prevention therapy (ERP) can be an effective psychotherapy for the client. According to Fenske and Petersen (2015), exposure therapy entails exposure of patients to stimuli that provokes stimuli and then making them learn not to engage in compulsive actions in response. CBT must be applied to engage the client in the understanding of maladaptive and dysfunctional thoughts of obsessive and compulsive that is inadvertently affecting the clients social and daily functions (Sadock, Sadock & Ruiz, 2014).
Combination of individual CBT with motivational interviewing might also be more effective. Incorporation of motivational interviewing might augment commitment with therapy an increase its effectiveness. Cognitive behavior therapy (CBT) is the first line psychological therapy for obsessive-compulsive disorder (OCD), with exposure and response preventive therapy (ERP) as the most significant constituent of cognitive behavioral therapy as well as belief modification. It is noted that, in patients with mild and moderate OCD, CBT/ERP monotherapy is recommendable, a combination of SRRI and CBT is recommended for patients with severe OCD (Janardhan Reddy, Sundar, Narayanaswamy & Math, 2017).
Medical Management Needs Specific to the Client
Medical management needs of the patient might vary at numerous phases along with the severity of the illness. The requirements of this particular client are needs associated with the symptoms, family, and treatment. Patients with obsessive-compulsive disorder (OCD) might report distress in coping with symptoms. Generally, the needs of OCD patients are parallel to the needs of the psychiatrist and the family, because they all want the disappearance of symptoms (Prasko et al., 2016).Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Medical management needs connected with symptoms include an excellent partnership with the therapists, augmenting of insight for the client and her family and enduring persistent symptoms. Besides, the needs associated with the client’s treatment will include family support, timely identification of the illness, along with encouragement to undergo treatment. Long-term needs include elimination or reduction of OCD symptoms along with proper treatment. It is essential to search for optimal treatment and ensure the patient adheres to it to meet those needs (Reckrey et al., 2015).
Community Support Resources and Community Agencies Available for Assistance
Obsessive-compulsive disorder (OCD) patients have impairments in social, cognitive, family, personal and vocation dysfunctions. Social dysfunction is a significant barrier to the social life of a person with OCD. Community, treatment centers, support groups, and telephone helplines help in providing an atmosphere for the clients with obsessive compulsive disorder and their families to meet to receive and provide support for one another . Patients are presented with information on self-management skills as well as coping strategies (Sahoo, Sethy & Ram, 2017).Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Taking part in group particularly Obsessive-compulsive disorder (OCD) support groups for families can lessen feelings of powerlessness and isolation because as the client shares her challenge with others, she will become more empowered and connected. It is also counseled that providing educational information for patients and their families and community resources can assist with social stabilization and adherence to treatment (Carron-Arthur et al., 2016).
Plan for follow-Up Intensity and Frequency and Collaboration with Other Providers
A follow-up is necessary for monitoring the way the patient responses to treatment and possible adverse effects like serotonin syndrome along with scheduling for subsequent treatment trial in case the original treatment do not generate satisfactory improvement A follow-up is also in all through the duration of the illness and treatment. The client will be referred to see her primary care physician while taking those medications in checking her liver and renal functions. This because the patient who has renal and hepatic impairments will need a lower initial dose of the drug and a slower titration of increment of dosages. However, the client will also be tested for a pregnancy test before the initial administration as exposure to SSRIs during pregnancy may be connected with heightened risk for of septal heart defects of the offspring (Stahl, 2014b)
Outpatient treatment is ordinarily adequate for the majority of patients with mild or moderate illness and for patients with a high likelihood of adhering to treatment. Clients might be followed up at cyclic intermissions firstly once or twice a month, and consequently at longer intermissions based on treatment tolerability along with adverse effects (Janardhan Reddy, Sundar, Narayanaswamy & Math, 2017).
In-patient treatment might be considered for patients at a higher risk of suicide, and intolerant to therapeutic side-effects. If the patient does not respond to trials of two or more SSRIs, she must be referred to a psychiatrist for further evaluation. I will work in close collaboration with other providers such as the primary care physicians, and other psychiatrists to formulate and implement the treatment plan for the client and deliver exceptional care (Janardhan Reddy, Sundar, Narayanaswamy & Math, 2017).
Conclusion
Obsessive-compulsive disorder (OCD) is a disorder that requires timely diagnosis and treatment. SSRIs and individual cognitive behavior therapy (CBT) are the most effective treatment options for the client. Since the client has severe OCD, a combination of CBT and SRRIs is recommended. Although SRRIs may be stopped after one to two year of continual remission, the client might need continued treatment with SSRIs to prevent relapse. A follow-up is necessary to monitor the patient’s response to treatment and possible adverse effects (Sadock, Sadock & Ruiz, 2014).

Introduction
Schizophrenia and other psychotic disorder are characterized by changes in behaviors, perceptions,and thoughts of an individual which are considered to be out of contact with the reality. Schizophrenic patients make up 1% of the population,and it usually presents during early adulthood(Sadock, Sadock & Ruiz, 2014). It is a psychotic illness that presents difficulties in the performance of daily activities and maintenance of social ties between people. In general, psychotic disorders including schizophrenia disconnect the affected people from the real world that they live in. The schizophrenia spectrum is associated with catatonia, delusional disorder, schizoaffective disorder, and schizophrenia (Murphy, 2011). Various research link genetic and environmental factors as well as psychosocial stress and neurobiology with the development of schizophrenia spectrum and other psychotic disorders even though the exact cause is yet to be known.
HPI and Clinical Impression
The client is a 26-year-old AA woman. She claims to be followed by people even at home. She encroaches herself in the corner of her apartment and claims that they know where she is and only waiting to get her. She reports having a secret that those people are looking for and they intend to open her skull to get it from her brain. She results in hiding in the closet, behind all the clothes to protect her brain as she believes that those people won’t see her.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9. The client, therefore, presents abnormal though disorder and processes associated with schizoaffective disease and delusional disorders. Her social and occupational functionality is also affected,andthus, she fits in the DSM-5 criteria for diagnosing schizophrenia spectrum and other psychotic Disorders.
Psychopharmacologic Treatments
Schizophrenia and other psychotic disorders are primarily treated using antipsychotic medications. These medications act by blocking the dopamine D-2 receptors which results in the improvement of the patient’s disorganization and positive schizophrenic symptoms(Ferreira et al., 2016). In this case, the client will receive a prescription of clozapine, a second-generation antipsychotic drug. This is because; the medication has been reported to have high toleration effects in many individuals and also demonstrates positive outcomes due to its increased efficacy (Stahl, 2014). Multiple researches from the medical databases have shown the effectiveness of this approach to delusional disorders, schizoaffective disorders, schizophreniform and schizophrenia (American Psychiatric Association, 2013).Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Psychotherapy Choices
Schizophrenia spectrum and other psychotic disorders are also managed using psychotherapy. This involves cognitive behavior therapies which seek to improve the thoughts, emotions,and behaviors of the patient. In this case, the client will be involved in individual, family and group therapies to enhance her lifestyle and social functionality(Gabbard, 2014). Family therapies will enable the family to care for Jamie at home as well as be able to cope with the distress associated with her condition. On the other hand, individual therapy will help her in understanding and accepting the illness and work in group therapies to gain coping skills. Group activities will involve physical activities and interaction through sharing of individual experiences. This will help in reducing symptoms of the client and enhance their participation in daily routine without delusions, reduce relapses and improve mental and physical wellbeing.
Medical Management Needs
Schizophrenia spectrum and other psychotic disorders are identified by primary care healthcare providers. Thisis achieved through diagnostic reasoning which examines the pathological factors of an individual to determine their symptoms. This will follow the collaborative efforts of the primary care provider with the mental and general health practitioners in diagnoses and formulation of treatment plans for the patient. This will prevent medical gaps which could result in misdiagnosis and occurrence of medical errors (Murphy, 2011). Moreover, it will support informed decision-making through the integration of multiple experts in the formulation of an evidence-based plan of treatment for Jamie. Consequently, they will create health awareness to the family and guide them on the coping skills necessary for such diseases.
Community Support Resources and Community Agencies Available
Community support services offer social, medical, physical and emotional support to clients with schizophrenia and other psychotic disorders. These include support groups, supported employment, community mental health team visits,and drop-in centers. Online based support groups are also essential in providing medical information and support to patients,and therefore, I would recommend the client to engage in their favorite programs.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Follow-up plan
Jamie will be given appointments a four-week appointment to assess her recovery progress. However, she will be engaged by her psychiatrist for 14 days for psychological therapies. She can also contact the practitioner via email or phone in the event of a worsened situation or for consultation. Failure of improvement, the severing of symptoms and adverse side effects should be reported immediately,and the client must present to the hospital immediately.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.
Conclusion
Schizophrenia spectrum and other psychotic disorders disconnect patients with external reality. They experience delusions, hallucinations and other symptoms which cause distress and affect normal productivity. The treatment options available include psychotherapies and pharmacotherapies as well as community support. Follow up plans helps in monitoring the patient’s recovery progress.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.