Wk6Assgn copy - Psychosis and Schizophrenia PDF

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Psychosis and Schizophrenia
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Assessing and Treating Clients with Psychosis and Schizophrenia

Master's in Science of Nursing, Walden University NURS 6630N – 33 Dr. Aaron Weiner October 9, 2020

Psychosis and Schizophrenia

2 Psychosis and Schizophrenia affect about 1% of the general population (Olper et al., 2017). There are several treatments and care options for individuals with these illnesses. Psychosis affects brain cells, which, in turn, affects individuals' thoughts. It is essential to find the correct medication regimen that will benefit people with psychosis. This paper aims to select a treatment with the most significant benefit and the least harm for this Pakistani woman with delusions.

Decision Point 1: Start Invega Sustenna 234mg intramuscular x1 followed by Invega Sustenna 156mg intramuscular on day four and every thirty days after that.

I chose this decision because of this Pakistani female as a history of not being compliant with psychotropics, partly due to her delusions and paranoid behavior. Invega Sustenna is also known as paliperidone, all under the antipsychotic class of medications. Paliperidone is attributed to the antagonism of the dopamine (D2) and serotonin 5-HT2A receptors in the brain, which means readjusting the balance of chemicals in mind-controlling symptoms of Schizophrenia and delusions related to psychosis (Rabinowitz et al., 2017). The treatment goal in prescribing this medication is to decrease the PANNS score with minimal to no side effects (Rabinowitz et al., 2017). After four weeks of receiving Invega Sustenna 156mg intramuscular, the patient returns for her follow up visit. The decision for monthly medication injections proves to be the correct choice. The PANNS score improved by 25%, along with a significant decrease in symptoms. Her support system is her husband, who accompanies her to follow up visits, ensuring she continues taking her monthly Invega Sustenna. However, she verbalizes pain at the injection site and an

3 increase in her weight by two pounds. Education was given regarding various injection sites such as the deltoid muscle that may decrease pain. Will continue to monitor weight and reassess on the next follow up visit. Due to the client's four-week progress of reducing the PANNS score by 25% and decreasing symptoms, a change in medication is not required. At this time, the decision to continue the medication regimen without change is ordered.

Decision Point 2: Continue the same medication regimen but to change injection to the deltoid

After four weeks of continuing Invega Sustenna 156mg IM to her deltoid, the patient comes in for a follow-up visit. The client improved her PANNS score another 25%, which means the score has been enhanced by 50% since her initial visit. She no longer has complaints of pain since the injection site was changed to the deltoid. However, she comes in today without her husband with concerns about her weight. The client gained a little over two pounds with a total weight gain of four in half pounds thus far. She says she feels her husband might not be accepting of this gradual gain in her weight. No other side effects were voiced. As stated above, Invega Sustenna falls under the class of atypical antipsychotics. One of the side effects is weight gain. It is expected to gain some poundage while on this medication (Stahl, 2014b). However, it is important not to dismiss the client's concerns of weight gain. Educating the patient to continue the medication regimen shows encouragement and reinforcement of the eight weeks' progress. Also, referring her to see a dietician about the four pounds gained within the past few months can assist with better food choices and a possible exercise program to maintain weight.

4 The hopes of improved results with continued regimen proved to be a success. Due to the clients continued success and significant improvement, no change in the medication regimen is ordered. Continue with the current order of Invega Sustenna 156mg intramuscular to the deltoid monthly. A follow-up appointment in four weeks.

Decision Point 3: Continue Invega Sustenna 156mg intramuscular to deltoid monthly and follow-up appointment monthly

Continuing the medication for this Pakistani female in this case study is shown to be the correct decision. I did not choose to add Abilify, nor did I decide to add Qysmia for these reasons. Abilify's ability to bind to dopamine receptors takes longer than Invega Sustenna (Stahl, 2014b). Also, Abilify has to be taken orally for two weeks before taking the Abilify Maintena injection. Totaling 30 days of oral and injection medication consumption before achieving therapeutic effects (National Alliance of Mental Illness, n.d.). As for adding Oysmia to the medication for weight loss is irrelevant at this time. The client is 5'5" weighing 140 lbs. with a BMI of 23, which is average. She gained a little over four pounds. This weight gain is not significant enough to warrant adding a weight control medication. This option can be revisited later if continued weight gain persists and BMI greater than 30. Referring the client to a dietician is the best option. Changing diet and adding an exercise regimen will lose the four pounds gained and maintain the original weight. I would also refer her to a psychologist. The psychologist will address her thoughts and concerns about her husband, not liking her weight gain. Conclusion

5 When initiating treatment for a patient, it is essential to know that individuals will respond differently to medications. Some will respond positively, as others may experience side effects, either mild or moderate. In this case scenario, Invega Sustenna injection was prescribed to this Pakistani female with absolute positive results. She was fortunate not to have experienced severe adverse effects such as Neuroleptic Malignant Syndrome (NMS), cardiac, metabolic, or seizures noted. For that would have resulted in a change of medicine that may often be a long and painful trial and error process.

References National Alliance of Mental Illness. (n.d.). Aripiprazole (Abilify). Retrieved October 9, 2020. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-

6 of-Medication/Aripiprazole-(Abilify) Opler, M., Yavorsky, C., & Daniel, D. G. (2017). Positive and negative syndrome scale (PANSS) training: Challenges, Solutions, and Future Directions. Innovations in Clinical Neuroscience, 14(11-12), 77–81. Rabinowitz, J., Schooler, N. R., Anderson, A., Ayearst, L., Daniel, D., Davidson, M., Khan, A., Kinon, B., Menard, F., Opler, L., Opler, M., Severe, J. B., Williamson, D., Yavorsky, C., Zhao, J. (2017). Consistency checks to improve measurement with the positive and negative syndrome scale (PANSS). Schizophrenia Research, 190, 74–76. https://doi.org/10.1016/j.schres.2017.03.017 Stahl, S. M. (2014b). The prescriber's guide (5th ed.). New York, NY...