Walden University Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N

Whether one passes or fails an academic assignment such as the Walden University Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N

The introduction for the Walden University Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

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How to Write the Body for Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N

After the introduction, move into the main part of the Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N

Psychosis and Schizophrenia are both mental health conditions. Schizophrenia is one of the causes of psychosis with other additional causes being bipolar disorder, depression, and dementia. Notably, the two conditions tend to alter the normal state of the brain. Consequently, those who suffer from the condition are not capable of maintaining a good relationship or interaction with colleagues at a workplace, school, and even friends in a social gathering. Some of the additional symptoms that are often evident amongst those suffering from the two conditions include delusions and hallucinations.

Despite their prevalence amongst the aged, especially those above 60 years, the symptoms of the two conditions can be effectively controlled (Remington et al., 2017). Positive and Negative Syndrome Scale (PANSS) is a diagnostic procedure that clinical psychologists can utilize in the management of symptoms related to the condition. Stahl (2013) advances that the effectiveness of the medicine issued to the patient and their tolerance levels impact the medication therapy after the diagnostic tests and procedures have been established.

This paper examines a Pakistani female adult suffering from psychosis and schizophrenia who has been taken through the diagnostic tests. The scores of the patient, according to PANSS are, 40, 20 and 60 for positive symptoms, negative symptoms, and general psychopathology respectively. The options for medication are also discussed in this paper as well as the ethical considerations for the nurse.

First Decision Point

Start Abilify (aripiprazole) 10 mg orally at BEDTIME

Justification

The Positive and Negative Syndrome Scale score of the patient affirms that she suffers from Schizophrenia, which is then responsible for the paranoid feelings that she develops. According to Stahl (2014b), Abilify is the first medication that needs to be granted to a patient who has schizophrenia. The chemical compound of the drug, known as Aripiprazole, works by balancing serotonin and dopamine within the brain in order to enhance behavior, mood, and thinking. The choice of the drug is premised on the minimal adverse effects that it may present to a patient. Also, aripiprazole has a favorable tolerability compared to other atypical antipsychotics that have been approved for schizophrenia. The medication is also highly effective in achieving the required therapeutic concentration within a duration of five to seven days. Studies have also revealed that Abilify contains a lower risk of increased prolactin as well as prolongation concerning the interval of the QTc, hence making it preferable to the given options. Lastly, a monotherapy comprised of Aripiprazole has the capacity to manage the symptoms of cognitive, negative, and positive symptomatology of schizoaffective disorder and schizophrenia.

On the other hand, Abilify is preferable over Zyprexa since the latter has low efficacy despite its tolerance levels being similar to that of Abilify. In fact, Zyprexa has been shown to have adverse events such as weight gain within the first four weeks of administration, which disqualified it from consideration (Harvey, James, & Shields, 2016). Further, the usage of Zyprexa raises the risk of metabolic syndrome in schizophrenic patients such as the Pakistani woman in this case.

Invega Sustenna has also been left out of the existent options since it is relatively inconvenient to administer compared to Abilify, and its tolerance levels are relatively lower. Further, Invega Sustena also increases the risk of weight gain in patients suffering from schizophrenia. Whereas it is more effective compared to Abilify, the inconvenient mode of administration and associated adverse effects such as head ache, tarchycardia, sexual dysfunction, and other extrapyramidal side effects makes it difficult to prescribe to the Pakistani woman (Leucht et al., 2013). Such leaves Abilify as the ideal medication to utilize for the patient.

Expected Results

For a patient taking Abilify medication, her condition needs to indicate an improvement within the second week of taking the drug. Therefore, in the third week, schizophrenia symptoms need to be less severe compared to their current state. Some of the expected results at the end of the fourth week include a reduction in hallucination and being paranoid and an improvement in judgment and insights that the patient exudes (Leucht et al., 2013). Thus, by the fourth week, the PMHNP expects the Pakistani woman to show improvements in her symptoms.

Difference between Expected and Actual Results

Hallucinations and delusions are still existent at the fourth week of the treatment. The incidences of the patient dozing off often are an indication that her concentration levels have become even lower. Therefore, it can deduce that there are no positive or expected results that are got out of taking the Abilify medication. The reason that this has happened to the patient could be attributed to a lack of response to Abilify or existence of concentrations of the drug beyond the therapeutic levels. All of these may be related to the genetic make-up of the patient.

Second Decision Point

Decision

Discontinue Abilify and start Geodon (ziprasidone ) 40 mg orally BID with meals

Justification

The medics have the discretion of discontinuing a given medication where it is affirmed that it is not useful in the treatment of a patient. Such is the basis upon which Abilify has been abandoned in the treatment process. Indeed, the discontinuation of Abilify from its supposed therapeutic dosage of 40mg of Geodon follows the standard protocol for the management of schizophrenia. The usage of Geodon 40 mg with meals is important since its absorption increases to optimal levels (Peng & Deng, 2017).

Further, the steady-state plasma concentration of the drug occurs 1-3 days after oral administration, which hastens its activity. Studies have demonstrated efficacy in the usage of Geodon within the dose range of 20-100 mg. The drug undergoes extensive metabolism to its active compound while its bioavailability is also high, making it effective for schizophrenia management.

Further, the drug does not have anticholinergic side effects owing to its insignificant affinity to the mACh receptor (Su, Lu, Shi, & Xu, 2018). Reducing the dosage of Abilify to 75 mg is not advisable as the symptoms of schizophrenia will persist even as the side-effects reduce. Further, the nurse cannot change the administration to AM as the some of the side-effects will remain while only slight improvements will be noted. Therefore, the correct decision at this point is to introduce ziprasidone while discontinuing Abilify.

Expected Results

The introduction of Gedeon would lead to the lessening of schizophrenic symptoms that the patient exudes in addition to minimizing or eliminating the adverse effects. The hallucinations that the patient experiences are also expected to reduce (Stahl, 2013).The patent improvement will be monitored after eight weeks of being under medication. Importantly, the scores in the Positive and Negative Syndrome Scale are expected to be lower compared to the time upon which the first scores were taken. The next appointment will be four weeks after commencement of the Geodon medication.

Differences between Expected and Actual Results

Based on the client account, there is a general improvement that she realizes when the Geodon medication is introduced. When taking the PANSS score as the 4th week, there was a reduction of 40% compared to the earlier scores that had been recorded as at the commencement of the medication. This is consistent with the expectations of the PMHNP when they changed the first antipsychotic therapy. However, unseen by the PMNHP, a critical issue that has been noted based on the 4th-week visit is the struggle that the patient has in complying with the drug. Therefore, headed to the remaining duration of taking the Geodon medication, it will be ideal to address the issue of compliance.

Decision Point Three

Selected Decision

Give her a few test doses of Risperdal 1 mg orally BID for 3 days to see if she tolerates the medication. If tolerated, start Invega Sustenna at an appropriate starting and maintenance dose

Justification

The oral therapy is proving to be effective, yet the patient is struggling with finding compliance for the Geodon medication. Such justifies the reason for shifting the patient from the Geodon medication to Invega Sustenna (Remingotn et al., 2017). However, in the event where the patient shows negative results with regards to tolerance of 1g Risperdal medication, it would be ideal to maintain Geodon medicines and increasing the dosage that is issued by the patient.

Expected Results

The two critical expectations of the decision include adherence to the Invega Sustenna and the reduction in the schizophrenic symptoms that the patient exudes (Alphs et al., 2015). Unlike with Gedeon, the Pakistani woman is expected to adhere to the Invega Sustenna as she tolerated the Risperdal 1 mg dose. Therefore, the choice would be ideal in improving the quality of life of the patient under medication as her PANSS scale rating is expected to demonstrate further improvements in the symptoms of Schizophrenia.

Differences between Expected and Actual Results

The decision to introduce Invega Sustenna is consistent with the manufacturer’s advice and even standard procedure for the treatment of schizophrenia. The essence of the third decision is influenced by the extent to which the patient tolerates the Invega Sustenna medication and compliance. Importantly, the decision premises on the tolerance levels to the Invega Sustenna and since that determination was made, it became ideal to choose the decision.

Ethical Consideration

The third decision is premised on the tolerance of the patient to the Invega Sustenna. Invega Sustenna will only replace Geodon based on its positive tolerance by the patient. Importantly, the nurse will need to discuss with the patient the side effects that are likely to take place owing to the change in treatment then enable the patient to make an informed decision on the choice of medication to continue with (Stahl, 2014b). In other words, the PMNHP will have to collaborate with the patient as they change from one therapy to another by giving them reasons for doing so. Moreover, the nurse is expected to share with the patient these decisions in order to ensure compliance out of the patient as they will feel part of the decision

Conclusion

Schizophrenia is a mental health condition that impacts both the patient and the people close to the patient. Of critical importance is the accurate diagnosis of the situation and making decisions that would lead to the overall improvement in the quality of life of the patient. Conducting regular Positive and Negative Syndrome Scale tests is essential in ascertaining the response of the patient. Importantly, before commencement of therapy, there is a need to adhere to ethical codes of medical practice, including the determination of the side effects of a given medication and discussing such with the patient.

References

Alphs, L., Benson, C., Cheshire-Kinney, K., Lindenmayer, J. P., Mao, L., Rodriguez, S. C., & Starr, H. L. (2015). Real-world outcomes of paliperidone palmitate compared to daily oral antipsychotic therapy in schizophrenia: a randomized, open-label, review board-blinded 15-month study. J Clin Psychiatry, 76(5), 554-561.

Harvey, R.C., James, A.C., Shields, G.E. (2016). A Systematic Review and Network Meta-Analysis to Assess the Relative Efficacy of Antipsychotics for the Treatment of Positive and Negative Symptoms in Early-Onset Schizophrenia. CNS Drugs, 30(1): 27–39

Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Orey, D., Richter, F., Samara, M., Barbui, C., Engel, R.R., Geddes, J.R., Kissling, W., Stapf, M.P., Lässig, B., Salanti, G., Davis, J.M. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet, 382(9896), 951–62. doi:10.1016/S0140-6736(13)60733-3. PMID 23810019.

Peng, A., & Deng, H. (2017). Curative effect of ziprasidone in the treatment of agitation in acute phase of schizophrenia. Chinese Journal of Primary Medicine and Pharmacy, 24(2), 283-286.

Remington, G., Addington, D., Honer, W., Ismail, Z., Raedler, T., & Teehan, M. (2017). Guidelines for the pharmacotherapy of schizophrenia in adults. The Canadian Journal of Psychiatry, 62(9), 604-616.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Su, L., Lu, Z., Shi, S., & Xu, Y. (2018). Ziprasidone, haloperidol and clonazepam intramuscular administration in the treatment of agitation symptoms in Chinese patients with schizophrenia: A network meta-analysis. General psychiatry, 31(2).

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.

By Day 7

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 7 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 7 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 7

To participate in this Assignment:

Week 7 Assignment

What’s Coming Up in Week 8?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will continue to build on your assessment and treatment skills as you examine patients presenting with signs and symptoms consistent with sleep/wake disorders.

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia NURS 6630N

Learning Resources

Note: To access this week’s required library resources, please click on the link to the
Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through this link provided.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and
practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed
tab on the Stahl Online website and select the appropriate chapter. Be sure to read all
sections on the left navigation bar for each chapter.
 Chapter 4, “Psychosis and Schizophrenia”
 Chapter 5, “Antipsychotic Agents”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge
University Press.

To access information on the following medications, click on The Prescriber’s Guide,
5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:
 amisulpride
 aripiprazole
 asenapine
 chlorpromazine
 clozapine
 flupenthixol
 fluphenazine
 haloperidol
 iloperidone
 loxapine
 lurasidone
 olanzapine
 paliperidone
 perphenazine
 quetiapine
 risperidone
 sulpiride
 thioridazine
 thiothixene
 trifluoperazine
 ziprasidone

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia:
Results and implications for clinicians. CNS Drugs, 23(8), 649-659.
doi:10.2165/00023210-200923080-00002

Document: Midterm Exam Study Guide (PDF)

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome
Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine.
Retrieved from
https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REM
S_A_Guide_for_Healthcare_Providers.pdf
Walden University. (2016). ASC success strategies: Studying for and taking a test.
Retrieved from https://academicguides.waldenu.edu/academic-skills-center/skills/study
Required Media
Laureate Education. (2016j). Case study: Pakistani woman with delusional thought
processes [Interactive media file]. Baltimore, MD: Author

Learning Resources

Required Readings (click to expand/reduce)

Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier.

American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf

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

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

McClellan, J. & Stock. S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 976–990. https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649–659. https://doi.org/10.2165/00023210-200923080-00002

Medication Resources (click to expand/reduce)

IBM Corporation. (2020). IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.

amisulpride aripiprazole asenapine brexpiprazole cariprazine chlorpromazine clozapine flupenthixol fluphenazine haloperidol iloperidone loxapine lumateperone	lurasidone olanzapine paliperidone perphenazine pimavanserin quetiapine risperidone sulpiride thioridazine thiothixene trifluoperazine ziprasidone

Optional Resources (click to expand/reduce)

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., Miller, A. L., & Miller, D. 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. https://doi.org/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. https://doi.org/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. https://doi.org/10.1007/s11126-014-9326-2

Delusional Disorders
Pakistani Female With Delusional Thought Processes

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

Decision Point OneSelect 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

Rubric Detail

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Name: NURS_6630_Week7_Assignment_Rubric

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Excellent

Point range: 90–100
Good

Point range: 80–89
Fair

Point range: 70–79
Poor

Point range: 0–69
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.

8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment.

The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient.

7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment.

The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.

0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing.

The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient.
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.

16 (16%) – 17 (17%)
The response accurately explains the decision selected.

The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected.

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

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

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

Examples provided support the decisions and responses provided.

14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected.

The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected.

The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response.

The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients.

Examples provided may support the decisions and responses provided.

0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected.

The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing.

The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing.

The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing.

Examples provided do not support the decisions and responses provided, or is missing.
Decision #2 (1–2 pages)