Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

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. Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

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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. Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

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. Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

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. Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

Background Information

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 a physician, who reported her to be in overall good health. Lab studies were all within normal limits.

Client admits that she was tolerating her Risperdal well but stopped taking 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. Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

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

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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

1. Decision Point One

Select 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- I will choose this option

Start Abilify (aripiprazole) 10 mg orally at BEDTIME

Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter

RESULTS OF DECISION POINT ONE

•  Client returns to clinic in four weeks
•  A decrease in the PANSS score of 25% (in positive symtpoms) is noted at this visit
•  Client seems to be tolerating medication
•  Her husband has made sure she makes her appointments for injections (one thus far)
•  She has noted a 2-pound weight gain, but it does not seem to be an important point for her
•  She does, however, complain of injection-site pain, telling you that she has trouble sitting for a few hours after the injections and doesn’t like having to walk around for such a long period of time

2. Decision Point Two

Select what the PMHNP should do next:

Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward- I will choose this option!

DC Invega Sustenna and start Haldol Decanoate (haloperidol decanoate ) 50 mg IM q2weeks with oral Haldol 5 mg BID for the next 3 months

Continue Invega Sustenna. Begin injections into the deltoid and add on Abilify Maintena 300 mg IM qmonthly with oral Abilify 10 mg in the MORNING for 2 weeks. Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward

RESULTS OF DECISION POINT TWO

•  Client returns to clinic in four weeks
•  Her PANNS has been reduced by a total of 50% (in positive symptoms) from the initiation of Invega Sustenna
•  When questioned about injection-site pain, she states it is much better in the arm
•  Her weight has increased by an additional 2.5 pounds (total of 4.5 pounds in a 2-month period). She is somewhat bothered by the weight gain and is afraid that her husband does not like it. He is not present at this visit as she brought herself
•  She likes how she feels on the Invega Sustenna but is wondering if there is another drug like it that would not cause the weight gain

3. Decision Point Three

Select what you should do next:

Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one month- I will choose this option

DC Invega Sustenna and start Abilify Maintena (aripiprazole ) 400 mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10 mg in the MORNING

Continue Invega Sustenna and add on Qsymia (phentermine and topiramate) for weight loss

Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one month

Guidance to Student
Weight gain can occur with Invega Sustenna. It is modest in nature and can be controlled with proper nutrition and exercise. It is always a good idea to try and control a client’s weight through consultation with a dietician and exercise physiologist (life coach) before switching to another agent when a product is showing efficacy for at least 6 months.

Abilify Maintena is a good option for someone who has good response to Abilify oral. Remember that Abilify does not bind to the D2 receptor for a great period of time (such as Invega) and can be less effective in certain individuals. Also, remember that akathisia can be a possible side effect. Once an IM long-acting medication is given, the effects of the drug (both efficacious and untoward effects) can be maintained for a long duration (up to a month or longer). Tolerability and efficacy should be established with oral medication before administering the first injection. Also a disadvantage to Abilify Maintena is that a 2-week overlap of oral therapy is required due to effective blood levels lagging behind the induction dose.

Qsymia is a weight loss medication that is a combination of phentermine and topiramate. It is only indicated to treat obesity. This client’s BMI (28.9 kg/M2) does not fit the definition of obesity (BMI >30 Kg/M2- Following from CDC website: Class 1: BMI of 30 to < 35, Class 2: BMI of 35 to < 40, Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity). There are two things wrong with this therapy option. First, there are only a few occasions where add-on therapy to treat a side effect is acceptable, and weight gain is not one of those scenarios. Secondly, phentermine has a lot of cardiovascular toxicities (such as elevated BP, HR, and increased workload on the heart). Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

Deliverable 01 – English Composition

Deliverable 01 – English Composition

Competency

Identify and illustrate steps of the writing process in composing written exercises.

Instructions

Compose a single body descriptive paragraph in formal written English. Be sure to include the following:

• Topic sentence that provides the main idea for the descriptive paragraph.
• Body sentences that discuss the main idea for the descriptive paragraph using explanation, examples, details, and of course, descriptive elements.
• Transition sentence: Your descriptive paragraph must include the use of at least one or more transitions that move the paragraph along. Deliverable 01 – English Composition
• Conclusion sentence: Your descriptive paragraph must end with a concluding sentence that wraps up and refers to the main idea of the topic sentence and signals to the reader that the paragraph is over.
• Your descriptive paragraph needs to contain a minimum total of five complete sentences.

Reminder: Descriptive refers to a style of writing. Choose your sentences for your descriptive paragraph from the following sentences, and use them together to construct your descriptive paragraph. They will not all be appropriate for this paragraph, so choose only the sentences that result in a complete descriptive paragraph as listed above. Use a topic sentence that provides the main idea for a single well-organized paragraph using the steps of the writing process.

Choose the best sentences to construct your descriptive paragraph, and put them together to make ONE well-organized descriptive paragraph. Remember that not all sentences need to be used.

1. It’s a soft, blue-sky break before the gray skies of winter begin to reflect the steely cold waters the lake becomes with the first freeze.
2. Dogs are sometimes fierce protectors that can attack anyone they feel is threatening a family.
3. In the old days, dogs were not considered companions, but seen more as working animals.
4. That’s what we can all call a red-letter day!
5. My dog, Bosco, is a Harlequin Great Dane that outweighs our 10 year old brother, and to the other dogs in our neighborhood he must look like a tall spotted monster because they avoid him at all cost. Deliverable 01 – English Composition
6. Do you think dogs are smarter than people?
7. Sometimes our dog seems to know when we are laughing at him because he tucks his head down and appears to shrink into a small ball resembling a lumpy soccer ball.
8. On a beautiful fall day, my family enjoys picnicking at a quiet beach we know that has a blue lagoon surrounded by rustic picnic tables and tall, green pines.
9. I really like dogs.
10. The whole family grabs sweaters and corduroys, Mom packs a cheese sandwich picnic basket with all the junk food we never get to taste otherwise, and we jump into Dad’s old blue jalopy and head out for one last day of fun before all the hub-bub of school gets into swing.
11. My brother is a great Jayvee football quarterback, my older red-headed sister is a cheerleader complete with red pom-poms, and I play cymbals and drums in the school pep band, so we are usually very tied up in school activities soon after school starts.
12. That dog can open the refrigerator and grab a can of soda! Deliverable 01 – English Composition
13. I really enjoy the pep band; it’s fun to get all dressed up in my red band uniform and beat those shiny drums during a game.
14. Our big dog needs to stay at home with the cat because he attracts sand and fleas.
15. On one hand, it is hard to get everything ready for the day trip; on the other hand, nobody in our family wants to miss such a day of fun.
16. My brother thinks he is smarter and more well-dressed than the rest of us because he is the oldest.
17. For example, cats can be really pretty, but they don’t seem to love everyone in the family.
18. At the end of a great day of flying kites, chasing each other around the lagoon, and eating great junk food, we all go home extremely tired and extremely happy.
19. A day with my dog.
20. My family comes in all shapes, ages, sizes, and hair colors, but no matter what we look like, we ALL love to eat.
21. As night falls and my father drives the old beat-up car towards home, most of us finish up the cheese sandwiches and chips and doze off after a day of

English Composition Self-directed Assessment 02

Deliverable 02 – English Composition

Competency

Demonstrate ability to comprehend and summarize in written material.

Instructions

Write a one page analysis of the document provided here following the steps of the writing process, as well as showing the thesis of the article, the main points that support that thesis, and your own response and reaction to the author’s point of view and how it is presented. Do this in complete paragraphs using correct formal English that has been revised, proofed, and edited to show good form. Deliverable 01 – English Composition

Grading Rubric

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English Composition Self-directed Assessment 03

Deliverable 03 – English Composition

Competency

Implement critical thinking and research strategies for clear communication of written ideas.

Instructions

Produce a complete 2-4 page paper in which you do a comparison and contrast between driverless cars and/or traditionally driven cars. Be sure to define your reason for writing (thesis), and treat both ideas equally as to pros and cons, costs to promote, validity, efficiency to use, probability of success, and manpower requirements, etc. Your paper should contain an introductory paragraph, thesis statement, body paragraphs each supporting a major idea regarding your point for writing, and a concluding paragraph to wrap-up the paper and signal the completion of your support for your reason for writing. Deliverable 01 – English Composition

Although actual research is not a part of this assignment, provide a brief statement at the beginning of the assignment explaining how you would have gone about finding and providing support for your paper.

Grading Rubric

English Composition Self-directed Assessment 04

Deliverable 04 – English Composition

Competency

Apply APA documentation techniques correctly in research.

Instructions

Using the Rasmussen College library (online database) for all resources, find a topic you feel is suitable (real world, everyday life) for a brief 2-3 page research paper, and compose an annotated bibliography (not the entire paper) of 100 word annotations from a minimum of five resources from credible academic databases or eBooks. Be sure to employ APA method of documentation.

Grading Rubric

English Composition Self-directed Assessment 05

Deliverable 05 – English Composition

Competency

Use collaboration techniques to correct written documents.

Instructions

Show your ability to analyze, correct, and revise the following rough draft, giving your input on the revision necessary to improve the quality of this essay. You will show successful completion of this deliverable by:

• Providing feedback for corrections/alterations using the Comments feature in Word (Review tab).
• Respond to the six questions at the end of the student rough draft linked above.
• Use complete sentences in all of your responses.

Grading Rubric

English Composition Self-directed Assessment 06

Deliverable 06: English Composition

Competency

Show ability to use standard professional English in formal written documents.

Instructions

Familiarize yourself with the strategies of research and produce an original five page minimum persuasive research essay using only the Rasmussen College library to find varied academic resources/databases. Choose five current, varied (by type), and credible sources to use in writing to support your topic which should result in a five page essay that persuades the reader that your perspective on a debatable topic is the correct position to take. Your APA paper should demonstrate your ability to engage the reader, provide a strong thesis with pattern for development, incorporate in-text citations as needed, and include a final reference page listing and using research resources as described above. Here is the topic for your persuasive essay assignment: Deliverable 01 – English Composition

What do you think will be the most important debatable economic or social problem facing your field of work 20 years from now? Choose the problem, define it, and defend your position using credible research from the Rasmussen College library databases.

Grading Rubric