Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .

Assignment Antipsychotic therapy According to the National Alliance on Mental Illness, approximately 100,000 people experience psychosis in the United States each year (NAMI, 2016). In practice, clients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric mental health nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for clients. This week, as you examine antipsychotic therapies, you explore the assessment and treatment of clients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies. Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .

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________________________________________ Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia. Learning Objectives Students will: • Assess client factors and history to develop personalized plans of antipsychotic therapy for clients • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy • Evaluate efficacy of treatment plans • Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan To prepare for this Assignment: • Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy. The Assignment Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: • Decision #1 o Which decision did you select? o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o Why were the other two decisions less advantageous? Support your response with evidence and references to the resource. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? • Decision #2 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o Why were the other two decisions less advantageous? Support your response with evidence and references to the resource. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .• Decision #3 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o Why were the other two decisions less advantageous? Support your response with evidence and references to the resource. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients. Learning Resources Note: Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .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. Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia . 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 Note: Retrieved from Walden Library databases. Document: Midterm Exam Study Guide (PDF) Kay, S. R., Fiszbein, A., & Opler, L. A. (1987).Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia . The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276. Note: Retrieved from Walden Library databases. Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting Required Media Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .Author Note: This case study will serve as the foundation for this week’s Assignment. Optional Resources Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2 Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471 Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2 To prepare for this Assignment: • Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy. Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .The Assignment Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: • Decision #1 o Which decision did you select? o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? • Decision #2 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia . • Decision #3 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients. Note: Support your rationale with a minimum of three academic resources and 2 external credible sources. While you may use the course text to support your rationale, it will not count toward the resource requirement. Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .PLEASE INCLUDE clinical application regarding other options not chosen. Submission and Grading Information To submit your completed Assignment for review and grading, do the following: • Save your Assignment using the naming convention “WK6Assgn+last name+first initial.(extension)” as the name. • Click on the Assignment Rubric to review the Grading Criteria for the Assignment. • Click on the Week 6 Assignment link. Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK6Assgn+last name+first initial.(extension)” and click on Open. • If applicable: From the Plagiarism Tools area, click in the checkbox for I agree to submit my paper(s) to the Global Reference Database. Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .

Paranoid Schizophrenia in a 34 Year-Old Female Pakistani Immigrant

Psychosis is a collection of symptoms whose hallmark is the presence of delusions coupled with disordered behavior and a convoluted appreciation of reality (Stahl, 2013). One of the causes of psychosis is schizophrenia. This Pakistani woman has been particularly diagnosed with paranoid schizophrenia (Laureate Media, n.d.). Paranoid schizophrenia is defined by paranoia, hostility, belligerence, and grandiosity. These are the symptom characteristics exhibited by this Pakistani immigrant. She has grandiose religious delusions of being the Prophet of Islam, is suspicious of her husband believing he wants to marry an American woman, believes she can save the world, and is also intermittently hostile towards the Psychiatric-Mental Health Nurse Practitioner (PMHNP) (Laureate Media, n.d.). Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .

Decision Point Number 1

I started her on paliperidone (Invega Sustenna) 234 mg intramuscular STAT, then 156 mg on day four to be followed afterwards by 156 mg every month (Laureate Media, n.d.). This decision was taken because this drug is first and foremost an atypical (second generation) neuroleptic (Stahl, 2017). According to Naber and Lambert (2009), there is sufficient scientific, anecdotal, and circumstantial evidence that atypical antipsychotics are better at managing symptoms if psychosis. Paliperidone would also start producing remission within one week and at most within 4-6 weeks of commencement. Yet another reason for choosing this medication is that it significantly reduces positive symptoms of schizophrenia and improves the negative ones (Stahl, 2017). This choice was made in the hope of achieving remission on the shortest time possible. This was thought to be achievable due to the long-acting nature of paliperidone. A modest gain in weight was expected since this is one of the known side effects of this drug (Stahl, 2017). Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .

When the patient came back for review after 4 weeks there was marked improvement. There was notably a 25% decrease in the PANSS score, which was a good start. This score examines the relationship between the positive and the negative symptoms of schizophrenia, and their connection to the overall psychopathology (Kay et al., 1987). The lady was tolerating the medication well, but had added two pounds in weight and was complaining of injection site discomfort (Laureate Media, n.d.). Between these outcomes and the expectations of treatment there was no significant difference. This is because the two side effects she was experiencing (weight gain and injection site irritation) were anticipated (Stahl, 2017). Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .

Decision Point Number 2

            Following the results of the first decision to start paliperidone, the second decision taken during the second visit was to continue with paliperidone but shift the site of injection from the gluteus to the deltoid muscle in the shoulder. This is because at that position she will not put her weight on the site when sitting down, compared to the gluteal site. Another reason for continuing paliperidone (Invega Sustenna) was because the PANSS score was improving (Kay et al. 1987; Leucht, 2005). This indicated progress in the right direction. What was hoped to be achieved by this decision was continued improvement (reduction) of the PANSS score, indicating remission. Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .

The results of this second decision taken during the second visit after 8 weeks of treatment were even more promising, save for the weight gain. The lady had gained another 2.4 pounds in weight, totalling to 4.5 pounds since start of therapy 2 months earlier. However, the PANSS score had now reduced by a total of 50%! (Kay et al., 1987; Leucht et al., 2005). This meant that this Pakistani lady was probably going to be free of symptoms to the extent that she would live independently again and be a functional member of the society (Stahl, 2017). The deltoid injection site was no longer painful, but she was only worried about her weight gain on the medication. There was no difference between what was hoped for with the treatment and the iutcome of the second decision, save for the rapid weight increase. This one difference could be attributed to the fact that this lady was already overweight at the start of treatment, hence predisposed to obesity. She had a body mass index or BMI of 28.9 kg/m2 meaning she was already overweight (Laureate Media, n.d.; Stahl, 2017). Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .

Decision Point Number 3

            On the third visit after 3 months of treatment it was decided that the paliperidone would continue. This is because she was responding very well to the treatment and showing promising signs of long-term remission. Going by the improving PANSS score, she would be free of symptoms and return to normalcy soon – a real superresponder (Stahl, 2017). This is what this decision hoped to achieve. However, the exponential weight gain was yhe worrying difference. The reason for this as has been alluded to earlier above was most probably the patient’s already present predisposition to obesity (BMI of 28.9). For this she was counselled that this is an expected side effect and that with the other available alternatives it could be even worse. Therefore, she was advised and referred to a dietician and exercise therapist to work on her weight and help her reduce it to a healthy level. Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia .