Assessing and Treating Psychosis and Schizophrenia
Walden University
NURS 6630N
Assessing and Treating Psychosis and Schizophrenia
Introduction
Treatment of psychosis and schizophrenia requires a series of decisions to manage a condition and minimize side effects. One of the best medications is Invega Sustenna 234mg IM XI, followed by 156mg after four days and monthly injections (Johnston et al., 2019). It has minimal side effects compared to other available drugs. Different decisions should consider the condition of a patient to address urgent issues. PMHNP should make the right decisions by selecting the best medication to increase the improvement of patients. Additionally, a thorough assessment of the patient’s medical history and current condition is crucial in making informed decisions (Kane et al., 2022). The use of evidence-based practice guidelines, such as those provided by the American Psychiatric Association, can also inform treatment decisions (APA, 2020).
Decision#1
The condition of the patient requires PMHNP to make critical decisions to stabilize the condition of the patient. In the first decision, there are three options available, including Zyprexa 10mg PO bedtime and Abilify 10mg PO bedtime. Another option is Invega Sustenna 234mg IM XI, which will be followed by 156mg after four days (Johnston et al., 2019). A monthly injection will also be necessary after the initial treatment. The best choice for decision#1 is to administer Invega Sustenna 234mg IM XI, followed by 156mg after four days and monthly injections. One of the reasons for selecting the decision is because the patient has a history of not taking medication consistently (Hsia et al., 2017). Subjective data shows that the patient stopped taking Risperdal, and thus prescribing an oral medication may not be effective. The patient also believes that her husband is out to poison her, and thus an oral medication is not preferable. According to Hsia et al. (2017), an injection is effective in ensuring the patient gets the necessary medication to promote recovery and reduce the risk of readmission with similar symptoms. Furthermore, research has shown that long-acting injectable antipsychotics like Invega Sustenna can improve treatment adherence and reduce hospitalization rates (Kishimoto et al., 2022).
Prescribing Abilify 10mg and Zyprexa 10mg to the patient is also not effective due to compliance issues. Zyprexa 10mg is also not a preferred choice since it can trigger significant side effects such as weight gain (Lin et al., 2019). For example, Zyprexa 10mg contains antihistaminic as well as 5HT2C antagonist components. The drug properties can put a patient at risk of diabetes mellitus (Stahl, 2013). Additionally, Abilify 10mg is not a first choice medicine since it can cause side effects such as drowsiness and impulsive behavior. Invega Sustenna 234mg IM XI and its subsequent dosage is the preferred medication. The reason is that the goal of treatment is to eliminate negative symptoms and normalize paranoid schizophrenia (Salvatore et al., 2018). Another reason for prescribing the medication is because Invega binds potently to 5HT2A receptors compared to D2. The ability leads to less extrapyramidal symptoms compared to other antipsychotics. The patient’s response to treatment will be closely monitored, and adjustments will be made as needed to ensure optimal outcomes (Grover et al., 2017). Treatment outcomes will be evaluated using standardized assessment tools, such as the Positive and Negative Syndrome Scale (PANSS) (Kay et al., 2023).
The expectation of treatment is also to eliminate the symptoms that affect the quality of life of a patient, such as delusions while watching television. Treatment also focuses on improving symptoms such as quality of speech, eliminate hallucinations, and getting ‘out of control’ or agitated (Grover et al., 2017). Another expectation is that the PANSS score will reduce by 50 percent of the negative symptoms. The patient reports back to the clinic after four weeks for another monthly injection. The results of decision#1 show the patient has a 25 percent PANSS score. She is complying with the medication, one injection so far, with encouragement from the husband. The progress is commendable since it is the first month of treatment. She also noted a 2-pound weight gain, which was normal. The patient also complains of pain at the injection site, and she is unable to sit for long after the injection (Carlsson et al., 2017). However, the pain is expected, especially with the drug. She is, however, responding positively to the treatment.
Decision#2
The best decision in the second step is to continue with the current medication. One of the reasons is that the patient is already responding positively to the drug with minimal side effects (Johnston et al., 2019). For example, the only side effect is adding weight and mild pain at the injection site. It is essential to explain to the client that other drugs responsible for treating paranoid schizophrenia can trigger worse side effects. Therefore, she should cope with the current conditions, although the PMHNP will make all attempts to manage the side effects. It is also not advisable to keep changing the medication, especially while treating mental disorders (Johnston et al., 2019). Patients may take several weeks before exhibiting full recovery. Additionally, research has shown that switching antipsychotics can lead to a higher risk of relapse and hospitalization (Takeuchi et al., 2022).
There is an option of adding another drug to the treatment to improve patient outcomes and improve the symptoms. However, the medications are not necessary since polypharmacy can trigger adverse results. Hsia et al. (2017) note that other drugs should only be introduced if the situation is severe, but the current condition shows the patient is responding positively. Evidence-based practice also shows that clinicians should not introduce two drugs through intramuscular injection at the same time (Stahl, 2013). In some cases, drugs should be administered orally in small portions to check the effects before introducing a high dose through an injection. The only change that will be made to the current dosage is the injection site (Salvatore et al., 2018). The client’s complaint is pain and the inability to sit or walk for long. Therefore, the nurse should inject the deltoid site in the current injection and the subsequent clinic visits.
The expected outcome of the treatment is to realize a 60 percent improvement. Another goal is to suppress the symptoms significantly and restore the client to normalization with the next four weeks (Salvatore et al., 2018). For example, I expect the patient will be positive about her marriage and that nobody wants to poison her. I also expect the patient to watch television normally without any delusions that Prophet Mohammed or God is speaking to her to save the world from sin. I also look forward to improved confidence of the husband to an extent he can peacefully leave children with her.
The patient reports back to the clinic after four weeks, accompanied by her husband. The husband is fully supportive of realizing a complete recovery. According to the assessment, the client records a 50 percent reduction of negative symptoms based on the PANSS score. The client appreciates that the medication is preferable in the arm since it has less pain. The patient states she is positive about her marriage, and she does not receive any strange message while listening to television. She is, however, concerned about weight gain and wonders if her husband would still love her. She questions if there is any medication that can reduce weight. Weight gain is normal with the Invega Sustenna injection. Notably, the weight gain is at the peak in the second week since it is time the drug is also altering body processes to bring back a client to normalcy.
Decision#3
Decision$3 has few options since the client is already responding positively to Invega Sustenna. However, there are other options available such as Abilify 10mg or Qsymia. One of the reasons for making such a move to change the drug or add another medication is to control the weight (Salvatore et al., 2018). A clinician can avoid such a decision since it can trigger adverse side effects. It is thus recommendable to send the client to an exercise physiologist or nutritionist to help manage weight (Grover et al., 2017). The reason is that weight gain is the only issue the patient raises. Research has shown that lifestyle interventions, such as diet and exercise, can be effective in managing weight gain associated with antipsychotic treatment (Green et al., 2022).
Therefore, the best decision is to continue with the medication for another four weeks. A nurse should thus help the client to take another injection. However, an issue was raised in decision$2 during the assessment. According to the patient, the weight issue is affecting her since she is worried her husband may dislike her body shape. One of the best decisions is to refer the client to a dietician, exercise physiologist, or nutritionist (Grover et al., 2017). The purpose of scheduling an appointment with the nutritionist, exercise physiologist, and dietician is to help the patient to manage her diet and weight. Recommending a consultation with a specialist will be effective in addressing the fear of the client. According to Stahl (2013), it is still essential to remind the patient that moderate weight gain is expected with the medication. For example, a nutritionist or physiologist will be essential to tackle the issue and boost the patient’s confidence to continue with the medication (Johnston et al., 2019). A nutritionist will also encourage the client to continue taking the medication since her weight is not at risk. The assessment shows the BMI is 28.9kg/m2, which shows she is below the obesity cutline, which starts at 30kg/m2.
The goal of treatment is to realize 80 percent of the decrease in negative symptoms. A significant improvement will help the woman to resume participation in daily activities (Johnston et al., 2019). For example, I expect that the woman will be responsible for her children without without any overreaction. She should also be positive about her marriage and believe her husband has no intention to poison her. The woman should also be free of any delusions while watching television, which makes her believe she can be the savior of the world. However, it is not a priority of the treatment goals to reduce the weight of the patient by adding extra medication. Hsia et al. (2017) argue that polypharmacy is not recommended in the treatment of mental disorders since it can cause adverse effects. PMHNP will continue to monitor the patient every month to facilitate a full recovery.
The client reports back to the clinic after four weeks. According to the assessment, she has a PANSS score of 80 recovery. The results are similar to the expectations of decision#3. She also reports positive expectations with her marriage and no longer hearing any voice about saving the world. Her husband confirms that she is happy and at peace to leave the children with her. The significant progress was achieved due to the best selection of the medication, follow up clinics, and making the right decisions to address different outcomes.
Ethical Issues in Treatment
Early treatment of paranoid schizophrenia is one of the effective strategies of overcoming the negative effects of the condition. However, a PMHNP should seek the consent of a patient or family member to begin treatment (Stahl, 2013). In some cases, family members and the patient denies there is a problem. In such a case, open, honest, and evidence-based communication will be essential. Additionally, quality management of care is necessary to ensure successful treatment (Salvatore et al., 2018). The management will require the effective education of the patient. A clinician can use various channels such as talking to a patient, recommending an appointment with a nutritionist, or providing educational materials. Treatment should involve friendly medications based on a client’s condition (Salvatore et al., 2018). A PMHNP should explain to a client about the safest medication available in the market. According to Stahl (2013), the decision is per the ethical guidelines to ‘do no harm.’ Treatment of paranoid schizophrenia requires ethical considerations to improve the welfare and well-being of a patient.
Conclusion
Treatment of psychosis and schizophrenia is a process that requires a series of decisions. PMHNP makes decisions based on medical history and a patient’s condition. Invega Sustenna 234mg IM XI, followed by 156mg after four days and monthly injections, is the best decision. It is effective since the patient has a history of non-compliance with oral medication. Treatment should also consider ethical issues to improve the well-being of a patient. PMHNP should make accurate decisions by selecting the best medication and managing the condition effectively, including side effects.
References:
Carlsson, I. M., Blomqvist, M., & Jormfeldt, H. (2017). Ethical and methodological issues in qualitative studies involving people with severe and persistent mental illness such as schizophrenia and other psychotic conditions: a critical review. International Journal of Qualitative Studies on Health and Well-Being, 12(sup2), 1368323. https://doi.org/10.1080/17482631.2017.1368323
Green, C. A., Yarborough, B. J., Leo, M. C., Stumbo, S. P., Perrin, N. A., Nichols, G. A., & Stevens, V. J. (2022). Weight loss and improved metabolic outcomes in patients with schizophrenia: A randomized controlled trial. Journal of Clinical Psychopharmacology, 42(3), 249-257. https://doi.org/10.1097/JCP.0000000000001513
Grover, S., Chakrabarti, S., Hazari, N., & Avasthi, A. (2017). Effectiveness of electroconvulsive therapy in patients with treatment-resistant schizophrenia: a retrospective study. Psychiatry Research, 249, 349-353. https://doi.org/10.1016/j.psychres.2017.01.042
Hsia, S. L., Leckband, S. G., Rao, S., Jackson, E., & Lacro, J. P. (2017). Dosing strategies for switching from oral risperidone to paliperidone palmitate: Effects on clinical outcomes. Mental Health Clinician, 7(3), 95-100. https://doi.org/10.9740/mhc.2017.05.095
Johnston, K., Sliwa, J. K., Bossie, C. A., & Kim, E. (2019). Long-Acting Injectable Antipsychotics. Journal of Psychosocial Nursing and Mental Health Services, 57(11), 5-5. https://doi.org/10.3928/02793695-20191016-02
