Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia- NURS 6630Week 6
Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia- NURS 6630Week 6
Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia- NURS 6630Week 6
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NURS 6630 Week 6: Antipsychotic Therapy
Impulsivity disorders are characterized by the inability to resist the sudden, powerful desire to do something and difficulties controlling emotions or behaviors. On the other hand, addiction is a complex mental condition characterized by compulsive substance use regardless of detrimental consequences. The purpose of this paper is to describe a patient with an addiction disorder and the treatment interventions.
Introduction to the Case
Mrs. Perez, a 53-year-old Puerto Rican woman, is portrayed in the case scenario as having alcohol drinking problems since her late adolescence. Perez has been a member of Alcoholics Anonymous on and off for the past 25 years. The patient also claims that it has become more difficult for her to stay sober in the two years since a casino opened in her neighborhood. Perez mentions getting high while gambling because she drinks while playing high-stakes gambling games. This, however, leads to increased alcohol consumption and reckless gambling. Furthermore, the client claims she has increased her smoking over the last two years and is concerned about the negative health effects.
Mrs. Perez reports that she has tried to abstain from alcohol consumption, but gambling gets her high, so she has a few drinks to compensate. She has also realized that while drinking alcohol, she smokes very little, but she enjoys smoking when gambling. The patient gained weight as a result of her excessive drinking, and she is now 122 pounds, having gained 7 pounds. The patient is concerned because she borrowed over $50,000 from her retirement account to pay off gambling debts. MSE findings of note include avoiding eye contact, a sad mood, and impaired impulse control. Mrs. Perez has a gambling disorder as well as an alcohol use disorder. Age, overall health status, comorbid mental health illnesses, the patient’s previous experience with medication, the patient’s beliefs and opinions on useful therapies, history of treatment compliance, and the patient’s motivation for abstinence are all patient factors that may influence treatment decision-making.
Decision #1
Vivitrol (naltrexone) injection, 380 mg IM in the gluteal region four-weekly.
Reason for this Decision
Naltrexone was the ideal treatment because it is an FDA-indicated drug for treating alcohol use disorder (AUD). Joshi et al. (2021) explain that naltrexone alleviates alcohol cravings, decreases alcohol consumption, and the monthly injectable formulation helps in compliance. Kranzler and Soyka (2018) explain that naltrexone decreases mesolimbic opioidergic activity, thus controlling the dopamine-mediated rewarding effects of alcohol, resulting in decreased alcohol consumption.
Why Other Decisions Were Not Selected
Disulfiram was not ideal because the physical reaction of alcohol and disulfiram causes dizziness, tachycardia, nausea, flushing, chest pain, and BP changes, which can harm patients, making it less recommended (Joshi et al., 2021). Acamprosate was not selected because it is approved by the FDA to promote abstinence in patients who are abstinent when starting treatment (Kranzler & Soyka, 2018). Mrs. Perez was not abstinent and thus not a suitable candidate for acamprosate therapy.
According to the National Alliance on Mental Illness (NAMI), around 100,000 Americans are diagnosed with psychosis each year (NAMI, 2016). Delusions, hallucinations, disorganized thinking, disorganized or aberrant motor movement, and other negative symptoms can be distressing for those suffering from mental illnesses. Anxiety, depression, and other mood disorders can all share symptoms with schizophrenia, making them even more difficult to manage. In order to select appropriate therapy and improve patient outcomes, psychiatric mental health nurses must understand the underlying neurobiology of these symptoms.
This week, as you study antipsychotic therapies, you will look at the assessment and treatment of clients suffering from psychosis and schizophrenia. You also think about the ethical and legal implications of these treatments.
Assessing and Treating Clients Suffering from Psychosis and Schizophrenia
Psychosis and schizophrenia have a significant impact on the brain’s normal processes, interfering with the ability to think clearly.
Clients may struggle to function in daily life if their symptoms of these disorders are uncontrolled. Clients, on the other hand, frequently thrive when they are properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. Consider how you might assess and treat clients presenting with psychosis and schizophrenia as you examine the client case study in this week’s Learning Resources for this Assignment. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia
Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Learning Resources
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Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia- NURS 6630Week 6
Patient History
The patient may not be a reliable source of information, particularly that she has a significant mental illness that affects her functioning, hence verifying her responses with her direct family members, and mental social workers to get clues to the underlying or precipitating causes of mental crisis. Also checking facility records from previous encounters, or any psychiatric hospitalizations would be useful.
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Diagnostics Testing
1. Thyroid Stimulating Hormone (TSH). Based on recent evidence, the prevalence of depressive symptoms in hypothyroidism was nearly 50%, and clinical depression occurs in more than 40% of people suffering from hypothyroidism ( Bhagwat, 2017)
2. Electrocardiogram (ECG) The client has cardiovascular diseases ( HTN, CAD), with risks of cardio complications. In the setting of taking antidepressants and antipsychotics, baseline ECG and possibly every three to six months would be appropriate. Several atypical antipsychotics including quetiapine (Seroquel) are known to cause prolongation of the QT interval, hypothesized to occur via direct inhibition of the cardiac delayed potassium rectifier channel, which extends the ventricular repolarization process (Zhai et al., 2017)
Differential Diagnoses
1. Posttraumatic Stress Disorder ( PTSD)_
2. Major Depressive Disorder (MDD)
3. Insomnia Disorder.
Pharmacotherapy Options for Sleep/ Wake cycle
1. Zolpidem (Ambien) 5mg oral at bedtime for Seven days.
Zolpidem is nonbenzodiazepine hypnotic, it works by enhancing GABA inhibitory actions that provide sedative hypnotic effects more selectively than other actions of GABA (Stahl, 2017). With its side effects of sedation, low dose prescribed as the client has respiratory problems (sleep apnea OSA)). Studies have shown that Zolpidem did not significantly worsen OSA as measured by the numbers and duration of pauses in breathing during sleep, but in one trial, it significantly lowered minimum oxygen levels during the night when compared with placebo ( Mason & Smith, 2015).
2. Trazadone 25 mg oral at bedtime for Thirty days.
Trazadone is a serotonin 2 antagonist/reuptake inhibitor, used in management of depression and insomnia. It is absorbed well, metabolized by CYP 450 3A4 with average half life of 6hrs. It has less side sedative effects compared to zolpidem (Stahl, 2017)
The best choice for the client would be Trazadone as there is no reliable evidence of dependence or withdraws and it can also work for the client’s depression.
Conclusion
The case was a perfect example how it is sometimes difficult to find effective pharmacological treatments of psychiatric illnesses. In the course of four years, the client was prescribed 5-6 medications targeting different neurotransmitters to improve the symptoms. Client’s polypharmacy increased risks of drug-drug interactions, and her medical comorbidities increased risks of adverse reactions. Lesson learned from this study was that treatment should be optimally initiated after diagnosis, and augment or switching to a new agent must be carefully done in consideration of possible side effects and better outcomes.
References
Bhagwat, N., Tayde, P., Sharma, P., Sharma, B., Dalwadi, P., Sonawane, A., … Varthakavi, P. (2017). Hypothyroidism and depression: Are cytokines the link? Indian Journal of Endocrinology and Metabolism, 21(6), 886. Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=7&sid=aeb79c1d-68dc-40a4-bd10-f956796bc9e8%40sessionmgr101
Cunha, J. (2016). Common Side Effects of Ventolin HFA (Albuterol Sulfate Inhalation Aerosol) Drug Center – RxList. Retrieved from https://www.rxlist.com/ventolin-hfa-side-effects-drug-center.htm
Mason, M., & Smith, I. (2015). Effects of opioid, hypnotic and sedating medications on obstructive sleep apnoea (OSA) in adults with known OSA | Cochrane. Retrieved from http://www.cochrane.org/CD011090/AIRWAYS_effects-opioid-hypnotic-and-sedating-medications-obstructive-sleep-apnoea-osa-adults-known-osa
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Assignment: Assessing And Treating Clients With Psychosis And Schizophrenia- NURS 6630Week 6