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.
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.

Grading Rubric
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.
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.
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.
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.
Decision #2 (1–2 pages)

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 how ethical considerations impact the treatment plan and communication
with patients.

Examples provided fully support the decisions and
responses provide
Decision #3 (1–2 pages)

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.
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.
The response accurately and clearly summarizes in detail the
recommendations on the treatment options selected for this patient.

The response accurately and clearly explains a
justification for the recommendations provided, including clinically relevant resources
that fully support the recommendations provided.

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 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
Start Abilify (aripiprazole) 10 mg orally at BEDTIME

Decision
point 2

Decision point
3

Please copy and paste in google search engine the following
title to view the full instructions : Decision point 2 and decision point 3. Click on each tab to view the outcomes: Delusional Disorders
Pakistani Female With Delusional Thought Processes

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