Assessment And Treatment Of Patients With Psychosis And Schi ✓ Solved

Assessment and treatment of patients with psychosis and schizophrenia

This assignment involves analyzing a complex case of a 34-year-old Pakistani woman diagnosed with paranoid schizophrenia and delusional thought processes. The task requires a comprehensive assessment, including an introduction summarizing the case and its pertinent patient factors that influence pharmacologic decision-making. The core of the assignment involves making three clinical decisions regarding medication management through a structured, evidence-based analysis, supported by primary literature. Each decision should include reasoning for the choice made, evaluation of alternative options, and ethical considerations impacting treatment and communication. The final component is a conclusion summarizing the recommended treatment plan with justification reinforced by current research. The assignment emphasizes critical thinking, evidence-based practice, and ethical considerations in psychiatric pharmacotherapy, with a minimum of five academic references, excluding the course text.

Sample Paper For Above instruction

Introduction and Case Summary

The presented case involves a 34-year-old Pakistani woman diagnosed with paranoid schizophrenia, manifesting persistent delusional thoughts, auditory and visual hallucinations, and paranoid ideation. She experienced a 21-day hospitalization following an episode where she believed she was the prophet Mohammad and that the television delivered divine messages, indicating a positive diagnosis of paranoid schizophrenia based on symptomatology and structured assessment tools like PANSS. Patient factors influencing pharmacologic treatment decisions include her cultural background, recent medication non-compliance, fears about poisoning, and her current mental state with impaired insight and judgment. Additionally, her weight (140 lbs., 5’5”), and her expressed paranoia about her husband's intentions, are crucial in selecting appropriate medications.

Decision Point One: Initiation of Olanzapine (Zyprexa) 10 mg at Bedtime

The first decision involved starting olanzapine at 10 mg nightly, observing a reduction in positive symptoms and monitoring side effects such as weight gain. Olanzapine was selected due to its proven efficacy in reducing positive and negative symptoms of schizophrenia, rapid onset, and favorable side-effect profile in symptom control, especially in acutely psychotic patients (Leucht et al., 2013). The choice was supported by literature emphasizing its utility in initial treatment, particularly for patients with profound delusional beliefs requiring rapid stabilization (Kane et al., 2012).

Alternative medications, such as risperidone or aripiprazole, were considered but not chosen initially due to their side effect profiles—risperidone's propensity to cause extrapyramidal symptoms (EPS) and prolactin elevation, and aripiprazole's partial agonism leading to less symptomatic reduction in some cases (Correll et al., 2015). The primary goal was to achieve symptom stabilization while applying minimal side effects that further impair the patient's insight and compliance.

Ethical considerations included balancing the benefits of rapid symptom remission against the risk of weight gain and metabolic disturbances. Clear, culturally sensitive communication about side effects and the importance of medication adherence was emphasized to foster trust and compliance, considering her beliefs about poisoning and her mistrust of medication.

Decision Point Two: Adjusting Olanzapine Dose to 7.5 mg at Bedtime

After four weeks, the patient's symptoms had partially improved, with a 25% reduction in positive symptoms; however, she began gaining weight (5 pounds), and her snacking behavior increased. The decision was to reduce olanzapine to 7.5 mg nightly based on evidence suggesting that lower doses can maintain efficacy while reducing side effects such as weight gain (Nasrallah et al., 2016). The goal was to balance symptomatic control with minimized metabolic risks.

Other options such as switching to risperidone or aripiprazole were considered but deferred, given her prior response and the need for stable symptom control. It was also deemed that dose reduction could potentially improve her metabolic profile while maintaining enough receptor blockade to prevent symptom exacerbation.

Ethically, this decision highlights the importance of monitoring for adverse effects, engaging the patient in shared decision-making, and providing education about potential side effects and their management to improve adherence and health outcomes.

Decision Point Three: Increasing Olanzapine Back to 10 mg at Bedtime

Four weeks later, her condition worsened, with increased positive symptoms and stabilization of weight, but her behavioral control at home was deteriorating, and her husband's concern grew. The decision was to increase olanzapine back to 10 mg to optimize symptom control, recognizing that insufficient dosage could lead to relapse (Kane et al., 2012). This decision aligns with evidence indicating that dose adjustments are often necessary based on symptom severity, side effects, and patient functioning (Leucht et al., 2013).

Alternatives such as switching to risperidone long-acting injection or clozapine, considered second-line options in treatment-resistant cases, were evaluated but not chosen at this stage due to her recent stabilization attempts and potential side effects (Meltzer et al., 2012). Clozapine requires rigorous monitoring and is typically reserved for treatment-resistant schizophrenia.

Ethically, this step underscores the importance of ongoing assessment, balancing symptom management with side effect mitigation, and maintaining open, transparent communication with the patient and her family to foster adherence and trust.

Conclusion

The optimal management of this patient's paranoid schizophrenia involves a nuanced approach that balances efficacy and side effects. Initiating treatment with olanzapine provided rapid symptom control but was associated with weight gain. Dose reduction mitigated metabolic side effects, but subsequent exacerbation of symptoms required dose escalation. Ongoing monitoring, patient education, and culturally sensitive communication are imperative to enhance compliance and therapeutic outcomes. Considering her unique cultural background and personal beliefs, incorporating psychoeducation and collaborations with culturally competent mental health providers can further support her adherence and recovery (Simoni et al., 2011). Future directions include exploring long-acting injectable options to improve adherence, while considering metabolic risks associated with atypical antipsychotics. Overall, individualized care tailored to her clinical presentation and personal context is vital for sustainable remission and improved quality of life.

References

• Correll, C. U., Leucht, S., & Kane, J. M. (2015). Quantifying the risk of metabolic syndrome and weight gain associated with antipsychotic medications. Schizophrenia Bulletin, 41(Suppl 1), S8–S13.
• Kane, J. M., Correll, C. U. (2012). Pharmacologic treatment of schizophrenia. Harvard Review of Psychiatry, 20(1), 1-7.
• Leucht, S., Cipriani, A., Spineli, L., et al. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. The Lancet, 382(9896), 951–962.
• Meltzer, H. Y., et al. (2012). Clozapine Boot Camp Consensus Conference, the role of clozapine in therapy-resistant schizophrenia. Journal of Clinical Psychiatry, 73(8), 77-84.
• Nasrallah, H. A., et al. (2016). Metabolic side effects associated with atypical antipsychotics, comparative analysis, and management strategies. American Journal of Psychiatry, 173(5), 459-469.