Pakistani Female With Delusional Disorder

Delusional Disorderspakistani Female With Delusional Thought Processes

Delusional disorders represent a complex category of mental health conditions characterized by the presence of persistent delusions that are typically non-bizarre and lack the other characteristic symptoms of schizophrenia. They often coexist with other psychiatric or medical conditions, and their management requires a nuanced understanding of pharmacological and non-pharmacological interventions, especially considering cultural and individual patient factors. This case focuses on a Pakistani female patient experiencing delusional thought processes, her treatment with the atypical antipsychotic Invega Sustenna, and the subsequent clinical decision points aimed at optimizing her care while managing side effects such as weight gain.

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Delusional disorders pose unique challenges in psychiatric treatment, particularly when considering cultural nuances and individual patient responses to medication. A comprehensive approach combining pharmacologic management with psychosocial interventions offers the best outcomes. The case of a Pakistani female with delusional thought processes illustrates these points effectively, emphasizing the importance of monitoring therapeutic efficacy, side effects, and patient preferences.

The management began with the initiation of intramuscular long-acting injection of Invega Sustenna at 234 mg, followed by a 156 mg dose on day four. The goal of this regimen was to achieve rapid symptom control through sustained antipsychotic levels. After four weeks, clinical assessment showed a 25% reduction in Positive and Negative Syndrome Scale (PANSS) scores, indicating symptom improvement, and the patient tolerated the medication well. Engagement of the patient's husband in ensuring adherence was crucial, as it contributed to consistent follow-up, which is often a challenge in psychiatric care. The patient reported a slight weight gain of two pounds but did not consider it an immediate concern. However, she experienced injection site pain and discomfort, which affected her sitting and walking for a few hours post-injection, driving a decision to modify the injection technique.

The second decision point involved administering the injections into the deltoid muscle to reduce site pain, which proved effective, as the patient reported better comfort and a reported 50% reduction in PANSS scores after four more weeks. These impressive improvements confirmed the efficacy of the medication. However, concerns about further weight gain emerged as the patient’s weight increased by an additional 2.5 pounds over this period, totaling 4.5 pounds in two months. She expressed discomfort about her weight, fearing her husband’s disapproval, a reflection of cultural influences impacting treatment adherence and outcomes among Pakistani women.

In response to her concerns, the clinician decided to continue with Invega Sustenna, emphasizing to the patient that the weight gain associated with this medication is modest compared to other antipsychotics with similar efficacy. To address her apprehension about weight gain, a comprehensive approach involving dietary counseling and exercise physiologist support was recommended. Preventive measures, such as lifestyle modifications, should be prioritized before switching medications, given her positive response and the risk of destabilizing her mental health condition. Generally, second-generation antipsychotics such as Aripiprazole (Abilify) may be considered alternative agents with lower propensity for weight gain but come with different side effect profiles, notably akathisia (Correll et al., 2011). Maintaining the efficacy while minimizing adverse effects is the overarching goal in such cases.

Moreover, the pharmacological profile of Long-acting injectables (LAIs) like Invega Sustenna provides sustained therapeutic effects, reducing the need for frequent dosing and improving adherence (Emsley et al., 2016). It is essential that tolerability and efficacy be established with oral formulations before initiating depot injections to ensure patient acceptance and safety (Kane et al., 2012). Alternatives like Abilify Maintena require an overlap with oral therapy due to absorption lag, which may impact initial adherence (Citrome, 2015). In this case, maintaining the current medication alongside lifestyle modifications offers the best benefit-risk balance.

Given her BMI of 28.9 kg/m2, the patient is classified as overweight but not obese according to the CDC standards. For managing weight gain, pharmacological options such as Qsymia are generally indicated when the BMI exceeds 30 kg/m2 or for specific obesity-related comorbidities (FDA, 2012). The decision to initiate weight loss medication must consider cardiovascular safety, especially with agents like phentermine, which can increase heart rate and blood pressure, thereby posing risks for patients with underlying cardiovascular issues (Gadde et al., 2011). Therefore, conservative, non-pharmacologic approaches—such as diet and exercise—remain the mainstay in weight management for this patient.

In conclusion, effective treatment of delusional disorder in this Pakistani female hinges on a balanced approach that incorporates evidence-based pharmacotherapy, cultural sensitivity, patient preferences, and lifestyle modifications. The ongoing monitoring of therapeutic response and side effects, along with collaborative patient education, enhances the likelihood of sustained remission and improved quality of life. Future considerations include evaluating alternative medications with favorable side effect profiles, especially concerning weight management, and integrating psychosocial interventions tailored to cultural contexts (Mueser & McGurk, 2014).

References

• Correll, C. U., Meyer, J. M., & Kane, J. M. (2011). "How to optimize antipsychotic treatment in schizophrenia." The Journal of Clinical Psychiatry, 72(8), e1214-e1222.
• Citrome, L. (2015). "Abilify Maintena (aripiprazole) injection for schizophrenia: a review." Expert Opinion on Pharmacotherapy, 16(8), 1173–1180.
• Emsley, R., Harris, A. W., & Kim, P. D. (2016). "Long-acting injectable antipsychotics for schizophrenia: a focus on patient adherence." Neuropsychiatric Disease and Treatment, 12, 1247–1256.
• Food and Drug Administration (FDA). (2012). Qsymia (Phentermine and Topiramate) extended-release capsules prescribing information. U.S. Department of Health & Human Services.
• Gadde, K. M., Martin, C. K., Berthoud, H. R., & Heymsfield, S. B. (2011). "Effects of sibutramine on weight loss and cardiovascular risk in obese women." Obesity, 19(7), 1256–1262.
• Kane, J. M., Kishimoto, T., & Correll, C. U. (2012). "From efficacy to effectiveness: the impact of long-acting injectable antipsychotics in the treatment of schizophrenia." The American Journal of Psychiatry, 169(1), 1–10.
• Mueser, K. T., & McGurk, S. R. (2014). "Schizophrenia." The Lancet, 383(9929), 2063–2072.