Assessing and Treating Clients with Psychosis and Schizophrenia

Introduction

A delusion is a schizophrenia and schizoaffective disorder that is characterized by a false belief. Schizoaffective disorder is a condition that involves psychosis, abnormal moods such as depression or elevated moods. It also demonstrates abnormality in the patient thought content. Symptoms of this psychotic disorder include hallucinations, false beliefs, troubled organization of senses and thoughts, disorganized thinking, minimal desire to engage with people challenges while speaking succinctly and lack of inspiration (Alphs et al., 2015). On the other hand, the mood symptoms may involve feeling helpless, hopeless, guilty, and worthless, interest or pleasure loss in daily activities and loss of appetite. The positive symptoms scale and negative symptom scales are quite high. The religious and cultural background, as well as intelligence level do not account for the condition. It also leads to disorganized behaviours, speech, and thought process. Furthermore, deterioration and negative symptoms may emerge (Stahl, 2013). Persons suffering from this condition normally encounter non-bizarre misunderstandings, which encompasses circumstances taking place in the actual life such as being conspired against, deceived or followed (Pandina et al., 2011). Therefore, it leads to misinterpretation of experiences or perceptions. The case study in this paper involves a Pakistan woman acerbating delusional thought processes. The paper will describe the decisions taken in her treatment processes.

Decision 1: Invega Sustenna 234 mg on the first day and 156 mg dosage on fourth day

Rationale of the decision

I will begin by prescribing Invega Sustenna 234 mg intramuscular X1. Moreover, Invega 156 mg intramuscular would follow on the fourth day and subsequent dosage monthly. The drug is essential in treatment of schizophrenia because it stimulates the brain to rebalance the serotonin and dopamine. In this regard, it enhances the behaviour, mood, and thinking (Alphs et al., 2015).

Expectation

I expected that after administering Invega Sustenna 234 the patient would reduce the symptoms associated with the disease. For instance, the patient would reduce the level of hallucinations and paranoid thought. Moreover, I would anticipate that the psychopathology scale would improve (Pandina et al., 2011). Similarly, I project that the judgement and insights would be enhanced. I expected that the patient would demonstrate enhanced organization of thought. The clarity of speech would also improve. Finally, I anticipated that positive symptoms scale and negative symptom scales would reduce (Bishara, 2010).

The difference between what I expected to achieve and the actual results

After the patient return for appointment in four weeks, the positive and negative scale scores reduced by 25 per cent (Bishara, 2010). The patient also appeared to be abiding to the medical recommendations. However, weight gain was noted of 2 pounds also she did not express any concern. The weight gain could be attributed to the side effects of the drug. Moreover, she complained of pain at the site of injection hence she had challenges sitting down after several hours since the injection. Therefore, she was unable to walk for long period (Alphs et al., 2015).

Decision 2: Maintain Invega Sustenna drug but start deltoid muscle injections

Rationale of this decision

I decided to continue the prescription of Invega Sustenna because the patient had recorded improvement in the disease symptoms. The intramuscular injection is started for patients who have stabilized condition. The injection would farther help the patient to have a feeling of less agitation and think more positively and clearly (Johnson, Remtulla, Poolay & Arshed, 2018). Moreover, the use of injections in the deltoid muscle would greatly assist in maintaining therapeutic concentrations. The drug is also efficient in elimination of the symptoms in the long term. Finally, the prescription is largely tolerated in the patients.

Expectations

I anticipate that the prescription would be effective in the improvement of positive and negative symptom scale (PANSS). Moreover, I projected that the patient would record further stabilization of the symptoms related to delusional syndrome (Johnson, Remtulla, Poolay & Arshed, 2018). Similarly, I expect that pain from the site of injection would have reduced. The patient also would register better feelings. Finally, I anticipate that the weight gain for the patient would slightly increase but the patient would not be concerned (Li, Turkoz & Zhang, 2016).

The difference between what I expected to achieve and the actual results

After four weeks, the patient returned to my officer. I noted that the positive and negative symptoms scales had lowered by more than 50 per cent since the introduction of Invega Sustenna drug, which is an indicator of improvement (Li, Turkoz & Zhang, 2016). Moreover, the pain at the site of injection subsided and the patient reported improvement. However, the weight of the patient rose by more than 2.5 pounds. Therefore, since the commencement of the therapy, the patient had gained 4.5 pounds in body weight (Johnson, Remtulla, Poolay & Arshed, 2018). However, the patient expressed concerns regarding the weight gain. She was scared that her spouse might not love it hence may prefer other leaner women. The weight gain was due to the side effects of the medication.

Decision 3: Maintain Invega Sustenna, regular exercise and proper nutrition

Rationale for this decision

Since Invega Sustenna has been effective in stabilization of delusional symptoms, it would be best option to sustain it. However, the drug causes weight gain in the patient, which necessitate introduction of exercise physiologist and dietician in order to guide in proper nutrition and regular exercise (Johnson, Remtulla, Poolay & Arshed, 2018). It is normally a better idea to manage the weight of the client via consultation with life coach (exercise physiogists) and a dietician prior to substituting to another drug when the substance is demonstrating efficacy in less than six months (Li, Turkoz & Zhang, 2016).

Expectations

I anticipate that the patient would demonstrate further improvement in terms of the symptoms. In addition, expects that the weight gain would stop.

The difference between what I expected to achieve and the actual results

The positive and negative symptoms scale of schizophrenia reduced significantly by 90 per cent. The patient’s weight slightly reduced which was attributed to non-adherence to nutritional advice from the nutritionists. The patient also requested to substitute to drug that would not lead to weight gain (Johnson, Remtulla, Poolay & Arshed, 2018). However, she would be advised to adhere to the schedule of physical exercise and recommended diet.

Ethical considerations

Expressed emotions normally causes relapse in persons suffering from schizophrenia even when medication is used. Expressed emotion refers to a hostile attitude or reaction that the kin have over a person with a disorder. The majority of persons experiencing these expressed emotions were from marital homes. In Pakistan culture, expressed emotions are largely prevalent (Sadiq, Suhail, Gleeson & Alvarez-Jimenez, 2017). For this reason, the ethical considerations demand that the nurse should pay close attention to emotional issues communicated by the Pakistan woman during hospital visit because they could be due to negative attitudes from their relatives.

References

Alphs, L., Benson, C., Cheshire-Kinney, K., Lindenmayer, J. P., Mao, L., Rodriguez, S. C., & Starr, H. L. (2015). Real-world outcomes of paliperidone palmitate compared to daily oral antipsychotic therapy in schizophrenia: a randomized, open-label, review board-blinded 15-month study. J Clin Psychiatry, 76(5), 554-561.

Bishara, D. (2010). Once-monthly paliperidone injection for the treatment of schizophrenia. Neuropsychiatric disease and treatment, 6, 561.

Johnson, S., Remtulla, R., Poolay, R. C., & Arshed, S. (2018). Efficacy of paliperidone palmitate in the treatment of schizophrenia and its effect on psychosocial and occupational functioning in patients: 2 Case studies. GSTF Journal of Advances in Medical Research (JAMR), 1(4).

Li, H., Turkoz, I., & Zhang, F. (2016). Efficacy and safety of once-monthly injection of paliperidone palmitate in hospitalized Asian patients with acute exacerbated schizophrenia: an open-label, prospective, noncomparative study. Neuropsychiatric disease and treatment, 12, 15.

Pandina, G., Lane, R., Gopal, S., Gassmann-Mayer, C., Hough, D., Remmerie, B., & Simpson, G. (2011). A double-blind study of paliperidone palmitate and risperidone long-acting injectable in adults with schizophrenia. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(1), 218-226.

Sadiq, S., Suhail, K., Gleeson, J., & Alvarez-Jimenez, M. (2017). Expressed emotion and the course of schizophrenia in Pakistan. Social psychiatry and psychiatric epidemiology, 52(5), 587-593.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press