Examine Case Study: Pakistani Woman With Delusional Thought Processes.
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/DT/week_06/index.html.
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.
Pakistani Woman with Delusional Thought Processes
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Pakistani Woman with Delusional Thought Processes
Introduction
Delusional disorder is a serious mental disorder that may cause detrimental effects on the health of the individual. It was previously called a paranoid disorder. It is marked by the presence of delusions, which are unshakable beliefs in something untrue (González-Rodríguez et al., 2019). People with delusional disorder experience non-bizarre delusions, which involve situations that could occur in real life, such as being followed, poisoned, deceived, conspired against or loved from a distance. Individuals suffering from delusional often socialize and function normally apart from being subjects of their delusion. The delusional disorder involves misinterpretation of perceptions or experiences (Taylor, 2018). Although delusions may be a symptom of more common mental illnesses such as schizophrenia, delusional disorder itself is rare. It usually occurs in the middle or later in life. Causes of delusional disorder are associated with genetic, biological, and environmental factors.
The case study is about a patient is a 34-year-old Pakistani female who presents to the hospital following a 21-day hospitalization for what was diagnosed as a brief psychotic disorder. The psychiatrist gave this diagnosis because the patient’s symptoms have lasted just less than a month. Before admission, the patient claimed that she was seeing Allah, and believed she was the Prophet, Mohammad. The patient believed that she would save the world from sin. According to the husband, the patient stated that she is afraid of leaving their four children with him. The patient has even seen people following her before. In that regard, the purpose of this paper is to discuss three decisions that can be applied to help the patient recover.
Decision Point One
The decision point one is to Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter. This decision was arrived at because the medication is widely used in the treatment of schizophrenia (González-Rodríguez et al., 2019). Invega Sustenna is an antipsychotic medication often used to reduce the delusional effects of schizophrenia. It works by restoring the balance of certain neurotransmitters in the brain. Invega impacts dopamine and serotonin in the brain. Invega Sustenna is usually injected into a muscle by a healthcare provider once every 3 months or as directed by a physician.
Starting Zyprexa (olanzapine) 10 mg orally at BEDTIME was not selected because the medication is associated with weight gain, which can be disgusting to many patients. weight gain is a common side effect of Zyprexa (Taylor, 2018). On the other hand, Ability is often used in treating psychosis and mania in schizophrenia while Invega relieves psychotic symptoms and improves mood. In delusional disorder, Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter was considered the best medication and dose for the patient.
The expected outcomes for decision point one are quite many. For example, it is expected that the patient will recover from more than 50% of her symptoms. The delusional symptoms are expected to reduce (González-Rodríguez et al., 2019). The false beliefs she has will also end or resolve to a greater extent. The belief that television talks to her and that Allah talks to her through the television will also resolve. After four weeks, the patient returned to the hospital and reported a decrease of 25% in the PANSS score (Taylor, 2018). The patient seemed to be tolerating medications. She gained 2 pounds but it is not a serious issue for her. She complains of injection-site pain. Ethical considerations include prescription of the best medications, patient education, and autonomy, as well as non-maleficence.
Decision Point Two
Decision point two is to Continue the same made but instruct the administering nurse to begin injections into the deltoid at this visit and moving forward. This decision was selected because the medication showed a positive response to the patient with minimal side effects. The patient reported significant improvement of the symptoms (González-Rodríguez et al., 2019). Therefore, there was no need to change the medication. It is appropriate to change medication or adjust does only when either there is no positive response or there are serious side effects. Injections into the deltoid were recommended to prevent and alleviate injection site pains.
The primary reason why the other two decisions were not selected is explained in the above paragraph. There was no need to discontinue Invega Sustenna to start Haldol Decanoate. Also, there was no clear reason for introducing ability, therefore, the other two decisions were not selected. It was expected that the positive trend with the selected option would continue in the next four weeks and that the result would be better than the previous one.
The therapist expects that the delusional symptoms would reduce by 50%. This amount of symptoms reduction is considered a full response to the medication, although it is not recognized as full recovery (Lähteenvuo et al., 2021). The false thoughts and beliefs as well as being easily irritated are expected to reduce. The PANSS score is expected to reduce by 25%. The patient is expected to continue tolerating the medication. Additionally, the pain at the injection site is expected to reduce (Taylor, 2018). The patient returned to the clinic in four weeks and the actual results were similar to the expectations. The PANNS was reduced by 50% and the pain at the injection sire reduced. However, the patient now raises concerns regarding her weight gain. Some ethical concerns include educating the patient about the medications and alternatives (Tamilarasi & Kanagavalli, 2018). Others include non-maleficence and beneficence.
Decision Point Three
Decision point three was to continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make an appointment with a dietician and an exercise physiologist (Lähteenvuo et al., 2021). Follow up in one month. This decision was selected because it is clear, comprehensive, and elaborate. It will help address the issue of weight gain while continuing with the medication, which tends to show positive results. A dietician and exercise physiologist will help the patient to identify ways of managing weight gain.
Ability is a good option, however, it does not bind to the D2 receptor for a great period of time, such as Invega. Therefore, it would be less effective in certain individuals. Introducing other medications such as phentermine and topiramate for weight loss would read to additional side effects. Qsymia is a weight loss medication that is a combination of phentermine and topiramate. It is only indicated to treat obesity. However, the patient’s BMI does not fit the definition of obesity. There are two reasons why Qsymia therapy was wrong. First, there are only a few occasions where add-on therapy to treat a side effect is acceptable, and weight gain is not one of those scenarios. Secondly, phentermine has a lot of cardiovascular toxicities (such as elevated BP, HR, and increased workload on the heart.
The results of the decision tree will be evaluated in one month. The patient is expected to recover fully from all the delusional disorders. In the next month, the PANNS score will reduce by 98% and above percent (Lähteenvuo et al., 2021). All the symptoms are expected to resolve. Additionally, the pain at the injection site is expected to resolve completely. Furthermore, the patient is expected to maintain a healthy weight. All these expectations will be assessed. The ethical considerations include beneficence, non-maleficence, and patient autonomy. All the decisions made should bring benefits to the patient and should be harmless (Tamilarasi & Kanagavalli, 2018). The patient should be educated and allowed to make independent decisions.
Conclusion
The delusional disorder can lead to very detrimental health effects. It is marked by the presence of delusions, which are unshakable beliefs in something untrue. The case study is about a patient is a 34-year-old Pakistani female who presents to the hospital following a 21-day hospitalization for what was diagnosed as a brief psychotic disorder. Therefore, various decisions have been proposed to help the patient recover.
The decision point one is to Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter. Decision point two is to Continue the same made but instruct the administering nurse to begin injections into the deltoid at this visit and moving forward. Decision point three was to continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make an appointment with a dietician and an exercise physiologist. Follow up in one month. Additionally, various ethical issues must be considered. They include beneficence, non-maleficence, justice, and patient autonomy.
References
González-Rodríguez, A., Esteve, M., Álvarez, A., Guardia, A., Monreal, J. A., Palao, D., & Labad, J. (2019). What we know and still need to know about gender aspects of delusional disorder: a narrative review of recent work. Journal of Psychiatry and Brain Science, 4(3).
Lähteenvuo, M., Taipale, H., Tanskanen, A., Mittendorfer-Rutz, E., & Tiihonen, J. (2021). Effectiveness of pharmacotherapies for delusional disorder in a Swedish national cohort of 9076 patients. Schizophrenia Research, 228, 367-372.
Taylor, D. (2018). The Maudsley Prescribing Guidelines in Psychiatry. John Wiley & Sons.
Tamilarasi, B., & Kanagavalli, P. (2018). Knowledge regarding legal and ethical issues in nursing practice among final year B. Sc nursing students. TNNMC Journal of Nursing Education and Administration, 6(2), 7-10. https://www.indianjournals.com/ijor.aspx?target=ijor:tnnmcjnea&volume=6&issue=2&article=002