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
People with delusional disorder often have one or more delusional thoughts for 1 month or longer. Delusional thoughts do not have to be, absolutely, unbelievable or outside the realm of possibility, they are usually based on reality. Delusional disorder is previously called a paranoid disorder. It is a type of serious mental illness called psychosis (González-Rodríguez et al., 2018). People with this mental disorder fail to recognize the difference between what is real and what is imagined. The main feature of delusional disorder is the presence of delusions, which are unreal beliefs that the individual believes are very true. The delusions often involve the misinterpretation of situations, experiences, or perceptions (Muñoz-Negro et al., 2020). There are several types of delusional disorder, such as erotomanic, grandiose, jealous, persecutory, somatic, and others. Delusional disorders can be treated using certain medications.
The case study is about a 34-year-old Pakistani female who moved to the United States in her late teens/the early 20s. The patient is in an arranged marriage. She shows up in the hospital following 21-day hospitalization after being diagnosed with what was described as a brief psychotic disorder. The patient was given this diagnosis because her symptoms had persisted for less than one month. Before the admission, the patient was reporting visions of Allah whom she believed was the Prophet, Mohammed. The husband is concerned about her situation and even afraid of leaving her with the children. The patient believes that she is the one who would save the world. During today’s assessment, the patient appears quite calm and denies beliefs about Prophet Mohammed. She demonstrates no noteworthy mannerisms, gestures, or tics. She appears to be listening to something, her speech is slow and at times interrupted. In that regard, this paper provides the best decisions to help the patient.
Decision Point One
The selected decision is to begin Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter. This selection was made because Invega Sustenna has proven to be effective in treating schizophrenia. It is an atypical type of antipsychotic drug that works by helping to restore the balance of certain natural chemicals (neurotransmitters) in the brain (Muñoz-Negro et al., 2020). It decreases hallucinations and helps one to think more positively and clearly about themselves, other people, situations, and places. Therefore, the therapist believed it was the best among the three options.
The other two options were not selected for one reason or the other. For example, Starting Zyprexa (olanzapine) 10 mg orally at BEDTIME was not the best option because the drug is often associated with significant weight gain. Zyprexa (olanzapine) is also associated with side effects such as dizziness, lightheadedness, dry mouth, and event slow heartbeat (Taylor, 2018). Starting Abilify (aripiprazole) 10 mg orally at BEDTIME was not selected because the ability is commonly used in treating manic episodes in schizophrenia, however, Invega Sustenna is best in the treatment of delusions.
The expected results include improvement or reduction of all the symptoms associated with delusional disorder. The patient will tolerate medication until she recovers (González-Rodríguez et al., 2018). Additionally, her speech will improve and all the un-noteworthy mannerisms, gestures, or tics are expected to reduce. She is expected to improve concentration and mood. The symptoms are expected to reduce by 50% on the PANSS scale. The patient returned to the clinic after four weeks and reported improvement. She seemed to be tolerating medications, the symptoms reduced by 25% on the PANSS scale. However, she complains of weight gain and injection site pain. Some of the ethical considerations include beneficence, non-maleficence, and patient autonomy (Leach & Welfel, 2018). These ethical concerns were developed to improve patient care, delivery, and outcomes.
Decision Point Two
The selected decision point two is to continue with the same dose of Invega Sustenna and begin injections into the deltoid at the visit and moving forward. The reason for making this decision was because the previous dose had shown positive patient outcomes (Taylor, 2018). Therefore, there was no need to change either the dose or the medication. However, it was important to instruct the attending nurse to begin injections into the deltoid site to prevent further pain at the injection site (Taylor, 2018). The dose was maintained because there were no serious side effects manifested by the patient as a result of the medication. Therefore, maintaining the dose was appropriate.
Discontinuing Invega Sustenna and starting Haldol Decanoate (haloperidol decanoate ) 50 mg IM q2weeks with oral Haldol 5 mg BID for the next 3 months. Was not selected because there was no apparent reason to discontinue Invega Sustenna (Muñoz-Negro et al., 2020). Similarly, there was no reason to support the need to introduce ability. Therefore, the two remaining options could not be applied. The previous dose showed a positive result, hence, had to be maintained and monitored in four weeks.
With decision two in place, the therapist expects most of the symptoms to be relieved in four weeks. Specifically, symptoms related to slow speech, drug intolerance, weight gain, and lack of concentration are expected to resolve completely (Taylor, 2018). The symptoms are expected to reduce by 50% on the PANSS scale. Most of the false beliefs, speech interruptions, and other suspicious behaviors will resolve. Again the patient returned to the clinic in four weeks. The expected results and the actual results almost matched. The patient showed significant improvement with 50% of the symptoms resolved. However, the patient seems bothered about weight gain. Ethical concerns about this decision include patient education. The patient should be educated about the side effects of the drug (Leach & Welfel, 2018). Also, the autonomy of the patient should not be despised to ensure she makes her preferred decisions.
Decision Point Three
The selected 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 (Taylor, 2018). This decision is broad and tries to address many problems currently being faced by the patient. Making an appointment with a dietician and exercise psychologist will help manage the weight gains. Follow-up will help identify any concerns and progress of the patient.
Ability does not bind to the D2 receptors for a prolonged time as Invega Sustenna. As a result, it is less effective in some patients. Qsymia is a weight loss medication that is a combination of phentermine and topiramate and is only indicated in the treatment of obesity (Muñoz-Negro et al., 2020). The patient’s MBI does not categorize her under obese individuals. medications such as phentermine and topiramate would only lead to serious medication side effects that would endanger the patient’s health. phentermine has a lot of cardiovascular toxicities (such as elevated BP, HR, and increased workload on the heart (Muñoz-Negro et al., 2020). Additionally, 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. Therefore, Qsymia therapy is not the correct regimen.
The expectation is that the patient will recover absolutely from the symptoms in one month. The delusional symptoms are expected to disappear. The PANNS score is expected to show 90% and above symptoms improvement (Muñoz-Negro et al., 2020). The patient is expected to achieve and maintain a healthy weight in one month. Ethical considerations include beneficence, non-maleficence, autonomy and informed consent, and justice (Leach & Welfel, 2018). All these ethical considerations must take effect to improve care delivery.
Conclusion
The delusional disorder can be detrimental to the health and life of patients. It is a type of serious mental illness called psychosis, where individuals fail to recognize the difference between what is real and what is imagined. Various types of delusional disorder include erotomanic, grandiose, jealous, persecutory, somatic, and others. The case study is about a 34-year-old Pakistani female who moved to the United States in her late teens/the early 20s. She shows up in the hospital following 21-day hospitalization after being diagnosed with what was described as a brief psychotic disorder. Before the admission, the patient was reporting visions of Allah whom she believed was the Prophet, Mohammed.
Proper decisions were made to improve the patient’s health. Every decision made was meant to bring benefits to the patient. Decisions one to three are clearly explained in the body of this paper. Additionally, ethical concerns have been identified. They include beneficence, non-maleficence, patient autonomy and consent, and the principle of justice.
References
González-Rodríguez, A., Estrada, F., Monreal, J. A., Palao, D., & Labad, J. (2018). A systematic review of the operational definitions for antipsychotic response in delusional disorder. International clinical psychopharmacology, 33(5), 261-267. https://doi.org/10.1097/YIC.0000000000000227
Leach, M. M., & In Welfel, E. R. (2018). The Cambridge handbook of applied psychological ethics. Cambridge University Press.
Muñoz-Negro, J. E., Gómez-Sierra, F. J., Peralta, V., González-Rodríguez, A., & Cervilla, J. A. (2020). A systematic review of studies with clinician-rated scales on the pharmacological treatment of delusional disorder. International clinical psychopharmacology, 35(3), 129-136. https://doi.org/10.1097/YIC.0000000000000306
Taylor, D. (2018). The Maudsley Prescribing Guidelines in Psychiatry. John Wiley & Sons.