ntroduction to the case (1 page)<\/p>\n
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.
\nDecision #1 (1 page)<\/p>\n
Which decision did you select?
\nWhy did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nWhy 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.
\nWhat were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
\nExplain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
\nDecision #2 (1 page)<\/p>\n
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nWhy 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.
\nWhat were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
\nExplain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
\nDecision #3 (1 page)<\/p>\n
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
\nWhy 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.
\nWhat were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
\nExplain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
\nConclusion (1 page)<\/p>\n
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.<\/p>\n
Decision Point One<\/p>\n
Start Zyprexa (olanzapine) 10 mg orally at BEDTIME<\/p>\n
RESULTS OF DECISION POINT ONE<\/p>\n
\u00b7 Client returns to clinic in four weeks<\/p>\n
\u00b7 Her PANSS decreases to a partial response (decrease in positive symptoms by 25%)<\/p>\n
\u00b7 She comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get full from her meals, so she is snacking constantly throughout the day<\/p>\n
Decision Point Two<\/p>\n
Change medication to Geodon (ziprasidone) 40 mg orally BID with meals<\/p>\n
RESULTS OF DECISION POINT TWO<\/p>\n
\u00b7 Client returns to clinic in four weeks<\/p>\n
\u00b7 Client has a significant reduction in her PANSS (reduction of 40% in positive symptoms)<\/p>\n
\u00b7 She notices her weight is down slightly from the previous visit (2 pounds) and that her hunger has been curbed since starting this med<\/p>\n
\u00b7<\/p>\n
\u00b7<\/p>\n
\u00b7 BACKGROUND<\/p>\n
\u00b7 The client is a 34-year-old Pakistani female who moved to the United States in her late teens\/early 20s. She is currently in an \u201carranged\u201d marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as \u201cbrief psychotic disorder.\u201d She was given this diagnosis as her symptoms have persisted for less than 1 month.<\/p>\n
\u00b7 Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was \u201cout of control,\u201d which resulted in his calling the police and her subsequent admission to an inpatient psych unit.<\/p>\n
\u00b7 During today\u2019s assessment, she appears quite calm and insists that the entire incident was \u201cblown out of proportion.\u201d She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an \u201cAmerican wife\u201d instead of her. She says she knows this because the television is telling her so.<\/p>\n
\u00b7 She currently weighs 140 lbs., and she is 5\u2019 5.<\/p>\n
\u00b7
\n\u00b7 SUBJECTIVE<\/p>\n
\u00b7 Client reports that her mood is \u201cgood.\u201d She denies auditory\/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.<\/p>\n
\u00b7 A review of her hospital records shows that she received a medical workup from physician, who reported her to be in overall good health. Lab studies were all within normal limits.<\/p>\n
\u00b7 Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.<\/p>\n
\u00b7
\n\u00b7 MENTAL STATUS EXAM<\/p>\n
\u00b7 The client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be \u201clistening\u201d to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.<\/p>\n
\u00b7 You administer the PANSS which reveals the following scores:<\/p>\n
\u00b7 -40 for the positive symptoms scale<\/p>\n
\u00b7 -20 for the negative symptom scale<\/p>\n
\u00b7 -60 for general psychopathology scale<\/p>\n
\u00b7 Diagnosis: Schizophrenia, paranoid type<\/p>\n
\u00b7
\n\u00b7 RESOURCES<\/p>\n
\u00b7 PANSS Scale. Available at: http:\/\/egret.psychol.cam.ac.uk\/medicine\/scales\/PANSS<\/p>\n
\u00b7 \u00a7 Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261\u2013276. doi:10.1093\/schbul\/13.2.261<\/p>\n
\u00b7 https:\/\/www.clozapinerems.com\/CpmgClozapineUI\/rems\/pdf\/resources\/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf<\/p>\n
\u00b7 \u00a7 Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from https:\/\/www.clozapinerems.com\/CpmgClozapineUI\/rems\/pdf\/resources\/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf<\/p>\n
\u00b7 http:\/\/www.ima.org.il\/FilesUpload\/IMAJ\/0\/40\/20149.pdf<\/p>\n
\u00b7 \u00a7 Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625\u2013629. Retrieved from http:\/\/www.ima.org.il\/FilesUpload\/IMAJ\/0\/40\/20149.pdf<\/p>\n
\u00b7<\/p>\n
\u00b7<\/p>\n
\u00b7<\/p>\n
\u00b7<\/p>\n
\u00b7<\/p>\n
\u00b7 She does complain that it is difficult to remember the second dose and admits to missing afternoon doses on several occasions over the past month<\/p>\n
Decision Point Three<\/p>\n
Give the client a few test doses of Risperdal 1 mg orally BID for 3 days to see if she tolerates the medication. If tolerated, start Invega Sustenna at an appropriate starting and maintenance dose<\/p>\n
Guidance to Student
\nChanging to Risperdal oral therapy to test for side effects and then switching to Invega Sustenna is a good option in a client who has problems with compliance and who shows good effect from oral therapy. The manufacturer advertises that clients can be switched from an entirely different medication to Invega Sustenna if tolerability can be shown through oral therapy. From a clinical standpoint, the client may or may not respond to the medication and therefore could be wasted time. Remember, manufacturers have a product to sell, and their information should always be verified before implementing in clinical practice.<\/p>\n
Although Geodon is recommended twice daily with meals, some providers will choose to give the dose once a day and monitor for efficacy in clients who have compliance issues with BID dosing regimens.<\/p>\n
Latuda is a medication that behaves much like Geodon and is therefore a good option for someone who responds to Geodon but has compliance problems due to its once daily dosing schedule. Tolerability can be an issue as doses are escalated. Particularly, nausea, vomiting, and extrapyramidal side effects can be problematic and therefore good counseling points for clients. Clients usually tolerate lower doses (40 mg), but significant GI distress and movement disorders can occur when doses are pushed upward toward the daily max of 160 mg.<\/p>\n","protected":false},"excerpt":{"rendered":"
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