Assessing and Treating Patients with Psychosis and Schizophrenia (Essay Sample)

Assessing and Treating Patients with Psychosis and Schizophrenia
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Assessing and Treating Patients with Psychosis and Schizophrenia
Introduction to the Case
Both Schizophrenia and Psychosis are serious mental disorders differentiated through drastic mood, insight, perception, and behavior changes. Schizophrenia is one of the causes of psychosis, and schizophrenia also has other symptoms. The patient described in the case study is a 34-year-old Pakistani married female who presents after staying in the hospital for a period of 21 days for a “brief psychotic disorder”. This diagnosis was made due to the fact that her symptoms had been less than one month. Prior to being hospitalized, the patient stated about visions of Allah, and claimed to be Prophet Mohammed. One night, she lost control, and her husband was frightened for their children's safety and called the cops. Today, the patient appears calm and attentive in the clinic. The event was “blown out of proportion,” she claims. The patient moved to the United States in her late teens and was married to her husband in an “arranged marriage”. She denies being Prophet Mohammad, but claims that her spouse sought after her since he wanted an “American wife,” as she had heard on the television.
Additionally, the patient becomes hostile at irregular intervals but then appears to be in good mood. According to the hospital records, the patient demonstrates overall good health, while the laboratory reference ranges are within normal limits. She admits to discontinuing the use of Risperidone a week following her hospital discharge since she believes her husband will poison her. She is alert and oriented to person, time, place, and event. Patient is appropriately dressed and exhibits no substantial mannerisms, gestures, or tics; has slow speech and intermittent silence periods; affect is diminished; insight and judgement are impaired; and denies suicidal or homicidal ideation. The Positive and Negative Syndrome Scale (PANSS) measures indicate a -40 for positive symptoms, -20 for negative symptoms, -60 for the general psychopathology scale. The patient is diagnosed with the paranoid type of schizophrenia. The purpose of this paper is to evaluate and then choose the most appropriate antipsychotic medications to treat the patient's disorder considering the pharmacokinetic and pharmacodynamic qualities of the suitable medications to make it possible for the necessary interventions for a successful treatment outcome.
Decision #1
Start Zyprexa (olanzapine) 10 mg orally at Bedtime.
Zyprexa is a second-generation atypical antipsychotic. It was selected for its efficacy and lower extrapyramidal effects in comparison to other antipsychotics in the therapeutic intervention for schizophrenia. Several studies show Zyprexa's efficacy in treating patients that experience their first schizophrenic episode and that the patients had a higher likelihood to discontinue treatment than other antipsychotics (Citrome et al., 2019). Zyprexa is reasonably free of EPS and prolactin elevation even at higher doses (Stern et al., 2016, p. 81).
The goal for prescribing Zyprexa is to reduce PANSS scores and create adherence. Zyprexa is recognized for its effectiveness and tolerability in studies. Ethical considerations for this decision are discussing the side effect of weight gain and other metabolic effects with the patient. Due to Zyprexa's metabolic disruption and weight gain, it is typically used as a second choice for treatment (Citrome et al., 2019). Speaking to the patient about the side effects is essential to build rapport with trust with the patient.
Invega Sustenna is an atypical antipsychotic that is approved to treat negative and positive symptoms of schizophrenia. In studies demonstrated efficacy with Invega in relapse prevention. Invega was not selected since it has severe side effects such as elevated prolactin, weight gain, and extrapyramidal side effects. During the early stages of the disease, these side effects may be considerable undesirable effects, particularly with the elevated prolactin for younger people (Emsley & Kilian, 2018). Invega may be an option later down the road when the patient has established a baseline.
Aripiprazole is another antipsychotic validated for therapeutic intervention in schizophrenia patients and has benefits as the first-line therapy (best treatment) for the patients who have recently presented, been assessed, and been treated for schizophrenia. This drug was not chosen because, in a study measuring effectiveness for the first episode of psychosis, Aripiprazole scored slightly higher in discontinuation rates, with Aripiprazole being 73.08% versus 69.09% for Olanzapine. The study also noted that there was a higher likelihood for patients to experience akinesia with Aripiprazole than with Olanzapine (Gуmez-Revuelta et al., 2020).
Decision #2
Change medication to Geodon (ziprasidone) 40 mg orally BID with meals.
After four weeks, the patient returns to the clinic with a decrease in positive symptoms on her PANSS by 25%. The patient does report a weight gain of 5 pounds, and although she is not eating full meals, she claims to constantly snack throughout the day. The decision is to change the patient to Geodon 40 mg orally BID with meals. Geodon is also a second-generation atypical antipsychotic approved for schizophrenia. Geodon was chosen because it does not cause weight gain and the goal for choosing this medication is to decrease the patient's elevated weight. Olanzapine carries adverse metabolic effects on glucose, lipid, weight, and body composition, which is why reducing it to 7.5 mg was not chosen (Citrome et al., 2019). Geodon is best taken with meals due to its rapid absorption (Stern et al., 2016, p. 82). Considerations for the patient when prescribing the medication Geodon would be a prolonged QT complex's rare side effect. In the study, half of the patients who were given medications like Geodon experienced a QT rise of 20 milliseconds or more. Prolongation of QT complex can lead to cardiac arrhythmias (Waleekhachonloet et al., 2019).
Wellbutrin XL 150 mg orally in the morning was not chosen as an adjunct because the patient does not appear to be presenting with depression-like symptoms. Antidepressants are typically added to treatment for patients with schizophrenia as well as diagnosed with depression or are having treatment-resistant negative symptoms. Depression in schizophrenia can appear with a lower mood, depressed appearance, hopelessness, lowered self-esteem (Zhang & Mao, 2015). The patient does not appear to be symptomatic of depression.
Decision #3
Discontinue Geodon and Start Latuda (lurasidone) 40 mg orally daily.
The patient returns to the clinic in four weeks with a significant reduction in PANSS score of 40% in positive symptoms. The patient states a decrease in weight by 2 pounds, and her hunger has been curbed. The patient does say it is difficult to remember her second dose and admit to missing afternoon doses. Geodon is discontinued, and Latuda 40 mg orally daily is prescribed. Latuda is a second-generation atypical antipsychotic validated for therapeutic intervention in schizophrenia patients. Latuda is a good choice for the patient because it is once a day and has a favorable side effect profile, such as low sedation levels, reduced gain in weight, and low cognitive-motor interference. Latuda has also been shown as the long-term treatment reduces the risk of relapse and has been examined and assessed in double blind randomised placebo-controlled trials for new medications that showed a constant improvement in the PANSS score. The goal of prescribing Latuda is to continue to see a decrease in PANSS on positive and negative symptoms, demonstrated in studies compared with a placebo. Dosing at 40mg/day has been shown significant efficacy; therefore, no titration is needed. Considerations when prescribing Latuda that may impact the patient is that Latuda is metabolized vis CYP3A4 primarily. We would need to assess the patient's liver function and address other medications that may interact with Latuda, and address possible side effects such as nausea, vomiting, and EPS that could potentially cause issues as dosing increases (Harvey, 2015).
Geodon increase to 80mg at bedtime was not chosen because increasing the Geodon dose may affect the patient's QT interval. Risperdal 1 mg orally BID for three days, then change to Invega Sustenna was not selected because the patient has already demonstrated noncompliance with taking medications more than one time daily. Switching over to Invega Sustenna would not be a clear choice either because of the weight gain and incre