Week 6 Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

NURS 6630 Week 6 Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Completed Sample Paper Included

NURS 6630 Week 6 Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Completed Sample Paper

(Assessing and Treating Clients With Psychosis and Schizophrenia)

Assessing And Treating Clients With Psychosis And Schizophrenia Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Psychosis and Schizophrenia

    In treating patients with mental disorders, it will be vital to evaluate the pharmacodynamics and the pharmacokinetics process of such drugs and their effects on the patients. This paper explores the decisions that will be made in treating a Pakistani woman with delusional thought processes.

Decision #1

    For the first decision, I selected the Pakistani Woman to start by taking Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day four and monthly after that. The administration of this medication seemed to be effective. After the client returned to the clinic after four weeks, they displayed a decrease in PANSS score by about 25% and a good way of tolerating medications. I selected the decision to administer Invega Sustenna to the patients as numerous evidence-based scholarly studies have shown that the drug effectively treats schizoaffective disorders when administered as a monotherapy (Li, Turkoz, & Zhang, 2015). The drug is effective, acting as a mood stabilizer, which is an important element in treating the Pakistani Woman. In the first decision I did not choose administer Zyprexa 10 mg orally as the drug is known to cause a lot of adverse side effects including weight gain, headaches, changes in personality and problems with memory and speech. I also did not choose to administer Abilify 10 mg orally as the drug is also known to cause adverse side effects including insomnia, weight gain, drooling, headache and dizziness and anxiety and restlessness among many others (Wani, Dar, Chandel, et al., 2015).

    In deciding to administer Invega Sustenna 234 mg to the Pakistani Woman, I was hoping that I would tone down her delusions, which have made it difficult for her to live with her husband and children. Therefore, I was hoping that the client would stop having delusions such as the TV talking to her and viewing herself as Prophet Muhamad. I was also hoping to decrease the patient’s PANSS score. What I was hoping to achieve by making the first decision was similar to what I achieved because by administering Invega Sustenna, I was able to decrease the patient’s PANSS score by nearly 25%. This showed an improvement in the patient’s condition and having fewer delusions. By administering Invega Sustenna, I expected some side effects on the patient, such as weight gain and pain in the injection area.

Decision #2

    For the second decision, I choose to continue the administration of Invega Sustenna to the patient but asked the nurses to change the injection sites to the deltoid muscle for the subsequent visits. I selected this decision as Invega Sustenna was effective in reducing the patient’s delusional symptoms. According to Morris and Tarpada (2017), the dosage of Invega Sustenna should be continued if no major side effects were experienced in the patients. After the first month of the administration of Invega Sustenna to the Pakistani Woman, no major side effects expected weight gain and pain in the injection site were witnessed. According to Emsley and Kilian (2018), to deal with pain in the injection areas, the injection in the patients would have to be performed on the deltoid muscles with adequate alternation of the injection. By making the second decision to continue the administration of Invega Sustenna but on the patient’s alternating deltoid muscles, I was hoping to keep lowering the incidences of delusions on the Pakistani Woman and to reduce the complaints of pain in the injection area.

     What I was hoping to achieve by electing to continue the administration of Invega Sustenna to the Pakistani Woman and what I achieved was similar. This is because the drug managed to reduce most of the patient’s delusional symptoms, with a PANNS score of the patient reducing by 50%. The patient also stated that they experienced less pain in the injection areas. However, in continuing the administration of Invega Sustenna to the patients, I was also hoping that the clients would gain some weight. According to Emsley & Kilian (2018), weight gain among patients is one of the common side effects of Invega Sustenna. The patient gaining only 4.5 pounds during a whole treatment period of two months was therefore not abnormal in any way.

Decision #3

    For the third decision, I decided to continue the administration of Invega Sustenna to the Pakistani Woman. According to Savitz, Xu, Gopal, et al. (2016), if Invega Sustenna effectively alleviates delusional symptoms among patients and does not cause any significant negative side effects on the patients, it should be continued till the client completely recovers. I also choose to counsel the patient on her weight gain as the weight gain caused by Invega Sustenna was the least the patient could encounter than other drugs that had similar efficacy. I made the decisions to make appointments with the dieticians and exercise psychologists.

     By deciding to continue the treatment of Invega Sustenna on the patients, I was hoping that all the client’s delusional symptoms would disappear, and the patient would return to their normal life. I was also hoping that the client could control her weight gain through a quality diet and exercise. What I expected to achieve in making the decision to continue Invega Sustenna administration in the patient and what I achieved were similar. This is because the patient’s delusions were alleviated so that they would perform daily living activities. The patient was also able to perform manage her weight by taking a healthy diet and exercising.

Ethical Considerations

    The ethical consideration that would impact the patients’ treatment plan would include beneficence, non-maleficence, and confidentiality (Howe, 2018). All the decisions made relating to the patient would thus be made for their benefits with any intentional harm to patients being avoided. The treatment process of the patient would also be kept confidential.

References

Emsley, R., & Kilian, S. (2018). Efficacy and safety profile of paliperidone palmitate injections

in the management of patients with schizophrenia: an evidence-based review. Neuropsychiatric disease and treatment, 14, 205–223. https://doi.org/10.2147/NDT.S139633.

Howe E. (2018). Ethical considerations when treating patients with schizophrenia. Psychiatry

    (Edgmont (Pa. : Township)), 5(4), 59–64.

Li, H., Turkoz, I., & Zhang, F. (2015). 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, 15–24. https://doi.org/10.2147/NDT.S83651.

Morris, M. T., & Tarpada, S. P. (2017). Long-Acting Injectable Paliperidone Palmitate: A

    Review of Efficacy and Safety. Psychopharmacology bulletin, 47(2), 42–52.

Savitz A ,J., Xu, H., Gopal, S, Nuamah, I., Ravenstijn, P., Janik, A., Schotte, A., Hough, D.,

Fleischhacker, W. (2016). Efficacy and Safety of Paliperidone Palmitate 3-Month Formulation for Patients with Schizophrenia: A Randomized, Multicenter, Double-Blind, Noninferiority Study, International Journal of Neuropsychopharmacology, Vol. 19, Iss. 7.

Wani, R. A., Dar, M. A., Chandel, R. K., Rather, Y. H., Haq, I., Hussain, A., & Malla, A. A.

(2015). Effects of switching from olanzapine to aripiprazole on the metabolic profiles of patients with schizophrenia and metabolic syndrome: a double-blind, randomized, open-label study. Neuropsychiatric Disease and Treatment, 11, 685–693. https://doi.org/10.2147/NDT.S80925

Week 6 Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

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

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 4, “Psychosis and Schizophrenia”

Chapter 5, “Antipsychotic Agents”

Stahl, S. M. (2014b)

The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

• amisulpride
• aripiprazole
• asenapine
• chlorpromazine
• clozapine
• flupenthixol
• fluphenazine
• haloperidol
• iloperidone
• loxapine
• lurasidone
• olanzapine
• paliperidone
• perphenazine
• quetiapine
• risperidone
• sulpiride
• thioridazine
• thiothixene
• trifluoperazine
• ziprasidone

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659. doi:10.2165/00023210-200923080-00002

Note: Retrieved from Walden Library databases.

Document: Midterm Exam Study Guide (PDF)

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

Note: Retrieved from Walden Library databases.

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

Required Media

Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

Case Study: Pakistani Woman with Delusional Thought Processes

Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.At each decision point stop to complete the following:

• Decision #1
  • Which decision did you select?
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Delusional Disorders Pakistani thought Processes

BACKGROUND

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 “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.

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 “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.

During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” 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 “American wife” instead of her. She tells you that she knows this because the television is telling her so.

She currently weighs 140 lbs, and is 5’ 5”

SUBJECTIVE

Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits.

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.

MENTAL STATUS EXAM

The client is alert, 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 constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described, above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.

The PMHNP administers the PANSS which reveals the following scores:

-40 for the positive symptoms scale

-20 for the negative symptom scale

-60 for general psychopathology scale

Diagnosis: Schizophrenia, paranoid type

RESOURCES

§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

§ Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

§ Paz, Z., Nalls, M. & Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal. 13. 625-629.

NURS 6630 Assessing and Treating Adult Clients with Mood Disorders Completed Sample Paper

A mood disorder describes a psychological disorder which is characterized as a fluctuation of one’s mood, such as a major depressive or bipolar disorder. An estimated 20 million individuals in the United States have depression which comprises of symptoms such as a loss of pleasure in activities, sadness, weight changes, feelings of hopelessness, fatigue as well as suicidal ideation; all of which can significantly impact daily functioning (Mental Health.gov, 2017). According to Park and Zarate (2019) onset of depression in adulthood continues to flourish where an estimated 30 percent of adults have a lifetime risk of experiencing a major depressive episode with a median age of 32.5. The author further indicates screening for depression, a thorough evaluation, and monitoring is necessary to ensure safety and wellbeing (Park & Zarate, 2019). Pharmacotherapy, along with psychotherapy are first-line therapies for effective outcomes (Park & Zarate, 2019). The purpose of this paper is to review a case study, choose the appropriate selection utilizing research, and discuss ethical considerations.

Case Study

A 32-year-old Hispanic American client presents to the initial appointment with depression.  Health history, along with medical workup, appears to be unremarkable except for the slight back and shoulder pain due to his occupation. The clinical interview reveals past feelings of being an “outsider” and has few friends (Laureate Education, 2016).  There is a decline in daily activities, a weight increase of 15 pounds over two months, along with diminished sleep and the inability to fully concentrate (Laureate Education, 2016).  The results of the depression screening administered by the psychiatric mental health nurse practitioner (PMHNP), indicates severe depression with a score of 51 (Montgomery & Asberg, 1979).

Decision Point One

The selections include Zoloft 25 mg orally daily, Effexor 37.5 XR mg orally daily, or Phenelzine 15 mg orally TID.  As a healthcare professional treating a client, Zoloft (sertraline) 25 mg is the first choice at decision point one.  Selective serotonin reuptake inhibitors (SSRIs) impede the reabsorption of this neurotransmitter; thus, increasing the serotonin levels of the nerve cells in the brain to allow for improvement in mood (Stahl, 2013).  SSRIs have been utilized as first-line therapy to treat major depressive disorder due to efficacy, fewer side effects, cost-effectiveness as well as a wider availability (Masuda et al., 2017). The therapeutic dosing range is typically 50 mg-200 mg (Stahl, 2017). However, beginning at 25 mg and gradually titrating the dose, depending on tolerability, is an appropriate health care decision (National Alliance on Mental Illness, 2018b). Therefore, a low dose of Zoloft appears to be the best option in caring for this client.

Effexor (venlafaxine) is classified as a selective serotonin-norepinephrine reuptake inhibitor (SNRI) which impedes the reabsorption of the neurotransmitters serotonin and norepinephrine changing the chemistry in the brain to regulate mood (Stahl, 2013). Bhat and Kennedy (2017) describe antidepressant discontinuation syndrome (ADS) as a “medication-induced movement disorder” along with various adverse reactions such as intense sadness and anxiety; periods of an “electric shock” sensation; sights of flashing lights; and dizziness upon movement (Bhat & Kennedy, 2017, p. E7).  These symptoms are often experienced a few days after sudden discontinuation of an antidepressant with a shorter-life (3-7 hours) such as venlafaxine or paroxetine (Bhat & Kennedy, 2017; Stahl, 2017). Moreover, Stahl (2017) indicates venlafaxine is one of the drugs with more severe withdrawal symptoms in comparison to other antidepressants. It may take some clients several months to taper off of this medicine; therefore, Effexor is not the optimal selection at this time.

Phenelzine is classified as an irreversible monoamine oxidase inhibitor (MAOI) which impedes the monoamine oxidase from deconstructing serotonin, dopamine, as well as norepinephrine.  Thus, boosting the levels of neurotransmitters in the brain to regulate mood (Stahl, 2017).  Park and Zarate (2019) purport the use of monoamine oxidase inhibitors have a higher risk profile; therefore, are not typically utilized unless a newer antidepressant is considered ineffective. Bhat and Kennedy (2017) indicate there is a need for a long taper with MAOIs. Further, this medication may lose effectiveness after long-term use, and it is considered to have habit-forming qualities for some individuals (Stahl, 2017). The initial dose for phenelzine is taken three times a day which research suggests medication adherence is often tricky when the administration is more than once a day (Goette & Hammwöhner, 2016).  Stahl (2017) describes certain risk factors comprising of frequent weight gain, interference of certain food products containing tyramine, drug interactions (serotonin syndrome), as well as a hypertensive crisis. When utilizing this medication for treatment-resistant depression, the advance practitioner is aware of the detrimental adverse reactions which may occur. Therefore, phenelzine is not the safest option for this client.

The overarching goal for this male client is to reduce the symptoms related to his major depressive disorder and to eventually achieve remission without relapse where he can maintain normalcy in his life. After four weeks, his depressive symptoms decrease by 25 percent which is progress; however, he has a new onset of erectile dysfunction (Laureate Education, 2016). Sexual dysfunction is a notable side effect of sertraline (Stahl, 2017). Therefore, the clinician will reevaluate the plan of care given this new information. The outcomes were to be expected as the client was started on a low dose of sertraline, and treatment is typically 50 mg to 200 mg.  A continuation in progress may require more time, approximately six to eight weeks in total (Stahl, 2017).  

Decision Point Two

The present selections include decrease dose to 12.5 daily orally, continue same dose and counsel client, or augment with Wellbutrin 150 IR in the morning.  The preference for decision point two is Wellbutrin (bupropion) 150 IR, which is considered a norepinephrine dopamine reuptake inhibitor (SDRI).  An SDRI elevates the neurotransmitters dopamine, noradrenaline, and norepinephrine in the brain to achieve an improvement in depressive symptoms (Stahl, 2017). The purpose of utilizing this agent is three-fold: (1) To boost mood (2) To treat the new onset of sexual dysfunction (3) To aid in weight-loss.  According to the National Alliance on Mental Illness [NAMI] (2018a), Wellbutrin is a medication administered for major depressive disorder often in conjunction with an SSRI (NAMI, 2018a).

 Further, Wellbutrin may be prescribed with an SSRI to reverse the effects of SSRI-induced sexual dysfunction (Stahl, 2017). Dunner (2014) purports combining antidepressants are safe and may enhance efficacy; however, the combination of medications may also be utilized as an approach to reduce the effects of antidepressant pharmacotherapy. Dunner (2014) concurs that bupropion is frequently used with an SSRI or SNRI to alleviate sexual dysfunction.  Stahl (2017), findings indicate the most common side effects of bupropion consist of constipation, dry mouth, agitation, anxiety, improved cognitive functioning, as well as weight loss. The client in this scenario has gained 15 pounds over two months; thus, this medication may aid in his desire to lose weight (Laureate Education, 2016).  Further, this agent typically is not sedating as it does not have anticholinergic or antihistamine properties yet have a mild stimulating effect (Guzman, n.d).

Decreasing the Zoloft dose from 25 mg daily to 12.5 mg would not prove feasible as the client has reached a 25 percent reduction in symptomology.  The treatment for adults is 50 mg-200 mg, taking an approximate six to eight weeks to see the results in some individuals (Stahl, 2017). If the provider is tapering the medication as part of the client’s plan of care, reducing the dose to 12.5 mg would prove beneficial.  Research finds that when taking an antidepressant, the neurons adapt to the current level of neurotransmitters; therefore, if discontinuing an SSRI too quickly some of the symptoms may return (Harvard Health Publishing, 2018). Under some circumstances, discontinuation signs may appear, such as sleep changes, mood fluctuations, unsteady gait, numbness, or paranoia (Harvard Health Publishing, 2018).  However, the client is experiencing slow and steady progress on his current dose of Zoloft, so no adjustments are warranted.

At this point, positive results have been verbalized with the current dose of Zoloft 25 mg daily, with the exception of the onset of erectile dysfunction, which is a priority at this time.  One study finds that comorbid depression and anxiety disorders are commonly seen in adult males with sexual dysfunction (Rajkumar & Kumaran, 2015). An estimated 12.5 percent of participants experienced a depressive disorder before the diagnosis of sexual dysfunction. The author’s findings suggest a significant increase in suicidal behaviors with this comorbidity.  Moreover, the study indicates, some men experienced a sexual disorder while taking prescribed medication such as an antidepressant (Rajkumar & Kumaran, 2015).  According to Li et al. (2018), cognitive-behavioral therapy (CBT) is a beneficial tool utilized with clients experiencing mood disorders.  The implementation of CBT may increase the response and remission rates of depression. However, the option of continuing the same dose and engaging in counseling services is not the priority at this time.  It is essential to address this side effect to enhance his current pharmacotherapy and prevent an increase in depressive symptoms.

The continued goal of therapy is to achieve “full” remission of this individual’s major depressive disorder and to enhance his wellbeing.  After four weeks, the client returns to the clinic with a significant reduction in depressive symptoms along with the dissipation of erectile dysfunction.  However, he reports feelings of “jitteriness” and on occasion “nervousness” (Laureate Education, 2016).  This course of treatment has proven successful thus far, and the outcomes are to be expected due to the medication trials.

Decision Point Three

The present selections are to discontinue Zoloft and continue Wellbutrin, change Wellbutrin to XL 150 mg in the morning, or add Ativan 0.5 mg orally TID/PRN for anxiety.  The selection for decision point three is to change the Wellbutrin from IR to XL 150 mg in the morning. The first formulation is immediate- release (IR) and the recommended dosing is divided beginning at 75 mg twice daily increasing to 100 mg twice daily, then 100 mg three times a day with the maximum of 450 mg (Stahl, 2017).   The second formulation is extended-release (XL), where the administration for the initial dose is once daily taken in the morning; the maximum is 450 mg in a single dose (Stahl, 2017).  The peak level of bupropion XL is approximately five hours; therefore, the side effects reported may subside as the absorption rate is slower than the IR dose (U.S. Food and Drug Administration, 2011a). The immediate-release peak level is approximately two hours which may account for the client’s notable feelings of being jittery and at times nervous (U.S. Food and Drug Administration, 2011b).  Furthermore, clients are switched to extended-release to improve tolerance and treatment adherence to once-daily treatment (Guzman, n.d). As a mental health provider, caring for this client, changing the formulation is the best decision at this point as well as to continue to monitor side effects.

As mentioned above, Zoloft, an SSRI, can be utilized as a first-line agent for major depressive disorder (Masuda et al., 2017).  Using Wellbutrin as an adjunct to the regimen has continued to reduce his symptoms of depression and has alleviated one of his primary concerns which is sexual dysfunction.  Therefore, discontinuing Zoloft and maintaining the use of Wellbutrin is not an appropriate option at this time.

Ativan (lorazepam) is a benzodiazepine with anxiolytic, anti-anxiety, and sedative properties. It provides short-term relief of anxiety symptoms or insomnia (U.S. National Library of Medicine [NLM], n.d.).  Lorazepam works by enhancing the effect of the inhibitory neurotransmitter GABA, which inhibits the nerve signals, in doing so, reducing the “nervous excitation” (NLM, n.d., para. 1).  In some instances, a low dose, 0.5 mg, may be administered short-term to reduce side effects from another medication. Stahl (2017), indicates many side effects will not improve with an augmenting drug. Common side effects consist of confusion, weakness, sedation, nervousness, and fatigue (Stahl, 2017). Further, Ativan has an increased risk for abuse potential as it is known to have habit-forming properties (Stahl, 2017). As a result, administering Ativan would not be in the best interest of the client.

The ultimate goal is to achieve remission of his mood disorder.  The medication regimen has proven effective; thus, considering this to be a successful plan of care.  Taking both the sertraline and bupropion can exhibit side effects of jitteriness; however, changing to the extended-release may aid in the dissipation of these feelings.  The addition of Ativan to relieve side effects, that are perhaps temporary, is against better judgment without first making an effort to change or modify the medication regimen (Laureate Education, 2016).

Summary with Ethical Considerations

Mood disorders affect millions of individuals in the United States on an annual basis. The prevalence of mental illness continues to flourish, impacting one’s quality of life. Initiating treatment, under the guidance of a healthcare professional, is of the utmost importance. Further, an individualized plan of care comprising of education, therapy, medication, and support is crucial for overall health and wellbeing.

The client is a Hispanic American male employed as a laborer in a warehouse (Laureate Education, 2016).  It is essential to assess his financial means before prescribing medications.  Although one cannot assume the client has financial hardships, having this knowledge will guide in the process of treatment. If the client is without insurance and has to pay out-of-pocket, medication adherence may not be sustainable.  Therefore, as a psychiatric nurse practitioner, providing a cost-effective means whether, through generic prescriptions, discount pharmacies, or prescribing a larger quantity may be a necessary option (Barker & Guzman, 2015).  Further, the partnership among clients and practitioners is essential; to establish trust and respect as well as understanding cultural preferences while avoiding stereotypes is vital.

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I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NURS 6630 Week 6 Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Completed Sample Paper

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. NURS 6630 Week 6 Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Completed Sample Paper

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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