NRNP – 6670F Psychiatric Mental Health Essay
Captain of the Ship” Project – Schizophrenia Spectrum and Other Psychotic Disorders
WRITE A BIT ABOUT SCHIZOPHRENIA AND DSM-5 criteria for the diagnosis (see websites sent, it might be helpful)
Patient is a 37 year old male with a diagnosis of Paranoid Schizophrenia, who was seen for psychiatric follow up. Patient was born and raised in Michigan with two younger siblings. He is single and has no children. He has not been in contact with his family since he was 19 years old. He relocated to Utah and then came to Florida in 2013. He was homeless for almost six years until he was baker act when the police brought him to the emergency department after walking into traffic to kill himself. He reported feeling suicidal, hopeless and helpless, “I was on drugs and probably drunk”. He has persistent auditory hallucination command type telling him to kill himself. The patient symptoms are triggered by poor compliance with medication and treatment for schizophrenia. He was taking Aripiprazole oral daily but was not compliant with that regime.He has a history of alcohol abuse and amphetamine abuse but he states last time he used was a year ago. He smokes a pack of cigarettes or more a day. He denies using any drugs or drinking alcohol at this time as he has been living in a “sober living”. He works partime at a nursery near his residence, which makes easier for him to ride his bicycle to and from. Patient is oriented to person, place, time and situation, he has intact present immediate and remote memory tested by general information. Mood is euthymic. Affect is congruent. Thought process logical, goal oriented. No abnormal movements were noted during the interview. He denies any suicidal or homicidal ideation and denies any auditory or visual hallucinations at this time. Patient educated on the benefits of medication compliance.NRNP – 6670F Psychiatric Mental Health Essay
Psychopharmacological approach is InvegaSustenna117mg IM monthly. Patient is on Trazodone 100mg oral daily at bedtime and doing “okay”.(Write a bit about medicationInvegaSustenna)
Individual psychotherapy and Cognitive behavior therapy (CBT) are the choices of psychotherapy for this patient.(WRITE A BIT ABOUT THE THERAPIES)
(Individual psychotherapy: During sessions, a therapist or psychiatrist can teach the person how to deal with their thoughts and behaviors. They’ll learn more about their illness and its effects, as well as how to tell the difference between what’s real and what’s not. It also can help them manage everyday life.
Cognitive behavior therapy (CBT). This can help the person change their thinking and behavior. A therapist will show them ways to deal with voices and hallucinations. With a combination of CBT sessions and medication, they can eventually tell what triggers their psychotic episodes (times when hallucinations or delusions flare up) and how to reduce or stop them.)COPIED AND PASTED from WebMD
Patient will benefit from NAMI Broward County (USE THIS WEBSITE: https://namibroward.org/about-nami-broward-county/
About NAMI Broward County) It has good information about what they offer for those with mental health issues (NAMI Broward County provides free support groups, education classes and seminars, legislative advocacy, and information for people in our community living with mental illness as well as their loved ones.)
Advocating for improved opportunities for housing, rehabilitation, and meaningful jobs. NRNP – 6670F Psychiatric Mental Health Essay
NAMI Connection is a support group for people with mental health conditions. Groups meet weekly, every other week or monthly, depending on location.
Patient to follow up monthly for medication management, continue with therapy as prescribed. Patient to follow up with primary care provider as needed, for well visits, blood work and any other medical needs.
(YOU CAN WRITE MORE IF YOU THINK IT’S NEEDED)
Schizophrenia: Overview and Treatment Options
Tracy D. Eells, Ph.D.
“Captain of the Ship” Project – Schizophrenia Spectrum and Other Psychotic Disorders
The HPI and clinical impression for the client
Patient is a 37-year-old male with a diagnosis of Paranoid Schizophrenia, who was seen for a psychiatric follow-up. The patient was born and raised in Michigan with two younger siblings. He is single and has no children. He has not been in contact with his family since he was 19 years old. He relocated to Utah and then came to Florida in 2013. He was homeless for almost six years until when the police brought him to the emergency department after walking into traffic to kill himself. He reported feeling suicidal, hopeless, and helpless, “I was on drugs and probably drunk”. He has persistent auditory hallucination command type telling him to kill himself. NRNP – 6670F Psychiatric Mental Health Essay
The patient’s symptoms are triggered by poor compliance with medication and treatment for schizophrenia. He was taking Aripiprazole oral daily but was not compliant with that regime. He has a history of alcohol abuse and amphetamine abuse but he states the last time he used was a year ago. He smokes a pack of cigarettes or more a day. He denies using any drugs or drinking alcohol at this time as he has been living in a “sober living”. He works part-time at a nursery near his residence, which makes it easier for him to ride his bicycle to and from. The patient is oriented to person, place, time, and situation; he has intact present immediate and remote memory tested by general information. Mood is euthymic. Affect is congruent. Thought process logical, goal oriented. No abnormal movements were noted during the interview. He denies any suicidal or homicidal ideation and denies any auditory or visual hallucinations at this time. Patient educated on the benefits of medication compliance.
Psychopharmacologic treatments and therapeutic endpoints for the psychopharmacologic agent
Atypical or second-generation antipsychotics (SGAs) with the exclusion of clozapine, are the first-line treatment for schizophrenia patients. Clozapine has the risk of causing seizures and that is why it is not recommended. Approximately 80 to 90 percent of schizophrenia patients experience a relapse in the course of the disease. Breakthrough in psychotic episodes might occur from noncompliance with maintenance therapy, stressful life events, poorer premorbid adjustment, or persistent substance use. Long-acting injectable (LAI) antipsychotics are often utilized to prevent relapse (Fellner, 2017). NRNP – 6670F Psychiatric Mental Health Essay
InvegaSustenna117mg IM monthly. Invega Sustenna or Paliperidone palmitate 1 month (PP1M) is a LAI that is administered once a month. According to Savitz et al. (2016), the total or partial-nonadherence to oral antipsychotic medication is that common occurrence in schizophrenia patients significantly impacts treatment outcomes. LAI removes the need for everyday dosing, ensures continued plasma levels for numerous weeks, and assists in reliable monitoring of adherence.
Psychotherapy choices (individual, family, and group)
Adjunctive psychosocial interventions including cognitive behavioral therapy (CBT), training on social skills, and family psychosocial education improve medication adherence and prevent relapse in schizophrenia patients. Individual CBT is the recommended psychotherapy choice for the client. According to Candida et al. (2016), CBT for schizophrenia depends on numerous techniques to efficiently target cognitive processing preconceptions along with the basic negative and positive symptoms. When dealing with hallucinations, the therapist considers numerous features of the patient’s voice-hearing including loudness, potential triggers, number of voices, and loudness. The therapist then carefully assesses the experience of the patient and recommends a variety of approaches to lessen distress: diverting the patient from the voice he hears, enhancing coping skills, utilizing responding techniques, normalization techniques, and metacognitive approaches to lessen negative emotions linked to the voices.
Medical management needs, including primary care needs, specific to this client
Schizophrenia is characterized by a wide range of emotional and cognitive abnormalities, which together with a decline in functioning connected with the disorder means that the quality of life and everyday behavior of the patient are negatively impacted. Long –term maintenance treatment and balancing medication effectiveness and adverse effects are the medical management needs specific to the client. De Bartolomeis et al. (2016) indicate that the majority of schizophrenia patients require long-term maintenance treatment for the regulation of their symptoms. However, numerous effectual antipsychotics are available, most patients do not get adequate long-term therapy majorly as a result of poor adherence. There is evidence that optimization of the balance between side effects and efficacy is of great significance for the improvement of adherence and maximization of quality of life. NRNP – 6670F Psychiatric Mental Health Essay
Community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client
NAMI Broward County is a community agency that is available to assist the Client. NAMI Broward c County is a grassroots organization of mentally ill individuals, particularly individuals with serious mental illnesses, their friends, and family members. The mission of the organization is to advocate for effective diagnosis, treatment, prevention recovery, research, and support that improves the QoL of all individuals affected y mental diseases (NAMI Broward County, 2021). The organization provides support to mentally ill patients, educates consumers and families, advocates for improved opportunities for meaningful jobs, rehabilitating and housing, and supports education programs intended to assist eradicate the pervasive mental health stigmatization. NRNP – 6670F Psychiatric Mental Health Essay
A plan for follow-up intensity and frequency and collaboration with other providers
A follow-up is essential to evaluate how the client is progressing and how he responds to treatment. Patient follow up will occur monthly for medication management and continuation with the prescribed therapy. The client will also be monitored for possible side effects and managed accordingly. I will collaborate with other providers including psychiatrists and therapists in the formulation of the treatment plan and decisions concerning the treatment setting. I will draw the treatment by consulting all providers involved in the patient’s care.
Candida, M., Campos, C., Monteiro, B., Rocha, N. R., Paes, F., Nardi, E., & Machado, S. (2016). Cognitive-behavioral therapy for schizophrenia: an overview on efficacy, recent trends and neurobiological findings. Medical Express, 3, 5). doi: 10.5935/MedicalExpress.2016.05.01
De Bartolomeis, A., Fagiolini, A., Vaggi, M., & Vampini C. (2016). Targets, attitudes, and goals of psychiatrists treating patients with schizophrenia: key outcome drivers, role of quality of life, and place of long-acting antipsychotics. Neuropsychiatric Disease and Treatment, 12, 99-108. doi: 10.2147/NDT.S96214
Fellner, C. (2017). New Schizophrenia Treatments Address Unmet Clinical Needs. Pharmacy and Therapeutics, 42(2), 130-134.
NAMI Broward County. (2021). About NAMI Broward County. https://namibroward.org/about-nami-broward-county/
Savitz, A. J., Xu, H., Gopal, S., Nuamah, I., Ravenstijn, P., Janik, A., Schotte, A., Hough, D, & Fleischhacker, W. W. (2016). Efficacy and Safety of Paliperidone Palmitate 3-Month Formulation for Patients with Schizophrenia: A Randomized Multicenter, Double-Blind, Noniferiority Study. International Journal of Neuropsychopharmacology, 19(7), https://doi.org/10.1093/ijnp/pyw018. NRNP – 6670F Psychiatric Mental Health Essay
NRNP – 6670F Psychiatric Mental Health Essay