Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

Review again: DSM 5: pp. 87 – 122

·         Read Tusaie & Fitzpatrick () Ch. 10 – Integrative Management of Psychotic Symptoms

·         Read Sadock, Sadock, & Ruiz () Ch. 7 – Schizophrenia Symptoms and Other Psychotic Disorders, pp. 300-326

·         Read Sadock, Sadock, & Ruiz ()  Ch. 31 – Child Psychiatry, pp. 1268-1272

·         Read Corrigan (2016) Ch 4 – Assessment pp. 69-113

·         Read Corrigan (2016) Ch 6 – Illness and Wellness Self Management pp. 133-162

·         Read Corrigan (2016) Ch 8 p. 170-174 Making Decisions About Medications & How Might Enhancing Self Determination Improve Health-Related Decisions

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·         Read Corrigan (2016) Ch 12 Psychosis and Cognitive Challenges pp. 222-244

·         Read Corrigan (2016) Ch15 Physical Health and Medical Care pp. 280-293

Schizophrenia: Module 2 Questions

Using the readings for this module respond to these two questions below and deposit them in this drop box.  Each response should be a minimum of three paragraphs synthesizing the content from the readings.  Submissions which are cut and pasted or not in the student\’s own words will get a zero.   Use appropriate APA format for references. Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

1.  From your readings, what are the variables that impact both quality of care and discontinuation of treatment for clients with schizophrenia.

2.  What if any special considerations would you want to include when treating clients with schizophrenia who have early-onset schizophrenia compared to adult onset; compared with geriatric clients?Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

Okay to use both textbook readings from the above and journal articles not more than 10 years old.

Each question at least 3 paragraphs. 2-3 total pages not including the reference page.Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

Schizophrenia is a psychiatric disorder characterized by psychosis. Together with other psychotic disorders, it is in the diagnostic category of ‘Schizophrenia Spectrum and Other Psychotic Disorders’ in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5. The symptomatology of schizophrenia manifests in terms of disorganization in the thought process, hallucinations, delusions, motor imbalance and disorganization (such as parkinsonism and catatonia), and negative symptoms such as anhedonia, apathy, loss of motivation ,and poverty of speech (Sadock et al., 2015; APA, 2013). This paper looks at the schizophrenia patient in terms of variables impacting quality of care and discontinuation of treatment, as well as special considerations when treating different populations of schizophrenic patients/ clients. Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

The Variables that May Impact the Quality of Care of a Schizophrenic Patient and Discontinuation of Treatment

(i) Quality of Care

The variables that may affect or impact the quality of care for a schizophrenia client derive from the severity of symptoms. Negative symptoms such as anhedonia (reduced capacity or inability to experience pleasure), loss of motivation and apathy will greatly affect the quality of life of the client if severe. Treatment has to be particularly effective to be able to reduce the severity of these negative symptoms. The variable therefore has a direct correlation to the quality of care and the latter can then be measured by the improvement in the negative symptoms. Other variables are the severity of delusions such as persecutory and referential delusions, motor disturbances, the convoluted thought processes, and hallucinations. All these symptomatic variables in schizophrenia will directly impact the quality of care. For instance, if the care given is evidence-based and effective the quality of care is positively impacted by these variables since the severity of the symptoms will be reduced with the patient undergoing remission (Corrigan, 2016; Sadock et al., 2015).Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

(ii) Discontinuation of Treatment

Discontinuation of treatment in schizophrenic clients/ patients is not an advisable practice because of the rebound severity of the symptoms in a relapse. However, two important variables may influence this decision. One of them is the continued worsening of symptoms and poor response to treatment or medications. When the client does not respond to treatment, there is no rationale in continuing with the same (Emsley, 2017; Corrigan, 2016; Sadock et al., 2015).

The other variable that may impact the discontinuation of treatment is intolerability of the antipsychotic medications. Although psychopharmacologic agents have debilitating side effects, when not well tolerated the side effects may be too pronounced as to make the medications cause more harm than good. Following the bioethical principle of nonmaleficence or primum non nocere (to do no harm), the best thing to do in this case is to discontinue the treatment (Emsley, 2017).Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

Special Considerations When Treating Different Populations of Schizophrenia Patients

1. Early-Onset Schizophrenia

Early-onset schizophrenia (EOS) occurs before the age of 18 years (Grover & Avasthi, 2019). There are two important considerations that may be made when treating this patent population. The first is to treat them in a less restrictive environment, preferably as outpatients unless they have suicidality or are catatonic. The other is to combine antipsychotic treatment with psychosocial therapies (Grover & Avasthi, 2019).Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

1. Adult-Onset Schizophrenia

The most important consideration to be considered for adult-onset schizophrenics is keeping them productive economically and reintegrating them socially. This means that psychotherapy will play a very important part in the treatment (Corrigan, 2016; Sadock et al., 2015). These are clients who will be having young families and will need to continue earning a living by working.

• Geriatric Schizophrenic Clients

The population of clients with schizophrenia developed in later life typically get it after the age of 40 years and are about 20% of all schizophrenia patients (Maglione et al., 2014). Because of the normal physiological functional deterioration that comes with ageing, their daily antipsychotic requirements need to be lowered. This is because this population is more prone to developing severe side effects such as metabolic syndrome (Maglione et al., 2014).Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

Conclusion

Schizophrenia is a debilitating psychotic disease. There are many variables that may impact the quality of care given to those who suffer from it. Some variables may also impact discontinuation of its treatment. Also, there are special considerations that need to be made for different populations of patients who have schizophrenia.

Schizophrenia is a psychiatric disorder characterized by psychosis. Together with other psychotic disorders, it is placed in the diagnostic category of ‘Schizophrenia Spectrum and Other Psychotic Disorders’ in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5. The positive symptoms of schizophrenia occur as a result of malfunction in the mesolimbic circuits of the brain. Negative symptoms occur due to malfunction in the mesocortical circuits. The mesolimbic regions involved include the nucleus accumbens which is pivotal in the brain’s reward circuitry (Stahl, 2013). The symptomatology of schizophrenia manifests in terms of disorganization in the thought process, hallucinations, delusions, and motor disorganization and imbalance (such as Parkinsonism and catatonia). Negative symptoms include anhedonia, apathy, loss of motivation, and poverty of speech (Sadock et al., 2015; APA, 2013). This paper is about the care and treatment of schizophrenia patients.Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

The Variables that May Impact the Quality of Care of a Schizophrenic Patient and Discontinuation of Treatment

The variables that may affect or impact the quality of care for a schizophrenia client derive from the severity of symptoms. Negative symptoms such as anhedonia (reduced capacity or inability to experience pleasure), loss of motivation and apathy will greatly affect the quality of life of the client when severe. Treatment and therapy must be evidence-based and address the disorder at the neurobiological level. This means that the interventions should focus on the dorsolateral prefrontal cortex which is the source of cognitive symptoms as a result of defective information processing, the ventromedial prefrontal cortex which is the source of affective symptoms, and the amygdala and orbitofrontal cortex where defective neurocircuitry and neurotransmission results in aggressive symptoms (Stahl, 2013). In these areas, dopamine and glutamate are the chief neurotransmitters. Effective psychopharmacologic agents will therefore include dopamine partial agonists such as aripiprazole (Stahl, 2017; Stahl, 2013). Such evidence-based, safe, effective, efficient, timely, patient-centered, and equitable interventions as above will positively impact the quality of care and guarantee patient remission (Corrigan, 2016; Sadock et al., 2015).Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

Discontinuation of treatment in schizophrenic clients/ patients is not an advisable practice because of the rebound severity of the symptoms in a relapse. However, two important variables may influence this decision – the continued worsening of symptoms and poor response to treatment or medications (Emsley, 2017; Corrigan, 2016; Sadock et al., 2015).

The other variable that may impact the discontinuation of treatment is intolerability of psychopharmacologic agents. When drugs cause more harm than good, the bioethical principle of nonmaleficence or primum non nocere (to do no harm) informs discontinuation of treatment (Emsley, 2017).Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

Special Considerations When Treating Different Populations of Schizophrenia Patients

Early-onset schizophrenia (EOS) occurs before the age of 18 years (Grover & Avasthi, 2019). There are two important considerations that may be made when treating this patent population. The first is to treat them in a less restrictive environment such as an outpatient setting, unless they have suicidality or are catatonic. The other is to combine antipsychotic treatment with psychosocial therapies (Grover & Avasthi, 2019).

The most important consideration for adult-onset schizophrenia patients is keeping them productive economically and reintegrating them socially. This means that psychotherapy will play a very important part in the management (Corrigan, 2016; Sadock et al., 2015).

The population of clients with schizophrenia developed in later life typically show symptoms after the age of 40 years. They represent about 20% of all schizophrenia patients (Maglione et al., 2014). Dose adjustment is important in this population because hepatic pharmacokinetic metabolic processes such as the cytochrome P450 pathway are slower and less efficient due to ageing (Maglione et al., 2014).Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.

Conclusion

Schizophrenia is a psychiatric disorder defined by psychosis. There are many variables that may impact the quality of care given to those who suffer from it. Some of the variables impact discontinuation of its treatment as well. Special considerations for various patient demographics exist for schizophrenia.Special Considerations and Variables Impacting Quality of Care and Discontinuation of Treatment.