ATTENTION!!!!!!!!! PLEASE PAY ATTENTION TO THE CASE STUDY, SAMPLE ESSAY (please follow the sample essay attached sequence because that is how the instructor wants the decision to be answered) AND CHAPTERS. GOOD INTRODUCTION.  



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?

Assessing and Treating Adult Clients with Mood Disorders

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, 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 o

Psychosis and schizophrenia

Psychosis is a difficult term to define and is frequently misused, not only in the media but
unfortunately among mental health professionals as well. Stigma and fear surround the concept of
psychosis, and sometimes the pejorative term “crazy” is used for psychosis. This chapter is not
intended to list the diagnostic criteria for all the different mental disorders in which psychosis is either
a defining feature or an associated feature. The reader is referred to standard reference sources
such as the DSM ( ) of the American Psychiatric Association and theDiagnostic and Statistical Manual
ICD ( ) for that information. Although schizophrenia isInternational Classification of Diseases
emphasized here, we will approach psychosis as a syndrome associated with a variety of illnesses
that are all targets for antipsychotic drug treatment.

Symptom dimensions in schizophrenia

Clinical description of psychosis

Psychosis is a syndrome – that is, a mixture of symptoms – that can be associated with many different
psychiatric disorders, but is not a specific disorder itself in diagnostic schemes such as the DSM or
ICD. At a minimum, psychosis means delusions and hallucinations. It generally also includes
symptoms such as disorganized speech, disorganized behavior, and gross distortions of reality.

Therefore, psychosis can be considered to be a set of symptoms in which a person’s mental
capacity, affective response, and capacity to recognize reality, communicate, and relate to others is
impaired. Psychotic disorders have psychotic symptoms as their defining features; there are other
disorders in which psychotic symptoms may be present, but are not necessary for the diagnosis.

Those as a feature of the diagnosisdisorders that require the presence of psychosis defining
include schizophrenia, substance-induced (i.e., drug-induced) psychotic disorders, schizophreniform
disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, and psychotic
disorder due to a general medical condition ( ). Table 4-1 Disorders that may or may not have

as features include mania and depression as well as severalpsychotic symptoms associated
cognitive disorders such as Alzheimer’s dementia ( ).Table 4-2

Psychosis itself can be paranoid, disorganized/excited, or depressive. Perceptual distortions and
motor disturbances can be associated with any type of psychosis. includePerceptual distortions
being distressed by hallucinatory voices; hearing voices that accuse, blame, or threaten punishment;
seeing visions;

Table 4-1 Disorders in which psychosis is a defining feature

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Antipsychotic agents

This chapter will explore antipsychotic drugs, with an emphasis on treatments for schizophrenia.
These treatments include not only conventional antipsychotic drugs, but also the newer atypical
antipsychotic drugs that have largely replaced the older conventional agents. Atypical antipsychotics
are really misnamed, since they are also used as treatments for both the manic and depressed
phases of bipolar disorder, as augmenting agents for treatment-resistant depression, and “off-label”
for various other disorders, such as treatment-resistant anxiety disorders. The reader is referred to
standard reference manuals and textbooks for practical prescribing information, such as drug doses,
because this chapter on antipsychotic drugs will

Figure 5-1. . ThroughoutQualitative and semi-quantitative representation of receptor binding properties
this chapter, the receptor binding properties of the atypical antipsychotics are represented both graphically and
semi-quantitatively. Each drug is represented as a blue sphere, with its most potent binding properties depicted
along the outer edge of the sphere. Additionally, each drug has a series of colored boxes associated with it.
Each colored box represents a different binding property, and binding strength is indicated by the size of the box
and the number of plus signs. Within the colored box series for any particular antipsychotic, larger boxes with
more plus signs (positioned to the left) indicate stronger binding affinity, while smaller boxes with fewer plus
signs (positioned to the right) represent weaker binding affinity. The series of boxes associated with each drug
are arranged such that the size and positioning of a box reflect the binding potency for a particular receptor. The
vertical dotted line cuts through the dopamine 2 (D ) receptor binding box, with binding properties that are more2
potent than D on the left and those that are less potent than D on the right. All binding properties are based on2 2
the mean values of published K (binding affinity) data ( ). The semi-quantitative depictioni

used throughout this chapter provides a quick visual reference of how strongly a particular drug binds to a
particular receptor. It also allows for easy comparison of a drug’s binding properties with those of other atypical

emphasize basic pharmacologic concepts of mechanism of action and not practical issues such as
how to prescribe these drugs (for that information see for example Stahl’s Essential

, which is a companion to this textbook).Psychopharmacology: the Prescriber’s Guide

Antipsychotic drugs exhibit possibly the most complex pharmacologic mechanisms of any drug class
within the field of clinical psychopharmacology. The pharmacologic concepts developed here should
help the reader understand the rationale for how to use each of the different antipsych

Delusional Disorders
Pakistani hought Processes

Hispanic male



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”


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.


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