The Assignment

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?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

  // Delusional Disorders

Delusional Disorders
Pakistani Female With Delusional Thought Processes

Hispanic male

 

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 t

  // Delusional Disorders

Delusional Disorders
Pakistani Female With Delusional Thought Processes

Hispanic male

 

Decision Point One

: Start Abilify (aripiprazole) 10 mg orally at BEDTIME

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Client returns and looks disheveled. Upon questioning, her husband states that she has not been sleeping at night. He states she is up and down all night and has also been disrupting his sleep
  • Clientis unable to participate in the PANSS rating tool because she continually is nodding off (sleeping) during the appointment
  • The appointment is not productive for assessing how she is responding to the Abilify started 4-weeks ago

Decision Point Two

Select what the PMHNP should do next:



Change Abilify administration time to AM dosing

RESULTS OF DECISION POINT TWO

  • Client reports that although he had no more episodes of passing out, he has been dizzy when he gets up at night to use the bathroom
  • Client arrives at office appearing to have slept better. Her husband tells you that she is still up and down at night but it is much less frequently. He notices that it is better when she takes her medication as soon as she awakens but some days she forgets and takes it when she remembers (in the afternoon)
  • Client’s PANNS has decreased by 5% since her initial visit

Decision Point Three

Select what the PMHNP should do next:



Increase dose to 20 mg at bedtime and counsel client on the importance of taking this medication first thing in the morning due to akathesia and insomnia that can be problematic in some clients. Counsel the husband on setting up reminders for her at home to help avoid these symptoms at night. E-prescribe Ambien 10 mg orally QHS to her pharmacy to help with sleep

Guidance to Student

This is week 8 since therapy was initiated. Although her side effects seem to be better managed, her PNSS is not changing by much. An acceptable time frame for treatment is defined as 4-6 weeks at an accept

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 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