Schizophrenia Spectrum
Schizophrenia Spectrum Essay Sample
Schizophrenia Spectrum Essay Sample
As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role. Schizophrenia Spectrum Essay Sample
Assignment 1: “Captain of the Ship” Project – Schizophrenia Spectrum and Other Psychotic Disorders
In this Assignment, you become the “captain of the ship” once again as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a schizophrenia spectrum/other psychotic disorder.
You will:
• Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with schizophrenia spectrum and other psychotic disorders
• Recommend psychotherapy based on therapeutic endpoints for clients with schizophrenia spectrum and other psychotic disorders
• Identify medical management needs for clients with schizophrenia spectrum and other psychotic disorders
• Identify community support resources for clients with schizophrenia spectrum and other psychotic disorders
• Recommend follow-up plans for clients with schizophrenia spectrum and other psychotic disorders
To prepare for this Assignment:
• Select an adult or older adult client with a schizophrenia spectrum and other psychotic disorder you have seen in your practicum. Schizophrenia Spectrum Essay Sample
Write a treatment plan for your client in which you do the following:
• Describe the HPI and clinical impression for the client.
• Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
• Identify medical management needs, including primary care needs, specific to this client.
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
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Treatment of Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia spectrum and other psychotic disorders is a class of related psychiatric conditions grouped together because of similarity in symptoms and for ease of diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This paper looks at one of these diagnoses and its management in a 35-year-old male Caucasian client. Schizophrenia Spectrum Essay Sample
History of Presenting Illness and the Clinical Impression
The patient was a 35-year-old Caucasian male who presented with a history of persecutory delusions (thinking that his family wanted to harm him), loss of emotions, disorganization in his thought process, auditory hallucinations (hearing voices that were telling him to go and jump from the top of the bridge), and disturbed sleep patterns. All these symptoms had been there for close to two months and were now getting more frequent. An examination of the patient revealed an unkempt person who had an unpleasant odor from the body with halitosis. Apart from the positive and negative symptoms attributable to the psychosis, he did not appear to have any physical illness since his vital signs and complete blood count were within normal parameters. The patient had no previous or current history of substance abuse that could explain some of the observed symptoms. After the assessment, the diagnosis or clinical impression reached was that of schizophrenia, or 295.90(F20.9). This was according to the guidelines in the DSM-5 (APA, 2013). Schizophrenia Spectrum Essay Sample
Psychopharmacologic Treatments and Their Therapeutic Endpoints
According to many authorities, the management of schizophrenia benefits most from a combination of psychoactive medications and psychotherapeutic or behavioral therapies (Hammer & McPhee, 2014). This is partly because the condition is not entirely curable (relapses are not uncommon) and in most cases it is a lifelong condition. For the neuroleptics, two main classes of medications exist for the treatment of schizophrenia. These are the first line or atypical agents (second-generation neuroleptics), and the second line typical, conventional, or first-generation neuroleptics (Katzung, 2018; Stahl, 2017). This 35-year-old schizophrenic would, therefore, benefit from one of the first line neuroleptics (atypical agents) as olanzapine (Zyprexa) 10-20 mg per day orally, paliperidone (INVEGA) 6 mg per day orally, or aripiprazole (Abilify) 15-30 mg per day orally (Stahl, 2017). Otherwise the first generation typical medications would suffice for this particular patient if cost were to be an issue as they are cheaper. However, they are more revolting because of their more debilitating adverse effects. In that case, he would have been given haloperidol (Serenace) 1-40 mg orally daily, or chlorpromazine (Lagarctil) 200-800 mg orally daily. Whether the atypical or first-generation, the initial duration of dosing would be one month to allow for assessment of progress and possible change of medication in the event that symptoms persist. Both of these classes of drugs are expected to provide remission. However, it is not a remission that is expected to occur at once with the commencement of treatment. The clinical response typically starts becoming apparent after a number of weeks. Also dependent on these therapeutic endpoints is the matter of compliance to medication. But in all, unwanted side effects are also expected to complicate therapy as a foreseeable therapeutic endpoint (Katzung, 2018; Stahl, 2017). Schizophrenia Spectrum Essay Sample
Psychotherapeutic Choices for Schizophrenia
As stated at the start, the best-recommended approach to the management of schizophrenia is a combination of medication and psychotherapy. It has been shown empirically that patients with schizophrenia tend to benefit more from individual psychotherapeutic approaches (Hammer & McPhee, 2014). For this 36 year-old schizophrenic the therapist would have weekly sessions of Cognitive Behavioral Therapy or CBT with him for an initial period of three months. The aim will be to help him function without assistance and to cope with his symptoms. CBT does not cure schizophrenia. Then the family of this patient would also be handled separately in family psychotherapy involving cognitive reappraisal and psychoeducation. This is to help them cope with the condition of their loved one and also to prepare them to assist in compliance with medication and therapy. The frequency will also be weekly for an initial two months, then the therapist can titrate the therapy according to need.
Medical Management Needs, Especially Primary Care Needs
The patient with schizophrenia is a patient whose state of mind and appreciation of reality are contorted. They, therefore, cannot properly take care of their day-to-day basic hygiene and cleanliness. As a result, they are very susceptible to contracting infections that may, in turn, complicate their treatment for mental illness. Thus this 35-year-old patient will need to be supervised and reminded to bathe, to take food, and to take medication. This is why the family also attends therapy as above. In the event that he may show signs of infection in whatever form, he would immediately be taken to the hospital for treatment. Counseling during the cognitive reappraisal and psychoeducation sessions will also be important to help this patient’s family deal with the social stigma attached to mental illness. Schizophrenia Spectrum Essay Sample
Community Support Resources
Because this schizophrenic patient cannot continue being productive at work (at least in the acute phase), there will be a need for community and social support for both himself and his family. This help will be in the form of housing through community resource mobilization such as neighborhood contributions, assistance with food, and facilitation in taking health insurance through the Affordable Care Act 2010, if not yet taken. Social security and community not-for-profit organizations or churches can also help this patient through charity.
Follow Up Plan
This patient will require very close follow-up. This is because there is usually a problem with compliance due to the unwanted adverse effects of medication for patients on long-term medication like him. Therefore, close collaboration between the Psychiatric-Mental Health Nurse Practitioner and the social worker will be paramount if success at therapy is to be realized. He will have monthly follow up visits that will serve to assess the impact of the schizophrenia medication instituted and the effectiveness of the psychotherapy. This will suffice, barring any serious eventualities like serious adverse side effects that may necessitate earlier review.Schizophrenia Spectrum Essay Sample
References
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington, VA: Author.
Hammer, D.G., & McPhee, S.J. (Eds). (2014). Pathophysiology of disease: An introduction to clinical medicine, 7th ed. New York, NY: McGraw-Hill Education.
Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. New York, NY: McGraw-Hill Education.
Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6th ed. New York, NY: Cambridge University Press. Schizophrenia Spectrum Essay Sample
