Schizophrenia Spectrum and Psychotic Disorders

Assignment 1: “Captain of the Ship” Project – Schizophrenia Spectrum and Other Psychotic Disorders
In earlier weeks, you were introduced to the concept of the “captain of the ship.” 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. Schizophrenia Spectrum and Psychotic Disorders
Learning Objectives
Students 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 Schizophrenia Spectrum and Psychotic Disorders
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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.
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.
Psychotic disorders and schizophrenia are some of the major psychopathologies impairing forms. These conditions are prevalently associated with a tremendous negative impact on a person’s social, occupational and educational functions. Unfortunately, studies show that the conditions manifest at the time of transition from adolescent to adulthood. Schizophrenia spectrum is indicative of a moiety of mental disorders that possess commonalities in their symptoms. Whereas the principal condition is schizophrenia, the spectrum includes the erstwhile subtypes of the condition inclusive of undifferentiated, residual, paranoid, disorganized, and catatonic (American Psychiatric Association, 2016). In the present paper, an adult client with a schizophrenia spectrum plus another psychotic disorder will be analyzed. The formulation of the treatment intervention based on the analysis will depend on myriad factors (Stahl, 2013). In addition, the treatment approaches for the condition will be multidisciplinary and it will involve psychopharmacologic, psychotherapeutic, and medical needs interventions. Moreover, the identification of community resources and the follow-up undertakings after the formulation of the multiple treatment modalities form fundamental processes in the management of the condition. Schizophrenia Spectrum and Psychotic Disorders

Patient Assessment

HPI: Mr. G is a 32-year-old male who was brought to the ship’s infirmary by the ship’s security staff. He had created a disturbance at the ship’s eating by and the security personnel were summoned, and she was brought to the infirmary under orders of protective custody from the captain. Mr. G. experiences various delusions, including believing that people are sneaking into his room during the night and stabbing him multiple times. He further believes that he is being taped by bog-bodies homosexual individual at night. Further, she seems to believe that his ideas were offered to a Russian communist who pretends to be him and that his feet were chopped off. Also, Mr. G believes that he had snakes in his stomach, and her backbone used to have transmitters. He similarly expressed certain grandiose ideations, inclusive of the belief that he was an astronaut, he owns swathes of land in the Himalayas, and that he is in the top 10 of the world’s richest people. He also displays a rambling speech pattern.

Diagnosis: Schizophrenia, the paranoid type plus delusional disorder (Hales & Kupfer, 2014).

Psychopharmacologic Treatments

For the schizophrenia and the symptomatic delusional disorder, the pharmacologic plan will include staring the patient on Risperidone, 1 Mg BID, which will be titrated up daily around 1-2 mg/day (Stahl, 2014b). The drug’s MDD per PI is equivalent to 16 mg/day whereas its usual dose range is 2-8 mg/day. To this end, the response of Mr. G to the medication will be monitored and decisive and relevant action taken accordingly after four weeks of using the medication.

Alternatively, the patient may be given Aripiprazole 10 mg qAM. The drug will then be titrated up q2weeks until the patient responds to the medication (Stahl, 2014b). Importantly, the drug’s MDD per PI is equivalent to 30 mg/day. However, the maximum effective dosage will depend on the response of the patient to the initial dosages as clinical trials have permitted the usage of up to 45 mg/day. Schizophrenia Spectrum and Psychotic Disorders

Psychotherapeutic Intervention

        The pertinent therapy for the patient would be psychosocial therapy. Such an individual therapy will be important. If a positive relationship is established with the therapist, the patient will have a reliable source of hope, encouragement, information and care. Assuming that the patient will be stabilized on the antipsychotic medication, issues such as self-care, work, motivation, and communication as well as the establishment and sustenance of relationship with other people will be addressed (Nathan & Goman, 2015). Alongside cognitive therapy, the symptoms of both schizophrenia and delusional disorder will undergo total remission after a period of time. Therefore, the usage of individual psychosocial and cognitive therapy will prove instrumental in managing the condition.

Medical Management Needs

The management of schizophrenia and other psychotic disorders is characterized by numerous unmet needs by the healthcare sector. In the present scenario, the psychosocial and economic needs of the patient need to be considered (Kuiper et al., 2014). The patient is obsessed with being wealthy yet the current economic climate is dynamic. The impact of the psychosocial and the economic need to the recovery of Mrs. G. will thus be considered even as he continues with the recovery process. Further, primary care needs such as the patient’s ability to comply with the prescribed medication may also impact the treatment plan.

Community Support Resources

Schizophrenia is a condition that afflicts a whole community. Due to the compassionate nature of people, a patient can join some of these groups so as to continue with the journey of managing the condition (In Schulz, In Green, & In Nelson, 2016). To this end, Mr. G can join the National Alliance on Mental Illness. The agency provides socio-economic support to mental health patients who are undergoing recoveries and thus might be able to help me. In addition, the patient can join the Disability Employment Service for financial assistance even as he recovers from the condition.

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Follow-Up Intensity Plan

The follow-up plan will involve a four week reassessment periods of the patient recovery process. During the first four weeks, the client will come back for reassessment of the effectiveness of the antipsychotic drugs. In addition, he will be reassessed regarding whether he is comfortable with the therapist or not. On the sixth week of treatment, the nurse will visit the therapist to review the progress of the patient. The client will again revisit the clinic on the eighth week of the treatment for further reassessment while notes will be compared with the therapist on the 12th week. The pattern will be maintained until all the 9 sessions are over.

Conclusion

Schizophrenic spectrum and other psychotic disorders are prevent and debilitating conditions. However, the social and cognitive functions of a patient can be improved when the condition and its comorbid symptoms are accurately diagnosed. Using a multidisciplinary intervention approach, a nurse can effectively combat the symptoms of comorbid schizophrenia. Schizophrenia Spectrum and Psychotic Disorders

References

American Psychiatric Association. (2016). Schizophrenia spectrum and other psychotic disorders: DSM-5 selections. Arlington, VA: American Psychiatric Publishing.

Hales, R. E., & Kupfer, D. J. (2014). The American Psychiatric Publishing textbook of psychiatry: [DSM-5 edition]. Washington, DC: American Psychiatric Publ.

In Schulz, S. C., In Green, M. F., & In Nelson, K. J. (2016). Schizophrenia and psychotic spectrum disorders. New York, NY : Oxford University Press.

Kuipers, E., Yesufu-Udechuku, A., Taylor, C., & Kendall, T. (2014). Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ: British Medical Journal, 348(7945), 33-35. doi:10.1136/bmj.g1173

Nathan, P. E., & Gorman, J. M. (2015). A guide to treatments that work. New York, NY : Oxford University Press

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. Schizophrenia Spectrum and Psychotic Disorders

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