Posted: November 9th, 2022

Schizophrenia Spectrum and Other Psychotic Disorders

College of Nursing-PMHNP, Walden University
NRNP 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults

Schizophrenia Spectrum and Other Psychotic Disorders
Introduction
Psychotic disorders can undermine the quality of life of a patient. The selected case study is of a 48-year-old woman with schizophrenia. The symptoms of schizophrenia include disordered thinking, hallucinations, and delusions. Initial presentation of patients with schizophrenia indicates anhedonia and low moods. The best medication for schizophrenia is Aripiprazole (Abilify). Cognitive behavior therapy is effective in changing the thinking patterns of the patient. Community support and collaboration with diverse professionals will enhance the chances of recovery. The treatment plan outlines the interventions for a 48-year-old woman with schizophrenia.
Case Study
The selected case study is of a 48-year-old woman with schizophrenia.
HPI of the Patient
Mrs. Pauline is a 48-year-old female whose psychiatric Assessment is needed due to the risk of suicidal attempts. She states that she was washing her bedroom when she drunk Pine-Sol, thinking it was juice. She was fired from her job after month-long absenteeism. She was distressed after a divorce. She lives alone since her children are at school in other states. The patient has disordered thinking, hallucinations, and delusions. She stares in the roof while it is sleep time. She has sleep difficulties and wants to sleep and never wake up again. The patient reports vomiting frequently, lack of appetite, insomnia, weight loss, fatigue, headache, and wants to do nothing.
Clinical Impression
According to the HPI, the client is likely to suffer from schizophrenia. Initial presentation of patients with schizophrenia indicates anhedonia and low moods. The presenting symptoms include stress, change in weight, sleep problems, fatigue, and headache. The patient complains of sadness, difficulty concentrating, irritability, and low mood.
Psychopharmacologic Treatments
The best medication for schizophrenia is Aripiprazole. The drug is well-tolerated, effective, and efficacious. Extensive evidence shows Aripiprazole treats symptoms of schizophrenia when administered in low doses (Howes et al., 2017). Aripiprazole 10 mg tablets daily orally are effective in lessening the severity of the symptoms. The drug controls or treats psychotic illnesses by blocking the receptors that dopamine acts on (Howes et al., 2017). The action prevents excessive activity of dopamine in the brain. The drug dosage can increase in the subsequent clinical visits depending on the outcomes (Goff et al., 2017). Aripiprazole can trigger side effects such as headache, constipation, fatigue, trouble sleeping, weight gain, and blurred vision.. Despite the side effects, Aripiprazole is the best medication since it causes fewer and less severe side effects than other antipsychotic drugs (Taipale et al., 2018).
Psychotherapy Choices
Psychotherapy is vital in the treatment of schizophrenia since it helps patients to understand and manage their symptoms. Cognitive behavior therapy is one of the best psychotherapeutic choices for the treatment of schizophrenia (Taipale et al., 2018). For instance, the therapy will help the patient to deal with hallucinations. The talk therapy will help the patient identify what triggers the symptoms and reduce them (Best & Bowie, 2017). Cognitive remediation improves the ability to organize thoughts. Rehabilitation is essential for problem-solving support and job counseling since schizophrenia develops mainly when people are building their careers or families (Best & Bowie, 2017). The patient will be scheduled for 10-session therapy each 60 minutes. Adherence to the sessions is vital to the full recovery.
Medical Management Needs
The medical management needs of the patient are critical in the successful recovery of the patient. The first line of treatment for schizophrenia spectrum and other psychotic disorders is antipsychotic agents (Howes et al., 2017). Aripiprazole (Abilify) is one of the preferred antipsychotic drugs. The purpose of the antipsychotic drugs is to ease the symptoms such as delusions and hallucinations (Howes et al., 2017). The patient can start with Aripiprazole 10 mg tablets per day orally. Individual patients may benefit from a higher dose such as 15mg tablets per day orally. The maximum dosage is 30mg tablets per day.
It will be critical to take Aripiprazole drug to improve the quality of life. Adherence to the drug is to address critical symptoms such as anhedonia and low moods. Prescription of medication should consider allergic reactions of the patient to various drugs (Howes et al., 2017). The side effects of the drug are headache, constipation, fatigue, trouble sleeping, weight gain, and blurred vision. The patient should continue taking the medication and visiting the healthcare for further examination. Treatment procedures should continue, and necessary reviews will be done depending on the outcome (Howes et al., 2017). The patient should visit the healthcare facility after every four weeks for a review.
Community Support Resources
Community Preventive Services Task Force (CPSTF) provides community intervention programs to improve the quality of life and health. The task force recommends a collaborative approach to treat schizophrenia (Goff et al., 2017). Collaborative care is essential since it links primary care providers and mental health specialists. A community wellness program aims to improve patients’ welfare and behavior with psychotic disorders (Taipale et al., 2018). The patient should enroll in a community wellness program to improve the mental health of patients. Enrolling in a support group will help the patient to learn how other people overcame the symptoms.
One door mental health is a community approach to help people with mental illnesses. The community approach provides an inclusive strategy, strong advocacy, and innovative services (Taipale et al., 2018). The patient requires linkage to community organizations to secure a job opportunity. Diverse empowerment of the patient will improve their financial position and restore their health (Best & Bowie, 2017). It will be critical to expose the patient to a new environment to trigger behavior change.
Follow-Up Intensity and Frequency and Collaboration
Follow-up is vital in the treatment of schizophrenia and other mental conditions. It helps practitioners to review the progress and adjust the intervention strategies. The patient will need to report back to the clinic after two weeks for the first clinic and subsequent clinics after four weeks (Best & Bowie, 2017). Four weeks is sufficient to allow the medications to take effect. The counseling sessions will take place weekly. During the clinics, it will be essential to review the progress and the side effects (Biagianti et al., 2018). After 12 weeks, the patient should have made a significant recovery. Collaboration with a counselor or psychologist is essential to facilitate psychotherapy. A psychiatrist is needed if the mental symptoms persist to evaluate the mental status. Collaboration with family practitioners and internists is necessary to provide comprehensive care (Biagianti et al., 2018). Family members can accompany the client to the therapy sessions to ensure family support.
Conclusion
Treatment of psychotic disorders goes beyond pharmacological and psychotherapeutic interventions. Patients require collaboration with professionals such as psychologists and psychiatrists. Community support is practical to enhance the chances of recovery. The community approach provides an inclusive strategy, strong advocacy, and innovative services. Follow-up is vital in the treatment of schizophrenia and other mental conditions. Extensive evidence shows Aripiprazole treats symptoms of schizophrenia when administered in low doses. Follow-up is effective to review the progress and make critical decisions about the health of the patient. Treatment of psychotic conditions requires a comprehensive approach to enhance recovery, community support and reduce the risk of relapse.

References
Best, M. W., & Bowie, C. R. (2017). A review of cognitive remediation approaches for schizophrenia: from top-down to bottom-up, brain training to psychotherapy. Expert Review of Neurotherapeutics, 17(7), 713-723.
Biagianti, B., Quraishi, S. H., & Schlosser, D. A. (2018). Potential benefits of incorporating peer-to-peer interactions into digital interventions for psychotic disorders: a systematic review. Psychiatric Services, 69(4), 377-388.
Goff, D. C., Falkai, P., Fleischhacker, W. W., Girgis, R. R., Kahn, R. M., Uchida, H., … & Lieberman, J. A. (2017). The long-term effects of antipsychotic medication on clinical course in schizophrenia. American Journal of Psychiatry, 174(9), 840-849.
Howes, O. D., McCutcheon, R., Agid, O., De Bartolomeis, A., Van Beveren, N. J., Birnbaum, M. L., … & Correll, C. U. (2017). Treatment-resistant schizophrenia: treatment response and resistance in psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. American Journal of Psychiatry, 174(3), 216-229.
Taipale, H., Mehtälä, J., Tanskanen, A., & Tiihonen, J. (2018). Comparative effectiveness of antipsychotic drugs for rehospitalization in schizophrenia—a nationwide study with 20-year follow-up. Schizophrenia Bulletin, 44(6), 1381-1387.

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