what is schizophrenia

Background Information

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/09/mm/decision_tree/index.html

The Assignment:

• Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

• Decision #1: Differential Diagnosis
  • 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: Treatment Plan for Psychotherapy
  • 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: Treatment Plan for Psychopharmacology
  • 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 and their families.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO CARRIE?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Early Onset Schizophrenia

Schizoaffective Disorder

Schizotypal Personality Disorder

My Decision: Early Onset Schizophrenia

Decision Point Two

BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

Refer for psychological testing

Begin Clozaril 100 mg orally daily

Begin psychotherapy using a psychodynamic approach

My decision: Begin psychotherapy using a psychodynamic approach

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Carrie appears to be engaged with her therapist, and reports that she “looks forward” to seeing her therapist, but her parents are not reporting any appreciable change in psychotic symptoms.

Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

Increase the frequency of psychodynamic psychotherapy sessions

Begin Haloperidol 5 mg orally daily

Begin Lurasidone 40 mg orally daily

My decision: Begin Haloperidol 5 mg orally daily

Guidance to Student

Some authorities have suggested that psychodynamic psychotherapies can be effective in the treatment of schizophrenia, especially modern psychoanalysts. Psychotherapy definitely has a place in terms of helping individuals with schizophrenia (especially in the treatment of residual symptoms), but is not considered a first-line treatment for the disorder.

Although not FDA-approved for use in children, Lurasidone (Latuda) is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs “off-label”; however, attention must be given to the concept of informed consent. When working with children/adolescents, the PMHNP must explain pros/cons, discuss therapeutic endpoints/goals of treatment, etc. The parent/guardian must have all of the information needed to make an informed consent. In consideration of an antipsychotic, Lurasidone may be the preferred antipsychotic as it appears to have the least impact on body weight and lipid profile.

Haldol should be initiated at 0.5 mg orally daily, with a target dose of 0.05 to 0.15 mg/kg per day for psychotic disorders. It is generally considered to be a second-line drug after second-generation antipsychotics have been attempted/failed. Haldol can also cause significant weight gain and alter lipid profiles significantly.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.

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