course materials

1. Discussion: Sychosis and schizophrenia
Discussion: Sychosis and schizophreniaDiscussion: Sychosis and schizophreniasychosis and
schizophrenia greatly impact the brain’s normal processes, which interferes with the ability
to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle
to function in daily life. However, clients often thrive when properly diagnosed and treated
under the close supervision of a psychiatric mental health practitioner. For this Assignment,
as you examine the client case study in this week’s Learning Resources, consider how you
might assess and treat clients presenting with psychosis and schizophrenia.Learning
ObjectivesStudents will:Assess client factors and history to develop personalized plans of
antipsychotic therapy for clientsAnalyze factors that influence pharmacokinetic and
pharmacodynamic processes in clients requiring antipsychotic therapyEvaluate efficacy of
treatment plansAnalyze ethical and legal implications related to prescribing antipsychotic
therapy to clients across the lifespanTo prepare for this Assignment:ORDER NOW FOR
CUSTOMIZED, PLAGIARISM-FREE PAPERSReview this week’s Learning Resources. Consider
how to assess and treat clients requiring anxiolytic therapy.The AssignmentExamine 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 #1Which decision did you
select?Why did you select this decision? your response with evidence and references to
the Learning Resources.What were you hoping to achieve by making this decision? 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 #2Why did you select this decision? your response with
evidence and references to the Learning Resources. Discussion: Sychosis and
schizophreniaWhat were you hoping to achieve by making this decision? 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 #3Why did you select this decision? your response with evidence
and references to the Learning Resources.What were you hoping to achieve by making this
decision? 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?SAMPLE ONLYNURS 6630WEEK SEVENCase 2:
Volume 2, Case #11: The figment of a man who looked upon the ladyIntroductionBriefly,

2. this is a scenario of a 42 year- old woman with a complex psychiatric history extending from
depression, posttraumatic stress disorder, insomnia, visual hallucinations (little man)and
impaired behavior with aggression. In the course of more than 36 months, the client was
treated with Paroxetine (SSRI), Bupropion ( NDRI), Tiagabine, Ramelteon and , but finally a
combination of Lexapro, Bupropion and quetiapine was able to decrease her symptoms .
The client’s medical history includes diabetes, hypertension, CAD, hyperlipidemia, COPD,
OSA, GERD, Glaucoma, overweight and a remote history of substance abuse.Related
Professional QuestionsCertain medications or supplements can cause symptoms of mental
illness and also due to her extensive medical history and usage of multiple medications I
would ask the following questions:1. Do you take any over -the – counter, herbal
supplements or remedies and I would check for interactions with current medication
regimen?2. When and how often do you use your albuterol inhaler ? Some of the side effects
of albuterol include anxiety, nervousness, and insomnia ( Cunha, 2016)Sleep Hygiene: Do
you keep regular sleep schedule ? Do you drink caffeine beverages close to bedtime?Patient
HistoryThe patient may not be a reliable source of information, particularly that she has a
significant mental illness that affects her functioning, hence verifying her responses with
her direct family members, and mental social workers to get clues to the underlying or
precipitating causes of mental crisis. Also checking facility records from previous
encounters, or any psychiatric hospitalizations would be useful.Diagnostics Testing1.
Thyroid Stimulating Hormone (TSH). Based on recent evidence, the prevalence of
depressive symptoms in hypothyroidism was nearly 50%, and clinical depression occurs in
more than 40% of people suffering from hypothyroidism ( Bhagwat, 2017)2.
Electrocardiogram (ECG) The client has cardiovascular diseases ( HTN, CAD), with risks of
cardio complications. In the setting of taking antidepressants and antipsychotics, baseline
ECG and possibly every three to six months would be appropriate. Several atypical
antipsychotics including quetiapine (Seroquel) are known to cause prolongation of the QT
interval, hypothesized to occur via direct inhibition of the cardiac delayed potassium
rectifier channel, which extends the ventricular repolarization process (Zhai et al., 2017)
Discussion: Sychosis and schizophreniaDifferential Diagnoses1. Posttraumatic Stress
Disorder ( PTSD)_2. Major Depressive Disorder (MDD)3. Insomnia
Disorder.Pharmacotherapy Options for Sleep/ Wake cycle1. Zolpidem (Ambien) 5mg oral at
bedtime for Seven days.Zolpidem is nonbenzodiazepine hypnotic, it works by enhancing
GABA inhibitory actions that provide sedative hypnotic effects more selectively than other
actions of GABA (Stahl, 2017). With its side effects of sedation, low dose prescribed as the
client has respiratory problems (sleep apnea OSA)). Studies have shown that Zolpidem did
not significantly worsen OSA as measured by the numbers and duration of pauses in
breathing during sleep, but in one trial, it significantly lowered minimum oxygen levels
during the night when compared with placebo ( Mason & Smith, 2015).2. Trazadone 25 mg
oral at bedtime for Thirty days.Trazadone is a serotonin 2 antagonist/reuptake inhibitor,
used in management of depression and insomnia. It is absorbed well, metabolized by CYP
450 3A4 with average half life of 6hrs. It has less side sedative effects compared to zolpidem
(Stahl, 2017)The best choice for the client would be Trazadone as there is no reliable
evidence of dependence or withdraws and it can also work for the client’s

3. depression.ConclusionThe case was a perfect example how it is sometimes difficult to find
effective pharmacological treatments of psychiatric illnesses. In the course of four years, the
client was prescribed 5-6 medications targeting different neurotransmitters to improve the
symptoms. Client’s polypharmacy increased risks of drug-drug interactions, and her
medical comorbidities increased risks of adverse reactions. Lesson learned from this study
was that treatment should be optimally initiated after diagnosis, and augment or switching
to a new agent must be carefully done in consideration of possible side effects and better
outcomes. Discussion: Sychosis and schizophreniaReferencesBhagwat, N., Tayde, P.,
Sharma, P., Sharma, B., Dalwadi, P., Sonawane, A., … Varthakavi, P. (2017). Hypothyroidism
and depression: Are cytokines the link? Indian Journal of Endocrinology and Metabolism,
21(6), 886. Retrieved from https://web-b-ebscohost-
com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=7&sid=aeb79c1d-68dc-
40a4-bd10-f956796bc9e8%40sessionmgr101Cunha, J. (2016). Common Side Effects of
Ventolin HFA (Albuterol Sulfate Inhalation Aerosol) Drug Center – RxList. Retrieved from
https://www.rxlist.com/ventolin-hfa-side-effects-drug-center.htmMason, M., & Smith, I.
(2015). Effects of opioid, hypnotic and sedating medications on obstructive sleep apnoea
(OSA) in adults with known OSA | Cochrane. Retrieved from
http://www.cochrane.org/CD011090/AIRWAYS_effects-opioid-hypnotic-and-sedating-
medications-obstructive-sleep-apnoea-osa-adults-known-osaZhai, D., Lang, Y., Dong, G., Liu,
Y., Wang, X., Zhou, D., … Zhang, R. (2017). QTc interval lengthening in first-episode
schizophrenia (FES) patients in the earliest stages of antipsychotic treatment.
Schizophrenia Research, 179, 70-74. Retrieved from https://resolver-ebscohost-
com.ezp.waldenulibrary.org/openurl?ID=pmid%3a27727006&genre=article&atitle=QTc+i
nterval+lengthening+in+first-episode+schizophrenia+(FES)+patien