Mental Health Decision Tree

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101

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Nursing

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Nov 24, 2024

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1 Mental Health Decision Tree Student Name: Course Name: Institutional Affiliation: Professor's Name: Date:

2 Mental Health Decision Tree Introduction This case study presents a 34-year-old female residing in the United States. She relocated to the United States from Pakistani in her early 20s. The woman is in an arranged married with a husband who was selected for her since she was nine. She visits a healthcare facility following hospitalization for 21 days whereby she is believed to have a “brief psychotic disorder” as her symptoms have only lasted for less than one month. Before being admitted, the patient says to have had visions of Allah whereby for a week, she has had a strong belief that she was Prophet Mohammad and that she would deliver the world from sin. Due to the change in her behavior, her husband has had serious concerns such that he would not even leave their children with her. In one evening, the patient is reported to have been out of control. Consequently, the husband was forced to call the police, which necessitated a subsequent admission to an inpatient psychiatric unit. During the assessment for this case, the patient appears to be quite calm whereby she emphasizes that the entire incident had blown out of proportion. Additionally, the patient does not believe that she visions herself as Prophet Mohammad and asserted that her husband was only out to get her because he did not love her and that all he wanted was an American wife and not her. She weighs 140 lbs and 5’5” tall. This paper aims at discussing three major decisions related to the medication recommended for the client with paranoid Schizophrenia. The paper also describes both the expected and actual outcomes for each decision and explains any potential differences that may be identified. More importantly, key ethical decisions capable of affecting the communication and treatment of the patient will also be discussed.

3 Decision #1 The decision selected is to prescribe Zyprexa 10 mg administered orally at bedtime for the client. The rationale for selecting this decision is that it influences brain chemicals. Also referred to as olanzapine, Zyprexa is approved towards treating symptoms of mental health disorders like schizophrenia and bipolar disorder among individuals aged at least 13 years ( Carlbo et al., 2018). Zyprexa acts as an atypical antipsychotic as it helps in restoring the neurotransmitters balance in the brain. With regards to the dosage, the medication will be administered once daily only during bedtime. According to Galling et al. (2018) , Zyprexa has been found to be effective in the treatment of dysfunctional behaviors, speeches, malfunctions, as well as distorted interpretations of the events and issues surrounding them. Abilify may be used as an alternative prescription for the patient for patients responding well to oral ability. However, it will not be prescribed for the patient due to its less effectiveness and potential side effects like akathisia, which could cause non-adherence to medication. Another potential alternative medication is Invega Sustenna, although it is associated with an increase in the risk of memory loss and side effects such as swelling, redness, and pain at the injection site ( Berger et al., 2018). Invega Sustenna is also associated with weight gain, high cholesterol, and muscle spasms, which could significantly affect the physical wellbeing of the patient on the basis of her weight. Through the administration of Zyprexa, the expectation is that the patient will not experience delusional thoughts or hallucinations as it has been the case. As a result, she will be able to think more clearly and positively about herself. Another expectation is that the client will feel less agitated and she will be able to actively take part in daily life activities. After four weeks of adhering to the medication, the patient returns to the clinic with her husband. She notes that

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4 her Positive and Negative Syndrome Scale (PANSS) has declined to a 25 percent partial response. The patient also reports gaining 5 pounds of weight. Further enquiries reveal that the patient states that she does not think she will ever get satisfied with her food. Consequently, she is constantly taking snacks throughout the day. According to Keepers et al. (2020) , increased appetite is one of Zyprexa’s major side effects as it leads to an increased frequency of taking meals, which explains the client’s weight gain. Additionally, the medication increases hyperglycemia risk, which potentially causes diabetes mellitus among patients ( Berger et al., 2018). Decision #2 The second decision selected would be to decrease the dosage of Zyprexa from 10 mg to 7.5 mg per day, which will also be taken at bedtime. The rationale of this decision is to control the weight gain reported by the client. Clearly, the patient was concerned with her increase in appetite and weight gain perpetrated by the 10 mg Zyprexa dosage. Thus, decreasing the 7.5 mg dosage will be prescribed with an objective of purposely countering the side effects of increased appetite and weight gain while also treating the client’s psychotic symptoms of behaviors, mood, dysfunctional thoughts, hallucinations, and delusions. The expectation of implementing the second decision is that through the reduction of the Zyprexa 10 mg to 7.5 mg dosage orally at bedtime, the patient will be able to lower her appetite, and consequently, her additional weight. Moreover, the current 7.5 mg dosage is within the weight of the patient. The client had been asked to stop taking snacks throughout the day whereby she would observe normal meal schedules while also engaging in regular physical exercises towards losing the excess weight that she had added.

5 After four weeks of taking the 7.5 mg dosage orally at bedtime, the client visits the clinic again. However, her situation has become worse. The practitioner notes that her PANSS had significantly risen by 10 percent, which is an indication that her negative symptoms were gradually becoming worse. However, she had realized a more stable weight and her excessive appetite episodes had significantly reduced. Her husband, whom she had accompanied to the hospital, laments that her wife had gradually become difficult to manage at home, something that forced him to take time off work because he feared leaving her wife alone at home. The overall implication is that the therapeutic goals recommended were not being realized, particularly with the current 7.5 mg Zyprexa dosage. Decision #3 Based on the previous visit of the client, it is evident that the 7.5 mg dosage did not help towards realizing the desired therapeutic outcomes. Although the client is no longer concerned about excessive appetite and weight gain, she had become unmanageable at home, which seriously inconvenienced her husband such that he had to take time off work. It is clear that the 7.5 mg Zyprexa prescription was an under dose for the client, implying that it was insufficient to realize the desired therapeutic treatment goals. However, raising the dosage to 10 mg would still lead to similar side effects as earlier, especially in terms of increased appetite and weight gain. Additionally, she will be exposed to an increased risk of diabetes mellitus. Thus, Risperdal is recommended as the perfect alternative in this case. This medication will be dosed twice every day. However, the biggest challenge for the Risperdal prescription is compliance. According to Galling et al. (2018 ), although Risperdal is also associated with weight gain side effect, it is not serious as it is the case with Zyprexa.

6 As an alternative, Risperdal is expected to lower the severe psychotic symptoms of the client while also making her more manageable at home. It is also expected that the client will portray little or no hallucinations and delusions, including significant improvement in terms of becoming more manageable. Moreover, the client will be more capable of executing her daily activities with little or no assistance. The associated symptoms of her disease will pose minimal impact/effect on the client’s overall life. Comparing the expected against actual outcomes, the client reported minor on and off hallucinations and delusional symptoms. Notably, there was a very minimal difference between the actual and expected outcomes. The client also reported to experience no side effects like weight gain or increased appetite, which is an indication that there is was a gradual realization of the therapeutic goals. Conclusion As part of the client’s treatment, a fundamental ethical consideration is to engage the client in counseling and ensure that the treatment plan takes into consideration her informed consent. According to Yu et al. (2018) , patients suffering from schizophrenia usually manifest neurological deficits, which make them psychologically/mentally unfit to make informed treatment decisions. Similarly, it is quite difficult to ascertain whether a patient’s content to the treatment plan implies that they fully understand what they are consenting to. Therefore, in an attempt to obtain a voluntary and informed consent from the patient, the practitioner needs to take caution towards ensuring that the decisions made are not capable of harming the patient. The implication is that mental health practitioners have the mandate to establish a balance between the principle of autonomy and non-maleficence. This case presents a perfect example of some of the difficult situations that both patients and practitioners find themselves in. In particular, the case shows that it is extremely challenging

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7 for practitioners to establish an effective pharmacological treatment, particularly for psychiatric illnesses. During the course of treatment, the patient does not respond well to Zyprexa, which is perceivably the most appropriate medication to treat the patient as she suffers from excess appetite and weight gain as part of the drug’s side effects. Decreasing the dosage does not even help, and the client’s psychiatric symptoms get even worse. However, the shift to Risperdal seeks to work perfectly for the client as it tremendously improves her mental health situation and she does not experience such side effects as weight gain and excessive appetite. From this study, a key lesson learned is that treatment needs to be optimally initiated immediately after the issue is diagnosed. Additionally, switching to a new agent or medication needs to be carefully conducted while considering the potential side effects and outcomes.

8 References Berger, M., Juster, R. P., Westphal, S., Amminger, G. P., Bogerts, B., Schiltz, K., ... & Sarnyai, Z. (2018). Allostatic load is associated with psychotic symptoms and decreases with antipsychotic treatment in patients with schizophrenia and first-episode psychosis. Psychoneuroendocrinology , 90 , 35-42. https://doi.org/10.1016/j.psyneuen.2018.02.001 Carlbo, A., Claesson, H. P., & Åström, S. (2018). Nurses' experiences in using physical activity as complementary treatment in patients with schizophrenia. Issues in mental health nursing , 39 (7), 600-607. https://doi.org/10.1080/01612840.2018.1429508 Galling, B., Vernon, J. A., Pagsberg, A. K., Wadhwa, A., Grudnikoff, E., Seidman, A. J., ... & Correll, C. U. (2018). Efficacy and safety of antidepressant augmentation of continued antipsychotic treatment in patients with schizophrenia. Acta Psychiatrica Scandinavica , 137 (3), 187-205. https://doi.org/10.1111/acps.12854 Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., ... & (Systematic Review). (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry , 177 (9), 868-872. https://doi.org/10.1176/appi.ajp.2020.177901 Yu, H., Yan, H., Wang, L., Li, J., Tan, L., Deng, W., ... & Chinese Antipsychotics Pharmacogenomics Consortium. (2018). Five novel loci associated with antipsychotic treatment response in patients with schizophrenia: a genome-wide association study. The Lancet Psychiatry , 5 (4), 327-338. https://doi.org/10.1016/S2215-0366(18)30049-X

Mental Health Decision Tree

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