Decisions
As a result of the brief psychotic disorder, the client has been taken to the hospital where she will remain for the next 21 days. The conditions described have persisted for a month's period. For the proper treatment of the patient, it is important for the clinician to make the right decisions. The psychotic disorder stems from her "arranged" marriage where she is supposed to marry someone who was predetermined when she was only nine years old. First, it is important to take into consideration some of her symptoms, including alertness and orientedness to time, place, and events. As such, this shows that her psychotic disorder has not developed to advanced stages. It is also critical to take into account the fact that she is properly dressed. However, some of the characteristics that depict the possibility of a problem include low speech, extended periods of silence, and euthymic moods. Therefore, her treatment will follow a systematic protocol characterized by several decisions.
Decision 1
My first decisions would be to start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter. Invega Sustenna is a drug used in the treatment of mental and mood disorders such as schizophrenia. The drug works in several mechanisms. First, it is an antipsychotic drug. In this fashion, it restores the balance between certain natural chemicals present in the brain. Secondly, it works by decreasing hallucinations that are primarily present when a person is experiencing a psychotic disorder (Emsley & Kilian, 2018). The primary mode of administration is through an injection in the upper arm or the gluteal muscles. In making the decision, I would have left out two possible potential regiments that could have been used in this case. The first was the use of Zyprexa 10 mg, and the second one was Abilify 10mg oral. Zyprexa is an antipsychotic drug primarily used in the treatment of diseases such as schizophrenia and other maniac episodes. However, the main problem associated with the drug includes side effects (Altamura et al., 2014).
Delegate your assignment to our experts and they will do the rest.
Some of the main side effects associated with Zyprexa include constipation, headache, dizziness, lightheadedness, and the inability to sit properly. Research has also shown that the use of the medication is associated with constipation, stomach pain, and in some instances, memory issues (Patel et al., 2014). Women using Zyprexa 10 mg have also reported missed menstrual periods. Other users of the drug have also complained of back problems. The other drug option was Abilify 10mg. The drug is known for its impact on treating bipolar disorder and schizophrenia. It also helps in reducing instances of hallucination. However, the only problem is that it has a plethora of side effects that could be counterproductive in the treatment process. Some of these side effects are similar to the ones seen in Zyprexa 10 mg. They include dizziness, drowsiness, lightheadedness, nausea, and vomiting, among others. Therefore, the best option to be chosen and backed by evidence would be Invega Sustenna.
The most expected outcome of the decision was a decrease in the Positive and Negative Syndrome Scale (PANSS) rating. The PANSS is a medical tool used in measuring the severity of symptoms for patients with schizophrenia. It was developed in 1987 by the help of three individuals including Abraham Fiszbein, Lewis Opler, and Stanley Kay. Assessment with this tool takes the form of a clinical interview that lasts for 45 minutes (Opler, Yavorsky, & Daniel, 2017). After the conclusion of the interview, the patient will be placed on a rating of 1 to 7 based on the symptoms they exhibit. Therefore, the decision taken is expected to improve the rating of the client in this tool. The client appeared to be tolerating the medication. Most significantly, an increase in weight was also recorded. However, a problem was identified. While sitting, the patient asserted that they felt uncomfortable due to the injection pain.
Decision 2
After all this, the second decision was to continue with the administration of Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular. However, this would be done differently compared to the first instance. Instead of using the arm, the deltoid muscle would be utilized for the injections (Gao et al., 2011). The main reason for continuing this drug is to enhance a sense of consistency. Consistency, in this case, is essential for two reasons. First, it is already a tried and tested method, and therefore, the clinician does not have any fears of eventualities such as the side effects. Secondly, the positive drug interactions that the medication has had with the body will define the treatment heading forward.
The client has reported improvements in their PANSS rating. With the injection site changing, the patient reported improved comfort. The continued use of the medication is also responsible for the patient's increase in weight by about 2.5 pounds. Most fundamentally, it is crucial to note that the patient is happy regarding how the drug is working for her. She is particularly pleased by the fact that the drug is not causing much weight as others would have done. In the third decision, three fundamental aspects will be taken into consideration. The first one regards whether or not to progress with Invega Sustenna. The second option will be whether the clinician will need to start Abilify Maintena 400g. Thirdly, the clinician will need to assess whether to add Qsymia to play a role in weight reduction. In this case, the client will need to continue with Invega Sustenna despite its role in adding weight. The client will need to control their weight through other reliable means such as exercise and eating healthy food.
The other option available for the patient is to use a combination of Invega Sustenna and Qsymia. However, this might not go well for the patient. Qsymia is mainly utilized as an option in the treatment of patients with obesity. From the patient's Basal Metabolic Index (BMI) of 28.9, she is not obese, and therefore applying Qsymia will amount to misdiagnosis. The use of Abilify Maintena will not be appropriate for this particular case. Other than being inappropriate, it might result in side effects and overlap in oral therapy over the two-week period.
Decision 3
The third decision would be to discontinue abilify. Instead, the best option would be to continue with Invega Sustenna. This is the most logical solution in this case. No literature material backs the idea of having a patient on duel antipsychotic therapy. Most importantly, the patient has shown positive signs with the initial drug therapy as shown with the current PANNS result. Although the add-on therapy can be a good option, it is not warranted. The client could have suffered certain side effects associated with Abilify such as akathisia. Therefore, with the discontinuation of the Abilify, it is expected that such symptoms would slowly abate.
Ethical Considerations
The first ethical consideration that should be put in place involves the evaluation and definition of the patient's problem. In this case, it is crucial to understand that the patient has psychotic disorders and has instances of hallucination, including the visual and the auditory ones. It is only after understand and defining the problem that the clinician can evidentially know the kind of prescriptions to give or not to give the client based on their manifestations. Ethical prescription also requires the physician to select an appropriate medication. This has been seen in the first decision where both Abilify and Zyprexa were disqualified due to their side effects. The physician has a professional and moral obligation to understand the repercussions that each drug could have on a patient. Although some drugs are beneficial, they can have far-reaching consequences that adversely impact the person. Such a situation places the clinician between two ethical principles that include beneficence and non-maleficence (Cole, Kesselheim, & Kesselheim, 2012). In this case, the clinician will have to go for what is best for the patient, a factor that will also be influenced by the patient’s autonomy.
Before the patient is given the power to exercise their autonomy, they must be given adequate information, instructions, and warnings. The clinician should ensure that they regularly monitor the patient to avoid drug misuse or abuse. Some of the drugs used in the treatment of mental health conditions such as schizophrenia are expensive. Therefore, it is an ethical obligation for the clinician to consider the drug costs to avoid instances where the patient will be overburdened unnecessarily. Prescription errors can be a common aspect of any medical care setting. However, ethically, the health professional must endeavor to reduce such incidents. In doing so, they will need to use tools such as electronic drug references and prescribing software (Salari et al., 2013). Lastly, the physician must also understand the social and cultural background of the client to ensure that they receive a cultural-sensitive prescription.
The patient is from Pakistani, which is predominantly a Muslim nation. The country has a bad reputation for most use of illegal drugs. Drug trading continues to be a culture in the country, thereby setting a bad precedence. Many locals today have negative attitudes towards both the medical and the non-medical drugs. After understanding this background, the clinician will need to take to the patient, get their perspectives, and debunk any myths with evidence and facts.
References
Gao, Y., Li, Z., Sun, M., Guo, C., Yu, A., Xi, Y. ... & Zhai, G. (2011). Preparation and characterization of intravenously injectable curcumin nanosuspension. Drug delivery.
Emsley, R., & Kilian, S. (2018). Efficacy and safety profile of paliperidone palmitate injections in the management of patients with schizophrenia: an evidence-based review. Neuropsychiatric disease and treatment, 14, 205.
Cole, L. W., Kesselheim, J. C., & Kesselheim, A. S. (2012). Ethical issues in new drug prescribing. Journal of bioethical inquiry, 9(1), 77-83.
Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. Pharmacy and Therapeutics, 39(9), 638.
Altamura, C., Fagiolini, A., Galderisi, S., Rocca, P., & Rossi, A. (2014). Schizophrenia today: epidemiology, diagnosis, course, and models of care. Journal of Psychopathology, 20, 223-243.
Opler, M. G., Yavorsky, C., & Daniel, D. G. (2017). Positive and Negative Syndrome Scale (PANSS) training: Challenges, solutions, and future directions. Innovations in clinical neuroscience, 14(11-12), 77.
Salari, P., Namazi, H., Abdollahi, M., Khansari, F., Nikfar, S., Larijani, B., & Araminia, B. (2013). Code of ethics for the national pharmaceutical system: Codifying and compilation. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 18(5), 442.
