Psychosis can be considered a variety of symptoms. Individuals who are experiencing this syndrome usually are considered having a break from reality. The symptoms portrayed with this condition are hallucinations and total misunderstanding of what is true. Schizophrenia on the other hand is a mental condition that results in psychosis (Schulz, Green & Nelson, 2016). Invega Sustenna is mostly a drug used in the treatment of mood and mental disorders. Antipsychotic drugs like Paliperidone works by restoring the equilibrium of the neurotransmitters fond in the brain (Hamilton, 2015) . The therapy once administered contributes to the decrement of hallucinations and enables the patient take control of what is real. The therapy is often through an injection on the upper arm and in some cases the buttock (Pedersen, 2018). The PANSS is a scale used to measure the severity of patients with schizophrenia An increase in the scores and a decrease both indicates severity of the condition respectively.
Decision 1
I selected Start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter .This decision was selected because the patient exhibited a decrease in PANSS score which was 25%. This indicates a mild decrease, which is a good start for the therapy. The patient tolerated well with the drug a fact that can be backed by the PANSS score. By selecting this decision, I was hoping to achieve a decrease in the hallucination levels that reflected in the PANSS score. Since Invega Sustenna contributes to a significant weight gain, I expected this to be observed and the patient to gain some pounds . Even though there was a slight weight gain of 2 pounds because of Invega Sustenna, critical monitoring and evaluation is required (Hamilton, 2015).
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Decision 2
Continue the same decision made but instruct the administering nurse to begin injection into the deltoid at this visit and moving forward.
I choose this decision because the significant reduction in the PANNS score by half since the administration of Invega sustenna confirms that the therapy was a success and there was no significant need to change the initial medication (Hamilton, 2015). The pain that was previously experienced by the patient has decreased tremendously and in this case, the patient will not complain of having to walk for long hours because of the pain. The deltoid injection has made a difference to the patient since she feels much better. The Invega sustenna injection has a side effect of weight gain. In this case, I expected the patient to have a significant change on the effect experienced previously. This was achieved. Since the patient in observant and cautious about this , the best solution will be to deliberate with the husband to understand how the therapy works and that with proper nutrition and exercise, the weight gain will significantly reduce. In addition, altering this drug now might result in adverse effect and a complete new therapy that might hinder the progress of what has been achieved.
Decision 3
Continue with the Invega Sustenna. Counsel patient on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one month.
I chose this decision because a remarkable improvement had been observed. Continuing with the Invega Sustenna was vital because the situation had improved because of the patient showing further symptoms reduction. The patient liked the feeling of the medication and with this, positivity was observed. The progression and tolerance to the injection by the patient means that, as the therapy progress the symptoms would be mild no null. I was hoping to a achieve another significant change in the PANNS score because from the initial stage of administration, the visits had recorded changes to a reducing level (Stanley, 1991). The scores might also have been affected because of the patient’s cautiousness of her body weight. The patient was more concerned about her body weight and her husband’s feeling of her weight increment. With such, she is more likely to relapse.
It is quite evident that Invega Sustenna injection result in a significant weight gain. In this case, patient had gained 4.5 pound, which to her was not going to be tolerated by her husband. Altering the progressive nature of Invega Sustenna may result in relapses. I would advise the patient to complete the therapy because alteration of the drug my result to further complications likes obesity and other cardiovascular ailment making the treatment difficult. With a well plan nutritional therapy, she will be able to maintain her fluid intake and balance her caloric intake. For the food consumed to be therapeutic while under Invega Sustenna, it must be nutrient- dense and incorporate all the minerals required ( Pedersen, 2018). In addition, exercise will help most of her cardiovascular processes and limit fatigue. Increase in rate of activity also result in an increase in metabolic processes, which in turn activates the psychological processes.
Through ethical considerations, changing the drugs in this case Invega Sustenna because of the mild weight gain would be inappropriate. Invega Sustenna causes weight gain and any changes that may affect its performance may affect the patient’s health. Altering the drugs without any adverse impact of the initial drug taken by the patient would be inappropriate. Unless unfortunate conduct is exhibited by the patient, the dosage should not be changed as this might result in serious side effects ( Ahronheim, Moreno, & Zuckerman, 2005).
References
Ahronheim, J. C., Moreno, J. D., & Zuckerman, C. (2005). Ethics in clinical practice . Boston: Jones and Bartlett Publisherxs.
Hamilton, R. J. (2015). Tarascon pocket pharmacopoeia 2016: 2016 professional desk reference edition . Burlington, MA : Jones & Bartlett Learning
Pedersen, D. D. (2018). Pocket psych drugs: Point-of-care clinical guide . Philadelphia : F.A. Davis Company
Schulz, S. C., Green, M., & Nelson, K. J. (2016). Schizophrenia and psychotic spectrum disorders . New York, New York : Oxford University Press
Stanley R. K,.(1991). Positive and Negative Syndromes in Schizophrenia: Assessment and Research . New York, NY: Taylor & Francis
