The delusional thought process and is a psychotic disorder related to schizophrenia where the patient presents delusions ( Naber & Lambert, 2009) . The client, in this case, is a middle-aged Pakistan female diagnosed with symptoms of schizophrenia and delusional thought process. She is introduced to the hospital after several weeks of hospitalization where she experiences delusions and hallucinations such as the television talking to her. She also has mood swings that entail being hostile and then calming down immediately. Her overall good health is good, but her mental status appears to be impaired, scoring 40 for the positive symptoms scale, 20 for the negative symptoms scale and 60 for the general psychopathology scale after the PMHNP administered the PANSS test ( Kay, Fiszbein & Opler, 1987) . The purpose of this study is to determine the best practice in treating this client with delusional thought process disorder.
Decision point 1
The first decision for treating this client is to begin Invega Sustenna 234 mg at bedtime intramuscular X1, followed by 156 mg intramuscular on the fourth day and a monthly basis after that. This is an atypical antipsychotic intended for intramuscular use with a dose administered in a single injection ( Sun et al., 2014). The recommended dosage for this medication is a dose of 234 mg on the first treatment day and 156 mg intramuscular one week later and then on a monthly basis, both administered in the deltoid muscle. I choose to start with this medication because it is the best medication that can be selected for dealing with mental disorders such as schizophrenia and an adjunct to antidepressants. The drug works by restoring the balance of neurotransmitters in the brain, thus improving the mood and behavior of the client ( Sun et al., 2014) . From this stage, it will be possible to determine how the client reacts to the medication and determine the next possible decision point.
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The expected result for this decision is that the client will show improvements in their moods and mental capability, including differences in the attitude and behavior as compared to when the client was not under medication. For example, it is expected that she will show improvements in her speech and mood while dealing with symptoms of delusional thought process. After four weeks of undergoing treatment, the client appears with some improvements in her symptoms, scoring a Positive and Negative Syndrome Scale (PANSS) score of 25 percent. An assessment shows that she is tolerating the medication and has been complying with the prescriptions, but she complains of site pain from the injections, which affects her ability to sit or walk around for long periods after an injection. However, the expected results of the medication were not fully attained with minimal changes in the condition of the patient. The differences between the expected results and outcome of first decision arise since the client needs time to adjust to the medication ( Stahl, 2017).
Decision point 2
The second decision is to continue with the medication, but instruct the administering nurse to begin injections into the deltoid muscle at this visit and to move forward to avoid the side effects experienced by the client. I choose to continue with this medication because the client has shown a positive response to the drug with changes in the symptoms and overall condition. However, the expected outcome of the medicine is yet to be attained and maintaining the dosage can allow the patient to respond adequately to the drug. The expected result for the second decision point is that there will be more improvement in the symptoms such as a change in her aggressive behavior, reduction in delusions and hallucinations as well as resuming normal mood and normal daily life ( Chakos et al., 2011) . The decision also focuses on reducing the injection site pain that the client reported from the first decision point.
After four weeks of medication, the client reports a positive response to the pill with a PANSS test showing a 50 percent reduction in the symptoms from the initiation of the drug. Changing the site of injection also paid off as the client reported to be in a much better condition from the injection site pain. The state of the patient shows that there is a positive response and soon the client will return to normal daily life after finishing the dosage. However, the client has started to experience some side effects of the medication by gaining weight. She reported an additional 2.5 pounds over the last four weeks of the medication and an overall 4.5 pounds increase in weight since she started taking the medication. This aspect is bothering her and making her wish to change the drug, despite liking its impact in reducing the symptoms of delusional thought process.
Decision point 3
The third decision selected is to maintain the medication of Invega Sustenna but introduce patient education to counsel the client on how to keep weight and avoid getting obese. Since the client is showing an excellent response to the medication and dosage as demonstrated with over 50 percent reduction in the symptoms, it is appropriate that she continues with the current dose to achieve full recovery from the delusional thought process. On top of that, the nurse administrator should advise that side effects from Invega Sustenna are lower compared to other medication with similar efficacy and therefore there is no need to change the drug ( Chakos et al., 2011) . However, she needs an appointment with a dietician and exercise physiologist as a remedy to deal with the weight worries.
The decision to maintain the dosage and medication is selected since the client has shown a positive response to medication with evidence showing that the drug is effective in dealing with the symptoms. Therefore, there is no need to increase or reduce the dosage to ensure the client achieves full recovery. Providing patient education and recommending a diet and exercise expert is to ensure that she overcomes the side effects arising from this medication ( Stahl & Stahl, 2013) . Proper nutrition and exercise can control the weight gain side effects as the first option before thinking of applying any other agent to deal with them. The expected results are that the client will achieve full recovery without any side effects from this third decision point. The dosage should be extended to 12 weeks while monitoring how the client responds to it in ensuring improvement in her condition.
References
Chakos, M., Patel, J., Rosenheck, R., Glick, I., Hamner, M., Miller, D., ... & Miller, A. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: longitudinal results from the CATIE study. Clinical schizophrenia & related psychoses , 5 (3), 124-134.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia bulletin , 13 (2), 261-276.
Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia. CNS drugs , 23 (8), 649-659.
Stahl, S. M. (2017). Prescriber's Guide: Stahl's Essential Psychopharmacology . Cambridge university press.
Stahl, S. M., & Stahl, S. M. (2013). Stahl's essential psychopharmacology: neuroscientific basis and practical applications . Cambridge university press.
Sun, F., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: trends in multiple health care systems. American Journal of Health-System Pharmacy , 71 (9), 728-738.
