NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Walden University NURS 6630 Week 7 Therapy for Patients With Schizophrenia-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6630 Week 7 Therapy for Patients With Schizophrenia assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Whether one passes or fails an academic assignment such as the Walden University NURS 6630 Week 7 Therapy for Patients With Schizophrenia depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6630 Week 7 Therapy for Patients With Schizophrenia

The introduction for the Walden University NURS 6630 Week 7 Therapy for Patients With Schizophrenia is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6630 Week 7 Therapy for Patients With Schizophrenia

After the introduction, move into the main part of the NURS 6630 Week 7 Therapy for Patients With Schizophrenia assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6630 Week 7 Therapy for Patients With Schizophrenia

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6630 Week 7 Therapy for Patients With Schizophrenia

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

Antipsychotic medication has been the common and standard method of treatment patients with Schizophrenia. These medications provide the patients with a therapeutic and safe environment effective in controlling symptoms (Chang et al., 2021). Schizophrenia is a disorder affecting the sensory nerves and also creating a great disturbance in the thinking process. Both generic and non-generic drugs have been important in the treatment of Schizophrenia and other disorders. These antipsychotic drugs are commonly used because of the wide spectrum of receptor activity, especially in stabilizing dopamine and serotine levels in the brain. Again, they are effective in controlling symptoms. Therefore, the purpose of this write-up is to develop a study guide for an antipsychotic drug.

Drug Description

Paliperidone Palmitate is a drug used in treating Schizophrenia. Its brand name is Invega Sustenna. This drug is approved by the FDA to treat Schizophrenia and other psychosis disorders. The drug is approved to treat the schizoaffective disorder as either adjunctive therapy or monotherapy.

Non-FDA uses

Invega Sustenna belongs to the general class of antipsychotics, and its non-FDA uses include the treatment of depression and treating hallucinations.

According to Kverno & Rozenberg (2021), Invega Sustenna is used in treating depression despite the reviews showing that it has been given a rating of 3.9 out of 10 in treating depression. Lower doses of Invega Sustenna are advised when a patient is suffering from mild depression.
Invega Sustenna has been found to reduce hallucinations and help patients better think of themselves (Kverno & Rozenberg, 2021).

NURS 6630 Week 7 Therapy for Patients With Schizophrenia According to the Schizophrenia and Related Disorders Alliance of America, approximately 3.5 million people in the United States are diagnosed with schizophrenia (n.d.), and it is one of the leading causes of disability. In practice, patients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders, such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for patients.
This week, as you examine antipsychotic therapies, you explore the assessment and treatment of patients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies.

Reference:

Schizophrenia and Related Disorders Alliance of America. (n.d.). About schizophrenia.https://sardaa.org/resources/about-schizophrenia/#:~:text=Quick%20Facts%20About%20Schizophrenia.%20Schizophrenia%20can%20be%20found,is%20one%20of%20the%20leading%20causes%20of%20disability

Sample Answer for NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Bipolar disorder is one of the most common mental illnesses characterized by drastic shifts in the patient’s mood, activity, and energy levels, affecting their ability to conduct daily tasks (Marzani, & Neff, 2021). Such drastic changes in the patient’s energy levels and mood are more severe, unlike the normal ups and downs experienced by most people. The National Institute of Mental Health (NIH) reported that approximately 2.8% of adults in the United States were diagnosed with bipolar disorder last year (Citrome, 2020). Bipolar disorders are associated with severe morbidity and mortality rates. However, through evidence-based practice, several treatment options have been proposed with proven effectiveness in the management of patients with bipolar disorder. In this discussion, the choices of medication used to manage a young Asian adult diagnosed with bipolar type 1 have been discussed in addition to the reasons behind the choice of psychotropic agent and the expected outcome and legal and ethical considerations encountered by the PMHNP. The choices of medications used are based on both pharmacodynamic and pharmacokinetic factors.

The case study provided described a 26 years old Asian woman who presented to the clinic with a primary diagnosis of bipolar type 1. The patient was previously hospitalized for 21 days as a result of the onset of acute mania. The patient is in good health with a stable mood at the moment but claims to hate sleeping. She is however underweight with a BMI of 18.3. Genetic testing reveals that the patient is positive for the CYP2D6*10 allele. She has been taking lithium to manage her mental condition during the hospitalization period, which she stopped talking when she was discharged. Mental examination results reveal that the patient is oddly groomed, but displays perfect orientation in person, time, and place. She is however rapid and pressured. Upon administration of the Young Mania Rating Scale (YMRS), the patient revealed a score of 22, which indicated mild mania. She however denies suicidal ideation and auditory or visual hallucination.

Decision #1

Begin Seroquel XR 100 mg orally at HS

Reason Behind Decision 1:

Seroquel (Quetiapine) is recommended by most study guidelines for the management of bipolar disorder as monotherapy. The mood-stabilizing effects of Seroquel are associated with its antagonistic effect at the 5-HT_2A and D2 receptors (Citrome, 2020). Studies have revealed great effectiveness of the drug and long-term adherence among patients on extended-release (XR) quetiapine which is administered once daily. The drug also exhibits a desirable safety profile with mild side effects which can be managed non-pharmacologically such as changes in weight. The drug is metabolized in the liver by cytochrome P450 (CYP) 3A4, which is low among patients with CYP2D6*10 allele such as Asians. This promotes slow metabolism, hence prolonged duration of action.

The use of lithium is not appropriate given that the patient stopped taking the drug immediately, which is discouraged as a result of increased risks of relapse and non-compliance. Lithium is also associated with undesirable side effects such as weight gain and GI disturbances especially when administered in higher doses like 300mg (Lin et al., 2020).

Risperdal is also not a good alternative for the patient as monotherapy. The drug displays great effectiveness when administered in combination with lithium (Marzani, & Neff, 2021). Consequently, the recommended starting dose with Risperdal is 2 to 3mg once daily, which makes the 1mg dose undesirable.

Expected Outcome

Within the next 4 weeks, the patient is expected to exhibit at least 50% remission of manic symptoms (Citrome, 2020). Her compliance level is also expected to improve, with good sleeping patterns. Her agitation is also expected to reduce. Upon administration of the Young Mania Rating Scale (YMRS), the patient should record a score of less than 12.

Ethical Considerations Impact on Treatment Plan

According to the legal and ethical guidelines, the PMHNP must take into account the patient’s race and ethnicity in formulating the most effective treatment plan (Lin et al., 2020). Consequently, given that the patient is an adult, the nurse needs to involve the patient in making decisions concerning the medication choice to promote satisfaction.

Decision 2:

Discontinue using Seroquel and Start 40mg Geodon 40 mg orally BID.

Reason Behind Decision 2:

The initial intervention revealed minimal effectiveness in controlling the patient’s manic episodes. Consequently, undesired side effects were exhibited by the patient such as constipation, weight gain, and dry mouth which made the patient uncomfortable with the drug. As such it is necessary to discontinue the drug and initiate Geodon which is FDA approved for the management of manic episodes among patients diagnosed with bipolar 1 disorder (Marzani, & Neff, 2021). The drug exhibits a desirable safety profile, unlike Seroquel. Consequently, studies show that Geodon has great bioavailability, and hence must be administered with a 500 calorie intake. The patient also disliked the weight gain side effect associated with the initial drug which will not be the case with Geodon.

Increasing the dose of Seroquel is not appropriate as this will only worsen the side effects already exhibited by the patient (Rhee et al., 2020). The patient also suggested the drug changes, and ignoring her request would only promote non-compliance and affects their therapeutic relationship with the nurse.

Continuing the same dose of the medication is also against the patient’s will as this will lead to a further increase in the patient’s body weight (Lin et al., 2020). Consequently, the drug displayed minimal effectiveness which is below the desired therapeutic threshold in the management of bipolar.

Expected Outcome

The patient is expected to display at least 50% remission of symptoms within the next four weeks. Her sleeping pattern and agitation levels are expected to improve significantly (Rhee et al., 2020). Consequently, the initial side effects such as dry mouth, constipation, and weight gain are expected to resolve once Seroquel has been discontinued.

Ethical Considerations Impact on Treatment Plan

The legal and ethical requirements give the patient the right of making decisions concerning her health (Marzani, & Neff, 2021). As such, the PMHNP must respect the patient’s decision and make appropriate interventions as desired by the patient to promote satisfaction which intern builds on a positive therapeutic relationship with the patient.

Decision 3:

Continue the same dose and reassess in 4 weeks.

Reason Behind Decision 1:

The patient displayed great tolerance and adherence to the previous intervention with 50% remission of symptoms. Consequently, the undesired side effects were resolved within this time, promoting patient compliance. Studies show that despite the goal of attaining 100% remission of symptoms with psychotropic agents, a 50% management of symptoms is still desirable. Consequently, Geodon takes up to 8 to 12 weeks to completely managed maniac symptoms among patients with bipolar disorder (Mazza et al., 2020). As such, it is necessary to continue the same dose to promote further management of the patient’s symptoms, with no side effects. The treatment outcome must however be evaluated after four weeks, given that the treatment regimen was changed just after the first intervention failed.

Increasing the dose of Geodon is not necessary given the great tolerance and effectiveness displayed by the patient (Mazza et al., 2020). Consequently, studies show that increased plasma concentrations of the drug are associated with severe side effects such as weight gain which resulted in to change of regimen in the first place.

Augmenting Geodon with lithium is desirable, but at low doses to avoid side effects (Mazza et al., 2020). Consequently, this intervention could only be considered among patients who are not lithium defaulters as this will only compromise the patient’s compliance levels.

Expected Outcome

The patient is expected to display complete remission of symptoms within the next four weeks. She should be able to sleep well, with significantly reduced agitation levels (Rhee et al., 2020). Her scores upon administration of the Young Mania Rating Scale should also display a reading of less than 8.

Ethical Considerations Impact on Treatment Plan

According to the nursing code of ethics, it is the obligation of the PMHNP to promote the patient’s health and prevent harm. Consequently, holistic care requires the nurse to promote patient-centered care to attain positive treatment outcomes (Rhee et al., 2020). As such, listening to the patient and involving them in making decisions concerning which intervention is appropriate for their health is necessary.

Conclusion

Bipolar disorder is one of the most common mental illnesses across the world with increased morbidity and mortality rates. However, with early detection, studies show that patients can greatly benefit from the available treatment options with improved quality of life. Clinicians must also consider pharmacodynamic and pharmacokinetic factors when deciding on which medication to use for a given patient (Citrome, 2020). In the provided case study, the first intervention was to initiate the patient on Seroquel which is FDA approved for the management of bipolar among adults. However, the drug displayed undesired side effects such as weight gain, which made the patient uncomfortable with taking the medication (Lin et al., 2020). Consequently, the drug displayed minimal effectiveness, which led to changing the treatment regimen is the second decision. Geodon, is also FDA approved for the management of manic episodes among bipolar patients, hence considered as the best replacement for Seroquel (Mazza et al., 2020). The patient displayed great adherence and tolerance to this medication with 50% remission of symptoms. Consequently, the initial side effects were resolved.

As a result, it was necessary to maintain the dose of this medication for the third intervention to avoid additional side effects and promote further remission of the patient’s symptoms. several legal and ethical considerations were encountered with the PMHNP in the management of this patient (Marzani, & Neff, 2021). For instance, the patient being an adult gives her the right of making decisions concerning her health. As such, the nurse needed to change the patient’s regimen when she was not comfortable with the weight to gain side effects as a result of Seroquel (Rhee et al., 2020). General, the nurse has the obligation of promoting the patient health and preventing harm.

References

Citrome, L. (2020). Food and Drug Administration–Approved Treatments for Acute Bipolar Depression: What We Have and What We Need. Journal of Clinical Psychopharmacology, 40(4), 334-338. DOI: 10.1097/JCP.0000000000001227

Lin, Y., Mojtabai, R., Goes, F. S., & Zandi, P. P. (2020). Trends in prescriptions of lithium and other medications for patients with bipolar disorder in office-based practices in the United States: 1996–2015. Journal of Affective Disorders, 276, 883-889. https://doi.org/10.1016/j.jad.2020.07.063

Marzani, G., & Neff, A. P. (2021). Bipolar Disorders: Evaluation and Treatment. American Family Physician, 103(4), 227-239. PMID: 33587568.

Mazza, M., Marano, G., Giuseppin, G., & Janiri, L. (2020). Ziprasidone in treating bipolar child and adolescent patients: More research is warranted. Bipolar disorders, 22(3), 311-312. https://doi.org/10.1111/bdi.12911

Rhee, T. G., Olfson, M., Nierenberg, A. A., & Wilkinson, S. T. (2020). 20-year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings. American Journal of Psychiatry, 177(8), 706-715. https://doi.org/10.1176/appi.ajp.2020.19091000

Sample Answer 3 for NURS 6630 Week 7 Therapy for Patients With Schizophrenia

Case: An Elderly Widow Who Just Lost Her Spouse

The case study portrays a 75-year-old female patient presenting with a chief complaint of insomnia. She has a history of DM, HTN, and MDD. The patient’s husband passed away ten months ago. Since the husband’s demise, she states her depression has worsened and her sleep habits. She had no history of depression before her husband’s death.

Three Questions I Might Ask the Patient

How has insomnia and depression affected your daily activities or interactions with people? The question will determine if the depressive symptoms have caused social and occupational dysfunction.
When did you begin experiencing insomnia? To determine if insomnia started after starting Sertraline since it is an adverse effect of the drug.
What is your current living status? The question will identify the persons currently living with the patient and her social support system. Living alone may be a cause of the depressive symptoms.

People in the Patient’s Life I Would Need to Speak To

Patient’s Primary Caregiver

Which activities of daily living have the patient had difficulties in carrying out in the past days? The question will determine the impact of depression on the patient’s daily functioning.
Does the patient engage in activities that put her life at risk? To identify the presence of self-mutilating behaviors.
How have been your interactions with the patient in the past weeks? To determine whether the patient’s depression and insomnia have resulted in impaired interpersonal or social functioning.

Physical Exams and Diagnostic Tests Appropriate For the Patient

Depression screening using the Patient Health Questionnaire (PHQ)-9. The PHQ-9 self-questionnaire will help rate the severity of the patient’s depression (Avasthi & Grover, (2018).
Hemoglobin A1c- To identify the mean glycemic level and establish whether the patient has achieved adequate glycemic control.
Cardiovascular Exam: To assess any abnormalities in the cardiovascular system, this can be caused by hypertension and diabetes mellitus.
Thyroid-stimulating Hormone Test to rule out Hypothyroidism, which presents with depression (Avasthi & Grover, (2018).
Mental Status Examination (MSE). An MSE will assess the patient’s affect, speech, memory, judgment, and cognition, which can be grossly affected by depression.

Differential Diagnoses

Major Depressive Disorder

Major depressive disorder (MDD) is a mood condition marked by a depressed mood or diminished pleasure or interest in most pleasurable activities. The DSM V diagnostic criteria require that a person presents with four other symptoms in addition to a depressed mood or diminished interest (APA, 2013). The symptoms are changes in appetite, weight changes, fatigue or low energy levels, sleeping difficulties, psychomotor agitation or retardation, reduced ability to concentrate and think or indecisiveness, feelings of worthlessness, and recurrent thoughts of death, suicidal ideations, or attempt (APA, 2013). MDD is a presumptive diagnosis based on the patient’s symptoms of worsening depression and insomnia. Besides, she has a history of MDD, which suggest a relapse of the disorder.

Insomnia

Insomnia is characterized by a continuous difficulty in initiating sleep, maintaining sleep, consolidation, or quality of sleep. Persons with insomnia present with difficulty falling asleep, frequent awakenings, or early morning awakening (APA, 2013). Persons with insomnia report dissatisfaction with quantity or quality of sleep. Insomnia is associated with daytime effects, such as fatigue, tiredness, lack of energy, irritability, reduced work performance, and difficulty concentrating (APA, 2013). Insomnia is a differential diagnosis based on the patient’s symptoms of difficulties in sleeping. Insomnia could be due to MDD, in which patients present with sleeping difficulties of insomnia or hypersomnia. Insomnia can also be attributed to the side effects of Sertraline.

Persistent Complex Bereavement Disorder (PCBD)

PCBD is a condition marked by unshakeable grief that does not follow the typical pattern of improvement over time. Persons continue to exhibit persistent and intense emotions or moods and unusual (APA, 2013). They also experience adverse symptoms that impair significant areas of functioning or cause extreme distress. Symptoms of PCBD include Indefinitely yearning for the deceased; A preoccupation with the events of the deceased’s death; Intense sorrow and distress that does not improve over time; Depression; Difficulty trusting others; Detachment and isolation (APA, 2013). In addition, one may experience difficulties pursuing interests or activities, persistent feelings of loneliness or emptiness, and impairment in occupational, social, and other areas of life (APA, 2013). PBCD is a differential diagnosis based on the patient’s report of depression and insomnia that has worsened since his husband’s death.

Pharmacologic Agents Appropriate For The Patient’s Antidepressant Therapy

Fluoxetine (Prozac) 10 mg PO once daily.

Prozac is an antidepressant belonging to the class of Selective serotonin reuptake inhibitors (SSRIs). SSRIs are indicated as first-line agents in uncomplicated depression owing to their few anticholinergic effects. Prozac is a preferred treatment choice in geriatric patients due to its fewer side effects (Avasthi & Grover, (2018). The dose will be gradually increased by 10-20 mg after four weeks based on the patient’s tolerance to the drug. Contraindications for Prozac include hypersensitivity to the drug and concomitant administration of Pimozide or Thioridazine (Avasthi & Grover, (2018). According to Simon et al. (2015), African Americans have a worse response to SSRIs than Whites. If the patient were an African American, she would have a low response rate.

Duloxetine (Cymbalta) 30 mg PO once daily.

Duloxetine is an antidepressant under the class of serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs are indicated as second-line agents in patients who have not responded to SSRIs (Muscatello et al., 2019). The patient will be started on a low dose of 30mg/day due to her advanced age. The dose will be increased after two weeks to a target dose of 60 mg/day. Contraindications for Duloxetine include concomitant administration of the drug with Monoamine oxidase inhibitors (MAOIs) prescribed to treat a psychiatric disorder (Muscatello et al., 2019). I would choose Prozac over Duloxetine since the former exerts no effect on cardiac conduction, heart rate, or blood pressure (Avasthi & Grover, (2018). It would thus be appropriate for this patient with HTN.

Check Points

After four weeks, I would evaluate the patient for improvement of depressive symptoms and insomnia. I would also assess for side effects. If there is a partial improvement of symptoms and no associated side effects with Prozac treatment, I will increase the dose to 20 mg per day. In week 8, I would assess for severity of depressive symptoms and compare them with the patient’s depression in the previous visit. If there is a partial improvement, I would increase the dose to 40 mg/day and monitor any side effects.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Avasthi, A., & Grover, S. (2018). Clinical Practice Guidelines for Management of Depression in the Elderly. Indian journal of psychiatry, 60(Suppl 3), S341–S362. https://doi.org/10.4103/0019-5545.224474

Muscatello, M., Zoccali, R. A., Pandolfo, G., Mangano, P., Lorusso, S., Cedro, C., Battaglia, F., Spina, E., & Bruno, A. (2019). Duloxetine in Psychiatric Disorders: Expansions Beyond Major Depression and Generalized Anxiety Disorder. Frontiers in psychiatry, 10, 772. https://doi.org/10.3389/fpsyt.2019.00772

Simon, G. E., Coleman, K. J., Waitzfelder, B. E., Beck, A., Rossom, R. C., Stewart, C., & Penfold, R. B. (2015). Should measures of antidepressant treatment quality be adjusted for race and ethnicity?. JAMA psychiatry, 72(10), 1055.https://doi.org/10.1001/jamapsychiatry.2015.1437

Learning Objectives
Students will:
• Assess client factors and history to develop personalized therapy plans for patients with insomnia
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for insomnia
• Assess patient factors and history to develop personalized plans of antipsychotic therapy for patients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring antipsychotic therapy
• Synthesize knowledge of providing care to patients presenting for antipsychotic therapy
• Analyze ethical and legal implications related to prescribing antipsychotic therapy to patients across the lifespan
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Learning Resources

Required Readings (click to expand/reduce)

Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier.

American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. https://doi.org/10.1093/schbul/13.2.261

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

McClellan, J. & Stock. S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9), 976–990. https://www.jaacap.org/article/S0890-8567(09)62600-9/pdf

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649–659. https://doi.org/10.2165/00023210-200923080-00002

Medication Resources (click to expand/reduce)

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.
• amisulpride
• aripiprazole
• asenapine
• brexpiprazole
• cariprazine
• chlorpromazine
• clozapine
• flupenthixol
• fluphenazine
• haloperidol
• iloperidone
• loxapine
• lumateperone • lurasidone
• olanzapine
• paliperidone
• perphenazine
• pimavanserin
• quetiapine
• risperidone
• sulpiride
• thioridazine
• thiothixene
• trifluoperazine
• ziprasidone

Required Media (click to expand/reduce)

Case study: Pakistani woman with delusional thought processes
Note: This case study will serve as the foundation for this week’s Assignment.

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Optional Resources (click to expand/reduce)

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., Miller, A. L., & Miller, D. D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124–134. https://doi.org/10.3371/CSRP.5.3.2

Fangfang, S., 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. https://doi.org/10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107–121. https://doi.org/10.1007/s11126-014-9326-2

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Discussion: Treatment for a Patient With a Common Condition

Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.
Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health.

https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.

Case: An elderly widow who just lost her spouse.

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
• Metformin 500mg BID
• Januvia 100mg daily
• Losartan 100mg daily
• HCTZ 25mg daily
• Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86

By Day 3 of Week 7

Post a response to each of the following:

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

Read a selection of your colleagues’ responses.

By Day 6 of Week 7

Respond to at least two of your colleagues on two different days in one of the following ways:
• If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
• If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days and
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria

To access your rubric:
Week 7 Discussion Rubric

Post by Day 3 of Week 7 and Respond by Day 6 of Week 7

To Participate in this Discussion:
Week 7 Discussion