497. Week 6: Antipsychotic Therapy According to the National Alliance on Mental Illness, approximately 100,000 people experience psychosis in the United States each year (NAMI, 2016). In practice, clients 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 mental health nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for clients. This week, as you examine antipsychotic therapies, you explore the assessment and treatment of clients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies. Photo Credit: Ingram Publishing/Getty Images Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Psychosis and schizophrenia greatly impact the brains normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this weeks Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia. Learning Objectives Students will: · Assess client factors and history to develop personalized plans of antipsychotic therapy for clients · Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy · Evaluate efficacy of treatment plans · Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan Learning Resources Note: To access this weeks required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahls essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. · Chapter 4, Psychosis and Schizophrenia · Chapter 5, Antipsychotic Agents Stahl, S. M. (2014b). The prescribers guide (5th ed.). New York, NY: Cambridge University Press. To access information on the following medications, click on The Prescribers Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. Review the following medications: amisulpride aripiprazole asenapine chlorpromazine clozapine flupenthixol fluphenazine haloperidol iloperidone loxapine lurasidone olanzapine paliperidone perphenazine quetiapine risperidone sulpiride thioridazine thiothixene trifluoperazine ziprasidone Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659. doi:10.2165/00023210-200923080-00002 Note: Retrieved from Walden Library databases. Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276. Note: Retrieved from Walden Library databases. Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting Required Media Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author Note: This case study will serve as the foundation for this weeks Assignment. Optional Resources Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, 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. doi: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. doi: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. doi:10.1007/s11126-014-9326-2 To prepare for this Assignment: · Review this weeks Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy. The Assignment Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the clients pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: · Decision #1 o Which decision did you select? o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? · Decision #2 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? · Decision #3 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients. Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.