Schizophrenia Essay Paper

Diagnosis

My diagnosis is schizophrenia and other psychotic disorders. Psychosis is a severe mental disorder characterized by personality disintegration, impairment in social functioning, and loss of contact with, or misinterpretation of, reality. Hallucinations and delusional thinking may be present (American Psychiatric Association, 2020). Psychosis can arise in the presence or absence of organic impairment.

Schizophrenia Essay PaperSchizophrenia Essay Paper

Persecutory delusions, in which the patient feels he will be injured, and tormented by the government, are the most prevalent. Referential delusions occur when the patient believes that particular gestures, words, environmental clues, and so on are aimed at him.

Differentials

Major depressive disorder or bipolar disorder with psychotic or catatonic symptoms -The differentiation is based on the timing of the mood disorder and the psychosis, as well as the degree of the depressed or manic symptoms. Depressed or bipolar disorder with psychotic characteristics is the diagnosis if delusions or hallucinations occur predominantly during a significant depressive or manic episode (American Psychiatric Association, 2020).

In schizoaffective disorder, a  major depressive or manic episode must occur along with the active-phase symptoms, and the mood symptoms must be present for the majority of the overall duration of the active phases.

Delusional disorder differs from schizophrenia in that it lacks the other symptoms associated with schizophrenia, such as delusions,  hallucinations, disordered speech, and negative symptoms (American Psychiatric Association, 2020).

Laboratory Diagnosis

According to Wassenaar et al. (2018), electrolyte imbalances can either cause or influence the emergence of neuropsychiatric symptoms. In acute psychiatric patients, hypokalemia is prevalent.

Organic Conditions That May Present With Psychosis

Organic or secondary psychosis, according to Joyce (2018), can be found in a variety of illnesses such as toxic and metabolic disorders, neurological disease, and stroke. Although poststroke psychosis is an uncommon occurrence, research into it has greatly advanced our knowledge of delusion creation. (Joyce, 2018)

Reasons For Discontinuing The Olanzapine Medication

The top major justifications for stopping olanzapine were inadequate progress and deteriorating positive symptoms. In this case, the patient had persistent delusions, adverse outcomes, and inadequate improvement of negative symptoms. The primary reason for stopping olanzapine is pharmaceutical effectiveness, particularly for positive symptoms (Townsend & Morgan, 2018). Reasons for medication termination varied somewhat from reasons for drug continuing, with a high level of agreement between patient and doctor replies.

Side effects of Second Generation Antipsychotics medication

One of the most significant advantages of second-generation antipsychotics is that they have a reduced risk of neurological symptoms than first-generation antipsychotics. This is not to say that they are without adverse effects (Townsend & Morgan, 2018). Weight gain, high cholesterol, high blood pressure, and high blood sugar are more likely to occur with second-generation antipsychotics.

If a person is taking an antipsychotic, especially a second-generation antipsychotic, a psychiatrist should check these parameters frequently (Townsend & Morgan, 2018). Patients must also engage in healthy habits such as being active, eating healthily, avoiding alcohol and recreational drugs, and stopping or lowering tobacco use, if relevant.

Sedation is one of the adverse effects of Second Generation Antipsychotics medicine that interferes with regular daily activities.  Sedation is associated with histaminergic receptor inhibition. Ward and Citrome (2018) note that whereas movement disorders were long regarded to be largely an issue related to typical or first-generation antipsychotic usage, more attention is now being paid to the likelihood that most atypical antipsychotics might trigger movement disorders. It has the potential to cause drug-induced parkinsonism and tardive dyskinesia. This is one of the reasons the patient on the SGA medication made it painful and hard to keep his legs still.

Medication Was This Likely To Cause The Gynecomastia

According to Pisano et al. (2018), dopamine blocking on the anterior lobe of the pituitary gland caused by SGAs is frequently linked with hyperprolactinemia. Prolactin increases can result in gynecomastia, galactorrhea, sexual dysfunction, decreased sexual desire, erectile-ejaculatory dysfunction, orgasmic dysfunction, and diminished fertility. Induced hypogonadotropic hypogonadism, in combination with low estrogen and testosterone levels, may result in osteoporosis.

According to a study by Shahi et al. (2019), a patient on olanzapine experienced asymmetric, sensitive growth of the breasts (gynecomastia was more evident on the left side than the right). The negative effect was documented with olanzapine at 10 mg/day, but it improved when the dose was dropped to 5 mg/day.

Special Considerations For Each Of The Second Generation Antipsychotics

Medication monitoring for patients taking second-generation antipsychotics

The American psychiatric association proposes the following screening procedures for SGA patients. A personal history, weight, waist circumference, blood pressure, fasting blood glucose, and fasting lipid profile are taken every four weeks.

Adults on second-generation antipsychotics may experience aberrant blood test results such as higher serum glucose, serum lipids, and increased prolactin levels (Townsend & Morgan, 2018). Weight gain, increased risk of type 2 diabetes, cardiovascular side effects, increased abdominal girth, diabetic ketoacidosis, and sudden death in the elderly are all possible outcomes.

Noncompliant With Medications What Is A Less Frequent Option That May Be More Sustainable

Fluphenazine decanoate is often injected deep intramuscularly (IM) into the gluteal area. Most patients are effectively maintained on a dosage range of 12.5 mg to 100 mg administered every two to five weeks. When used as a maintenance medication, a single injection is expected to help treat schizophrenia symptoms for up to four weeks (Chokhawala & Stevens, 2022).

In a few patients on maintenance medication, the response to a single dosage has been shown to persist for up to six weeks. Fluphenazine (decanoate) has a half-life of 6.8 to 9.6 days after infusion. The intervals between fluphenazine decanoate doses are crucial in regulating patients’ symptoms and efficacy.

Depot antipsychotic medicine has the benefit of eliminating covert non-compliance. It is indicated that it significantly influences compliance, which impacts and minimizes the risk of relapse and hospitalization (Chokhawala & Stevens, 2022). Community psychiatric nurses who provide regular injections may regularly follow patients in the community.

Medication Causing The Tremors And Dehydration

Dopamine receptors of the first generation (typical, conventional) are blocked.

Examples include chlorpromazine and haloperidol. Dystonia, spasms, Parkinson-like symptoms, akathisia, motor restlessness, tardive dyskinesis, and involuntary movements are some of the extrapyramidal adverse effects.

Individual Psychotherapy

Individual recovery-oriented psychotherapy and cognitive treatments are evidence-based strategies for treating schizophrenia patients. In all circumstances, the primary focus must be on reducing fear and increasing trust. After establishing a therapeutic interpersonal relationship, reality orientation is maintained through exploring the client’s behavior within relationships.

Education is offered to assist the client in identifying sources of real or imagined threats and suitable responses (Townsend & Morgan, 2018). Attempts to improve interpersonal communication, emotional expression, and frustration tolerance have shown to be extremely therapeutic procedures for these people. Clients with schizophrenia tend to benefit more from groups that provide a supportive environment than those with a more confrontational approach.

Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) for Clinicians

This Suicidal Thinking, Behavior, Attempts evaluation may be used by mental health professionals after their initial interaction with a suicidal individual and completed Suicidal Thinking, Behavior, Attempts. The assessment approach comprises identifying, undertaking a suicidality inquiry, coming up with a risk level, selecting an appropriate response, and recording the process, including a follow-up plan (Townsend & Morgan, 2018).

References

  • American Psychiatric Association. (2020). Diagnostic and statistical manual of mental disorders, 5th ed.: DSM‐5. In The Wiley Encyclopedia of Personality and Individual Differences (pp. 125–129). Wiley. https://doi.org/10.1002/9781119547174.ch198
  • Chokhawala, K., & Stevens, L. (2022). Antipsychotic Medications. In StatPearls [Internet]. StatPearls Publishing.
  • Joyce, E. M. (2018). Organic psychosis: The pathobiology and treatment of delusions. CNS Neuroscience & Therapeutics24(7), 598–603. https://doi.org/10.1111/cns.12973
  • Pisano, S., Catone, G., Veltri, S., Lanzara, V., Pozzi, M., Clementi, E., Iuliano, R., Riccio, M. P., Radice, S., Molteni, M., Capuano, A., Gritti, A., Coppola, G., Milone, A., Bravaccio, C., & Masi, G. (2018). Update on the safety of second generation antipsychotics in youths: a call for collaboration among paediatricians and child psychiatrists. Italian Journal of Pediatrics42(1), 51. https://doi.org/10.1186/s13052-016-0259-2
  • Shahi, M. K., Kar, S. K., & Singh, A. (2019). Asymmetric, tender gynecomastia induced by olanzapine in a young male. Indian Journal of Psychological Medicine39(2), 215–216. https://doi.org/10.4103/0253-7176.203118
  • Townsend, M., & Morgan, K. (2018). Pocket guide to psychiatric nursing, 10e (10th ed.). F.A. Davis.
  • Ward, K. M., & Citrome, L. (2018). Antipsychotic-related movement disorders: Drug-induced parkinsonism vs. Tardive dyskinesia-key differences in pathophysiology and clinical management. Neurology and Therapy7(2), 233–248. https://doi.org/10.1007/s40120-018-0105-0
  • Wassenaar, E., O’Melia, A. M., & Mehler, P. S. (2018). A causality dilemma: ARFID, malnutrition, psychosis, and hypomagnesemia. The International Journal of Eating Disorders51(9), 1113–1116. https://doi.org/10.1002/eat.22939