Case StudyDelusional DisordersPakistani Female With Delusional Thought ProcessesHispanic maleBACKGROUNDThe client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control,” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.During today’s assessment, she appears quite calm and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She says she knows this because the television is telling her so.She currently weighs 140 lbs., and she is 5’ 5.SUBJECTIVEClient reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.A review of her hospital records shows that she received a medical workup from physician, who reported her to be in overall good health. Lab studies were all within normal limits.Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.MENTAL STATUS EXAMThe client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideationYou administer the PANSS which reveals the following scores:-40 for the positive symptoms scale-20 for the negative symptom scale-60 for general psychopathology scalDiagnosis: Schizophrenia, paranoid typeRESOURCESPANSS Scale. Available at: http://egret.psychol.cam.ac.uk/medicine/scales/PANSS§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. doi:10.1093/schbul/13.2.261https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf§ Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdfhttp://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf§ Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625–629. Retrieved from http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdfDecision Point OneSelect what you should do:Start Zyprexa (olanzapine) 10 mg orally at BEDTIMEStart Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafterStart Abilify (aripiprazole) 10 mg orally at BEDTIMEThe AssignmentExamine 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 client’s pharmacokinetic and pharmacodynamic processes.At each decision point stop to complete the following:Decision #1o Which decision did you select?Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereaftero 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 #2Decision Point TwoSelect what the PMHNP should do next:Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forwardDC Invega Sustenna and start Haldol Decanoate (haloperidol decanoate ) 50 mg IM q2weeks with oral Haldol 5 mg BID for the next 3 monthsContinue Invega Sustenna. Begin injections into the deltoid and add on Abilify Maintena 300 mg IM qmonthly with oral Abilify 10 mg in the MORNING for 2 weeksWhich decision did you select?Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forwardo 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 #3Decision Point ThreeSelect what you should do next:Decision Point ThreeSelect what you should do next:Continue with the Invega Sustenna. Counsel client 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 monthDC Invega Sustenna and start Abilify Maintena (aripiprazole ) 400 mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10 mg in the MORNINGContinue Invega Sustenna and add on Qsymia (phentermine and topiramate) for weight lossDC Invega Sustenna and start Abilify Maintena (aripiprazole ) 400 mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10 mg in the MORNINGContinue Invega Sustenna and add on Qsymia (phentermine and topiramate) for weight lossWhich decision did you select?Continue with the Invega Sustenna. Counsel client 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 montho 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

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