Answer

Pakistani Woman with Delusional Thought Processes

Human beings experience delusions because of different factors, including psychological, biological, genetic, and environmental factors (Mental Health America, 2018). According to Tonna et al. (2019), a psychotic disorder could be a delusional genetic component because it runs in the family. Rowland et al. (2009) indicated that there are high chances of an individual developing delusion when they have an imbalance of the neurotransmitters. According to Mental Health America (2018), mental delusions can be triggered by stress and trauma. Isolated individuals have a high chance of suffering from stress thus vulnerable to delusion disorder.

Schizophrenia is one of the known severe and chronic mental disorders with the capability of interfering with the thinking, feeling, and behavior of an individual. Schizophrenia affects people of all ages; for men, it starts at the age of 20, while women start feeling the disorder’s symptoms at the age of between 20 to 30 (Bandelow et al., 2013). In the United States of America, about 2% of the population suffers from Schizophrenia.

According to the National Alliance of Mental Illness (2018), the signs of Schizophrenia are grouped into three, with the first group being a positive symptom which includes delusions, hallucination, agitated body movements, and change in the way of thinking. The second category consists of the negative symptoms. These include the reduction in speaking, reduced expression, and change in the feeling of pleasure. The third category is cognitive symptoms, and they include trouble in focusing on something, memory loss, and poor execution of functions (National Alliance of Mental Illness 2018). The rationale for developing this assignment is making three decisions concerning the treatment of Pakistan women suspected of having schizophrenia.

Decision One: Start Invega Sustenna 234 mg Intramuscular x1 followed by 156 mg intramuscular on day four and monthly after that

According to National Alliance of Mental Illness (2018), Invega Sustenna is a medication utilized in treating various mental and mood disorders such as Schizophrenia and schizoaffective disorders. The patient has been diagnosed with Schizophrenia, and this makes the prescription of the drug appropriate. The first dose of Invega sustenance 234 mg is often 234 mg. For 156 mg to be added to the patient, Invega sustenna 234 mg must indicate any side effects. 

Stahl (2020) indicates that the US Food and Drug Administration (FDA) approved Invega Sustenna as a typical drug of the second generation. Invega Sustenna’s working mechanism is aiding the restoration of the balance of some neutral chemicals collectively known as neurotransmitters in the brain. Invega Sustenna also can reduce hallucination and help the patient think positively for himself or herself (Stahl, 2020). The patient is hallucinating by believing that the television talks to her. At the same time, she reports having curbed using Risperdal after one week of being discharged on the ground that her husband plans to kill her to marry another woman (Laureate Education, 2016). In addition, this is a negative thought, thus a need for inducing positive thought. 

Zyprexa is an alternative option for this patient’s ability to inhibit dopamine 2 receptors which causes the positive manifestation of the psychosis and stabilizing symptoms. According to Stahl (2014), the enhancement of dopamine improves both acute symptoms and affective symptoms. Another alternative available is Abilify because it lowers the dopamine output when the concentration is high, hence bettering manifestations and arbitrating antipsychotic activities. Despite the above alternatives being practical, I opted against prescribing them because they are taken orally. Evidence from the case suggests that the patient is noncompliant with oral drugs such as Risperdal.

Anticipated Results

During her next visit after four weeks, I project that her delusional symptoms would have decreased or subsidized. The anticipation includes reducing her positive manifestation and improvement in both affective, aggressive, and cognitive symptoms of Schizophrenia. I also expect her PANSS scores to reduce by at least 35%.

Decision Two: Continue with decision one but begin injection into the deltoid at that visit and progressing forward.

The anticipation from one of the reductions of delusional symptoms and the Positive and Negative Syndrome Scale (PANSS) scores for at least 35% after four weeks when she came back, a 25% decrease in PANSS score was noted. The client reported having pain at the injection site, a clear evidence that the gluteal muscle is troubling her, prompting her to continue with the same drug but changing the injections from the gluteal muscle to the deltoid. I decided to stick to the medication because of the decrease in score.

Changing the injection site from the gluteal muscles to the deltoid muscles is that an injection made at the deltoid muscles increases the likelihood of transporting the drug into the intramuscular region. The injection made at the deltoid muscle is associated with less pain and increased tolerability, thus further decreasing the client’s PANSS score. Steinwachs et al. (2011) reported that administering medication at different regions will surely decrease the muscle damage and decrease the discomfort that a patient is undergoing.

In this case, another option is starting Haldol Deaconate IM orally. The drug can reduce psychosis symptoms, but I did not administer it because it seems noncompliant with oral drugs. The IM Abilify was not considered for being an oral drug because despite being effective. Compared to both Haldol Deaconate IM and IM Abilify, Invega Sustenna has rapid actions (Stahl,2013).

Anticipated Results

I projected that her delusional symptoms would have a significant decrease in her next visit after four weeks, and her PANSS will reduce significantly. I also expect the pain to reduce significantly, if not, vanish completely.

Decision Three: Continue with the current drug (Invega Sustenna). Advise the patient that weight addition resulting from Invega Sustenna is smaller compared to other drugs with similar efficacy. Make appointments with the dietician and an exercise physiologist. Follow up with the client in one month.

Reflecting on decision two, it is evident that Invega Sustenna is effective for the client because she felt better after changing the injection site, and there is a decrease in PANSS score of 50%. The patient is coming for the medical checkup alone, which is a clear indication of a good recovery process. It is essential to counsel her on the importance of using Invega Sustenna compared to other drugs with similar working mechanisms and healthcare providers should advise her that proper nutrition and exercise have to be controlled. 

According to Rowland et al. (2019), a typical antipsychotic drug regime is associated with several metabolic adverse side effects such as dyslipidemia, weight gain, and glucose metabolism dysregulation. Therefore, her weight gain is likely a result of using Invega Sustenna. For effective weight management, behavioral interventions are critical, and they function by providing techniques for adhering to exercise and diet modification (Eich &Nick, 2018).

Various alternatives were not considered. For instance, Abilify was not considered due to its failure to bind to the D2 receptor for an extended period, and this implies that the drug is less effective (Laureate Education, 2016). Abilify also results in akathisia, which is a side effect with the capability of increasing the likelihood of non-compliance. Another possible drug is Qsymia, which people use for weight loss. However, the study did not consider it in this case due to its components, like phentermine, associated with increased cardiovascular toxicity (Laureate Education, 2016).

Anticipated Results

I expect to observe less delusional symptoms with more apparent judgments and sights when the patient visits after one month. According to Stahl (2013), some patients need between 16 and 20 weeks to indicate good response, particularly when it comes to cognitive symptoms. I also expect to observe a significant reduction in PANSS score.

Ethical Considerations

The purpose of ethical consideration is to achieve success in the treatment. The medical practitioner should obtain Informed consent from the patient before commencing treatment. The patient has some delusional symptoms; this makes her unfit to make clear decisions. Therefore, the informed consent will be obtained from the husband. The patient’s family should be included in informed consent because they have a critical role in the patient’s recovery. According to Steinwachs et al. (2011), the family members can ensure that the patient adheres to the drugs. Educating the family on ways of overseeing and monitoring PANNS score improvements and monitoring weight gain and ways of avoiding distressing relationships is a critical ethical consideration (Bandelow et al., 2013).

Conclusion

Delusions are caused by several factors, which include mental elements, natural elements, ecological variables, and genetic elements. Schizophrenia is one of the most well-known kinds of delusional disorder with the capacity to influence an individual’s behavior, thinking, and feeling. Schizophrenia is expected on account that it influences people of all ages. In men, the condition is accounted for to begin at 20 years. Women start experiencing this condition between the age of 20 and 30. In the United States of America, about 2% of the citizens experience the effects of Schizophrenia. The signs indications of Schizophrenia are ordered into three gatherings.

Invega Sustenna is the best drug for controlling Schizophrenia because it can decrease hallucination and helping a patient think more positively and clearly.