Treating Delusional Disorders

1 Treating Delusional Disorders Background Psychiatric conditions have a crushing impact on all aspects of a person’s life, including social, emotional, physical, and psychological well-being. People with psychological conditions rarely enjoy life since most symptoms of these conditions are hard to cope with. They include disordered thinking patterns, extreme anxiety and fear, depression, reduced concentration, agitation, irritability, and overwhelming sadness. Finn and Leonard (2015) clarified that some individuals present with multiple symptoms that complicate treatment, care, and management.

These symptoms persist for extended periods, thus necessitating long-term treatment. APA (2015) noted that patients experience difficulties in attending to daily living activities and engaging in social and communal activities besides losing self-care ability.

Finn and Leonard (2015) pointed out that since the causative factors for most psychological disorders are unknown, clinicians provide treatment to alleviate symptoms and improve life quality. Treatment comprises pharmacological agents and therapy. Although these interventions might not eradicate the disease, they reduce symptoms’ severity and arrest the condition before advancing to critical phases

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2 Therapeutic interventions also enable individuals to have a near-normal life. Therapists must, however, perform a comprehensive patient assessment to correctly diagnose a condition, develop suitable treatment and care plans. This discussion elucidates the care plan for a middleaged female with delusions and paranoia.

Case Summary The client, a 34-year-old female of Pakistani origin, visited the facility for her initial follow-up following a 21-day hospitalization with psychosis disorder. The client has a history of paranoia and delusion but denies these symptoms. Health history shows that she believed she was prophet Mohamad during her previous hospitalization. She believed that Allah sent her to redeem the people. She communicates with slow disorganized speech and concentrates on imaginary voices. She experiences bouts of agitation and aggressiveness. Police have previously arrested her for behaving aggressively towards family members. However, she rejects her family’s claim that she acted aggressively and points out that they took issues out of context.

During her discharge from the hospital, she was given Risperdal. However, she does not adhere to the clinician’s instructions. The PMHNP diagnosed her with schizophrenia, a paranoid type, since her PANSS score was -20, -40, and -60 for negative symptoms, positive symptoms, and general psychopathology. The client had experienced these symptoms for over a month.

Treatment Decision Point One Selected Option: Start Zyprexa (olanzapine) 10 mg orally at BEDTIME Rationale: The PMHNP prescribed Zyprexa, an atypical antipsychotic agent, to its effectiveness in eradicating psychotic symptoms. This agent accomplishes the intended therapeutic effect by rebalancing the neurotransmitters dopamine and serotonin in the CNS. While investigating the

3 effectiveness of Zyprexa in a cohort of 9076 patients, Lähteenvuo et al. (2021) revealed that this medication eradicates delusional symptoms and improves life quality for patients. Lähteenvuo et al. (2021) noted that this mediation is often utilized as a first-line agent in schizophrenia and delusional disorders.

Rejected alternatives: The PMHNP did not prescribe Abilify and Invega Sustena IM despite being effective antipsychotic agents since they have side effects, including dizziness and drowsiness, that may negatively affect compliance. Further, Abilify’s low bioavailability makes it unsuitable for the client. Molecular compounds of this drug attach temporarily to the D2receptors that reducing its effectiveness in eradicating delusional symptoms (Miola et al., 2020).

Since the blood levels of Abilify are lower than the original dose, the client might require a twoweek overlap therapy to attain the intended outcome (Miola et al., 2020).

Expected results: The PMHNP wanted to lower the PANSS score by about 50% besides alleviating the psychotic symptoms. Moreover, the nurse intended to improve the client’s family and social life.

Treatment results: The treatment plan had only achieved the targeted outcomes partially after four weeks. For instance, the client’s PANSS score had dropped by 25%. The client also demonstrated remarkable tolerance to medications. Her husband helped ensure that she took her medication as prescribed by the care provider. Unfortunately, she experienced a 5lbs increase in weight, and her appetite had increased besides experiencing severe pain at the injection site. She complained that injection site pain made it difficult to walk and sit for extended periods.

Decision Point Two Selected option: Change medication to Geodon (ziprasidone) 40 mg orally BID with meals Rationale: Zyprexa had not improved the client’s condition with the expected rate. She had also

4 experienced several side effects that necessitated the change of medications. These symptoms include increased appetite and injection site pain. Geodon, as highlighted by Arnold et al. (2021), effectively rebalances brain-based neurotransmitters, thus preventing psychotic symptoms, including depression.

Rejected alternatives: The PMHNP could not lower the Zyprexa dosage to 7.5mg since a higher dose had not been effective. Although a lower Zyprexa dose would have produced less severe side effects, it would not have eradicated delusional symptoms. Replacing Zyprexa with Wellbutrin was also not practical at this time. Increased appetite is a crucial side effect of Wellbutrin. This drug could have contributed to a further weight gain in the client.

Treatment goals: The projected treatment outcomes include eradicating the psychotic symptoms and reducing the PANSS score.

Attained results: Geodon had proven effective for the client. Her PANSS score indicated a 40% decline in positive symptoms. Her weight had also dropped by 2lbs from the previous visit. She noted that the medication had curbed her extreme appetite. However, she pointed out that the medication had created some memory problems. She was struggling with medication compliance since she kept missing the afternoon dose.

Decision Point Three Selected option: Discontinue Geodon and start Latuda (Lurasidone) 40 mg orally daily Reasoning: The client had demonstrated noncompliance to Geodon due to memory problems, hence replacing it with a more potent agent. Latuda produces therapeutic effects similar to Geodon (Mattingly et al., 2020). The client can tolerate this medication since it has less severe side effects. Lurasidone compliance rate is higher than Geodon since it is taken once daily.

5 Rejected alternatives: The nurse could not have replaced Geodon with Invega Sustenna or Risperdal at this point due to the risk of side effects that affect compliance. Risperdal, for instance, is associated with dizziness, lightheadedness, and weight gain. Invega Sustena, on the other hand, increases the risk of injection site reactions, stiffness, restlessness, and weight gain.

Treatment goals: The anticipated treatment results include reduced psychotic symptoms and improved adherence to treatment.

Attained results: The treatment plan was effective since the patients attained a further 50% reduction in PANSS score. Delusions and hallucinations had stopped, and the patient could associate with her family appropriately. During clinical interviews, she demonstrated calmness and composure and did not report significant side effects.

Ethical Considerations Ethical guidelines, as denoted by Bipeta (2019), provide standards for mental health professionals to protect the well-being and dignity of clients. Ventura et al. (2021) argued that ethical codes help professionals decide the best care plan for clients. Importantly, these codes provide a base for addressing complaints and inquiries made regarding mental health professionals. Privacy and confidentiality ensure that health data is not disclosed to unauthorized individuals without the client’s knowledge (Ventura et al., 2021). This code protects patient data from being used in illegal activities. On the other hand, beneficence ensures that patients are treated with interventions suitable for their condition. This code supports medication replacement and dose adjustment to fit the client’s health needs. Nonmaleficence prohibits the use of interventions that could cause harm to a person (Bipeta, 2019). This code clarifies that all medications that could cause harm to a person should be withdrawn from the treatment plan.

Conclusion

6 Hallucinations and delusions are important symptoms of schizophrenia that affect social interactions and self-care ability. These symptoms are alleviated using different antipsychotic agents. Antipsychotic medications such as Risperdal, Geodon’ and Zyprexa effectively eradicate hallucinations and other psychotic symptoms. However, the care provider must regularly assess treatment outcomes and adjust the medications appropriately. The PMHNP conducts a thorough patient assessment to determine their condition and the best medications to include in the treatment plan.

7 References American Psychiatric Association. (APA) (2015). Understanding mental disorders: Your guide to DSM 5. American Psychiatric Pub Arnold, M. J., Fulleborn, S., & Farrell, J. (2021). Medications for treatment-resistant depression in adults. American Family Physician, 103(1), 16-18.

Bipeta R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19 Finn, D. P., & Leonard, B. E. (2015). Pain in psychiatric disorders. Karger Lähteenvuo, M., Taipale, H., Tanskanen, A., Mittendorfer-Rutz, E., & Tiihonen, J. (2021).

Effectiveness of pharmacotherapies for delusional disorder in a Swedish national cohort of 9076 patients. Schizophrenia Research, 228, 367-372. http://doi:10.1016/j.schres.2021.01.015.

Mattingly, G. W., Haddad, P. M., Tocco, M., Xu, J., Phillips, D., Pikalov, A., & Loebel, A. (2020). Switching to Lurasidone following 12 months of treatment with risperidone: results of a 6-month, open-label study. BMC Psychiatry, 20, 1-13. http://doi:10.1186/s12888-020-02523-1.

Miola, A., Salvati, B., Sambataro, F., & Toffanin, T. (2020). Aripiprazole for the treatment of delusional disorders: A systematic review. General Hospital Psychiatry, 66, 34-43. http://doi:10.1016/j.genhosppsych.2020.06.012 Ventura, C. A. A., Austin, W., Carrara, B. S., & de Brito, E. S. (2021). Nursing care in mental health: Human rights and ethical issues. Nursing Ethics, 28(4), 463-480. https://doi.org/10.1177%2F0969733020952102