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.

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

Psychosis and schizophrenia greatly impact the
brain’s 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 week’s 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 week’s 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 this link provided.

Stahl, S. M. (2013). Stahl’s 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 prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s 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

Document: Midterm Exam Study Guide (PDF)

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

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: AuthorNote: This case study will serve as the foundation for this week’s 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 week’s 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 client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

• Decision #1
  • Which decision did you select?
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support
    your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with
    Decision #1 and the results of the decision. Why were they different?
• Decision #2
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support
    your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with
    Decision #2 and the results of the decision. Why were they different?
• Decision #3
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support
    your response with evidence and references to the Learning Resources.
  • 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.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Save your Assignment using the naming convention “WK6Assgn+last name+first initial.(extension)” as the name.
• Click on the Assignment Rubric to review the Grading Criteria for the Assignment.
• Click on the Week 6 Assignment link. Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK6Assgn+last name+first initial.(extension)” and click on Open.
• If applicable: From the Plagiarism Tools area, click in the checkbox for I agree to submit my paper(s) to the Global Reference Database.

Grading Criteria

To access your rubric:Week 6 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:Submit your Week 6 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:Week 6 Assignment

Midterm Exam

Learning Objectives

Students will:

• Assess psychopharmacologic approaches to treatment for clients across the lifespan

This exam will cover the following topics,
which relate to psychopharmacologic approaches to treatment for clients
across the lifespan:

• Introduction to neuroscience
• Therapy for pediatric patients with mood disorders
• Adult and geriatric antidepressant therapy
• Bipolar therapy
• Anxiolytic therapy
• Antipsychotic therapy

By Day 7

Complete the Midterm Exam. Prior to starting the
exam, you should review all of your materials. There is a 2-hour time
limit to complete this 76-question exam. You may only attempt this exam
once.

This exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.

Submission and Grading Information

Submit Your Midterm Exam by Day 7

To submit your Midterm Exam:Week 6 Midterm Exam

Making Connections

Now that you have:

• Assessed clients presenting with psychosis and schizophrenia
• Developed personalized plans of antipsychotic therapy for clients
• Examined factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy
• Explored ethical and legal implications of prescribing antipsychotic therapy to clients

Next week, you will build on your
assessment and treatment skills as you examine clients presenting for
therapy for pain and sleep/wake disorders.
To go to the next week:Week 7

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