Pam Case Study (Schizophrenia)

Pages:

4

Academic Level:

University

Paper Type:

Article

Discipline:

Psychology

Paper detalis:

Either listen to the case studies in the Case Studies: Kenisha, Jose, and Pam media piece, or read their case studies below. Then, choose one of the case studies to write about in your assignment.

Kenisha: Kenisha is a 22-year-old woman who recently broke up with her girlfriend. She’s been having trouble sleeping at night, frequently bursts into tears, and has lost interest in spending time with her friends and family. She has been coping by eating brownies and ice cream whenever she feels too down. She went to her family doctor, who started her on medication. The medication has left her feeling drowsy and she sleeps throughout the day. She also feels hungry most of the time and has been gaining weight.

José: José is a 31-year-old male who has spent the past 2 years in his house. He’s terrified of leaving and any attempt to walk out the door leaves him paralyzed. He has sought help via teletherapy and his doctor has put him on medication. He can leave the house but is often too tired to do so.

Pam Pam is a 56-year-old woman who was diagnosed with schizophrenia when she was 25 years old. She’s remained on the same medicine for the past 20 years. In the past 2 months, she’s become increasingly paranoid. She is sure the government has bugged her house and that the police are watching her every move. She’s begun to take apart her electronics to search for monitoring devices like hidden cameras and microphones.

Instructions
Write a 3–4 page paper for your chosen case study. Use the APA Paper Template [DOCX] to format your paper. In your paper:

Describe the case study briefly.
Describe the medication you chose to treat the disorder in the case study, including:
The biological actions and effects of the medication.
The behavioral and psychological effects of the medication.
At least two scholarly sources. In addition, you can use information from the PDR or FDA websites and your course text.
Describe the disorder you identified from the case study.
Common symptoms of the disorder.
Analyze how the medication treats the disorder.
Include strengths and weaknesses of this medication to treat the disorder.
Support with evidence from at least two scholarly sources. In addition, you can use information from the PDR or FDA websites and your course text.
You can use the following sources to find more information about your chosen medication:

Prescribers’ Digital Reference (PDR). (n.d.). https://www.pdr.net
You can access basic information about medications without a login, just type the name of the medication in the search area. The PDR has been the standard go-to for information on medications for a number of years and is considered one of the more credible sources.
U.S. Food & Drug Administration. (n.d.). Information for consumers and patients | Drugs. https://www.fda.gov/drugs/resources-you-drugs/information-consumers-and-patients-drugs
You can access the FDA's information on a number of medications using the search feature. Government websites are a great source for credible information and often a primary source for demographic information and other statistics.
Once you’ve gathered information from one or both of the above websites, find four scholarly sources to use.

Assignment Requirements
Your assignment should also meet the following requirements:

Writing style: Text is well-organized, incorporates evidence, and uses appropriate tone in grammatically sound sentences. Learn more in the Capella Writing Center.
APA format: References and citations are formatted according to current APA style and formatting guidelines. Learn more in the Evidence and APA section of the Writing Center.
Resources: Four scholarly resources—two sources with evidence on the biological, behavioral, and psychological effects of the medication and two sources with evidence on the strengths and weaknesses of the medication. Your Psychopharmacology text may be used as one of the resources.
Length of paper: 3–4 typed, double-spaced pages of content, in addition to a title page and a reference page.
Font and font size: Times New Roman, 12 point.

Pam Case Study (Schizophrenia)

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Pam Case Study (Schizophrenia)

Brief description of the case and the disorder

Pam is a 56-year-old woman. When she was 25 years old, she was diagnosed with schizophrenia and medication was prescribed to her. Pam has remained on the same medication for the past 20 years. However, the patient has become increasingly paranoid over the past two months. She argues that the government has bugged her house and that law enforcement agencies are surveilling her every move. She has begun to take apart her electronics in search of monitoring devices like microphones and surveillance cameras.

The disorder identified in this case study is schizophrenia. A severe mental disorder causes a patient to have an abnormal perception and interpretation of reality. The most common symptoms can include a combination of delusions, hallucinations, and abnormal thoughts and behavior that, in turn, impairs everyday functioning. The disorder requires lifelong medication and care. Delusions encompass false beliefs (Mayo Clinic, 2022). In this case study, the patient believes that police are after her and have bugged her house. Hallucinations involve seeing and hearing voices that are not true. Schizophrenia can impair communication, and the patient may provide answers unrelated to questions asked by offering meaningless statements. The patient has shown bizarre behavior, such as a search for cameras and microphones that she believes the police are using to monitor her. Negative symptoms of the disorder are reduced ability to function normally. After diagnosis, a psychiatrist can recommend early treatment to control the severity of symptoms and complications.

Medications are crucial for the treatment of schizophrenia after diagnosis. The most commonly prescribed drugs are antipsychotics. These medicines can calm symptoms by changing the brain neurotransmitter dopamine. Psychiatrists aim to manage symptoms using the least dosage possible. They may try different combinations and doses over time. Other medications that reduce symptoms include anti-anxiety and antidepressants.

Medications might have serious side effects that may lead to non-compliance among some patients. The first-generation antipsychotics that can be prescribed include chlorpromazine, haloperidol, perphenazine, and fluphenazine. Although first-generation drugs are cheaper, they have frequent neurological side effects that might not be reversible. Second-generation drugs include Aripiprazole, Asenapine, Cariprazine, Brexpiprazole, Lurasidone, etc. These have lower risks of side effects than first generations. The psychiatrist may also administer long-acting injectable antipsychotics every 2-4 weeks to improve adherence to medication (MayoClinic, 2022). In addition to medications, psychosocial therapies can play a crucial role in treating schizophrenia. Therapies include individual therapy, social skills training, family therapy, and vocational rehabilitation. In case of severe symptoms, the patient can be admitted to the hospital to improve safety to self and others, proper nutrition, basic hygiene, and adequate sleep. For adults who fail to respond to medications and therapy and show signs of depression, the psychiatrist can use electroconvulsive therapy (ECT).

Medication for schizophrenia

According to DSM-5, the criteria for diagnosis of schizophrenia requires at least two persistent symptoms that have lasted over one month. In the differential diagnosis, the patient must show at least disorganized speech, delusion, or hallucination, among other symptoms. Pharmacological therapy after diagnosis is implemented by administering antipsychotics. Initiation of drug therapy in the first five years is essential to reduce changes in the brain. Poor prognosis can occur due to stimulants on the nervous system, including amphetamines, drugs, and alcohol. An acute psychotic episode requires immediate drug administration. The first seven days focus on returning the patient to normal body functioning and reducing hostility. The long-term goals are increasing self-care, positive mood, and socialization. Appropriate dosage depends on individual patient characteristics and responses. Maintenance treatment reduces the chances of relapse. Drug therapy is used continuously for at least 12 months after diagnosis and initialization of treatment.

The first stage of treatment is first-line monotherapy. If there is no response, then stage two is implemented, which can combine monotherapy with SGA or FGA. In case of no response, the third stage employs clozapine monotherapy while monitoring the count of White Blood Cells (WBC). Patients who experience agranulocytosis require an immediate end of clozapine monotherapy. The fifth stage applies monotherapy with a different SGA or FGA. If all the above fails, then the last stage is implemented. It comprises a combination of SGA, FGA, mood stabilizer, and ECT.

In routine stages, the doctor must avoid prescribing two or more drugs to avoid drug interaction risks. It is significant to monitor medication history in transitioning from one stage of treatment to another. The psychiatric decision is guided by the patient's response to medication at every stage of treatment. Clozapine is the most effective medication for most resistant cases of schizophrenia. However, it increases the risks of orthostatic hypotension, and high doses can result in seizures.

Aripiprazole medication was used as a monotherapy for the current patient. SGAs were preferred over FGAs to reduce the patient's extrapyramidal symptoms and other side effects. However, the symptoms seem to have come back even after medications. The next stage would use antipsychotic polypharmacy by combining the first drug with another SGAs (Clozapine).

Biological actions and effects of the medication

Aripiprazole restores a balance in natural chemicals in the brain. It improves concentration and can minimize episodes of hallucination. It aims at helping reduce nervousness and help me think clearly. According to research, Aripiprazole can induce peripheral antinociceptive implications and pathway activation (Ferreira et al., 2022). The drug works by inhibiting microglia activation, thus, causing an anti-inflammatory impact that has clinical utility in patients suffering from schizophrenia (Casey & Canal, 2017).

There is a significant percentage of patients whose biological response to medication is undesirable, possibly due to varying neurochemical pathologies. Most SGAs are associated with metabolic side effects, including diabetes mellitus, weight gain, and hyperlipidemia. In turn, these effects increase CVD risks and mortality rates. Aripiprazole may have side effects like nausea, restlessness, and somnolence depending on the dosage and tolerance among individual cases.

Behavioral and psychological effects of the medication

Dopamine agonists activate receptors and open brain pathways. The patient can develop psychological side effects like increased pathological addictions, euphoria, and orgasmic activity. Some patients who take Aripiprazole develop unusual and compulsive behavior (PDR, 2017). These may include increased shopping behavior, gambling, change in appetite, and sexual urges. The drug also has psychological-related impacts, like increased anxiety and mood changes.

According to PDR (2022), using Aripiprazole can result in suicide ideation. Since Aripiprazole failed to work, it is significant to change medication to minimize the risks of hospitalization, self-harm, and suicide ideation (Montastruc et al., 2019). Research indicates that certain polypharmacy types result in less rehospitalization than monotherapy in schizophrenia (Tiihonen et al., 2019). The study showed that Clozapine and Aripiprazole (Abilify) combination has a better outcome than when the former is used alone. Therefore, the next stage of treatment for the patient can try a combination of the two.

References

Casey, A. B., & Canal, C. E. (2017). Classics in Chemical Neuroscience: Aripiprazole. ACS Chemical Neuroscience, 8(6), 1135–1146.

Ferreira, R. C., Almeida, D. L., Duarte, I. D., Aguiar, D. C., Moreira, F. A., & Romero, T. R. (2022). The antipsychotic Aripiprazole induces peripheral antinociceptive effects through PI3Kγ/NO/cGMP/KATP pathway activation. European Journal of Pain, 26(4), 825-834.

Mayo Clinic. (2022). Schizophrenia. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443#:~:text=Schizophrenia%20is%20a%20serious%20mental,with%20schizophrenia%20require%20lifelong%20treatment.

MayoClinic. (2022). Schizophrenia. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449#:~:text=Medications%20are%20the%20cornerstone%20of,affecting%20the%20brain%20neurotransmitter%20dopamine.

Montastruc, F., Nie, R., Loo, S., Rej, S., Dell’Aniello, S., Micallef, J., . . . Renoux, C. (2019). Association of Aripiprazole With the Risk for Psychiatric Hospitalization, Self-harm, or Suicide. JAMA Psychiatry, 76(4), 409-417.

PDR. (2017, 9 20). FDA Drug Safety Communication. Retrieved from PDR: https://www.pdr.net/fda-drug-safety-communication/abilify?druglabelid=103&id=12006

PDR-2. (2022). aripiprazole - Drug Summary. Retrieved from PDR: https://www.pdr.net/drug-summary/Abilify-aripiprazole-103.8375

Tiihonen, J., Taipale, H., Mehtälä, J., Vattulainen, P., Correll, C. U., & Tanskanen, A. (2019). Association of Antipsychotic Polypharmacy vs. Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia. JAMA Psychiatry, 76(5), 499-507.