The 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 since she was 9 years old). She presents to your office today 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 tells you that she knows this because the television is telling her so.
She currently weighs 140 lbs, and is 5’ 5”
SUBJECTIVE
Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.
You reviewed her hospital records and find that she has been medically worked up by a 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 EXAM
The client is alert, 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 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 ideation.
The PMHNP administers the PANSS which reveals the following scores:
-40 for the positive symptoms scale
-20 for the negative symptom scale
-60 for general psychopathology scale
Diagnosis: Schizophrenia, paranoid type
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?
Expert Solution Preview
Introduction: In this case, the client is a 34-year-old female of Pakistani origin who recently moved to the United States. She was diagnosed with “brief psychotic disorder” following a hospitalization. Prior to admission, she experienced delusions of being the prophet Mohammad and had visions of Allah. Her husband was concerned about her behavior and admitted her to an inpatient psychiatric unit. During the assessment, the client presents as calm and denies believing herself as the prophet Mohammad, attributing her husband’s concerns to his desire for an American wife. She reports the television talks to her and that Allah sends messages through it. The client also reveals that she stopped taking her antipsychotic medication due to fears of poisoning by her husband. The mental status exam suggests impaired insight and judgment. The PANSS assessment confirms a diagnosis of schizophrenia, paranoid type.
Decision #1:
The decision to be selected is to re-educate the patient about the importance of taking the antipsychotic medication and address her concerns about her husband’s intentions.
Reasoning for Decision #1:
This decision is based on the understanding that medication compliance plays a crucial role in managing symptoms of schizophrenia. Antipsychotic medication, such as Risperdal, helps reduce delusions, hallucinations, and disorganized thinking. By re-educating the patient about the benefits and risks of the medication, it is hoped that she will understand the importance of adhering to the prescribed treatment plan. Addressing her concerns about her husband’s intentions can help alleviate her fears and increase her trust in the treatment process.
Expected Outcome of Decision #1:
The expected outcome of this decision is that the patient will gain a better understanding of the importance of medication adherence. By addressing her concerns about her husband’s intentions, she may feel more supported and be more likely to continue taking her medication as prescribed. This can lead to a reduction in her symptoms and an improvement in her overall functioning.
Difference from Expected Outcome:
If the patient does not understand or accept the importance of medication adherence, she may continue to believe her husband’s intentions and fear being poisoned. This could result in non-compliance with medication, leading to ongoing symptoms of schizophrenia and potentially worsening her condition.
Decision #2:
The decision to be selected is to involve the patient’s husband in the treatment process and educate him about schizophrenia and the importance of support and understanding.
Reasoning for Decision #2:
Involving the patient’s husband in the treatment process can be beneficial for several reasons. Educating him about schizophrenia can help him gain a better understanding of the illness, its symptoms, and the effects it has on the patient’s thoughts and behaviors. By understanding the nature of schizophrenia, the husband may become more supportive and understanding, thereby reducing the potential stressors that could exacerbate the patient’s symptoms. It is also important to address any misunderstandings or cultural beliefs that may be influencing the husband’s perception of the patient’s behavior.
Expected Outcome of Decision #2:
The expected outcome of this decision is that the patient’s husband will gain a better understanding of schizophrenia and its impact on the patient’s thoughts and behaviors. With increased knowledge and support, he may become more empathetic and accepting, reducing potential conflicts and stressors in the family dynamic. This can create a more conducive environment for the patient’s recovery and overall well-being.
Difference from Expected Outcome:
If the patient’s husband does not respond positively to the education and remains unsupportive, it may create additional stress and strain on the patient. This could further exacerbate her symptoms and hinder her progress in treatment.
Decision #3:
The decision to be selected is to collaborate with the patient to develop a relapse prevention plan and discuss strategies to manage stress and early warning signs of symptom exacerbation.
Reasoning for Decision #3:
Collaborating with the patient to develop a relapse prevention plan empowers her to take an active role in managing her illness. By discussing strategies to manage stress and identify early warning signs, the patient can become more self-aware and proactive in preventing relapses. This can include stress reduction techniques, engaging in regular therapy sessions, and maintaining a support system. By actively participating in her own care, the patient can have a sense of control over her illness and increase her chances of long-term stability.
Expected Outcome of Decision #3:
The expected outcome of this decision is that the patient will develop a relapse prevention plan and gain knowledge and skills to manage stress and early warning signs of symptom exacerbation. By implementing these strategies, the patient can minimize the likelihood of relapses and maintain better overall functioning.
Difference from Expected Outcome:
If the patient is resistant to developing a relapse prevention plan or does not follow through with the discussed strategies, she may be at a higher risk for relapse and experiencing worsening symptoms. Lack of engagement or adherence to the plan can hinder her progress in managing her schizophrenia effectively.
