Posted: September 5th, 2023

Week 1 Discussion/ Initial Post Case Study

Week 1 Discussion/ Initial Post

Case Study

John Doe is a 28 year old male diagnosed with Bipolar disorder with psychotic features and a history of polysubstance use. He referred from a County jail, and he presented with severe agitation, physical aggression and delusional thoughts. Patient was manic, had pressured speech, was angrily threatening to hit anyone that comes close to him and had reportedly punched and spat on an officer during transfer. Mr. Doe repeatedly and loudly said he worked for the FBI and the CIA, and will sue the facility for admitting him to the unit because he does not belong there. Records show that he had refused his psychiatric medications since he was in jail, had not slept for days and became more and more aggressive with time.

Pharmacokinetics, Pharmacodynamics and Patient’s Response to Drug Therapy

According to Rosenthal and Burcham (2018), pharmacokinetics defines how drugs move through the body from the site of administration to reach the bloodstream, get transformed and absorbed, and the elimination of resulting byproducts; whereas pharmacodynamics refers to the processes by which drugs affect the body. Mr J. Doe’s records show that he was previously taking antipsychotics and become noncompliant with his medication regimen. A recorded history of substance use. A study by Phan (2016), reported that the mentally ill are prone to deviating from their medication routines secondary to factors that include their lack of awareness and the negativity of the stigma attached to their disease process. Non adherence and substance use had deplete drug levels leading to consequent exacerbation of symptoms.

Behavior and Genetic Influences on Pharmacokinetics and Pharmacodynamics

Social alcohol consumption can be harmless for an individual that has self control. Substance use becomes a habit for the psychiatric patient due to poor insight, and this leads to noncompliance with prescribed antipsychotic treatments followed by reemergence of severe psychotic symptoms (Mohamed, Rosenheck, He & Yuping, 2014). A study by Foley et. al. (2016) revealed a familial medical history among individuals with diabetes mellitus and their consequent diagnosis of schizophrenia. This implies a possible underlying genetic trait. On the other hand, Xavier, Vordestrasse, Keefe and Duncan (2018) concluded that more evidence is needed with replicated results to link genetics to the lack of insight in Schizophrenia. And other psychiatric diagnoses.

Personalized Patient Care Plan

Mr J. Doe’s initial plans of care include maintaining his safety and gradual reintroduction of antipsychotics to include medications that will allow him to get needed sleep and help stabilize him mentally. He will also benefit from other methods of psychotherapy such as nonpharmacologic treatments to help promote future medication adherence and prevent decompensation. Carr, McKernan, Hillbrand and Hamlett (2018) suggested including family and community oriented treatment modalities. These include cognitive behavioral therapy, and individualized cultural and recovery-oriented resources, to help support medication treatments and promote adherence.

References

Carr, E. R., McKernan, L. C., Hillbrand, M., & Hamlett, N. (2018). Expanding traditional paradigms: An integrative approach to the psychotherapeutic treatment of psychosis. Journal of Psychotherapy Integration, 28(2), 154–170. https://doi-org.ezp.waldenulibrary.org/10.1037/int0000083

Foley, D. L., Mackinnon, A., Morgan, V. A., Watts, G. F., Castle, D. J., Waterreus, A., & Galletly, C. A. (2016). Common familial risk factors for schizophrenia and diabetes mellitus. Australian & New Zealand Journal of Psychiatry, 50(5), 488–494. https://doi-org.ezp.waldenulibrary.org/10.1177/0004867415595715

Mohamed, S., Rosenheck, R., He, H., & Yuping, N. (2014). Insight and attitudes towards medication among inpatients with chronic schizophrenia in the US and China. Social Psychiatry & Psychiatric Epidemiology, 49(7), 1063–1070. https://doi-org.ezp.waldenulibrary.org/10.1007/s00127-014-0824-1

Phan, S. V. (2016). Medication adherence in patients with schizophrenia. International Journal of Psychiatry in Medicine, 51(2), 211–219. https://doi-org.ezp.waldenulibrary.org/10.1177/0091217416636601

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Xavier, R. M., Vorderstrasse, A., Keefe, R. S. E., & Dungan, J. R. (2018). Genetic correlates of insight in schizophrenia. Schizophrenia Research, 195, 290–297. https://doi-org.ezp.waldenulibrary.org/10.1016/j.schres.2017.10.021