Case #3
A young girl with strange behaviors

A young girl with strange behaviors

 

Decision Point One


 Schizoaffective Disorder
Decision Point Two
BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:


Begin Celexa 20 mg orally daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Upon return to the office, Carrie’s parents state that she is no different than she was when she was last in your office. Carrie reports that she feels a little bit more “relaxed.” When assessed, Carrie continues to acknowledge auditory hallucinations and delusional thought processes.
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Increase Celexa to 40 mg orally daily
Guidance to Student

At this point, it should be noted that based on the initial presenting symptoms, Carrie’s condition is more consistent with schizophrenia. In order for schizoaffective disorder to be present, in addition to the psychotic features, the patient must meet the criteria for a mood disorder (depression or mania) concurrent with criterion A of schizophrenia. Nothing in the case description leads us to believe that Carrie is experiencing such a mood disorder.

Because of the diagnosis, increasing Celexa would be of minimal therapeutic benefit.

Based on the correct diagnosis of schizophrenia, Seroquel would be appropriate, as it is FDA-approved for treatment of schizophrenia in individuals aged 13 years and older, but not in addition to Celexa.

In this case, reconsideration of the diagnosis would be the most appropriate course of action.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.


Add Seroquel 25 mg orally at bedtime
Guidance to Student

At this point, it should be noted that based on the initial presenting symptoms, Carrie’s condition is more consistent with schizophrenia. In order for schizoaffective disorder to be present, in addition to the psychotic features, the patient must meet the criteria for a mood disorder (depression or mania) concurrent with criterion A of schizophrenia. Nothing in the case description leads us to believe that Carrie is experiencing such a mood disorder.

Because of the diagnosis, increasing Celexa would be of minimal therapeutic benefit.

Based on the correct diagnosis of schizophrenia, Seroquel would be appropriate, as it is FDA-approved for treatment of schizophrenia in individuals aged 13 years and older, but not in addition to Celexa.

In this case, reconsideration of the diagnosis would be the most appropriate course of action.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.


Reconsider Diagnosis
Guidance to Student

At this point, it should be noted that based on the initial presenting symptoms, Carrie’s condition is more consistent with schizophrenia. In order for schizoaffective disorder to be present, in addition to the psychotic features, the patient must meet the criteria for a mood disorder (depression or mania) concurrent with criterion A of schizophrenia. Nothing in the case description leads us to believe that Carrie is experiencing such a mood disorder.

Because of the diagnosis, increasing Celexa would be of minimal therapeutic benefit.

Based on the correct diagnosis of schizophrenia, Seroquel would be appropriate, as it is FDA-approved for treatment of schizophrenia in individuals aged 13 years and older, but not in addition to Celexa.

In this case, reconsideration of the diagnosis would be the most appropriate course of action.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.


Begin Risperdal 0.5 mg orally twice a day

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Upon return to your office, Carrie’s parents report that Carrie appears less preoccupied. Carrie reports that she has felt “tired,” but no longer reports the ability to make people be her friend by mental force. She continues to report auditory hallucinations and still believes that some television shows are shown just for her.
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Increase Risperdal to 1 mg orally twice a day
Guidance to Student

At this point, it should be noted that based on the initial presenting symptoms, Carrie’s condition is more consistent with schizophrenia. In order for schizoaffective disorder to be present, in addition to the psychotic features, the patient must meet the criteria for a mood disorder (depression or mania) concurrent with criterion A of schizophrenia. Nothing in the case description leads us to believe that Carrie is experiencing such a mood disorder.

This outcome is an excellent example of how at times, even with the lack of diagnostic clarity, psychotropic medications can serendipitously effectively treat a client’s condition. Clearly, Risperdal is beginning to work in terms of resolution of psychotic symptoms, and a dose increase would be most appropriate. Carrie is feeling more “tired,” but this is most likely a consequence of Risperdal. The PMHNP should evaluate the tiredness to determine whether or not it is negatively impacting Carrie and if not, uptitrate the dose.

Since Carrie does not have schizoaffective disorder, the addition of a selective serotonin reuptake inhibitor would be inappropriate.

Augmentation with psychotherapy to address residual symptoms would be useful, and while that can be started concurrently, the PMHNP should optimize the Risperdal dose to treat positive symptoms.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.


Add Paxil 10 mg orally daily to current regimen
Guidance to Student

At this point, it should be noted that based on the initial presenting symptoms, Carrie’s condition is more consistent with schizophrenia. In order for schizoaffective disorder to be present, in addition to the psychotic features, the patient must meet the criteria for a mood disorder (depression or mania) concurrent with criterion A of schizophrenia. Nothing in the case description leads us to believe that Carrie is experiencing such a mood disorder.

This outcome is an excellent example of how at times, even with the lack of diagnostic clarity, psychotropic medications can serendipitously effectively treat a client’s condition. Clearly, Risperdal is beginning to work in terms of resolution of psychotic symptoms, and a dose increase would be most appropriate. Carrie is feeling more “tired,” but this is most likely a consequence of Risperdal. The PMHNP should evaluate the tiredness to determine whether or not it is negatively impacting Carrie and if not, uptitrate the dose.

Since Carrie does not have schizoaffective disorder, the addition of a selective serotonin reuptake inhibitor would be inappropriate.

Augmentation with psychotherapy to address residual symptoms would be useful, and while that can be started concurrently, the PMHNP should optimize the Risperdal dose to treat positive symptoms.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.


Augment with psychotherapy
Guidance to Student

At this point, it should be noted that based on the initial presenting symptoms, Carrie’s condition is more consistent with schizophrenia. In order for schizoaffective disorder to be present, in addition to the psychotic features, the patient must meet the criteria for a mood disorder (depression or mania) concurrent with criterion A of schizophrenia. Nothing in the case description leads us to believe that Carrie is experiencing such a mood disorder.

This outcome is an excellent example of how at times, even with the lack of diagnostic clarity, psychotropic medications can serendipitously effectively treat a client’s condition. Clearly, Risperdal is beginning to work in terms of resolution of psychotic symptoms, and a dose increase would be most appropriate. Carrie is feeling more “tired,” but this is most likely a consequence of Risperdal. The PMHNP should evaluate the tiredness to determine whether or not it is negatively impacting Carrie and if not, uptitrate the dose.

Since Carrie does not have schizoaffective disorder, the addition of a selective serotonin reuptake inhibitor would be inappropriate.

Augmentation with psychotherapy to address residual symptoms would be useful, and while that can be started concurrently, the PMHNP should optimize the Risperdal dose to treat positive symptoms.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.


Begin Latuda 40 mg orally daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Upon return to your office, Carrie’s parents report that Carrie appears less preoccupied. Carrie reports that she has felt “tired,” but no longer reports the ability to make people be her friend by mental force. She continues to report auditory hallucinations and no longer believes that some television shows are shown just for her, to which she says “no, I guess that was kind of silly of me to think, wasn’t it?”
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.


Increase Lurasidone to 60 mg orally daily
Guidance to Student

At this point, it should be noted that based on the initial presenting symptoms, Carrie’s condition is more consistent with schizophrenia. In order for schizoaffective disorder to be present, in addition to the psychotic features, the patient must meet the criteria for a mood disorder (depression or mania) concurrent with criterion A of schizophrenia. Nothing in the case description leads us to believe that Carrie is experiencing such a mood disorder.

This outcome is an excellent example of how at times, even with the lack of diagnostic clarity, psychotropic medications can serendipitously effectively treat a client’s condition. Clearly, Lurasidone is improving Carrie’s positive symptoms. Carrie seems to be having no side effects, which is another bonus. Although Lurasidone is not FDA-approved to treat schizophrenia in adolescents, it does not mean that the drug is unable to be prescribed, it means that the PMHNP must be certain to provide parents with a detailed explanation of risks versus benefits and obtain true informed consent. Since Carrie is experiencing a significant improvement in positive symptoms, the PMHNP could increase to 60 mg daily. It should be noted that it can take several weeks before full efficacy to be noted; therefore, maintaining the current dose is also an option.

Since Carrie does not have schizoaffective disorder, the addition of a selective serotonin reuptake inhibitor would be inappropriate.

Augmentation with psychotherapy to address residual symptoms would be useful, and while that can be started concurrently, the PMHNP should optimize the Lurasidone dose to treat positive symptoms.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.


Add Zoloft 25 mg orally daily
Guidance to Student

At this point, it should be noted that based on the initial presenting symptoms, Carrie’s condition is more consistent with schizophrenia. In order for schizoaffective disorder to be present, in addition to the psychotic features, the patient must meet the criteria for a mood disorder (depression or mania) concurrent with criterion A of schizophrenia. Nothing in the case description leads us to believe that Carrie is experiencing such a mood disorder.

This outcome is an excellent example of how at times, even with the lack of diagnostic clarity, psychotropic medications can serendipitously effectively treat a client’s condition. Clearly, Lurasidone is improving Carrie’s positive symptoms. Carrie seems to be having no side effects, which is another bonus. Although Lurasidone is not FDA-approved to treat schizophrenia in adolescents, it does not mean that the drug is unable to be prescribed, it means that the PMHNP must be certain to provide parents with a detailed explanation of risks versus benefits and obtain true informed consent. Since Carrie is experiencing a significant improvement in positive symptoms, the PMHNP could increase to 60 mg daily. It should be noted that it can take several weeks before full efficacy to be noted; therefore, maintaining the current dose is also an option.

Since Carrie does not have schizoaffective disorder, the addition of a selective serotonin reuptake inhibitor would be inappropriate.

Augmentation with psychotherapy to address residual symptoms would be useful, and while that can be started concurrently, the PMHNP should optimize the Lurasidone dose to treat positive symptoms.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.


Augment with psychotherapy
Guidance to Student

At this point, it should be noted that based on the initial presenting symptoms, Carrie’s condition is more consistent with schizophrenia. In order for schizoaffective disorder to be present, in addition to the psychotic features, the patient must meet the criteria for a mood disorder (depression or mania) concurrent with criterion A of schizophrenia. Nothing in the case description leads us to believe that Carrie is experiencing such a mood disorder.

This outcome is an excellent example of how at times, even with the lack of diagnostic clarity, psychotropic medications can serendipitously effectively treat a client’s condition. Clearly, Lurasidone is improving Carrie’s positive symptoms. Carrie seems to be having no side effects, which is another bonus. Although Lurasidone is not FDA-approved to treat schizophrenia in adolescents, it does not mean that the drug is unable to be prescribed, it means that the PMHNP must be certain to provide parents with a detailed explanation of risks versus benefits and obtain true informed consent. Since Carrie is experiencing a significant improvement in positive symptoms, the PMHNP could increase to 60 mg daily. It should be noted that it can take several weeks before full efficacy to be noted; therefore, maintaining the current dose is also an option.

Since Carrie does not have schizoaffective disorder, the addition of a selective serotonin reuptake inhibitor would be inappropriate.

Augmentation with psychotherapy to address residual symptoms would be useful, and while that can be started concurrently, the PMHNP should optimize the Lurasidone dose to treat positive symptoms.

Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.