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Disorder Analysis Project

GNRS 584 Brenna Sandberg Raquel McCarthy

PICOT Question

Do patients with schizophrenia who receive therapy/ interventions have better medication adherence than patients with schizophrenia
Do patients with schizophrenia who receive therapy/
interventions have better medication adherence than
patients with schizophrenia who do not receive
therapy/interventions over the course of one year?
Dynamics of Schizophrenia ● ● ● ● ● ● ● ● Psychosocial dysfunction Depreciation of independent
Dynamics of Schizophrenia
Psychosocial dysfunction
Depreciation of independent living
Failure to maintain quality of life
Decreased cognitive/occupational
performance
Inability to perceive reality
accurately
Biological/neurobiological factors
Brain structure abnormalities
Diathesis-stress model
Dynamics of Schizophrenia ❖ Two or more of the following symptoms present for 6 months and
Dynamics of Schizophrenia
❖ Two or more of the following symptoms
present for 6 months and include at
least 1 month of active symptoms:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized speech
Catatonic behavior
Negative symptoms
❖ Rule out other mental illnesses
❖ Not attributable to substance use/

medical conditions

American Psychiatric Association, 2013.

 

Patient Introduction

   
 

53-year-old, Mexican-American female

 

Single, never married, and has 9 biological children

History of instability with jobs and housing

● History of instability with jobs and housing
 

Relied on prostitution for income

8th grade education Long psychiatric history of hospitalizations 1994-Present Wears garish, eccentric makeup Maintains eye contact

Currently adhering to medication regimen, history of non-compliance

Receives 1 injection monthly for psychosis

Currently resides in ILF housing with a roommate

DSM-IV-TR Diagnoses

Axis I Schizophrenia, Paranoid Type 295.30 Cocaine Dependence, continuous 304.21 Amphetamine Dependence, continuous 304.41 Alcohol Abuse,
Axis I
Schizophrenia, Paranoid Type 295.30
Cocaine Dependence, continuous 304.21
Amphetamine Dependence, continuous 304.41
Alcohol Abuse, continuous, 305.01
Axis II
No diagnosis, V71.09
Axis III Breast cancer, in remission, and HIV
Axis IV C. Educational Problems
D.
Occupational Problems
A. Primary Support Group
D.
Problems related to Social Environment
F.
Economic Problems

Mental Status Exam Findings

Positive symptoms ● Auditory hallucinations ● Command hallucinations ● Paranoid delusions
Positive symptoms
● Auditory hallucinations
● Command hallucinations
● Paranoid delusions

Negative Symptoms

Flat affect

Anhedonia

Inattention/ distracted easily

Poor decision-making skills

Impaired judgment

Poor insight

Hopelessness

Avolition

Inability to maintain job

Halter, 2014.
Halter, 2014.
Medication Table
Medication Table

Medication

Classification

Action

Dosage and

Side Effects

Rationale for

Route

Patient

Abilify Maintena

Atypical

Provides partial agonist

400

mg IM once a

Most common:

Indicated for patients

(Aripiprazole)

antipsychotic

activity at dopamine and serotonin (5-HT1A)

month

weight gain,

with Schizophrenia.

(dopamine system stabilizers DSSs,

receptors and antagonist

headache, agitation, nervousness, anxiety,

Poses a low risk for EPS. Maintains

dopamine agonist)

activity at serotonin (5-HT2A) receptor

Therapeutic: Decreases schizophrenic behavior;

improves cognitive function, positive symptoms, and negative symptoms.

insomnia, nausea, vomiting, dizziness, and somnolence.

stability in patients with schizophrenia.

Reduces positive and negative symptoms.

Triumeq

Antiviral

Inhibits HIV reverse

DNA chain termination.

300

mg (one tab)

Frequent (35-10%):

Patient is HIV

(lamivudine/abacavir)

transcriptase by viral

Inhibits

PO qd

headache, nausea, malaise, fatigue, nasal disturbances, diarrhea, cough,

depression, myalgia,

positive, used to prevent progression

Therapeutic: Slows HIV replication, reduces progression of HIV

musculoskeletal pain, neuropathy, insomnia, anorexia, dizziness, fever, chills; Occassional (9-5%):

of disease to AIDS.

infection

abdominal cramps,

dyspepsia, arthralgia

Lehne, 2016.

Nursing Diagnoses

1.

Nonadherence to medication regimen related to Schizophrenia, as evidenced by verbalization of non-compliance.

 
  • 2. Ineffective management of therapeutic regimen related to lack of understanding of not following the prescribed treatment plan, as evidenced by persistence of symptoms.

  • 3. Deficient knowledge related to medication non-compliance, as evidenced by lack of integration of treatment plans into daily activities.

 

Varcarolis, 2010 .

 

First Intervention

   
       

Use therapeutic nursing techniques in a peer support program to share feelings in an atmosphere of acceptance (Varcarolis, 2010).

Rationale: Peers have a distinctive role in enhancing medication adherence by providing problem-solving and mutual support. Mental health nurses are in a position to encourage peer support in the clinical and outpatient environment (Boardman et al, 2013).

 

Evaluation:

 
 

Client will attend at least one peer support meeting/session by next monthly visit.

   

By 1 year, client will attend weekly peer support meeting/session.

 

Boardman, McCann, & Kerr, 2014.

Varcarolis, 2010.

Second Intervention

Encourage patient to participate in decision-making process regarding her plan of care (Varcarolis, 2010).

Rationale: Allowing client to participate in care can give her a sense of control and the opportunity to choose interventions that she might decide to try. Trained nurses are able to guide clients through problem-solving strategies to generate solutions and overcome medication noncompliance (Beebe et al, 2014).

Evaluation:

By month 1, client will identify 3 personal difficulties regarding

medication adherence. By month 3, client will be able to generate 3 solutions to be

compliant. By month 1 year, client will problem solve and implement solutions using decision making skills to remain compliant.

Second Intervention Encourage patient to participate in decision-making process regarding her plan of care (Varcarolis, 2010).
Third Intervention Ask patient to share her rationale for nonadherence to the prescribed regimen (Varcarolis, 2010).
Third Intervention
Ask patient to share her rationale for nonadherence to the prescribed regimen
(Varcarolis, 2010).
Rationale: Asking for patient’s rationale helps identify areas of misunderstanding or poor insight. Improved
insight is likely to lead to increased adherence (Novick et al, 2015).
Evaluation:
By month 1, client will acknowledge poor
insight/misunderstanding as rationale for
nonadherence.
By 1 year, client will have increased awareness of
disorder.
Novick, Montgomery, Treuer, Aguado, Kraemer, & Haro, 2015.

Varcarolis, 2010.

Conclusion ● ● Schizophrenia is characterized by positive and negative symptoms. Medication adherence is extremely important
Conclusion
Schizophrenia is characterized by positive and negative symptoms.
Medication adherence is extremely important to managing these
symptoms and improving quality of life.
All 5 of our articles found nonadherence is a main cause for relapse,
rehospitalization, increased cost of medical resources, reduces quality
of life, and increased burden on patients family.
Peer support, texting, and phone calls gives client the ability to
participate in their plan of care and improve symptoms as well as
problem solving skills to overcome non-adherence.
Insight has the strongest association to increased medication
adherence.

References

American Psychiatric Association. (2013). Diagnostic and statistical

manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American

Psychiatric Association.

Anderson, K. H., Ford, S., Robson, D., Cassis, J., Rodrigues, C., & Gray, R. (2010). An exploratory, randomized controlled trial of adherence therapy

for people with schizophrenia. International Journal of Mental Health

Nursing, 19(5), 340-349. doi:10.1111/j.1447-0349.2010.00681.x

Beebe, L., Smith, K. D., & Phillips, C. (2014). A comparison of telephone and texting interventions for persons with schizophrenia spectrum disorders.

Issues In Mental Health Nursing, 35(5), 323-329.

doi:10.3109/01612840.2013.86341

References

Boardman, G., McCann, T., & Kerr, D. (2014). A peer support programme for enhancing adherence to oral antipsychotic medication in consumers with schizophrenia. Journal of Advanced Nursing, 70(10), 2293-2302.

Halter, M.J. (2014). Varcarolis’ foundations of psychiatric mental health

nursing. (7 th ed.). St. Louis, MO: Sanders Elsevier.

Hegedüs, A., Kozel, B. (2014). Does adherence therapy improve medication adherence among patients with schizophrenia? A systematic

review. International Journal of Mental Health Nursing, 23, 490-497.

References

Jelastopulu, E., Giourou, E., Merekoulias, G., Mestousi, A., Moratis, E., & Alexopoulos, E. C. (2014). Correlation between the Personal and Social Performance scale (PSP) and the Positive and Negative Syndrome Scale (PANSS) in a Greek sample of patients with schizophrenia. BMC Psychiatry, 14(1), 197-203. doi:10.1186/1471-244X-14-197

Lehne, Richard (2016). Pharmacology for Nursing Care (9 th ed). Pp. 330 St. Louis, Missouri: Saunders.

References

Novick, D. Montgomery, W., Treuer, T., Aguado, J., Kraemer, S., & Haro, J.M. (2015). Relationship of insight with medication adherence and the impact on outcomes in patients with schizophrenia and bipolar disorder: Results from a 1-year European outpatient observational study. BMC Psychiatry, 15, 189. doi 10.1186/s12888-015-0560-4

Varcarolis, E. (2010 ). Manual of psychiatric nursing care plans. (5 th ed.). St.

Louis, MO: Sanders Elsevier.