NURS 6670 Week 9 Assignment Sample
Week Nine Case Study
This week’s case study is of a 63-year-old veteran Caucasian male who was diagnosed with schizophrenia and Post-Traumatic Stress Disorder (PTSD). The patient is jobless and homeless. He complains of auditory and visual hallucinations and paranoia. This paper describes the management and the history of presenting illness of the patient.
History of Presenting Illness and Clinical Impression
The patient is a 63-year-old veteran Caucasian male who has visited the clinic for psychiatric review, evaluation, and treatment. He is was diagnosed with schizophrenia 1 month ago and was prescribed olanzapine 10 mg PO OD for schizophrenia. He has been hearing voices in the sleep at night yelling at him and ordering him to jump out through the window. When he wakes up, he sees shadows of people dancing on the wall. As a result, he does not sleep well at night and has to wake up and walk around. These symptoms have been present for 9 months after retiring from the army. He has no home and usually sleeps in his car. He has no close family members or friends but reports that his friends are still active in the US army. The patient has developed a fear for his life whenever he is near people for more than three months now. He develops palpitations and becomes paranoid. He, therefore, avoids people because they give him flashbacks of memories of his time during wars but cannot remember these events clearly.
This patient was diagnosed with schizophrenia (F20.9) using the DSM-5 criteria and MSE findings. He also has Post-Traumatic Stress Disorder (F43.10). He met the criteria for PTSD by showing symptoms of persistent avoidance, negative cognition, and alterations in arousals and sleep for more than three months (Dallel & Fakra, 2018). His late-onset schizophrenia can be associated with psychotic PTSD (McIntosh & Story, 2021). However, the diagnosis of psychotic PTSD cannot be made at this point without full history and assessment of the events around the associated traumatic events
Psychopharmacologic Treatments for the Patient
Treatment goals for this patient include reduction in anxiety, psychosis, and panic episodes. Pharmacologic therapy will include an antipsychotic and anxiolytic. He is already on olanzapine 10 mg PO OD daily for schizophrenia. Additional buspirone 10 mg PO Od will be added to his psychopharmacotherapy. Buspirone is an anxiolytic medication that would alleviate the patient’s panic episodes from his PTSD. This therapy will take one month before evaluation for effectiveness. However, side effects may necessitate earlier dose adjustments or termination of the medications. Caution will be taken to avoid drug-drug interactions between buspirone and olanzapine. Olanzapine treatment will be long-term and regular reassessments will be done every two weeks to evaluate improvements and adverse effects that might warrant dose adjustments.
The therapeutic endpoints of this psychopharmacotherapy include improvement thought processes, reduction in hallucinations frequencies, and improvement in sleep patterns and durations. Prevention of his nighttime auditory and visual hallucination will improve his sleep. The absence of negative symptoms of schizophrenia is a good prognosticator. The overall treatment endpoint is to improve the quality of life of the patient.
Cognitive Behavior Therapy (CBT) would be the best psychotherapy option for this patient. The gold standard for the management of PTSD is trauma-specific CBT (World Health Organization, 2019). In this therapy, the patient will be assessed properly to understand the traumatic experiences from the war encounters, their sequelae, and lifetime emotional traumatic experiences. This would determine the intensity and the impact of the trauma (Cornerstone of Recovery, 2019). The impacts of the trauma would be of more importance because the trauma severity, in most cases, is not related to the severity of the PTSD (Watkins et al., 2018). This therapy would be done on an individual basis. The second most appropriate psychotherapy option will be individual counseling. However, this can be done alongside the trauma-specific CBT sessions.
Medical Management Needs
The patient has no known chronic medical illnesses that would require attention. The most outstanding medical concern for this patient would be medication adherence and compliance. His prescription would, therefore, be designed in such a way that both medications be taken at the same time of the day. Screening for cardiovascular and metabolic diseases such as diabetes and hypertension would be indicated in this patient because of his living conditions, poor sleep patterns, and age.
Community Support Resources
The major community resource need for this is housing. The patient is homeless and sleeps in his car since retirement from the army. He also has socioeconomic needs since he is unemployed and would not afford the medications. He would therefore benefit from the services of veteran homes available in the state. The PTSD Foundation of America is an agency that would help the patent through the promotion of recovery and networking (Wright, 2020). These resources would be essential in adjunction to pharmacotherapy and psychotherapy.
Follow-up Plan and Collaboration
The patient will be followed up and reassessed every two weeks alongside his psychotherapy sessions. Alongside the fortnight visit to the psychiatrist, the patient would be kept in daily communication with his care team. The care team will consist of a psychiatric nurse, a psychiatrist, and a psychologist. The collaboration between the nurse and the psychiatric team will be important for this follow-up and reassessments.
The patient is an elderly veteran Caucasian male who is homeless and has no close social relationships. He was diagnosed with schizophrenia about a month ago but has no negative symptoms. He also has PTSD that is associated with memories of traumatic experiences during the wars. Therefore, buspirone would be added to his olanzapine for the management of anxiety episodes. He has socioeconomic and housing needs that need to be addressed in his general management.
Cornerstone of Recovery. (2019, October 16). Cognitive Processing Therapy (CPT): An Evidence-Based Approach To Healing Trauma. Cornerstoneofrecovery.Com. https://www.cornerstoneofrecovery.com/cognitive-processing-therapy-cpt-an-evidenced-based-approach-to-healing-trauma/
Dallel, S., & Fakra, E. (2018). Prevalence of posttraumatic stress disorder in schizophrenia spectrum disorders: A systematic review. Neuropsychiatry, 08(03), 1027–1037. https://doi.org/10.4172/neuropsychiatry.1000430
McIntosh, I., & Story, G. W. (2021). Psychotic PTSD? Sudden traumatic loss precipitating very late-onset schizophrenia. BMJ Case Reports, 14(1), e235384. https://doi.org/10.1136/bcr-2020-235384
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258
World Health Organization. (2019, October 4). Schizophrenia. Who.Int. https://www.who.int/news-room/fact-sheets/detail/schizophrenia
Wright, C. V. (2020). Foundations of PTSD treatments. In Casebook to the APA Clinical Practice Guideline for the treatment of PTSD (pp. 21–46). American Psychological Association. https://doi.org/10.1037/0000196-002