Posted: December 30th, 2021

NRNP 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults

Captain of the Ship Project – Delusional Disorder

Student Name
College of Nursing-PMHNP, Walden University
NRNP 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults
Faculty Name
Assignment Due Date

Captain of the Ship Project – Delusional Disorder
Introduction
Delusional disorder is a health complication that triggers irrational thoughts or worries. The patient in the case study is a 50-year old African-American female. She is excessively afraid of getting infected with coronavirus after the death of her husband. Psychopharmacologic treatment is effective in improving the ability to cope with stress and improve the quality of life. Psychotherapy will reduce the irritable and angry moods of the patients, address hallucinations and delusions. Community support resources are essential since the client lost his job and lost his husband to COVID-19 related complications. Follow-up is essential to improve recovery and prevent relapse. The purpose of the essay is to discuss treatment for somatic delusional disorder.
HPI and Clinical Presentation
The selected patient is a 50-year old African-American female. The woman has a past drug and alcohol abuse problem. She lost her husband last month after he succumbed to COVID-19 related complications. She presents to the clinic with a delusional tendency. A psychiatric evaluation is essential to determine the disorder. She lives alone after the death of the husband. She presents with diverse symptoms such as anger, depression, and anxiety. She is excessively afraid of the virus and believes she is infected. The patient thinks she cannot live long since the virus is deadly. She experiences hallucinations of her death and burial. During the interview, she complains her lung have collapsed. The presentation shows the patient is likely suffering from a somatic type of delusional disorder. The symptoms increase the inability to sleep or perform daily duties.
Psychopharmacologic Treatments and Therapeutic Endpoints
Antipsychotics are the primary treatment drugs for delusional behavior. The drugs block dopamine receptors to improve the brain’s cognitive functions (Munoz-Negro et al., 2020). Chlorpromazine (Thorazine) is one of the conventional antipsychotic drugs. Newer drugs such as Risperidone (Risperdal) can be used to improve the role of neurotransmitters in the brain (Munoz-Negro et al., 2020). Tranquilizers and antidepressants treat depression and anxiety prevalent among people with delusional disorder (Lahteenvuo et al., 2021). Psychopharmacologic treatment is effective in improving the ability to cope with stress and improve the quality of life. Chlorpromazine is essential since it improves participation in daily activities, helps patients think more clearly, and feel less nervous (Lahteenvuo et al., 2021).
Psychotherapy Choices and Therapeutic Endpoints
Psychotherapy is the primary treatment for delusional disorder. Talk therapy is effective for patients to discuss their symptoms. Cognitive behavior therapy can be used to correct irrational thinking (Bjornestad et al., 2018). CBT encourages the patients to embrace functional and healthier behavior and attitudes. Individual therapy is vital to help an individual correct distorted thinking patterns. Family therapy can help families understand and support a loved one with delusional behavior (Bjornestad et al., 2018). Supporting a family member can lead to better outcomes. Psychotherapy will reduce the irritable and angry moods of the patients, address hallucinations and delusions. The focus is to restore the quality of life of a patient. The patient should attend 10 sessions each 60 minutes to facilitate a change of behavior and thinking patterns through a conversation with a therapist. A family member will accompany the patient in one of the sessions to ensure they understand the condition and support the patient effectively.
Medical Management Needs
The first line of treatment for somatic delusional disorders is anti-psychotics. Chlorpromazine will help the patient think more clearly, participate in daily activities, and feel less nervous (Negro & Cervilla, 2017). Chlorpromazine 25 mg tablets orally t.d.s. In case the patient does not demonstrate improvements after four to eight weeks, it will be essential to prescribe 75 mg at bedtime (Negro & Cervilla, 2017). If the patient has adherence problems with the drug, it will be vital to consider an injection. Chlorpromazine works by blocking postsynaptic dopamine receptors, thus preventing excess dopamine in the brain (Negro & Cervilla, 2017). The reduction is effective in limiting hallucinations and delusions.
The side effects of Chlorpromazine include dizziness, restlessness, agitation, and nervousness. During the first days of taking the medication, the patient may feel fatigued and improve as they continue taking the drug (Redzuan & Silim, 2020). Allergic reactions to Chlorpromazine are rare, but the patient should seek immediate medical assistance if they notice anything unusual. Adherence to the drug is vital in the recovery of the patient. During the clinics, after every four weeks, the patient should indicate the level of adherence (Redzuan & Silim, 2020). The patient will take Chlorpromazine until full recovery. The justification for changing the drug is if only the patient is not responding positively to the drug.
Community Support Resources
Community support resources are essential since the client lost his job and lost his husband to COVID-19 related complications. A collaborative approach is practical to establish a healthy relationship with other stakeholders (Redzuan & Silim, 2020). She is afraid of going out of the house since she believes she will get infected. It will be essential to find community organizations with employment opportunities for the patient. She has been an alcoholic and currently struggling to quit despite past therapeutic measures. An alcohol anonymous support group will be a healthy avenue for the patient (Redzuan & Silim, 2020). Community Preventive Services Task Force (CPSTF) provides community interventions for the patients. Another resource in the community is One door mental health, which helps people with mental illnesses. The community resources will enhance the chances of recovery (Redzuan & Silim, 2020).
Follow-Up Intensity and Frequency and Collaboration
The patient requires a prescription of Risperidone 2mg tablets orally. The patient should take the drugs for the next four weeks and come back for further evaluation. Adherence to the drug is essential to enhance consistency of recovery (Bjornestad et al., 2018).
The patient will attend 10 psychotherapeutic sessions. Each session will be 60 minutes long. A report from the therapist will be essential to review the improvements in distorted thinking patterns. During the therapy, a family member should accompany the patient. Family therapy will be essential to facilitate support (Bjornestad et al., 2018). During the recovery, the family is crucial to reintegrate the patient into the daily activities.
A collaborative approach is essential in the treatment of mental disorders. The collaborators will include psychotherapists, psychiatrists, pharmacists, and family practitioners (Bjornestad et al., 2018). For example, a psychiatrist is essential to evaluate the mental status of the patient. A report from a psychiatrist will be essential to rule out other mental conditions or indicate the possibility of comorbidities.
Conclusion
Treatment of delusional disorder involves psychotherapeutic and psychopharmacological interventions. Treatment involves collaboration with various professionals. A collaborative approach is vital in the treatment of mental disorders. Treatment objectives include reducing irritable and angry moods of the patients, addressing hallucinations and delusions.
References
Bjornestad, J., Veseth, M., Davidson, L., Joa, I., Johannessen, J. O., Larsen, T. K., … & Hegelstad, W. T. V. (2018). Psychotherapy in psychosis: experiences of fully recovered service users. Frontiers in Psychology, 9, 1675.
Lähteenvuo, M., Taipale, H., Tanskanen, A., Mittendorfer-Rutz, E., & Tiihonen, J. (2021). Effectiveness of pharmacotherapies for delusional disorder in a Swedish national cohort of 9076 patients. Schizophrenia Research, 228, 367-372.
Munoz-Negro, J. E., Gómez-Sierra, F. J., Peralta, V., González-Rodríguez, A., & Cervilla, J. A. (2020). A systematic review of studies with clinician-rated scales on the pharmacological treatment of delusional disorder. International Clinical Psychopharmacology, 35(3), 129-136.
Negro, J. M., & Cervilla, J. (2017). A systematic review of the pharmacological treatment of delusional disorder. European Psychiatry, 41(S1), s825-s825.
Redzuan, N. I., & Silim, U. A. (2020). Coordinated Care in Managing a Postnatal Mother with Delusional Disorder and Opioid Use Disorder: A Case Report. Malaysian Journal of Psychiatry, 30(1).

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