Review the clinical scenario below and address the questions that follow.
Mark is a 37-year-old client with a 15-year history of schizophrenia. When he was first diagnosed, he was prescribed a second-generation antipsychotic medication. He complained about drowsiness and difficulty concentrating. He experienced a 40 lb. weight gain over a year. His girlfriend complained about his reduced sex drive and ended their relationship. He tried several different medications alone and in combination but found the side effects intolerable. He stopped taking his medications and started self-medicating with alcohol. Over time, he experienced several relapses and his condition declined markedly. He lost his housing and began living in his car. After being involuntarily committed following a psychotic episode, he was referred to the PMHNP at the outpatient clinic. When he presented for his appointment, he told the PMHNP that he stopped taking his medications due to their side effects.
A. What is the most appropriate response by the PMHNP? How can the PMHNP support adherence for this client?
B. What are the ethical and legal obligations for the PMHNP in the above situation?
C. Goals that are not mutually shared between providers and patients can be very challenging, both clinically and emotionally. What steps can the PMHNP take to promote their personal emotional and mental health when working with clients whose health choices are likely to lead to adverse health outcomes?
Integration of Evidence: The student post provides support from a minimum of one scholarly in-text citation in addition to the textbook. Sources from 2020 to present
The student provides references that have complete information as required by APA Style (0-1 errors). In-text citations are included for all references AND references are included for all in-text citations (zero errors). Sources cannot be more than 5 years old. Sources should be 2020 to present.
The student presents information in a logical, meaningful, and understandable sequence, and is relevant to the discussion topic.
Grammar, spelling, and/or punctuation are accurate.
Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 10 words). The quote must add substantively to the discussion.
Textbooks:
Boland, R., & Verduin, M. L. (2022). Kaplan and Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Chapter 5: Schizophrenia Spectrum and Other Psychotic Disorders
Chapter 21.1: Antipsychotics
First, M. B. (2014). DSM-5 handbook of differential diagnosis Links to an external site.. American Psychiatric Association. https://chamberlain.primo.exlibrisgroup.com/permalink/01CUCON_INST/1jsf8v8/alma991000113909606766
Chapter 2: Differential Diagnosis by the Trees
Decision Tree for Delusions
Decision Tree for Hallucinations
Decision Tree for Catatonic Symptoms
Chapter 3: Differential Diagnosis by the Tables
Schizophrenia Spectrum and Other Psychotic Disorders table
