Reference no: EM133877903

Assignment:

James is a 25yr Caucasian male who presents to clinic for evaluation of medication. He began medication 4 months ago while in the hospital following a psychotic episode. He began experiencing command auditory hallucination telling him to kill himself. He also began to see shadow figures in his periphery. During the episode he was fearful and anxious. There was no symptoms of depression, mania or hypomania. This was his first episode of symptoms and treatment. While inpatient James was started on Risperidone 1mg and titrated to Risperidone 2mg two times per day. After discharge James had breakthrough symptoms which led to titrating medication to Risperidone 3mg two times per day. He experienced benefit with each increase, but medication faded within 2 to 3 weeks. He reports of taking medication most days.

James now presents in clinic actively responding to internal stimuli. He reports of auditory hallucinations daily including command statements and paranoia. He also reports of seeing "shadow figures" at night. He reports of anxiety related to the paranoid statements from auditory hallucinations. He has struggled to maintain showering and appointments. He averages 2 showers per week and is sporadically eating. He denies thoughts or plan of harming self or others. He is struggling to initiate sleep and is averaging 3-4 hours per night. He feels tired during the day and is mostly isolating in his room.

Physical: He has no current medications or reported physical health issues.

Social: James is a single male who currently lives alone. He is currently on leave from work due to current issues. He has struggled to maintain employment since his issues began. He has minimal supports and denies close friends.

Vital: Height - 5ft 8 inches, Weight - 240 lbs., Heart Rate- 88 BPM, BP - 125/70

1. What are the core symptoms you have identified to treat with medication?

2. Identify three possible medications for James current issues and rationale for these medications.

3. From the three medications above, identify a selected treatment including prescription, mechanism of action, and titration plan.

(ex. Fluoxetine 10mg QAM - Take one capsule in the morning. Increase to 20mg in two weeks if no effect)

4. Explain rationale for medication selection from question 3 including why other medications listed in question 2 were ruled out.

5. What patient education is important for the selected medication? Include common side effects, monitoring, lab work, etc.