Schizophrenia/ Antipsychotic: Ability use

Order Description

rеspond to 3 of mу clаssmates dіscussion post with at least 250 words. I need to add on to the discussion to further the discussion by adding information.. maybe
state what you thought was interesting and add information to further discussion.

Discussion 1:
Abilify, or aripiprazole is a medication known as an atypical antipsychotic or second-generation antipsychotic. Some common side effects of Abilify include nausea,
vomiting, headache, constipation, anxiety, feeling restless, tremors and insomnia. (NAMI, 2016).
Extrapyramidal effects (EPS) and tardive dyskinesia (TD) are two side effects that involve muscle movement and excitation. EPS symptoms include stiffness, tremors and
restlessness while TD symptoms include slow or jerky movements that cannot be controlled and they often start with tongue rolling, smacking of the lips, sucking,
grimacing, or movements that mimic chewing. If these symptoms should appear it is important to contact your healthcare provider immediately. (NAMI, 2016). The AIMS is
an Abnormal Involuntary Movement Scale and patients taking first or second generation antipsychotic medications should have this completed regularly to monitor for
tardive dyskinesia.
Although schizophrenia has an early adolescent onset, it is important that as the patient ages, their current needs are assessed and met. As the patient ages, they
are at greater risk for adverse effects to medication (Jeste & Maglione, 2013). Symptoms of schizophrenia tend to become less prominent and severe with age so in the
case of this patient it is important to assess the side effects he is having and decide whether or not they are related to the disease itself or to the medication he
is taking. “Treatment plans for older adults with schizophrenia must consider the effects of age on the course of the illness as well as on the response to
antipsychotics and to psychosocial interventions.” (Jeste & Maglione, 2013). The patient should be monitored closely to ensure that the risks of treatment don’t
outweigh the benefits. In a study done by Jeste and Maglione they found that there is a natural tendency for improvement of symptoms but an increased risk of adverse
effects to medication with age. Because of this it has been found that as the patient ages it might be appropriate to decrease the dose of medication by about 50%.
It is important to education the patient on the risks of missing a dose or stopping the medication without consulting their physician first. Missing a dose can
increase the patients risk for relapse of symptoms so it is very important that the patient continue to take his medication and talk with his physician before stopping
or making any changes. This could be the cause of non-compliance for the patient. If a dose is missed it should be taken as soon as the patient remembers unless it
is close in time to when the next dose would normally be taken. Alcohol and illegal drugs can decrease the effectiveness of Abilify so they should be avoided.

Discussion 2:
Abilify (Aripiprazole), third generation class of antipsychotics/ dopamine-serotonin system stabilizer (DSSs), Abilify is used to treat schizophrenia, bipolar
disorder, depression, and Tourette syndrome. Abilify can control both the positive and negative symptoms of schizophrenia. Adverse effects include dizziness,
lightheadedness, drowsiness, nausea, vomiting, tiredness, excess saliva/drooling, blurred vision, weight gain, constipation, headache, and trouble sleeping.
When taking antipsychotics medication you have to be careful with other interactions with medications, food, alcohol, and smoking. Given the information, I have
George’s needs to tell me more about his history to help investigate more into his symptoms. Some following questions I would ask are. Are you on any other medication?
, Any alcohol or drug abuse? , Can you explain to me some of the symptoms you feel while taking the medications?
Extrapyramidal effects- there are four sets of adverse reactions to antipsychotic drugs, acute dystonia, akathisia, Parkinsonism, and tardive dyskinesia.
Acute dystonia: severe spasms, back muscles, tongue, and facial muscles; twitching movements.
Akathisia: constant pacing with repetitive, compulsive movements.
Parkinsonism: tremor, muscle rigidity, stooped posture, and shuffling gait.
Tardive dyskinesia: bizarre tongue and face movements such as lip smacking and wormlike motions of the tongue; puffing of cheeks, uncontrolled chewing movements.
When experiencing extrapyramidal effects they can be managed by an anticholinergic agent such as Benztropine, (Cogentin), diphenhydramine (Benadryl) and
trihexyphenidyl (Artane), also dopamine agonist agent’s pramipexole.
Tardive Dyskinesia: a condition affecting the nervous system, often caused by long term use of some psychiatric drugs.
Tardive Dyskinesia cannot be cured but treatment can help revert back to semi normal function. Medications like sedatives may help, discontinue or taper down
antipsychotic drugs, seeing a specialist like a neurologist or a psychiatrist who treats mental disorders.
My assessment for George, I want to start with a baseline assessment, viewing his health history, obtain Vital signs, Labs, history of depression, current medications,
and assess for EPS. I am concerned with his noncompliance to the daily drug regimen, showing repetitive tongue movements, and his body temperature. Also, another
concern about Abilify is taking the max: 30mg/day, I would undergo evidence base practice by finding information about Abilify being tapered up to the max dose.
George’s noncompliance is a concern and giving his age and wife states she does not like Abilify either has me thinking they may not know one of Abilify’s side
effects. Abilify can cause low libido. Many antipsychotic drugs increase prolactin levels which can lead to decreased libido. High prolactin can cause lack of libido,
impotence, or gynecomastia and another side effect is weight gain. Talking to the health care provider to give them options to medications that will not lower libido
may help with the noncompliance.
Patient teaching- the patient will be compliant with the daily drug regimen, also understanding and recognizing adverse effects.
• Compliant with daily drug dose
• Patient will address any concerns he/she may have
• Address safety issues being noncompliant with medication dose
Involve patient and caregiver to remain on a regular. medication routine.
Instruct patient or caregiver to report EPS for additional treatment.
Encourage patient or caregiver to record a weekly weight.
Encourage a healthy diet and exercise.
Address any sexual concern to health care provider.
Patient or caregiver should state the reason for the drug and appropriate scheduled dose.

discussion 3:
Abilify is an anti-psychotic medication used for treatment of psychotic conditions and disorders such as schizophrenia and bipolar disorders. This medication is also
used for treatment for depression. The mechanism of action of this drug is that is binds to a number of CNS receptors. One of the receptors that has a huge role in
this drug, is the dopamine receptor which relieves positive symptoms for this drug. This drug also helps stabilize both dopamine and serotonin levels in the brain. The
adverse reactions and side effects of this medication are; drowsiness, sedation, nervousness, insomnia, manic reactions, orthostatic hypotension, tachycardia, dry
mouth, incontinence, sweating, dry skin, and hypoglycemia.
In George’s situation, I would want to know more on if there were any life or traumatic events that have happened since he has stopped the medication. Why does his
wife Sheila not like this medication. How long the symptoms have been going on for. Is there anything that is bothering him at home or in his personal life. With his
appearance unkept and body odor the physical assessment makes me wonder if things are okay at home or if there are any illegal substances being used. Extrapyramidal
effects are a particularly serious set of adverse reactions to antipsychotic drugs. These symptoms include acute dyskinesia and dystonic reactions, tardive dyskinesia,
Parkinsonism, akinesia and akathisia. The treatment for this effect is medication; depending on the symptom the medication that will be used will be different. For
example, according to this article on NCBI, treatment for acute dystonia can be diazepam; this can be used as an alternative therapy to help with symptoms. Along with
tardive dyskinesia treatment of clonazepam can be used to help manage this condition. This condition affects the nervous system which is caused by the use of
neuroleptic drugs for prolonged periods of time. The symptoms are unpleasant it causes the body to have involuntary movements and grimacing.
I would want to assess any chemical alterations such as if George taking other medications that would contribute to this effect and also checking his electrolyte
imbalance. Having a healthy support system is important. For example, Shelia she states that she does not like Abilify. Assessing our patient’s support system is
important because we are an advocate to them. We want the best for our patients, if we assess unhealthy or negative behaviors with their support system we can educate
our patients on the contributing factors that can lead to noncompliance down the road. As I stated above I would be sure to assess any stressful events that could have
caused fear or anxiety. Educating a schizophrenia patient could be difficult but I would encourage them to have healthy habits to improve functioning; maintaining
self-care and having a regular sleeping pattern. Showing empathy with George’s feelings will help reassure my interest and care. I would also educate and teach coping
skills that help minimize worry; for example, going to the gym, talking to someone he trusts, and playing the tape through. Teaching these different strategies can
help when he is alone.