Study Discussion Instructions

Scenario:

Jean Louis Pierre is a 20 year old business major at a large university. His family and friends have noticed increasingly bizarre behaviors over the past several months. On many occasions they’ve overheard him whispering in an agitated voice, even though there is no one nearby. Lately, he has refused to answer or make calls on his cell phone, claiming that if he does it will activate a deadly chip that was implanted in his brain by Vodou priests.

Based on this scenario, respond to the following prompts:

Which condition does the psychiatric NP associate with these patient behaviors? What do you know about the etiology of this disorder?
What are positive symptoms of schizophrenia? What are negative symptoms of schizophrenia? What is the difference between Brief Psychotic Disorder, Schizophreniform, and Schizoaffective disorder?
What treatment options will you offer this patient and why? (Provide non-pharmacological and pharmacological interventions, including nursing interventions as well as cultural considerations among Haitian populations with psychiatric conditions)
What do you know about the mechanism of action of anti-psychotic medications? What labs should you order prior to or during the course of treatment for patients on this class of medication and why? What is the metabolic syndrome and how is it relevant to this case?

Assignment Guidelines

Format: Your response must be written in APA format.

SOLUTION

Diagnosis & Etiology
The psychiatric nurse practitioner would most likely associate Jean’s symptoms—whispering in agitation when alone, delusional fears of a brain “chip” implant—with schizophrenia spectrum disorder, specifically schizophrenia. This is supported by the presence of persecutory delusions and auditory hallucinations. The etiology of schizophrenia is multifactorial, involving genetic susceptibility, neurochemical imbalances (particularly dopamine dysregulation), structural brain differences, and environmental stressors. Studies indicate roles for prenatal complications, cannabis use, and psychosocial stress.

Positive vs. Negative Symptoms
Positive symptoms are exaggerated or added functions, including hallucinations, delusions, disorganized speech or behavior—e.g., hearing voices or believing in a brain implant.
Negative symptoms are deficits in normal function, such as reduced affect, social withdrawal, flat speech, or lack of motivation. Both types significantly affect daily functioning.

Differentiating Psychotic Disorders

Brief Psychotic Disorder: Psychotic symptoms lasting less than one month, with full return to premorbid functioningen.wikipedia.org+8publicsafetymedicine.org+8ncbi.nlm.nih.gov+8webmd.com+15en.wikipedia.org+15publicsafetymedicine.org+15.
Schizophreniform Disorder: Symptoms resembling schizophrenia lasting between one and six monthsen.wikipedia.org+5en.wikipedia.org+5my.clevelandclinic.org+5.
Schizoaffective Disorder: Features both psychosis and mood disorder symptoms. Psychosis occurs for at least two weeks in the absence of mood episodessciencedirect.com+15medicalnewstoday.com+15ncbi.nlm.nih.gov+15. Unlike schizophrenia, mood symptoms (depression or mania) are also prominent.

Jean’s symptoms have persisted for several months and include classic psychotic features, making schizophrenia the most likely diagnosis.

Treatment Options
Pharmacological: Initiate a second-generation antipsychotic (e.g., risperidone or aripiprazole) to target both positive and negative symptoms with a favorable side effect profileverywellmind.com.

Non-Pharmacological:

Cognitive Behavioral Therapy for psychosis (CBTp) to challenge delusional beliefs.
Family psychoeducation and support to improve insight, medication adherence, and reduce relapse.
Social skills training, occupational therapy, to improve functioning and social engagement.
Cultural considerations: Jean’s Haitian background and belief in Vodou traditions should be respected. Care must include understanding stigma around mental illness in Haitian culture, involving culturally sensitive practitioners, and possibly integrating trusted community or religious leaders into his care.

Mechanism of Antipsychotics & Monitoring
Antipsychotics primarily block dopamine D2 receptors, reducing positive symptoms. Second-generation agents also antagonize serotonin 5-HT2A receptors, which helps reduce negative symptoms and improve tolerabilitymedicalnewstoday.com.

Recommended labs & monitoring (baseline and periodically):

Weight, BMI, waist circumference – assess metabolic syndrome riskpsychiatrictimes.com+2nypep.nysdoh.suny.edu+2cdn-uat.mdedge.com+2
Fasting glucose or HbA1c – identify new-onset diabetescdn-uat.mdedge.com
Lipid profile – dyslipidemia detection
Liver function tests, prolactin (if risperidone) – monitor endocrine/hormonal effects.
EKG if using agents like ziprasidone – assess QT prolongation risk.

The metabolic syndrome—defined by obesity, hypertension, dyslipidemia, and insulin resistance—increases patients’ risk for diabetes and cardiovascular disease. Monitoring is essential, as antipsychotic use compounds this riskncbi.nlm.nih.gov+9psychiatrictimes.com+9psychiatrictimes.com+9.

Conclusion
Jean’s symptoms align with schizophrenia, characterized by persistent positive and negative symptoms. Treatment should include antipsychotic medication and culturally sensitive psychosocial interventions, especially considering his Haitian identity. Regular metabolic monitoring and lab work are critical to prevent long-term complications. Through respectful, comprehensive care, psychiatric nurse practitioners can support Jean’s recovery and quality of life.

References
Verywell Health. (2021). Understanding schizophrenia spectrum disorders. Verywell. psychdb.com+6verywellhealth.com+6verywellhealth.com+6
HealthLine. (n.d.). Understanding the difference between psychosis and schizophrenia. healthline.com
NCBI Bookshelf. (2023). Schizophrenia. In StatPearls. ncbi.nlm.nih.gov
PMCID. (2021). Clinical pearls for monitoring and treatment of antipsychotic medications. PMC. pmc.ncbi.nlm.nih.gov
Psychiatric Times. (XXXX). Metabolic monitoring of antipsychotic medications.

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