The main concern of the Health care providers is to provide appropriate and holistic health care to the patient. This essay aims to provide the details of the care provided to a patient during the clinical placement. After the introduction of the patient, the pathophysiology and pharmacology will be discussed. An investigation based on the diagnostic activities will be discussed and recommendations for the patient will be outlined. In the end, the conclusion will be made.

 

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Mr. J (pseudonym), an 81 years old man was referred to older community mental health from the aged care due to change in his mental health condition. Mr. J was married and had 2 sons and 6 grandchildren. Mr. J was retired from his job and lived in an aged care facility because he needed support for his daily life activities. His wife was supportive and often visit him. Sons were also supportive and kept visiting their father. However, due to the COVID-19 pandemic, the family visits were made restricted by the aged care facility. Due to Mr. J’s change in mental health condition, the consent for using his information was taken from the family and all his information was kept confidential.

From the last 2 weeks, Mr. J was difficult to engage with. I had difficulty in conversation, social contact, and maintaining relationships with other residents. He liked to have food and drink in his room as well. He was noted with the problem in his cognition and was incapable of any activity of daily life. His background medical and mental history contains front temporal dementia, cholesterol gallstone, and cancer of gallbladder, hypertension, asthma, and obstructive sleep apnea.  He had previous ideation of self-harm 25 years ago and a history of depression and manic behavior. No known allergy was reported for Mr. J. His current medication includes Diazepam, Aspirin, Symibcort (2 puffs bd), Oesmoprazole, Amlodipine, Paracetamol. On assessment Mr. J was found with no change in facial expression, avoiding eye contact, symptoms of delusion, difficulty in conversation, social withdraw, and loss of interest in daily activities. Mr. J used to walk slowly with a four-wheel frame with assistance and there was no superficial wound or injury was found. He was at high risk of falls.

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Pathophysiology and Pharmacology

Mr. J was diagnosed with Schizoaffective disorder by the psychiatrist. Schizoaffective disorder is one of the chronic mental health illness illustrated by the unusual thought process (psychosis) and unstable mood (Coryell, 2016). Schizoaffective disorder is characterized by the symptoms of schizophrenia-like delusion and hallucination and symptoms of mood disorders like depression (Coryell, 2016). The pathophysiology of the schizoaffective disorder is unknown. According to some studies, serotonin, dopamine, and norepinephrine play a role in the happening of schizoaffective disorder (Wy & Saadabadi, 2019). Other studies show that abnormalities in the white matter of the brain especially left temporal gyrus and right precuneus can be related to schizoaffective disorder (Amann et al., 2016). Drug use and stressful events may lead to schizoaffective disorder (Mancuso et al., 2015).

The important symptoms of the Schizoaffective disorder are characterized in schizophrenic like symptoms and mood disorder related symptoms (Wy & Saadabadi, 2019). Schizophrenic symptoms include hallucinations and delusions (McCarthy-Jones et al., 2017). Hallucination is the incorrect perception of the objects and sounds whereas delusion is the false belief that does not exist in reality. Hallucination and delusion are important factors for the diagnosis of schizoaffective disorder as they represent the abnormal thought process (McCarthy-Jones et al., 2017). In the case of Mr. J delusion was present. Another important symptom of schizophrenia is the impairment of cognitive functioning which includes difficulty in conversation, memory alteration, perception, learning, and decision-making abilities (Green, 2016). All these symptoms were present in Mr. J. Negative symptoms like unhygienic behavior are also associated with the presence of schizophrenia.

A mental disorder like symptoms such as depressed mood and manic behavior are important symptoms of schizoaffective disorder (Coryell, 2016). Loss in interest in daily life activities, social isolation, difficulty in maintaining relationships, and unhygienic behavior is the common sign and symptoms associated with the depressive mood (Hägele et al., 2015). These symptoms were also present in Mr. J.

For the treatment of schizoaffective disorder, doctors prescribed clozapine and diazepam. Clozapine is an atypical antipsychotic medicine that binds with both dopamine and serotonin receptors and indicated in the treatment of resistant schizophrenia (Kar et al., 2016). Clozapine binds with the 5-HT subunit of the serotonin receptor and improves anxiety, depression, and adverse cognitive functioning related to schizophrenia and schizoaffective disorder (Andressen et al., 2015). Clozapine is also proved to be effective in reducing suicidal ideation in patients with schizoaffective disorder (Sriretnakumar et al., 2015). Clozapine is associated with some high-risk side effects, for example, Agranulocytosis, Myocarditis/ Cardiomyopathy, Seizures, and Metabolic syndromes (Kar et al., 2016). So, in Australia, it is mandatory to monitor the treatment of the Clozapine. Before the start of the treatment, consent is taken from every patient regarding the clozapine treatment and inclusion in the clozapine database. Consumer agreement is signed regarding the initiation of treatment and regular blood monitoring. The patients and health care providers involved in prescribing and dispensing Clozapine must be registered in the Clozapine Patient Monitoring System. Neutrophil count and white blood cell must be measured weekly up to 18 weeks from the start of treatment and then every 28 days until the treatment left (Royal Perth Hospital, 2017). A study suggests that physical and cardiovascular examination should be done at baseline, third month, the sixth month, and twelve months after the start of treatment to find out any cardiovascular changes related to Clozapine (Kar et al., 2016). Diazepam has an anxiolytic, muscle relaxant, sedative/hypnotic, and anticonvulsant effect by binding to a specific receptor in the brain and cause increase inhibitory effect of neurotransmitters (Leão et al., 2016).

Investigation

Vital signs are important in detecting the early signs of deterioration of physical health (Mok et al., 2015). Mr. J’s breath rate was 18 breath per minute which come under normal range. His SpO2 was 97% on room air which also comes in the normal range (Loughlin et al., 2018). The blood pressure of Mr. J was 151/71 mmHg, which is slightly on the higher side (Fasolino & Verdin, 2015). Regular medication for blood pressure (Amlodipine) was given with good results. Mr. J’s heart rate was 71 beats per minute which come under normal range (Mok et al., 2015). Vital signs for Mr. J did not show any signs of deterioration. The blood glucose level of Mr. J was also measured as he was using clozapine which may cause weight gain, glucose intolerance, and type 2 diabetes (Mayfield et al., 2016). Mr. J’s blood sugar level was 7.3 mmol/l which is within the normal range (Nasouhi et al., 2015).

Mental health examination (MSE) of the patient is the assessment of the cognitive functions and the behavior of the mental health patient (Huang et al., 2016). MSE of Mr. J showed that Mr. J was inappropriate dress according to the season, his behavior was co-operative but did not make eye-contact. Mr. J’s mood was depressed and felt difficult in speaking with irregular speech. Mr. J showed a euthymic effect and was confused in thoughts. He showed delusion about God with normal insight and judgment. Mr. J had a sleep problem. He used to sleep 2-3 hours and his appetite was normal and wanted to consume more sugar. Mr. J often felt tired and always want assistance when walking with a four-wheel frame.

 

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