course material

1. Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic
Disorders-Wk9.
Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic Disorders-
Wk9. Assignment 1- Captain of the Ship-Project – Schizophrenia Spectrum and Other
Psychotic Disorders-Wk9In earlier weeks, you were introduced to the concept of the
“captain of the ship.” In this Assignment, you become the “captain of the ship” once again as
you provide treatment recommendations and identify medical management, community
support resources, and follow-up plans for a client with a schizophrenia spectrum/other
psychotic disorder.Captain of the Ship-Project – Schizophrenia Spectrum and Other
Psychotic Disorders-Wk9.ORDER A PLAGIARISM-FREE PAPER HERELearning
ObjectivesStudents will:• Recommend psychopharmacologic treatments based on
therapeutic endpoints for clients with schizophrenia spectrum and other psychotic
disorders• Recommend psychotherapy based on therapeutic endpoints for clients with
schizophrenia spectrum and other psychotic disorders• Identify medical management
needs for clients with schizophrenia spectrum and other psychotic disorders• Identify
community support resources for clients with schizophrenia spectrum and other psychotic
disorders• Recommend follow-up plans for clients with schizophrenia spectrum and other
psychotic disorders.Captain of the Ship-Project – Schizophrenia Spectrum and Other
Psychotic Disorders-Wk9.QUESTIONTo prepare for this Assignment:• Select an adult or
older adult client with a schizophrenia spectrum and other psychotic disorder you have
seen in your practicum.In 3–4 pages, write a treatment plan for your client in which you do
the following:• Describe the HPI and clinical impression for the client.• Recommend
psychopharmacologic treatments and describe specific and therapeutic endpoints for your
psychopharmacologic agent. (This should relate to HPI and clinical impression.)•
Recommend psychotherapy choices (individual, family, and group) and specific therapeutic
endpoints for your choices.• Identify medical management needs, including primary care
needs, specific to this client.• Identify community support resources (housing,
socioeconomic needs, etc.) and community agencies that are available to assist the client.•
Recommend a plan for follow-up intensity and frequency and collaboration with other
providers.By Day 7NOTEALL REFERENCES 5 YEARS OR LESS.Schizophrenia Spectrum and
Other Psychotic DisordersSchizophrenia and other psychotic disorder are characterized by
changes in behaviors, perceptions,and thoughts of an individual which are considered to be
out of contact with the reality. Schizophrenic patients make up 1% of the population,and it

2. usually presents during early adulthood(Sadock, Sadock & Ruiz, 2014). It is a psychotic
illness that presents difficulties in the performance of daily activities and maintenance of
social ties between people. In general, psychotic disorders including schizophrenia
disconnect the affected people from the real world that they live in. The schizophrenia
spectrum is associated with catatonia, delusional disorder, schizoaffective disorder, and
schizophrenia (Murphy, 2011). This paper explores a client diagnosed with schizophrenia
spectrum and other psychotic disorders, her treatment options, community and medical
needs as well as her follow-up plan.Captain of the Ship-Project – Schizophrenia Spectrum
and Other Psychotic Disorders-Wk9.HPI and Clinical ImpressionThe client is a 26-year-old
AA woman. She claims to be followed by people even at home. She encroaches herself in the
corner of her apartment and claims that they know where she is and only waiting to get her.
She reports having a secret that those people are looking for and they intend to open her
skull to get it from her brain. She results in hiding in the closet, behind all the clothes to
protect her brain as she believes that those people won’t see her. The clientpresents
abnormal thought disorder and processes associated with schizoaffective disease and
delusional disorders. Her social and occupational functionality is also affected.Physical
Assessment- ObjectiveThe client presents no physical abnormalities and she is dressed and
groomed according to the time and age.Mental Status Examination (MSE)The client is well
groomed and dressed appropriately. She has a steady gait and normal psychomotor activity.
She does not make eye contact and her speech is incoherent, irrelevant, disorganized and
irregular. The client’s mood is anxious and has intrusive thoughts with increases impulse.
The client is fearful of death and imaginary people. She has hallucinations and delusional
thoughts.Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic
Disorders-Wk9.DiagnosisAccording to the DSM-5 criteria, schizophrenia spectrum and
other psychotic disorders cause delusions, hallucinations and thoughts that affect the
client’s social and occupational aspects (American Psychiatric Association. 2013). The client
exhibits such symptoms which are associated with the fear of losing her mind and her being
followed by imaginary people. She also presents disorganized thoughts and speech as well
as abnormal behavior associated with catatonia.Psychopharmacologic
TreatmentsSchizophrenia and other psychotic disorders are primarily treated using
antipsychotic medications. These medications act by blocking the dopamine D-2 receptors
which results in the improvement of the patient’s disorganization and positive
schizophrenic symptoms(Ferreira et al., 2016). In this case, the client will receive a
prescription of clozapine, a second-generation antipsychotic drug. This is because; the
medication has been reported to have high toleration effects in many individuals and also
demonstrates positive outcomes due to its increased efficacy (Stahl, 2014). Multiple
researches from the medical databases have shown the effectiveness of this approach to
delusional disorders, schizoaffective disorders, schizophreniform and schizophrenia
(American Psychiatric Association, 2013).Captain of the Ship-Project – Schizophrenia
Spectrum and Other Psychotic Disorders-Wk9.Psychotherapy ChoicesSchizophrenia
spectrum and other psychotic disorders are also managed using psychotherapy. This
involves cognitive behavior therapies which seek to improve the thoughts, emotions,and
behaviors of the patient. In this case, the client will be involved in individual, family and

3. group therapies to enhance her lifestyle and social functionality(Gabbard, 2014). Family
therapies will enable the family to care for Jamie at home as well as be able to cope with the
distress associated with her condition. On the other hand, individual therapy will help her in
understanding and accepting the illness and work in group therapies to gain coping skills.
Group activities will involve physical activities and interaction through sharing of individual
experiences. This will help in reducing symptoms of the client and enhance their
participation in daily routine without delusions, reduce relapses and improve mental and
physical wellbeing.Medical Management NeedsSchizophrenia spectrum and other psychotic
disorders are identified by primary care healthcare providers. Thisis achieved through
diagnostic reasoning which examines the pathological factors of an individual to determine
their symptoms. This will follow the collaborative efforts of the primary care provider with
the mental and general health practitioners in diagnoses and formulation of treatment plans
for the patient. This will prevent medical gaps which could result in misdiagnosis and
occurrence of medical errors (Murphy, 2011).Captain of the Ship-Project – Schizophrenia
Spectrum and Other Psychotic Disorders-Wk9. Moreover, it will support informed decision-
making through the integration of multiple experts in the formulation of an evidence-based
plan of treatment for Jamie. Consequently, they will create health awareness to the family
and guide them on the coping skills necessary for such diseases.Community Support
Resources and Community Agencies AvailableCommunity support services offer social,
medical, physical and emotional support to clients with schizophrenia and other psychotic
disorders. These include support groups, supported employment, community mental health
team visits,and drop-in centers. Online based support groups are also essential in providing
medical information and support to patients,and therefore, I would recommend the client to
engage in their favorite programs.Follow-up planJamie will be given appointments a four-
week appointment to assess her recovery progress. However, she will be engaged by her
psychiatrist for 14 days for psychological therapies. She can also contact the practitioner via
email or phone in the event of a worsened situation or for consultation. Failure of
improvement, the severing of symptoms and adverse side effects should be reported
immediately,and the client must present to the hospital
immediately.ConclusionSchizophrenia spectrum and other psychotic disorders disconnect
patients with external reality. They experience delusions, hallucinations and other
symptoms which cause distress and affect normal productivity. The treatment options
available include psychotherapies and pharmacotherapies as well as community support.
Follow up plans helps in monitoring the patient’s recovery progress.Captain of the Ship-
Project – Schizophrenia Spectrum and Other Psychotic Disorders-
Wk9. ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders (DSM-5®). American Psychiatric Pub.Ferreira, C. D., de Souza,
M. G. D., Fernández-Calvo, B., Machado-de-Sousa, J. P., Cecilio Hallak, J. E., & Torro-Alves, N.
(2016). Neurocognitive functions in schizophrenia: A systematic review of the effects of
typical and atypical antipsychotic drugs. Psychology & Neuroscience, 9(1), 12–31.
doi:10.1037/pne0000045Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric
disorders (5th ed.). Washington, DC: American Psychiatric PublicationsMurphy, L. (2011,
July 21). Types of schizophrenia – A day in the life (scary) [Video file]. Retrieved from

4. https://www.youtube.com/watch?v=LWYwckFrksgSadock, B. J., Sadock, V. A., & Ruiz, P.
(2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.)Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th
ed.). New York, NY: Cambridge University PressObsessive Compulsive DisorderObsessive-
compulsive disorder (OCD) is a chronic and significantly impairing disorder, characterized
by distressing, unwanted obsessions and time-consuming and intense, recurrent
compulsions (Sadock, Sadock & Ruiz, 2014). This assignment describes a client diagnosed
with OCD and the pharmacological and psychotherapy treatments for the client. It also
addresses the client’s medical management needs, community support resources available
to help the client. The subsequent follow-up plans and partnership with other providers and
ways to manage the client's psychiatric disorder will be examined.Captain of the Ship-
Project – Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.HPI and Clinical
ImpressionJean is a 30- year old female client with a university education and has a 6-year
old daughter. The primary symptoms of the client included an intense fear of dirt and
infections, and an irrepressible desire to clean her hands or clean all things, including floor
and furniture at her workplace and home. The client was not able to manage her hand
cleaning and frequently disinfected everything with alcohol. These obsessions and
compulsions made it hard for Jean to work, and also caused severe worry and insomnia.
Jean also compelled her daughter and spouse to carry out similar ritual behavior, and when
they declined to perform these rituals, she became irritable and depressed. There was not a
familial or personal history of psychosis or physical illness. The client reported that the
intrusive thoughts initially occurred three years ago after the death of her grandmother as a
result of an infectious disease. The client reported feeling frightened by contacting such
infectious disease if her environment is not clean and fear of her daughter who might easily
become sick form dirt.The client reports of no prior psychiatric treatment and has no acute
or chronic medical conditions. The client reports of a regular menstrual period and is
heterosexual, but with no active sexual relationship at this time. The patient also denies any
abuse from drug, alcohol or domestic issue.Captain of the Ship-Project – Schizophrenia
Spectrum and Other Psychotic Disorders-Wk9.Physical Assessment- ObjectiveThe client
appears well groomed of her stated age and with no noted physical ill effects.Mental Status
Examination (MSE)A mental status examination revealed that the client is dressed
appropriately and well groomed, with normal psychomotor activity and steady gait. The
client makes fair eye contact, and with an intact association. The client’s speech is regular,
coherent and relevant, and answers questions appropriately. Mood and affect is slightly
anxious and constricted. The client reports of no suicidal or homicidal thoughts or ideation.
Has moderate impulse control with intrusive thoughts of having to clean her environment
to avoid dirt. The insight and judgment are fair and need to comply with treatment (Sadock,
Sadock & Ruiz, 2014).Captain of the Ship-Project – Schizophrenia Spectrum and Other
Psychotic Disorders-Wk9.DiagnosisThe Yale-Brown Obsessive compulsive scale was
utilized to evaluate the client’s behavior symptoms, and the client had a baseline score of
twenty-eight points, signifying obsessive-compulsive disorder (OCD). The client also
exhibited compulsions with repetitive behaviors of hand washing and checking that she is
dirt free and the client rigidly applies these behavior as rules in her life. Besides, the clients

5. find the obsessive intrusive thoughts very upsetting of not sticking to them. Moreover, the
obsessions cause the client to have clinically paramount distress, and these are not
attributable to physiologic effects of substance abuse. The client, therefore, met the
obsessive-compulsive disorder (OCD) diagnostic criteria according to the DSM-IV with
recurrent and persistent thoughts that are being experienced with uncleanliness and unable
to stop them (American Psychiatric Association. 2013).Pharmacological treatmentsSelective
serotonin reuptake inhibitors (SSRIs) such as fluvoxamine, paroxetine, citalopram, and
fluoxetine have been confirmed to be effective in the treatment of obsessive-compulsive
disorder (OCD) disorder in adults. It is argued that SSRIs are more effective as they are
administered for a prolonged period and in higher doses than those used in depression.
SRRIs can help to reduce the OCD symptoms in the client through adjusting and increasing
levels of serotonin in the brain and reduce the frequency and severity of compulsions and
obsessions (Del Casale.et al. 2018). For instance, when using Fluvoxamine for the client, the
initial dose to start will be 20mg daily in the morning. The client will be required to return
to the clinic in two to four weeks to check for the therapeutic effect of the medication. If not
effective, then there will be an increase in dosage slowly while bearing in mind the
maximum dosage of 80mg/day. It is paramount to recognize that aggressive and early
treatment of the patient, with an objective of remission, is crucial for a positive result (Stahl,
2014b).Captain of the Ship-Project – Schizophrenia Spectrum and Other Psychotic
Disorders-Wk9.On the other hand, if the treatment with SSRIs is effective, it must be
sustained for one to two years or indefinitely. It is also asserted that guidelines propose
administration of SSRIs for not less than one to two years after achievement of remission.
Discontinuation of treatment after this duration must be considered carefully based on
individual patient factors, entailing residual symptoms, duration, and severity of illness,
history of reversion following discontinuation, and comorbidities (Janardhan Reddy,
Sundar, Narayanaswamy & Math, 2017).Captain of the Ship-Project – Schizophrenia
Spectrum and Other Psychotic Disorders-Wk9.Psychotherapy choicesIndividual cognitive
behavioral therapy (CBT), particularly exposure and response prevention therapy (ERP)
can be an effective psychotherapy for the client. According to Fenske and Petersen (2015),
exposure therapy entails exposure of patients to stimuli that provokes stimuli and then
making them learn not to engage in compulsive actions in response. CBT must be applied to
engage the client in the understanding of maladaptive and dysfunctional thoughts of
obsessive and compulsive that is inadvertently affecting the clients social and daily
functions (Sadock, Sadock & Ruiz, 2014).Combination of individual CBT with motivational
interviewing might also be more effective. Incorporation of motivational interviewing might
augment commitment with therapy an increase its effectiveness. Cognitive behavior
therapy (CBT) is the first line psychological therapy for obsessive-compulsive disorder
(OCD), with exposure and response preventive therapy (ERP) as the most significant
constituent of cognitive behavioral therapy as well as belief modification. It is noted that, in
patients with mild and moderate OCD, CBT/ERP monotherapy is recommendable, a
combination of SRRI and CBT is recommended for patients with severe OCD (Janardhan
Reddy, Sundar, Narayanaswamy & Math, 2017).Medical Management Needs Specific to the
ClientMedical management needs of the patient might vary at numerous phases along with

6. the severity of the illness. The requirements of this particular client are needs associated
with the symptoms, family, and treatment. Patients with obsessive-compulsive disorder
(OCD) might report distress in coping with symptoms. Generally, the needs of OCD patients
are parallel to the needs of the psychiatrist and the family, because they all want the
disappearance of symptoms (Prasko et al., 2016).Captain of the Ship-Project –
Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.Medical management needs
connected with symptoms include an excellent partnership with the therapists, augmenting
of insight for the client and her family and enduring persistent symptoms. Besides, the
needs associated with the client’s treatment will include family support, timely
identification of the illness, along with encouragement to undergo treatment. Long-term
needs include elimination or reduction of OCD symptoms along with proper treatment. It is
essential to search for optimal treatment and ensure the patient adheres to it to meet those
needs (Reckrey et al., 2015).Community Support Resources and Community Agencies
Available for AssistanceObsessive-compulsive disorder (OCD) patients have impairments in
social, cognitive, family, personal and vocation dysfunctions. Social dysfunction is a
significant barrier to the social life of a person with OCD. Community, treatment centers,
support groups, and telephone helplines help in providing an atmosphere for the clients
with obsessive compulsive disorder and their families to meet to receive and provide
support for one another . Patients are presented with information on self-management
skills as well as coping strategies (Sahoo, Sethy & Ram, 2017).Captain of the Ship-Project –
Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.Taking part in group
particularly Obsessive-compulsive disorder (OCD) support groups for families can lessen
feelings of powerlessness and isolation because as the client shares her challenge with
others, she will become more empowered and connected. It is also counseled that providing
educational information for patients and their families and community resources can assist
with social stabilization and adherence to treatment (Carron-Arthur et al., 2016).Plan for
follow-Up Intensity and Frequency and Collaboration with Other ProvidersA follow-up is
necessary for monitoring the way the patient responses to treatment and possible adverse
effects like serotonin syndrome along with scheduling for subsequent treatment trial in case
the original treatment do not generate satisfactory improvement A follow-up is also in all
through the duration of the illness and treatment. The client will be referred to see her
primary care physician while taking those medications in checking her liver and renal
functions. This because the patient who has renal and hepatic impairments will need a
lower initial dose of the drug and a slower titration of increment of dosages. However, the
client will also be tested for a pregnancy test before the initial administration as exposure to
SSRIs during pregnancy may be connected with heightened risk for of septal heart defects of
the offspring (Stahl, 2014b)Outpatient treatment is ordinarily adequate for the majority of
patients with mild or moderate illness and for patients with a high likelihood of adhering to
treatment. Clients might be followed up at cyclic intermissions firstly once or twice a month,
and consequently at longer intermissions based on treatment tolerability along with
adverse effects (Janardhan Reddy, Sundar, Narayanaswamy & Math, 2017).In-patient
treatment might be considered for patients at a higher risk of suicide, and intolerant to
therapeutic side-effects. If the patient does not respond to trials of two or more SSRIs, she

7. must be referred to a psychiatrist for further evaluation. I will work in close collaboration
with other providers such as the primary care physicians, and other psychiatrists to
formulate and implement the treatment plan for the client and deliver exceptional care
(Janardhan Reddy, Sundar, Narayanaswamy & Math, 2017).ConclusionObsessive-
compulsive disorder (OCD) is a disorder that requires timely diagnosis and treatment. SSRIs
and individual cognitive behavior therapy (CBT) are the most effective treatment options
for the client. Since the client has severe OCD, a combination of CBT and SRRIs is
recommended. Although SRRIs may be stopped after one to two year of continual remission,
the client might need continued treatment with SSRIs to prevent relapse. A follow-up is
necessary to monitor the patient’s response to treatment and possible adverse effects
(Sadock, Sadock & Ruiz, 2014).IntroductionSchizophrenia and other psychotic disorder are
characterized by changes in behaviors, perceptions,and thoughts of an individual which are
considered to be out of contact with the reality. Schizophrenic patients make up 1% of the
population,and it usually presents during early adulthood(Sadock, Sadock & Ruiz, 2014). It
is a psychotic illness that presents difficulties in the performance of daily activities and
maintenance of social ties between people. In general, psychotic disorders including
schizophrenia disconnect the affected people from the real world that they live in. The
schizophrenia spectrum is associated with catatonia, delusional disorder, schizoaffective
disorder, and schizophrenia (Murphy, 2011). Various research link genetic and
environmental factors as well as psychosocial stress and neurobiology with the
development of schizophrenia spectrum and other psychotic disorders even though the
exact cause is yet to be known.HPI and Clinical ImpressionThe client is a 26-year-old AA
woman. She claims to be followed by people even at home. She encroaches herself in the
corner of her apartment and claims that they know where she is and only waiting to get her.
She reports having a secret that those people are looking for and they intend to open her
skull to get it from her brain. She results in hiding in the closet, behind all the clothes to
protect her brain as she believes that those people won’t see her.Captain of the Ship-Project
– Schizophrenia Spectrum and Other Psychotic Disorders-Wk9. The client, therefore,
presents abnormal though disorder and processes associated with schizoaffective disease
and delusional disorders. Her social and occupational functionality is also affected,andthus,
she fits in the DSM-5 criteria for diagnosing schizophrenia spectrum and other psychotic
Disorders.Psychopharmacologic TreatmentsSchizophrenia and other psychotic disorders
are primarily treated using antipsychotic medications. These medications act by blocking
the dopamine D-2 receptors which results in the improvement of the patient’s
disorganization and positive schizophrenic symptoms(Ferreira et al., 2016). In this case, the
client will receive a prescription of clozapine, a second-generation antipsychotic drug. This
is because; the medication has been reported to have high toleration effects in many
individuals and also demonstrates positive outcomes due to its increased efficacy (Stahl,
2014). Multiple researches from the medical databases have shown the effectiveness of this
approach to delusional disorders, schizoaffective disorders, schizophreniform and
schizophrenia (American Psychiatric Association, 2013).Captain of the Ship-Project –
Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.Psychotherapy
ChoicesSchizophrenia spectrum and other psychotic disorders are also managed using

8. psychotherapy. This involves cognitive behavior therapies which seek to improve the
thoughts, emotions,and behaviors of the patient. In this case, the client will be involved in
individual, family and group therapies to enhance her lifestyle and social
functionality(Gabbard, 2014). Family therapies will enable the family to care for Jamie at
home as well as be able to cope with the distress associated with her condition. On the other
hand, individual therapy will help her in understanding and accepting the illness and work
in group therapies to gain coping skills. Group activities will involve physical activities and
interaction through sharing of individual experiences. This will help in reducing symptoms
of the client and enhance their participation in daily routine without delusions, reduce
relapses and improve mental and physical wellbeing.Medical Management
NeedsSchizophrenia spectrum and other psychotic disorders are identified by primary care
healthcare providers. Thisis achieved through diagnostic reasoning which examines the
pathological factors of an individual to determine their symptoms. This will follow the
collaborative efforts of the primary care provider with the mental and general health
practitioners in diagnoses and formulation of treatment plans for the patient. This will
prevent medical gaps which could result in misdiagnosis and occurrence of medical errors
(Murphy, 2011). Moreover, it will support informed decision-making through the
integration of multiple experts in the formulation of an evidence-based plan of treatment
for Jamie. Consequently, they will create health awareness to the family and guide them on
the coping skills necessary for such diseases.Community Support Resources and
Community Agencies AvailableCommunity support services offer social, medical, physical
and emotional support to clients with schizophrenia and other psychotic disorders. These
include support groups, supported employment, community mental health team visits,and
drop-in centers. Online based support groups are also essential in providing medical
information and support to patients,and therefore, I would recommend the client to engage
in their favorite programs.Captain of the Ship-Project – Schizophrenia Spectrum and Other
Psychotic Disorders-Wk9.Follow-up planJamie will be given appointments a four-week
appointment to assess her recovery progress. However, she will be engaged by her
psychiatrist for 14 days for psychological therapies. She can also contact the practitioner via
email or phone in the event of a worsened situation or for consultation. Failure of
improvement, the severing of symptoms and adverse side effects should be reported
immediately,and the client must present to the hospital immediately.Captain of the Ship-
Project – Schizophrenia Spectrum and Other Psychotic Disorders-
Wk9.ConclusionSchizophrenia spectrum and other psychotic disorders disconnect patients
with external reality. They experience delusions, hallucinations and other symptoms which
cause distress and affect normal productivity. The treatment options available include
psychotherapies and pharmacotherapies as well as community support. Follow up plans
helps in monitoring the patient’s recovery progress.Captain of the Ship-Project –
Schizophrenia Spectrum and Other Psychotic Disorders-Wk9.