The best medication choice for T. S. based on her history of uncontrolled diabetes would be Vraylar or Abilify. According to Chwastiak et al. (2015), people with psychotic disorders experience “substantial health disparities concerning diabetes” (p. 465). Therefore, the pharmacological treatment should assess possible complications associated with the condition. Antipsychotics may cause weight gain in such cases, for instance, clozapine was shown to have such an impact on individuals. Foley et al. (2015) state that “a positive synergy between antipsychotic drug effects and a pre-existing liability to diabetes mellitus” exists (p. 1092).
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The family history of diabetes has a substantial role in prescribing treatment, as it determines response to the prescribed medications. According to Foley et al. (2015), state that mellitus was observed in patients prescribed with clozapine, quetiapine, aripiprazole, risperidone, or olanzapine, without occurrences of diabetes within his or her family. Currently, no clear identification of the family’s medical and psychiatric history was provided by this patient.
Vraylar can be prescribed as an alternative medication for T. S. According to Watts (2015), it was recently approved for use and has shown fewer side effects when compared to Risperdal. The risk profile for Vraylar and Abilify was found to be similar. Watts (2015) states that in clinical trials 76 adverse outcomes were registered for Vraylar, compared to 150 for Abilify. At the same time, out of patients who were prescribed with Risperdal, 177 had adverse reactions. Based on this data, it appears that safer alternatives for psychotic disorders treatment exist. Therefore, it is advised to consider an option of prescribing either Vraylar or Abilify for treatment of schizophrenia in the case of T. S.
Other essential components of the treatment plan for T. S. include monitoring of medical care for diabetes and application of collaborative care model. Chwastiak et al. (2017) state that the collaborative care model is a better option for patients with schizophrenia and diabetes when compared to usual care.
Patients participating in the study that was in the collaborative care group have shown a significant decrease in hemoglobin levels. McBain et al. (2015) state that “integrated care provision and shared information technology (IT) services between mental health and physical services, and clearly defined roles and responsibilities” improve outcomes for such patients (p. 222). Therefore, the study substantiates a more inclusive approach offered by Chwastiak et al. (2017). The treatment plan should include diabetes management, while cooperation with other medical professionals can have beneficial results for T. S.
Many types of research have highlighted the link between psychotic disorders and diabetes, which may be connected to genetics or lifestyle preferences. Thus, the primary concern in the case of T. S. is to ensure that she receives her medication and learns how to control her diabetes correctly.
Assistance from family members will be required because the patient may struggle with adherence to the treatment plan. T. S. should be taught how to manage glucose levels, while her family members should receive information regarding possible complications and interventions they may carry out. T. S is currently not safe for discharge; thus, there is a need to examine her response to the current treatments. Additionally, more information regarding family history is required for better diagnostics. A patient is at risk of not adhering to diabetes treatment, therefore she should be monitored for additional time.
Chwastiak, L. A., Freudenreich, O., Tek, C., McKibbin, C., Han, J., McCarron, R., & Wisse, B. (2015). Clinical management of comorbid diabetes and psychotic disorders. The Lancet Psychiatry, 2(5), 465-467. Web.
Chwastiak, L. A., Luongo, M., Russo, J., Johnson, L., Lowe, J. M., Hoffman, G., McDonell, M. G., & Wisse, B. (2017). Use of a mental health center collaborative care team to improve diabetes care and outcomes for patients with psychosis. Psychiatric Services, 69(3), 349-352. Web.
Foley, D. L., Mackinnon, A., Morgan, V. A., Watts, G. F., Castle, D. J., Waterreus, A., & Galletly, C. A. (2015). Effect of age, family history of diabetes, and antipsychotic drug treatment on risk of diabetes in people with psychosis: A population-based cross-sectional study. The Lancet Psychiatry, 2(12), 1092-1098. Web.
McBain, H., Mulligan, K., Lamontagne-Godwin, F., Jones, J., Haddad, M., Flood, C., Thomas, D., & Simpson, S. (2016). Implementation of recommended type 2 diabetes care for people with severe mental illness – a qualitative exploration with healthcare professionals. BMC Psychiatry, 16, 222. Web.
Watts, V. (2015). Vraylar found to be less risky than Risperdal, comparable to Abilify. Psychiatric News. Web.