Nursing: Plan of Care for a Patient with Drug-Induced Psychosis

This article discusses the development of a plan of care for a 45-year-old aboriginal man with drug-induced psychosis and aggressive behavior. The plan includes providing culturally safe care, managing disruptive behavior related to drug abuse, and addressing physical health concerns such as high blood pressure and high blood sugar levels.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

1
NURSING
Plan of care
A plan of care will be developed for Mr. C.M , a 45 years old aboriginal man Nangiri Mob
(Yorke Penincula), who had been recently released from the prison and was on a community
treatment order. He was brought in the mental health department due to the aggressive and
assaultive behaviour towards the neighbours, along with a drug induced psychosis. Psychosis
can be considered as a multiple handcapping, chronic disorder involving amarked impairment
in the social functioning skills. He is transferred to the acute care unit and is currently being
managed in the high dependency unit. According to the diagnostic reports, he is being faced
with increased restlessness, wandering in the streets and meeting with friends, having
suspected drug addiction.
However the plan of care would involve provision of a culturally safe care to the
patient, cessation of the cannabis uptake, managing the disruptive behaviour of the patient
related to the drug abuse. As reported from the physical assessment report, it can be seen that
the blood pressure, respiratory rate and the heart rate of the patient is high than the normal
value. Hence, another clinical priority would be restore blood pressure value and a normal
heart rate. The normal value of blood glucose level is 7mmol/L and the patients was found to
have a blood glucose level of 11.1mmol/L, which is higher than the standard value. Hence,
the plan of care would also take in management of the blood sugar level under consideration.
Considering the environment
As evident from the case scenario, it is evident that the patient s is from an aboriginal
background. Furthermore, he had been under imprisonment and after being released from the
prison, he was under the community treatment order (CTO). Mental health issues among the
aboriginal and Torres Strait Islanders has been found to be much higher than that of the non-

2
NURSING
aboriginal counterparts (Das et al., 2018). The need of the mental health clinicians to practice
cultural safety is necessary to ensure a meaningful care to the patients. The concept of
cultural safety is mainly relevant for the mental health patients for promoting cultural
integrity and promotion of social justice, respect and equity (McGough, Wynaden & Wright,
M.2018). The case study revealed that the mother of the patient was not willing to take help
from the doctors due to the associated stigma and prejudices (Kirmayer, Guzder & Rousseau,
2013). The care plan would facilitate parent education such that the associated stigma and the
prejudices regarding mental illness can be reduced. This would include an aboriginal
caregiver (if the patient demands so), provision of a non –hostile environment so that the
patient can share with the grievances. Language translator might be used in case the patient
does not know English (Lazowski et al., 2012). The Community programs like the Anger
management, drug/ alcohol management should be there to provide the patient with social
support. Staying in jail for a long period of time might limit the development of cognition.
Hence, the entire care plan has should also consider the effects of the surroundings where the
patient had been in jail.
The priorities of care
The priorities of care of the patients involves provision of a culturally competent care,
management of the disruptive and the aggressive behaviour of the patient, management of
high blood pressure, respiratory rate and diabetes . Another priority of care is the cessation
of the drug uptake.
Psychosocial aspect of care
Provision of psychosocial intervention can be considered to be an important approach
towards mental health. Although medication is the most important component of the
treatments. It is always s not sufficient to give the diffuse nature of the residual

3
NURSING
neurocognitive impairment. In addition to the medications, some of the effective care
management would involve patient-specific psychosocial treatment, family psychoeducation,
vocational rehabilitation and educational opportunities. Four psychosocial treatments
approaches can be used for the disruptive behaviour.
Social skills training-Social skill training can be provided individually or in groups. Anger
coping skills can be taught to the patient (Turner et al., 2016).
Cognitive therapy – Talk therapies, rational analysis can be utilised for reducing the distress
associated with psychotic symptoms.
Psychoeducation- Psycoeducation should be provided to the family or the informal caregiver
of the patients, to understand the triggers of the disruptive behaviour of the patient and to
control them.
Cognitive rehabilitation- These techniques employs the repetitive practice over the
neurocognitive tasks using computers (Hutton & Taylor, 2014).
Specific nursing interventions
The case study reveals that the patient had been admitted due to disruptive behaviour
and aggression due to excessive consumption of drugs. Behavioural disturbances are common
in patients suffering from psychotic disorder. According to Mahone, Maphis & Snow, (2016),
a four step approach has to be taken for managing behavioural disturbances in patients from
drug related psychosis. It is necessary to ensure, that the patient is not in the imminent danger
to the self or the other. In this case study it can already be seen that patient had displayed
aggressive behaviour towards his neighbours and has smashed a car in the neighbourhood. It
is necessary to assess for delirium, comorbid illness, the environmental factors and the drugs
that can be causing physical disturbances. Efforts for reinforcing independent positive

4
NURSING
behaviour and effectively channelize the energy of the patient into more positive activity
rather than trying to eliminate the unwanted behaviour has been recommended (Das et al.,
2016). Distraction techniques and reassurance have been found to be sufficient foe many
patients. Environmental changes seeking to lessen spatial and the visual cluster might also be
helpful for the patient. The progressively lowered Stress Threshold model aims to decrease
the environmental stress to decrease the behavioural disturbances in the patients displaying
aggressive behaviour. Cognitive behavioural therapy might be suitable for this patient.
Recent treatment methods focuses on the use of cognitive behavioural therapy in the
treatment of this patient Hutton & Taylor, 2014). Some of the other non-pharmacological
interventions that can be used in case of this patient are stimulated presence therapy, where
autotapes of the conversation of families or videotapes of good old days were played. Regular
exercises like walking, swimming has been found to be reducing aggression in patients. The
case study revealed that the patient suffered from higher blood glucose level due to the
inappropriate consumption of high calorigenic food along with drug intake .Regular exercises
have also been found to be useful for the controlling the diabetes in the patient. Another
interventions that has to be used in this patient is the management of the blood sugar level
(Bauer, Wulsin & Guadagno, 2012). According to, most of the psychiatric manifestation
involves confused state, hyperhlycemia. In order to control the blood sugar level. In order to
control the blood sugar level it is necessary to ensure a regular screening of the blood glucose
level. The patient in this case would be able to use the blood glucose check device and to
reman adhered to the treatment regimen. Exposure to medicines with higher metabolic
liability would be reduced. According to Mahone, Maphis and Snow, (2016) some of the
drugs like aripiprazole, metformin, paliperidone (Invega), olanzapine (Zyprexa) can be used
in patients suffering from diabetes as well as drug induced psychosis (Sahoo, Mehra & Grover,
2016).

5
NURSING
Another intervention that can be used for the hypertension. Elevated blood pressure is
commin in patients with psychotic disorders. An acute psychotic patients have always shown
an increased pulse and heart rate. Anxiety and depression can again be related to psychotic
diosrder.
Biological treatments
According to FDA, serotonergic therapies have been found to be useful for the
manipulation of the neurotransmitters for alleviating the behavioural and the psychological
symptoms of the drug induced psychosis. Cholinesterase inhibitors can be used to decrease
the psychotic symptoms. Again antipsychotic monotherapy has been found to be useful for
such patient.
However, as per the case study, it has been found that the patient suffered from
Oculogyric crisis, that is a dystonic reaction to certain drugs and clinical conditions guided by
a prolonged involuntary upwards deviation of the eyes (Nebhinani & Suthar, 2017). It should
be remembered that Akathisia is a very common problem among the patients who had been
under the neuroleptic . This involves stepping up and down the stairs or swinging of legs.
Ceftaroline and cefpodoxime can be administered to the patient suffering from Akathisia.
Again, immediate application of the drug induced OGC can be achieved with the help of the
intravenous antimuscarinic benzatropine or procyclidine. Antipsychotics has to be prescribed
such as the application of clozapine (Nebhinani & Suthar, 2017).
Critical review of the experience of care
Reflecting on the plan of care as per the surrounding condition of the patient, it can be
stated that that the patients had been released from jail and he is of aboriginal origin. Owing
to the aboriginal origin, a culturally safe care is required, since, notable disparities exists in

6
NURSING
the health outcomes between the aboriginal and the non-aboriginal patients. There remains a
chasm between the policies with many mainstream services, that fails to provide proper
services to the indigenous people.
Psychosocial aspect of care would involve the social skill, training the cognitive
behavioural therapy, psychoeducation. Emphasis has been given on the social skills and the
anger coping skills training. The angrv training skills and the problem solving training skills
helps the patients to deal with the external problems that can evoke disruptive behaviour in
patients. According to Lecomte et al., (2016), social skill training has been found to be
efficient in managing the negative symptoms in psychosis. Cognitive behavioural therapy
and social skills training has been found to improve the symptomatology and the functional
recovery of the patient in the early onset of psychosis. Cognitive behavioural therapy has
been introduced as one of the treatment procedures, due to the fact that it is used to the boost
the happiness of the patients by the modification of dysfunctional emotions, thoughts and
behaviours. CBT is based on the idea that perception and thoughts influences perceptions and
influences behaviour of person. Emphasis has also been given to the family psychoeducation.
As stated by Desousa, Kurvey and Sonavane, (2012), family plays an important role as
caregivers in the lives of individuals suffering from Schizophrenia or drug induced
Schizophrenia. Another psychosocial intervention is the cognitive rehabilitation. Psychotic
disorders often have significant impact on the functioning of the community and are partially
cured by medicine. Cognitive rehabilitation has been found to be effective in increasing the
attention, memory capacity and high levels of problem solving skills.
From the perspective of the caregivers, all the treatments was taken properly. Form
the nurse’s viewpoints. However, we should also mention that long acting antipsychotic
medicines might bring about the adverse drug reaction. Prescribing medicine like clozapine
requires blood cell monitoring,that might increase the risk of fatal agranulocystisis.

7
NURSING
From the viewpoint of the patient, it can be said that the prolonged effect of the
antipsychotic medicine can develop adverse reactions which can lead to the further
complications.
Outcome
On successful application of nursing interventions, disruptive behaviour in the
patient would be lessened to some extent. The pharmacological interventions that has been
taken would help to decrease the psychotic disorder (Chen et al., 2014). Patient will be able
to demonstrate his thoughts in a logical and cohesive manner. Patient will show much less
aggressive disorders. Effective teaching of the distraction techniques and breathing exercise
promise a better life style, with no incidences of delusional thoughts. Furthermore the
medicines to treat the high blood glucose level and high blood pressure has also found to be
effective.

8
NURSING
References
Bauer, L. K., Wulsin, L. R., & Guadagno, G. (2011). Acute psychosis and type 2 diabetes
mellitus:should screening guidelines be revised?. The primary care companion for
CNS disorders, 13(1), PCC.10br01006. doi:10.4088/PCC.10br01006
Chen, R. C., Liu, C. L., Lin, M. H., Peng, L. N., Chen, L. Y., Liu, L. K., & Chen, L. K.
(2014). Non‐pharmacological treatment reducing not only behavioral symptoms, but
also psychotic symptoms of older adults with dementia: A prospective cohort study in
T aiwan. Geriatrics & gerontology international, 14(2), 440-446.
Das, M., Kini, R., Garg, G., & Parker, R. (2018). Australian aboriginal and torres strait
islanders' mental health issues: A litany of social causation. Indian Journal of Social
Psychiatry, 34(4), 328.
Desousa, A., Kurvey, A., & Sonavane, S. (2012). Family psychoeducation for schizophrenia:
a clinical review. Malaysian Journal of Psychiatry, 21(2).
Hutton, P., & Taylor, P. J. (2014). Cognitive behavioural therapy for psychosis prevention: a
systematic review and meta-analysis. Psychological medicine, 44(3), 449-468.
Kirmayer, L. J., Guzder, J., & Rousseau, C. (Eds.). (2013). Cultural consultation:
Encountering the other in mental health care. Springer Science & Business Media.
Lazowski, L., Koller, M., Stuart, H., & Milev, R. (2012). Stigma and discrimination in people
suffering with a mood disorder: a cross-sectional study. Depression research and
treatment, 2012.

9
NURSING
Lecomte, T., Leclerc, C., Corbiere, M., Wykes, T., Wallace, C. J., & Spidel, A. (2018).
Group Cognitive Behavior Therapy or Social Skills Training for Individuals With a
Recent Onset of Psychosis?: Results of a Randomized Controlled Trial. The Journal
of Nervous and Mental Disease, 196(12), 866-875.
Mahone, I. H., Maphis, C. F., & Snow, D. E. (2016). Effective Strategies for Nurses
Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery.
Issues in mental health nursing, 37(5), 372–379.
doi:10.3109/01612840.2016.1157228
McGough, S., Wynaden, D., & Wright, M. (2018). Experience of providing cultural safety in
mental health to Aboriginal patients: A grounded theory study. International journal
of mental health nursing, 27(1), 204-213.
Nebhinani, N., & Suthar, N. (2017). Oculogyric crisis with atypical antipsychotics: A case
series. Indian Journal of Psychiatry, 59(4), 499.
Sahoo, S., Mehra, A., & Grover, S. (2016). Acute Hyperglycemia Associated with Psychotic
Symptoms in a Patient with Type 1 Diabetes Mellitus: A Case Report. Innovations in
clinical neuroscience, 13(11-12), 25–27.
Stafford, M. R., Jackson, H., Mayo-Wilson, E., Morrison, A. P., & Kendall, T. (2013). Early
interventions to prevent psychosis: systematic review and meta-analysis. Bmj, 346,
f185.
Turner, D. T., McGlanaghy, E., Cuijpers, P., Van Der Gaag, M., Karyotaki, E., & MacBeth,
A. (2017). A meta-analysis of social skills training and related interventions for
psychosis. Schizophrenia bulletin, 44(3), 475-491.