Case Study: Medications and Treatment for Delusional Thought Processes

This case study examines the treatment of a Pakistani woman diagnosed with delusional thought processes, a mental disorder characterized by false beliefs. The assignment explores the rationale behind prescribing three different medications: Fluphenazine (a conventional antipsychotic), Risperidone (an atypical antipsychotic), and Clozapine (another atypical antipsychotic). The analysis includes discussions of each medication's mechanism of action, expected outcomes, and observed results, including side effects and the patient's response. Furthermore, the paper considers ethical principles relevant to treating patients with mental illnesses, such as patient autonomy and informed consent, especially in cases where the patient's ability to perceive reality is impaired. The study highlights the importance of careful evaluation, considering both the therapeutic benefits and potential adverse effects of medications while adhering to ethical guidelines.

Running Head: DELUSIONAL THOUGHT PROCESS
DELUSIONAL THOUGHT PROCESS
Name of the Student
Name of the University
Author’s Note

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Introduction
Delusional thought process is a delusional disorder, which is also known as paranoid
disorder. It is a mental disorder that is included in psychotic disorders and people suffering from
it cannot distinguish between real and imagination. The major symptom of this disorder is
delusions, which is a strong believe in something that is not true. However, the delusions are not
bizarre and it can happen in real life such as being followed, deceived, being loved from a
distance or being poisoned. These delusions involve perceptions and experiences that are not true
but they socialize and interact with people how a normal person does. This can get affected when
they come across another episode of delusion. The types of delusions in delusional disorders are
erotomanic, grandiose, jealous, persecutory somatic and mixed. This paper will discuss the
treatment of a Pakistani woman with delusional thought process and three medications given to
her (Asif et al., 2018).
Discussion
Decision 1: conventional antipsychotics
These medications are also known as neuroleptics and is used to treat mental disorders since the
beginning of time. These class of drugs are used for blocking dopamine receptors in the brain
and dopamine is a neurotransmitter that increases delusions in the brain. The medicine used will
be Fluphenazine and its generic name is Prolixin.
This medicine was selected because it is a conventional antipsychotic drug that is used for
symptomatic management of psychosis in patients with delusional disorders and schizophrenia.
This medicine acts through the antipathy of post synaptic dopamine-2 receptors in nigrostriatal,
mesolimbic and tuberoinfundibular neural pathways (Muñoz-Negro & Cervilla, 2016). The

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postsynaptic dopamine-2 receptors gets blocked in the mesolimbic pathway that aims towards
the symptoms such as delusion. This is a first generation anti-psychotic medicine that should be
the first hand treatment for patients with delusional disorders. It is a member of phenothiazine-
derived neuroleptic antipsychotics and that includes medications such as chlorpromazine and
thioridazine, but fluphenazine is considered to be the most efficient drug treatment for this
mental illness. It is available in oral form as well as in the form of injections, which can be easily
used by the patient. This medicine has the half-life of 14 to 16 hours. The pharmacokinetics of
this drug suggests that the bioavailability of this medicine is 2.7% by mouth and it is eliminated
through feces and urine. The metabolism of this medicine is still unclear as the studies are still
being conducted (Matar, Almerie & Sampson, 2018).
This decision was taken because it is a conventional anti-psychotic drug, which is prescribed for
several mental disorders such schizophrenia and depression. It was expected that the woman who
was given this medicine will show less symptoms of delusions because this medication blocks
the receptors that are behind the mechanism (Rajab et al., 2017).
The result of the decision was mixed because the symptoms were decreasing but it had few side
effects that was also becoming visible such as sedation, constipation, dry mouth, dizziness and
hypotension. The expectation regarding the treatment of the disease was met but the issues was
the side effects that came with it.
Decision 2: atypical antipsychotic drugs
These medicines work similarly like conventional antipsychotic drugs but it also blocks the
receptors of serotonin that is another neurotransmitter linked with delusional disorders. The class
of drug is known as Risperidone and the generic name is Risperdal, and it is used for similar

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types of mental illness such as schizophrenia and delusional disorders. It is a second generation
medicine that gets metabolized with the help of enzyme cytochrome P450 2D6 (Spanarello &
Ferla, 2014). The reason for selecting this medication is that it works like the conventional
antipsychotic drug but it also targets the chemical known as serotonin that will work efficiently
to treat the delusional disorder in this woman. It is also used as an antidepressant and can be used
for treating patients with delusional disorder and depression. The pharmacokinetic of this drug
suggests that the volume of distribution for this drug is 1-2 L/kg and it binds to alpha1-acid
glycoprotein and albumin. These are available in oral tablets and oral solution and the peak
plasma levels can be achieved within one hour. The half-life of this medicine is 3 hours in
extensive metabolizers and 20 hours in poor metabolizers, and less than 1% is excreted through
feces (Kulkarni et al., 2017).
The expected outcome of this decision was the accurate treatment for delusional disorders as it is
used for this mental illness. These are atypical antipsychotic drugs and they have been useful for
such complications but these are second generation drugs, which might be the reason that it
might not function like conventional antipsychotic drugs. The results showed that she was able to
distinguish between delusions and reality slightly better than before, which is a change that was
noticeable. The drug did function according to the expectations but antipsychotic drugs has its
own side effects, which makes them dangerous for certain patients. The common side effects
found in this patient was depression, tremors, weight gain and dry mouth. The difference was
shown between the expected outcome and the actual results was not major because the
antipsychotic drug functioned properly as it was meant to do so (Skelton, Khokhar & Thacker,
2015).
Decision 3: atypical psychotic drugs

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Clozaril is another drug that is from the Clozapine class of drug, which is used for similar
psychotic conditions that include schizophrenia and delusional disorders. This medication was
selected because it is popularly used for this condition and it functions by reducing the secretion
of certain neurotransmitters by blocking the receptors such as serotonin and dopamine. It binds
itself to serotonin and dopamine receptors (Warnez & Alessi-Severini, 2014). An interaction
between GABA receptors and clozapine is also found as it helps in doing similar activities such
as decreasing the production of serotonin. It was expected that the drug will function according
to the antipsychotic drugs during mental illnesses and it will help in reducing the symptoms of
delusions this patient is suffering from. The bioavailability of this medicine is 60-70% and the
time for peak concentration is 2.5 hours after the oral dosage. The half-life of this medicine is 14
hours when the body is in steady conditions.
There was not much difference between the expected result and the actual results because it did
function properly targeting the symptoms of delusions. Changes were seen in the patient and it
looked like she was recovering after some evaluation (Whitney et al., 2015).
Ethical principles have to be considered when treating such patients with mental illness as it is
their right to know about their condition and the treatment they will be getting. However, it can
also lead to the risk of the patient running away from the treatment because they are unable to
observe reality due to their delusions. The nurse has to follow the principle of patient’s autonomy
in all the cases but due to the mental stability of the patient she can withhold the information as it
is for the betterment of the patient and it might value them in some other way. It is still a conflict
that exists in medical professionals when they have to deal with such patients as withholding
information is against a patient’s rights (Mittal et al., 2015).

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Conclusion
Patients with psychotic conditions and mental illnesses should be handled with optimum
care and the patient in this case who is suffering from delusional disorders should be given the
appropriate medicine after evaluating her condition. As it is a critical condition, the side effects
and pharmacodynamics should be taken care of considering the assessment of the patient after
prescribing the medicine. The ethical principles have to be respected, but the correct treatment is
a vital intervention.

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References
Asif, U., Saleem, Z., Yousaf, M., Saeed, H., Hashmi, F. K., Islam, M., ... & Saleem, F. (2018).
Genderwise clinical response of antipsychotics among schizophrenic patients: a
prospective observational study from Lahore, Pakistan. International journal of
psychiatry in clinical practice, 22(3), 177-183.
Kulkarni, K., Arasappa, R., Zutshi, A., Chand, P. K., Murthy, P., Philip, M., & Muralidharan, K.
(2017). Risperidone versus olanzapine in the acute treatment of Persistent Delusional
Disorder: A retrospective analysis. Psychiatry research, 253, 270-273.
Matar, H. E., Almerie, M. Q., & Sampson, S. J. (2018). Fluphenazine (oral) versus placebo for
schizophrenia. Cochrane Database of Systematic Reviews, (6).
Mittal, V. A., Dean, D. J., Mittal, J., & Saks, E. R. (2015). Ethical, legal, and clinical
considerations when disclosing a high‐risk syndrome for psychosis. Bioethics, 29(8),
543-556.
Muñoz-Negro, J. E., & Cervilla, J. A. (2016). A systematic review on the pharmacological
treatment of delusional disorder. Journal of clinical psychopharmacology, 36(6), 684-
690.
Rajab, T., Alsamarrai, O., Alhalabi, N., Addeen, S. Z., Mheish, O., Aljojo, A., ... & Abbas, F.
(2017). Fluphenazine decanoate (timing of administration) for people with
schizophrenia. The Cochrane Database of Systematic Reviews, 2017(10).
Skelton, M., Khokhar, W. A., & Thacker, S. P. (2015). Treatments for delusional
disorder. Cochrane Database of Systematic Reviews, (5).

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Spanarello, S., & Ferla, T. L. (2014). The pharmacokinetics of long-acting antipsychotic
medications. Current clinical pharmacology, 9(3), 310-317.
Warnez, S., & Alessi-Severini, S. (2014). Clozapine: a review of clinical practice guidelines and
prescribing trends. BMC psychiatry, 14(1), 102.
Whitney, Z., Procyshyn, R. M., Fredrikson, D. H., & Barr, A. M. (2015). Treatment of
clozapine-associated weight gain: a systematic review. European journal of clinical
pharmacology, 71(4), 389-401.