Kootu Bulambo is a 34-year-old African female admitted to your psychiatric inpatient unit with worsening social withdrawal, apathy, and poor independent functioning over the past year.
Two years ago, she had a brief admission when she displayed aggression and persecutory delusions believing that male and female police officers were frequently having sex with her and that she was being recorded through cameras. She was not treated with psychotropic medications at the time. From the records, her symptoms appear to have remitted spontaneously and she was discharged. She was lost to follow-up thereafter.
Kootu is from Zimbabwe and was granted asylum status approximately 10 years ago. She was employed with good social functioning for about eight years. Following her first admission, she lost her job and her apartment due to not paying rent.
For the past six months, she has been living at a homeless shelter and has become increasingly reliant on staff for her basic needs. Her self-care is poor, and apathy is felt to be the prominent feature. She has very limited funds and has not claimed federal or state benefits. Her interaction is very limited. Shelter staff have not witnessed any behavior indicative of positive psychotic symptoms and there were no incidences of aggression or violence.
On this second admission, Kootu was noted to have poor self-care, weight loss, and poor motivation. There were no objective symptoms of clinical depression and she denied ongoing low mood. She did not engage with staff and refused physical examination, blood tests, and oral medication. Positive and Negative Syndrome Scale (PANSS) scoring was completed, yielding 18, 36, and 64 on the positive scale, the negative scale, and the general psychopathology scale, respectively. Prior, she had had two doses of aripiprazole short acting intramuscular injections without any adverse effects.
Questions
From your perspective as Kootu’s psychiatric nurse practitioner, answer the following questions in your initial post.
What diagnosis would you consider for Kootu?
You decide to start a long-acting injection. What are the pros and cons of starting a long-acting injection? What barriers are you going to run into with her being homeless?
Pick an appropriate long-acting injection and explain the mechanism of action, starting dose, patient education, baseline labs that need to be done, and possible food/drug interactions that you must be aware of while you have her on this injection.
What additional challenges will you face with Kootu due to her being homeless and without an income or financial support? Call a local lab and ask about what it costs for the blood tests you want her to have. Call a local pharmacy and ask how much the medication would be out of pocket.
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