Introduction: Schizophrenia is a mental condition affecting an individual’s thought process, feelings, and perception. It is principally marked by psychosis, affecting personal, social, and family life. Additionally, the condition significantly affects one’s education and occupation (WHO, 2022). The WHO (2022) asserts that people with schizophrenia often experience stigma, discrimination, and violation of their human rights. Their challenges are worsened by the fact that they have limited access to mental health care. Homelessness is a significant factor contributing to the exacerbation of mental health conditions. As in this case study, this essay analyzes various aspects of schizophrenia, including diagnosis, treatment, and community resources available for its management, concerning Kootu.
Diagnosis for Kootu
From the case study, Kootu has residual schizophrenia. She has a history of positive schizophrenia symptoms- aggression and persecutory delusions. She now has negative symptoms, including poor motivation, poor self-care, and weight loss. Additionally, she scored 18, 36, and 64 on PANSS, confirming a diagnosis of schizophrenia with prominent negative symptoms.
Pros and Cons for Long-Acting-Injections (LAIs) and Barriers Associated with Homelessness
Adhering to schizophrenia medication is vital to achieving a stable and good quality of life. However, only a few people can keep up with daily medications. Most forget or give up and quit, especially when they start feeling better. As a result, they experience a lot of schizophrenia relapses and cannot maintain a stable life. Health care providers and patients can easily keep track of adherence to medication with LAIs as they are administered every two to three months (Miyamoto & Wolfgang, 2017). Also, LAIs are better for people who often forget to take their pills, even though the oral drugs relieve their symptoms. Kootu is homeless, and this implies that she can easily misplace her medications; therefore, an LAI would be more appropriate for therapy.
On the flip side, one has to put effort, follow set appointments, and go to the clinician for the medication. Also, one experiences the common side effects of injections such as pain during the shot, and post-injection delirium sedation experienced by less than 1% of patients after olanzapine pamoate injection (Miyamoto & Wolfang, 2017).
As a homeless and jobless patient, several barriers are likely to impede her successful treatment. First, financial constraints might contribute to non-adherence through a lack of money to purchase medications, nutritious food, and transport. Semahegn et al. (2020) establish that antipsychotic medications are associated with appetite stimulation which poses an immense economic burden on patients with financial insecurities.
Another barrier to patient treatment is her attitude toward medication. She has already declined a physical examination, lab tests, and oral medication. Semahegn et al. (2020) note the significance of patient attitude to treatment adherence. Those with negative attitudes had poor compliance and were more likely to seek alternative treatment strategies such as traditional or religious treatment options.
According to Thomas and Saadabadi (2018), olanzapine exerts action on dopamine and serotonin receptors. It binds to dopamine D2 receptors, inhibiting dopamine action in the mesolimbic pathway. The effect of inhibiting D2 receptors’ activity decreases the positive schizophrenia symptoms. These symptoms include delusions, hallucinations, and disorganized thought and behaviour. Also, olanzapine binds to serotonin 5HT2A receptors and antagonizes their actions in the frontal cortex. This action reduces negative schizophrenia symptoms such as poor motivation, poor attention, withdrawal, and flat affect.
The starting dose of olanzapine LAI is 405mg every four weeks, given as an intramuscular injection deep into the gluteus during the first eight weeks. After eight weeks, the olanzapine maintenance dose is administered at 300mg every four weeks intramuscularly (Citrome, 2021).
In most patients, one common side effect of olanzapine injection is post-injection delirium/ sedation syndrome. Even though it affects only 1% of the patient population, patients should take caution and have someone accompany them for the medication for close monitoring and safety (Thomas & Saadabadi, 2018). The symptoms completely resolve in 72 hours and are present with every new injection (Thomas & Saadabadi, 2018). Also, patients should note that food does not affect olanzapine’s absorption; thus, they can take it with or without food. Lastly, patients on this drug should avoid alcohol as it potentiates the central nervous system’s adverse effects and causes orthostatic hypotension (Thomas & Saadabadi, 2018).
Before commencing treatment, it is key to obtain baseline lab values of hepatic and renal function tests. Olanzapine is extensively metabolized in the liver by the cytochrome P450 system and glucuronide enzymes (Thomas & Saadabadi, 2018). Therefore, hepatic impairment can decrease the drug’s efficacy. Obtaining liver function tests at the onset of treatment can inform the clinician’s decision on the continuity of therapy with this medication. Also, the products of metabolism are excreted through urine and feces (Thomas & Saadabadi, 2018). A normal renal function is thus necessary for the clearance of the drug from the body. Obtaining renal function tests at the onset of the treatment is crucial in determining the pat of treatment.
Olanzapine interacts with specific foods to produce undesirable effects. For instance, it interacts with grapefruit and juice, and tobacco products to minimize the drug’s efficacy. It also interacts with alcohol to potentiate the CNS side effects and cause orthostatic hypotension (Thomas & Saadabadi, 2018).
Additional challenges associated with being homeless
One of the challenges that might impede Kootu’s treatment is the lack of proper social support. She does not have her family here, thus relying on the homeless shelter staff for social support. Strong evidence suggests poor compliance with treatment regimens when there is no social support (Semahegn et al., 2020). Lack of family support and social assistance from healthcare providers and other relevant support groups increases one’s susceptibility to stigma and discrimination and, consequently, poor adherence to drugs.
Additionally, being homeless predisposes one to several illnesses that can negatively impact their health-seeking behavior and compliance with antipsychotic medications. Co-morbidities with other mental disorders and physical illnesses significantly impair adherence to drugs (Semahegn et al., 2020). The most common illnesses among the homeless are malnutrition, respiratory tract infections, and mental health problems such as depression. Malnutrition is particularly a challenge in this patient since antipsychotics stimulate one’s appetite, requiring them to feed generously. These factors hinder the patient’s efforts to seek proper treatment and adhere to the existing treatment regimen.
Community support is necessary to keep individuals with mental illness going. They meet other people with similar diagnoses and situations on these platforms and find encouragement to strive and live a quality life. One of the community resources is the NAMI in California which prioritizes treatment access and housing of people with mental illnesses. They are available on physical and online platforms for their meetings. For any inquiries, they are available at https://namica.org/ .
Citrome, L. (2021). Long-acting injectable antipsychotics: what, when, and how. CNS spectrums, 26(2), 118-129.
Miyamoto, S., & Wolfgang Fleischhacker, W. (2017). The use of long-acting injectable antipsychotics in schizophrenia. Current treatment options in psychiatry, 4(2), 117-126.
Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Systematic reviews, 9(1), 1-18. https://doi.org/10.1186/s13643-020-1274-3
Thomas, K., & Saadabadi, A. (2018). Olanzapine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532903/#:~:text=Go%20to%3A-,Mechanism%20of%20Action,at%20the%20post%2Dsynaptic%20receptor.
World Health Organization (WHO). (2022). Schizophrenia. Retrieved from https://www.who.int/news-room/fact-sheets/detail/schizophrenia
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