NR546 Week 3 Discussion: Drug to Treat the Diagnosis (Es) Or Symptoms

• Drug to Treat the Diagnosis (Es) Or Symptoms

A first-line treatment in the case of WS is applied to a patient, a 22-year-old male diagnosed with schizophrenia (F20.9). The antipsychotic drug that can be used is Risperidone. His positive and negative symptomatology of schizophrenia are in accordance with his symptoms, namely, auditory hallucinations, paranoid delusions, disorganised thoughts, and social/occupational decline. Since the level of his insight and functioning is low, pharmacological treatment is to be initiated to reduce the intensity of the symptoms and prevent further deterioration of his psychosocial condition.

Medication Class and Mechanism

Risperidone is a second-generation antipsychotic drug. It is an antipsychotic that works by blocking the dopamine D2 and serotonin 5-HT2A receptors of the brain. This is a two-fold receptor block that is beneficial in decreasing the positive symptoms, such as hallucinations and delusions, and also in the treatment of the negative symptoms, such as social withdrawal and flat affect. In addition, the first-generation antipsychotics have a higher risk of extrapyramidal side effects than the second-generation antipsychotics.

Prescription In Prescription Format

Patient: WS, DOB: MM/DD/YYYY 

Medication: Risperidone 1 mg tablets 

Sig: 3 days at bedtime, 1 mg orally, and then 1mg twice a day. 

Disp: #60 (sixty) tablets 

Refills: 0 

DAW: Yes 

Provider: [Your Name], PMHNP-BC 

DEA: X1234567 

Date: 07/22/2025

Evidence-Based Rationale

The effectiveness of risperidone in the treatment of schizophrenia has a lot of support in the literature. A huge meta-analysis conducted by Alamo (2022) established that risperidone outperformed placebo, and that it is equally effective as other second-generation antipsychotics in treating positive as well as negative symptoms. It can also be used on different phases of treatment, considering that it is an oral and a long-acting injectable medication, which is particularly handy with patients like WS with low insight as well as with low adherence to drugs. In addition, it supports the use of risperidone as a sensible initial therapy since it is tolerable and covers the symptoms.

Side Effects or Adverse Effects

Sedation, weight gain, appetite stimulation, fatigue, anxiety, dizziness, and insomnia are the most frequent side effects of risperidone (Thakur et al., 2020). Other, less critical but more serious side effects include extrapyramidal conditions (EPS), hyperprolactinemia, orthostatic hypotension, and an increase in QT interval, with the uncommon but serious risk of neuroleptic malignant syndrome. In particular, WS is at a great risk of gaining weight and metabolic side effects that ought to be carefully monitored due to his unhealthy eating and inactivity.

Diagnostic Testing

Pre risperidone baseline testing must include a CBC, a complete metabolic panel (CMP), fasting blood glucose, lipid profile, and prolactin level, and an EKG to rule out the existence of QT prolongation. They are also expected to check weight, BMI, blood pressure and waist circumference. The initial year would be followed by three months of monitoring weight, glucose, and lipids, and after another year. The usual laboratory readings include fasting glucose: 70-99mg/dl, A1C= <5.7, LDL= less than 100mg/dl, and prolactin= 4-15 ng/ml in males. When the symptoms occur, repeat EKGs are suggested, and a normal QTc interval in males is less than 450 ms.

Medication-Related Teaching Points

The primary messages to WS and his family are that he needs to take the medication as prescribed, even when he feels better, since he might experience a relapse of the symptoms by making a choice not to continue taking the medicine. They should be made aware that they should get medical care in case of any abnormal side effects, such as restlessness, stiffness, breast enlargement, or dizziness (Cleveland Clinic, 2024). They will also be warned to minimise their use of alcohol and marijuana, as drugs can be counterproductive to the effect of the medication and deteriorate psychiatric symptoms. A healthy diet and slowing down of physical activity should also be encouraged to avoid potential weight gain.