Assignment 2: Practicum – Week 1 Journal Entry and Journal Submission
XX female aged 72 presented to the ER accompanied by a family member with complaints of increased confusion and paranoia, as well as auditory verbal hallucinations. Other vital signs were okay apart from B/P that indicated hypertension at 151/84. Patient’s hallucinations center on her deceased son. Patient reported feeling sad sometimes. She is currently employed in a school. Her current medications include Zoloft 5 mg po daily; Abilify 150 mg po two times daily; Ativan 1 mg po every 6 hours prn for anxiety; Vistaril 25 mg po q6hrs prn for anxiety; and Motrin 600 mg q8 hrs prn for pain Schizophrenia Assignment Paper Essay.
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Diagnosis for the Client
The client manifests symptoms of schizophrenia. According to DSM 5, a patient with schizophrenia should experience minimum of two of the following symptoms: negative symptoms, catatonic behavior, delusions, disorganized speech and hallucinations. The rationale for this schizophrenia diagnosis is because the patient manifests auditory verbal hallucinations; delusions as depicted by the delusional imaginations about her son; negative symptoms such as poverty of speech; mood symptoms such as sadness; and catatonic behavior which is manifested by the client’s inability to respond to instructions (Leede-Smith & Barkus, 2014). The client also manifests psychological distress like depression.
Efficacy of Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) would be effective for this client. This is because CBT would focus on reducing the positive symptoms, depressive symptoms and also the negative symptoms the client is manifesting. CBT is also likely to improve functioning for the client. The client is also manifesting verbal auditory hallucinations and CBT can focus on the voices and reduce convictions in beliefs regarding the control of voices (Waters & Fernyhough, 2017) Schizophrenia Assignment Paper Essay. This is supported by Nowak et al (2016) who explain that CBT for patients with schizophrenia can also specifically target the psychotic symptoms such as hallucinations and delusions as well as the depression associated with the psychotic symptoms, and their effect on the life of an individual. RTCs have shown that CBT is effective in treating positive and negative symptoms in patients with schizophrenia at the end of therapy and the effects are sustainable. The expected outcome is that hallucinations and delusions present in the client would reduce because CBT has been shown to be effective in treating hallucinations and delusions. Additionally, it is expected that mood symptoms such as sadness, depression, and catatonic behavior would improve because CBT has been shown to be effective in treating mood symptoms and depressive symptoms (Nowak et al, 2016).
Legal and/or Ethical Implications
The most notable ethical/legal issue is the aspect of informed consent for the client. The client was involuntary brought for treatment by a family member. Whereas informed consent is an important element of care, this aspect presents some challenges for clients with mental illnesses such as schizophrenia because the mental impairment as well as psychotic symptoms may hinder an individual’s ability to make informed decisions regarding their treatment (Morris & Heinssen, 2014). Accordingly, ensuring informed and voluntary treatment can be challenging.
Secondly, the client is paranoid and hence a psychiatrist may be forced to withhold some information about her probable psychodynamics or the fundamental emotional needs. Ethically, the level to which a therapist withholds information might be regarded as disrespecting autonomy of the patient and can also be perceived as lying by omission. On the other hand, the therapist may be forced to withhold information due to other mutually exclusive values beneficial to the client (Bellesheim, 2016) Schizophrenia Assignment Paper Essay.
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