This assignment will focus on a client with schizophrenia spectrum and other psychotic disorders. First, the client’s HPI will be presented, followed by the recommended psychopharmacologic treatments. Secondly, psychotherapy choice for the client will be discussed. Finally, the medical management needs and community support resources for the client will be discussed. Finally, a follow-up plan regarding the client’s treatment regimen will be presented. Schizophrenia Spectrum and Psychotic Disorders
HPI and Clinical Impression for the Client
Mr. A, a 45-year-old man, is and without a job. His first mental disorder diagnosis was 10 years ago. Four months before presentation, he stopped taking the medications because he believed they were poison and he was overly talkative and disorderly. Over the following two months, she started having insomnia, laughed loudly without any reason and would give unfathomable and irrelevant answers whenever holding a conversation with his friends or family members. He stayed in the house always and stopped interacting with the family members ad would become extremely agitated whenever he felt anyone was intruding his privacy. He believed that “he was one of the disciples of Jesus and that God had come to him through a vision and instructed him to purify himself through isolation till the return of Jesus”. He stopped eating food made by his wife because he believed the food was poisoned. He also stopped sharing a bedroom with the wife because he believed the wife invoked spirits from the dead to invade the room. The client has also been hearing voices either taunting him or humiliating him. MSE revealed that his voice was high tined and he was disheveled. His speech was illogical and his thought content included religious themes, being Jesus’ representative, and persecution from the evil spirits. The client’s diagnosis is schizophrenia spectrum and delusional disorder as depicted by symptoms such as hallucinations, delusions and hearing voices.
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Olanzapine: Olanzapine is the proposed medication to treat and reduce the negative symptoms in the client. Olanzapine is a second-generation antipsychotic (SGA) and SGAs are the first treatment choice for individuals with schizophrenia (Patel et al, 2014). Studies show that olanzapine is effective in decreasing symptoms in clients with psychotic disorders and has minimal adverse motor effects and minimal extrapyramidal symptoms (Roudsari et al, 2015). Kumar et al (2016) also show that olanzapine improves negative symptoms, hallucinations, disorganized behavior, and also improves thought disorder in patients with schizophrenia. The client is manifesting majority of these symptoms.
Cognitive behavioral therapy (CBT): CBT will be used to target positive symptoms as well as hallucinations for the client. There will be 20 treatment sessions. During the first sessions, informed consent will be sought and a treating therapeutic relationship will be built and it will be maintained throughout the course of treatment (Laws et al, 2018). The second phase will involve a comprehensive symptom assessment of the client’s symptoms and functioning. Standardized rating scales will be used to assess any improvement. The third phase is the engagement phase where the therapist will explain to the client about the therapy. Socratic questioning will be used in order to understand the client’s coping mechanisms (Hazel et al, 2016). The therapist will also use vulnerability-stress model to help the client to understand the client’s stress perspective. ABC model will be used to help the client organize the confusing experiences by trying to link the client’s emotional distress with his experiences and his beliefs (Laws et al, 2018). The psychotic experiences will also be decatastrophized. Finally, maladaptive alternatives to the client’s presumptions will be done, followed by a discussion of coping mechanisms. Generally, it is expected that CBT will equip the client will the necessary strategies to combat the symptoms, and particularly the psychotic symptoms (Hazel et al, 2016).
Medical Management Needs
Medical management needs for the client encompasses the side effects of the medication, substance abuse, inactivity, as well as disorganized patterns of diet and hygiene and this can result to other comorbid medical problems for the client such as obesity, diabetes, and other infective disorders (Torres et al, 2014). Most importantly, it will be necessary to monitor the client’s substance abuse because it strongly impacts psychopathology, treatment regimen, and prognosis of patients with schizophrenia (Torres et al, 2014). In addition, it is important to educate the client and the family about medication adherence because the clinical aspects of the disease may impair his ability to follow the treatment regimen. In addition, the disease might impair the ability of the client to identify symptoms of an illness and seek appropriate treatment (Torres et al, 2014). Therefore, close monitoring of the client by the caregiver and family is necessary. Schizophrenia Spectrum and Psychotic Disorders
Community Support Resources for the Client
The client will be referred to a support group that has other individuals with the same disorder. This will help the client to reach out and interact with other individuals experiencing similar challenges (Webber & Meredith, 2017). Additionally, the client will be referred to the local social services that will assist him with affordable housing and assist in his medical expenses since the client is currently unemployed and he might not afford his expenses. Moreover, the client will be provided with educational materials regarding his condition and management (Villain & Kovess-Masfety, 2017). Finally, the client will be assisted to join an organization that offers stress-reduction techniques like yoga and breathing exercises.
Follow-up Plan and Collaboration
The client will be reviewed after every two weeks in order to assess his progress. A community social worker will be assigned to monitor the client’s progress and treatment adherence while at home. The social worker, as well as the GP, will keep reminding the client and the caregiver about the scheduled clinic appointments through the communication means such as phone calls. The psychiatrist and mental health nurse will collaborate throughout the client’s treatment duration.
The client is Mr. A, a 45-year-old man who manifests symptoms of schizophrenia spectrum. The psychopharmacologic treatment for the client is olanzapine that has been demonstrated to be effective in treating psychotic and negative symptoms in individuals with schizophrenia. On the other hand, CBT has been recommended as the appropriate psychotherapy for the client. Medical management needs for the client include his medication adherence, monitoring any substance abuse, nutrition, among other needs. Finally, the client will be referred to local support resources such as support groups and social services and he will be reviewed after every two weeks. Schizophrenia Spectrum and Psychotic Disorders
Hazel C, Mark H, Kate C & Strauss C. (2016). A systematic review and meta-analysis of low-intensity CBT for psychosis. Clinical Psychology Review. 45(1), 183-192.
Kumar S, Anish P & Rajmohan V. (2016). Olanzapine has better efficacy compared to risperidone for treatment of negative symptoms in schizophrenia. Indian J Psychiatry. 58(3): 311–316.
Laws K, Darlington N, Kondel T, Peter M & Sameer J. (2018). Cognitive Behavioural Therapy for schizophrenia – outcomes for functioning, distress and quality of life: a meta-analysis. BMC Psychology. 6(32).
Patel K, Cherian J, Gohil K & Dylan A. (2014). Schizophrenia: Overview and Treatment Options. Pharmacy & Therapeutics. 39(9): 638–645.
Roudsari M, Chun J & Theo M. (2015). Current Treatments for Delusional Disorder. Current Treatment Options in Psychiatry. 2(2), 151-167.
Torres F, Saldivia S, Grandon P, Xavier M & Manuel G. (2014). Unmet needs in the management of schizophrenia. Neuropsychiatr Dis Treat. 1(10): 97–110.
Villain M & Kovess-Masfety V. (2017). How Do People Experiencing Schizophrenia Spectrum Disorders or Other Psychotic Disorders Use the Internet to Get Information on Their Mental Health? Literature Review and Recommendations. JMIR Ment Health. 4(1): e1.
Webber M & Meredith F. (2017). A review of social participation interventions for people with mental health problems. Soc Psychiatry Psychiatr Epidemiol. 52(4): 369–380. Schizophrenia Spectrum and Psychotic Disorders