Demographics of the Patient
- Peter is 18 years old
- He lives at home with his parents.
Chief Complaint/Identifying Features
- The patient has gained 20 pounds without any diet changes
- His glucose is at 145
- He has not been taking his Olanzapine as prescribed.
Past Psychiatric History
- The patient was recently diagnosed with schizophrenia
- His psychotic break manifested at the age of 16 where he got into a car accident and damaged the family car.
Past Medical Trials
- The patient was put on Olanzapine medication
- He has been having scheduled appointments with a psychiatric mental health nurse practitioner
- The only legal issue that he has gotten into is a bad road accident in which he blamed alcohol use.
Diagnosis
From his behavior and past diagnosis, it can be asserted that the patient is suffering from schizophrenia. The patient has shown symptoms that are consistent with the disease. On the same breath, his recent behaviors contributed to confirmation of the disease. According to Agius, Goh, Ulhaq and McGorry (2014), one of the main symptoms of schizophrenia is paranoia. In many cases, patients suffering from schizophrenia believe that everyone is against them. When Peter had his psychotic breakdown after the car accident, he felt that his family believed it was as a result of his schizophrenia. He vehemently denied the relation and blamed the accident on disillusions brought on by alcohol use. It can also be argued that Peter is still in denial over his condition as he believes that everyone is ganging on him yet he is not sick. As a result, the patient has defaulted on taking his Olanzapine medication.
It can also be argued that the patient suffers from loss of memory, a condition that is also common with most schizophrenic patients, resulting in his failure to take his medication. The weight gain that Peter is experiencing is the reason why his insulin levels are at 145. With schizophrenic patients, the different antipsychotics that are prescribed to them have several side effects, including obesity (Iriondo, Salaberria, & Echeburua, 2013). It is for this reason that Peter is gaining weight albeit not significantly changing his diet. The weight gain is causing his insulin levels to shoot up.
Impact of the Psychiatric Disorder
Due to his schizophrenic state, Peter’s quality of life and functionality have been affected in very many ways. First, the patient has regular hallucinations that affect his behavior making him see, hear and smell things that do not exist. Many a time, the hallucinations have disorganized the patient’s thoughts due to the delusions that he experiences when having them. Apart from the disorganized thoughts, the patients also suffers from constant jumbled and incoherent speech that makes it difficult for him to communicate effectively. Cannon (2014) states that the inability to successfully communicate with people could easily lead to depression in schizophrenic patients as they may feel like they are not understood and might end up feeling lonely. The most worrying aspect of depression is the fact that the patient may give up on life and stop taking proper care of themselves (Reed & Shearer, 2012). This can be seen through their inability to perform the daily basic activities of life such as taking a shower, grooming themselves and cleaning their rooms.
Planning and Treatment
Due to the fact that the disease has progressed significantly, it is suggested that a slightly higher dose of Olanzapine be prescribed. This will also suffice due to the fact that the patient has not been taking his medications as prescribed. With schizophrenic patients, treatment is usually long term meaning that this dosage will need to be continued even after Peter starts to improve, albeit occasional changes in dosage. Continuous medication will reduce the patient’s chances of having future psychotic episodes.
According to Nordentoft, Jeppersen, Pertesea, Bertelsen and Thorup (2012), it is difficult and near impossible to completely cure schizophrenia. The medication that is administered aids in reducing and managing symptoms such as hallucinations, paranoia, delusions, disorderly thinking and depression. Once these symptoms have been dealt with, it will be possible for Peter to have close to normal human interactions that can significantly reduce his depression.
Peter will also have to continue engaging in therapy. It is suggested that the patient be scheduled for group therapy sessions to ensure that he does not feel alone. The therapy modality should also include his parents as they will be able to understand him more and vice versa.
Apart from medication and therapy, there are other treatment methods that can be used in Peter’s case. One of them is regular exercise which is a form of self-help medication. This will not only help with the weight gain that is contributing to depression but also boost the patient’s energy levels and help him focus. If the patient finds it difficult to exercise alone, he can seek community centers with facilities that support schizophrenic patients.
Implementation and Coordination
Peter’s family will have to form a strong partnership with community health centers that cater for schizophrenic patients. The said partnership will not only be beneficial to Peter but to his family as well as they will have the opportunity to interact with other families that are going through the same thing. Kendall (2016) notes that in most psychiatric treatment processes, the caregivers are usually forgotten yet they also undergo emotional, and at times physical turmoil. With such a partnership, Peter’s parents can find a support group to help them take care of their son better.
Health Teaching and Health Promotion
In symptom management on schizophrenia, it is important for family members to understand that the patient feels like he or she is misunderstood, thus, they should not be judgmental (Iriondo et al., 2013). In instances where a patient has a psychotic breakdown, his or her family needs to try and calm the patient down, instead of reminding him or her that he/she is sick. The family should not tie sickness to the bad mood during a psychotic breakdown. Patience is the key.
Peter’s medication and intake also need to be monitored by his parents at all times. In this case, the hazard is not so much in overdosing but in forgetting to take medication. Peter has a record of forgetting to take his medication and if his parents do not ensure he takes the medicine on time and as prescribed, then the patient will fall back on his treatment plan. The best self-care activities for Peter include daily exercises and a healthy diet to reduce his weight and increase his energy.
Outcomes
Schizophrenia is a disease that requires long term treatment (Agius et al., 2014). This means that Peter will have to be on constant medication and therapy for the better part of his life. It can be detrimental to him if he skips his medication. It is important that his parents ensure that their insurance plan is updated as the costs can be expensive in the long run. For the community based activities such as centers that cater for schizophrenic patient activities, the family can look for local facilities that offer services at a cheaper price.
Expected Outcomes
- Through therapy (both group and individual), it is expected that Peter will be able to communicate more about his feelings, thus, reducing his depression. With time, he will no longer need antidepressants.
- His thoughts will be more organized after a period of time, in turn, resulting in a more coherent speech.
- He will have few psychotic breakdowns.
Client Goals
- The first goal is to make Peter more socially aware of his environment in an attempt to make him actively participate in daily activities. Once the patient stops feeling objectified and judged, it will be easier for him to connect with people.
- Leading a healthier lifestyle is the second client goal. To avoid obesity, Peter should eat healthier foods and exercise regularly. It is expected that this, alongside proper medication, will have an impact in bettering his life and helping him have more organized thoughts.
Assessment Tools
- Being 18 years old, Peter will be responsible for writing a self-report that will include, but should not be limited to any of the changes that he will have noted after every three weeks. In this report, he will also include the challenges that he is facing so that the psychiatric mental health nurse practitioner can keep track of his progress.
- Provider administer tools include regular blood sugar tests and weight tests that will determine whether he has changed his lifestyle.
The self-assessment tests are important as they show Peter’s state of mind, whereas, the provider administered tools reflect whether the physical is in line with the mental.
References
Agius M., Goh C., Ulhaq S., & McGorry, P. (2014). The staging model in schizophrenia and its clinical implications. Psychiat Danub, 22, 211- 220.
Cannon, T. (2014). Clinical and genetic high risk strategies in understanding vulnerability to psychosis. Schizophrenic Research, 79, 35-44.
Iriondo M., Salaberria, K., & Echeburua, E. (2013). Schizophrenia: Analysis and psychological treatment according to the clinical staging. Actas Españolas de PsiquiatrĂa, 41(1), 52-59.
Kendall, P. C. (2016). Child and adolescent therapy: Cognitive behavioral procedures. New York, NY: The Guildford Press.
Nordentoft, M., Jeppersen, P., Pertesea, L., Bertelsen, M., & Thorup, A. (2012). The rationale for early intervention in schizophrenia and related disorders. Early Intervention Psychiatry, 53- 57.
Reed, P., & Shearer, N. (2012). Perspectives on nursing theory. Philadelphia, PA: Wolters Kluwer.