Mr. Dashiell, a 25-year-old man, is brought to the mental health unit for a checkup following some delusions. Upon interaction with the family members who brought him to the hospital, Dr. Francis, a Clinical Psychologist in the hospital found out that he always claims that some people were after his life and that the next door neighbor was involved. The medic also learned that Dashiell experienced hallucinations as he could sometimes talk by himself believing that he was talking to his long dead ancestors. According to the family members who shared this information, this strange behavior had lasted for more than two months. Observing the patient, he found out that he was dirty, disorganized, and he never seemed to care about his hygiene. Most of the time, Mr. Dashiell preferred sitting in isolation without interacting, eating, or doing anything.
His speech was poor, and he did not talk much. He would sit and fail to move even an inch even for a whole day. He also found that the patient was having a problem with his thoughts as he seemed to have a disorganized mind. The thoughts appeared to be incoherent. He found out that Mr. Dashiell had lost tangentially, suffered neologisms, suffered thought to block, and his thoughts were broadcasted. According to his family members, he had lost interest in his job and many activities he initially loved to undertake. He learned from Mr. Dashiell that he had suicidal ideations when he told him that he was tired of this life and needed a break from it. He said he wanted to drown in River Dell, which he later found out was close to his home. Problem statement – there is a need to come up with a relevant treatment plan for the patient so as to make sure that Mr. Dashiell gets better as soon as possible without any serious interference caused by means of strong medications and strict practices that may undermine his health instead of improving it.
Treatment Plan
Symptoms
Mr. Dashiell displays a number of negative schizophrenic symptoms. These relate to the lack of critical human abilities. First of all, he experiences the lack of emotion, and that can be witnessed in Mr. Dashiell’s inability to engage in activities that were fun before. Also, the patient displays a schizophrenia-specific low level of energy. Mr. Dashiell started to sleep more than he normally did and lost any interest in life lately. Accordingly, even the level of his motivation dropped significantly. Another symptom that contributes to the idea that Mr. Dashiell has schizophrenia is his blunted facial expression. The latter can also be characterized as affective flattening because the patient became less lively and gave up on the majority of physical movements that were typical of him in the past. From time to time, Mr. Dashiell also suffers from the inability to speak properly (this is known as alogia). One of the most critical symptoms is the patient’s lack of interest in interacting with other people. The low level of socialization also hints at the idea that these schizophrenic symptoms have to be treated as soon as possible. Expanding on the topic of socialization, Mr. Dashiell does not care if he has friends anymore. He does not want either to make or keep friends. The symptom of social isolation also contributes to the development of schizophrenia in Mr. Dashiell because he spends most of the day without his close ones.
Goals
The first goal is to eliminate the symptoms affecting Mr. Dashiell to make him feel comfortable. The symptoms that have been seen in the patient paranoid delusion, hallucinations depressions, suicidal behavior, substance use disorder, and thought disorders. There is also a need to promote his recovery and prevent his health from the incapacitating effects of schizophrenia to the maximum extent possible. Some of the effects observed on Mr. Dashiell include frequent agitation, disturbed behavior (including suicidal attempts), and command hallucinations (such as the conversations with the dead).
Objectives
One of the most important objectives of this treatment plan is to diagnose Mr. Dashiell to identify the cause of the condition. The second objective will entail treatment of the identified symptoms using a combination of drugs that will be prescribed after examining the patient. The last objective will involve an evaluation of the treatment outcomes by constantly monitoring any notable health improvements. This aim of the study is to examine the case of Mr. Dashiell, a 25-year-old patient who is suffering from schizophrenia. His management will involve a laboratory test and imaging investigations to determine related medical or neurological conditions.
5-Axis Diagnosis
Delusion
Mr. Dashiell is vividly undergoing delusion of persecutions as he believes that somebody close to him is after his life.
Hallucinations
When Mr. Dashiell claims to be talking to his grandfather, who died many years ago, he indicates that he is undergoing hallucinations. He is seen to be hearing voices and talking to nonexistence people who just exist in his mind.
Suicidal behaviors
The patient attempts to commit suicide. He admits having attempted to drown himself in River Dell, which shows that he has suicidal ideations; thus, he needs therapeutic interventions to help him to recover.
Social and Occupational Dysfunction
The family members report that Mr. Dashiell can no longer go to work as he used to do before the onset of the illness. He appears withdrawn and prefers to sit in isolation without talking to anybody. He cannot maintain proper personal hygiene.
Schizoaffective and mood disorders
These characteristics are not applicable in the case of Dashiell’s illness because there are no major depressive, manic, or mixed episodes that have occurred concurrently from the onset of the symptoms of the condition. The duration over which the mood episodes had occurred is short and, therefore, disqualifies the illness to be a mood or schizoaffective disorder.
Substance or General Medical Conditions
Dr. Francis has learned that the patient was not a drug addict. Thus, he was not suffering from the effects of drug abuse. The disturbance Mr. Dashiell is experiencing is due to the direct physiological effects of any drug.
Management and Treatment of the Symptoms
The management of Mr. Dashiell will involve an integration of medication, social support, and psychological counseling.
Investigations
Before the antipsychotic initiation medication is essentials to perform a neurological examination as a baseline component of medication since the drugs have effects on the neurological system. The patient in the context might be having motor disturbance (Xiao, Bartel, & Brekke, 2017). Schizophrenia is rarely characterized by specific laboratory physiognomies. However, the following tests should be carried out either at the initial stages of the condition, periodically, or after the patient undergoes treatment to determines other ailments that may assume similar characteristics as Mr. Dashiell’s.
- Complete blood count
- Liver, renal functioning, and thyroid test
- Urine testing for misuse of drugs including cocaine, opioids, alcohol, and cannabis
- Urine culture and sensitivity (to investigate if there are any urinary tract infections)
- CT scan or MRI of the head. This test is important in examining the patient for possible vasculitis, growths, subdural hematomas, and brain swellings.
- Glucose, electrolytes, serum methylmalonic acid, vitamin B-12, folate, and calcium levels.
- Electroencephalography (EEG).
It is also necessary to perform a lumber to examine the cerebrospinal fluids to rule out any inflammatory process that could be arising due to infectious diseases. Nonetheless, the neurological test is paramount to the determination of the patient’s cognitive strength and weaknesses, which are beneficial during treatment.
Pharmacotherapy
Antipsychotics are the primary drugs used in the treatment of schizophrenic conditions. They are useful in the treatment of the positive schizophrenic symptoms. Based on scientific research, every patient has different reactions to antipsychotic medications. Treatment of schizophrenia may perhaps require the physician to use several approaches to find out the best and effective drug for the patient. If the medication is successful, it is essential to continue with the medication since a stop in medication can encourage schizophrenic condition, which can be worse.
Mr. Dashiell’s will undergo electrocardiography (ECG) before initiation of antipsychotic treatment and when needed, notably if the dose is increased. The first antipsychotic medications may be chlorpromazine 25-50mg IM TDS or QID and haloperidol 1.5mg IM TDS or QID depending on the severity. These are known as dopamine D2 antagonists. If the patient does not respond to this treatment then, the second generation of the drugs are used, which include olanzapine10 mg IM OD or BD, and clozapine 12.5mg PO OD or BD. For Mr. Dashiell, lower doses of first-generation antipsychotic will work well since he developed the episode later (Coon et al., 2014). The failure of the first generation drugs raises a need to introduce second-generation doses such as olanzapine 10mg OD IM. However, caution should be taken since olanzapine and clozapine drugs may result in weight gain. Scientific research has proven that an average of about 100 people who are taking clozapine lose the ability to produce white blood cells required to fight infections. However, due to its effect on the production of the blood cells, the patient might need regular blood check up to ensure that its production does not go below the required level (Coon et al., 2014).
Adverse Effects of the Antipsychotics
Mostly, patients who have used antipsychotics have reduced adherence to medication since they are afraid of their harmful effects. Frequently, they experience Akathisia (a subjective sense of restlessness, irritability, mental unease, and dysphoria), dystonia (painful muscle cramps that affect the neck and the head, and could extend to the limbs and truck), neuroleptic malignant syndrome (high fever, altered mental state, Parkinsonism), and tardive dyskinesia (TD).
Patient Education
As much as antipsychotic medications are given to decrease Mr. Dashiell’s condition, it is important for him to accept his mental condition. This will help him to take a proactive role in his management and self – help hence enhancing his recovery (Ndetei, Khasakhala, Meneghini, & Aillon, 2013). He could do so by making lifestyle changes, attending medical therapy and adhere to the medications. He is also expected to associate himself with the people who see beyond his psychological condition, rather than accepting stigmatization from people who have a negative attitude towards schizophrenic patients. He is also expected to communicate with his doctor about his condition and address the side effects of the treatment. By doing so, he will be making the doctor understand more of his condition and decide on whether to maintain the same treatment or change to another regime of antipsychotic medications (Leucht et al., 2013). Dr. Francis should also advise Mr. Dashiell to set life goals and work towards achieving them.
Psycho-Social Treatment
Mr. Dashiell will highly benefit from the psychosocial treatment, which has several approaches. The first method involves psychotherapy sessions that will help to decrease the lack of motivation and uplift his ability to communicate with others besides reducing the effects of distancing himself from other people. During this treatment plan, the therapist will give Mr. Dashiell an opportunity to express his feeling and thoughts. This exercise will provide more information about the patient’s condition. It will establish a relationship necessary for the therapist to discuss and explain psychotic symptoms to the patient in real terms; hence, diffusing the distressing effect (Halford, 2014). Secondly, Mr. Dashiell will benefit from assertive community treatment. In this action, the caregivers will be making frequent contacts with him, monitor his medication adherence, and assess his health and psychosocial needs. The health providers will also offer emotional support to the victim’s family. As a result, it will reduce the relapse of the condition and encourage his healing and comfort (Haslam, 2014).
Also, Mr. Dashiell needs a comprehensive program that will help him to adjust his behaviors on general health such as being clean to avoid opportunistic diseases that he might contract. He also requires education on the importance of avoiding drugs and other harmful substances that pose negative effects on health.
Recovery
Consistent with Mr. Dashiell’s condition, it is crystal clear that his illness demands more than just medication and counseling. In the recovery stage, Mr. Dashiell will learn about how he will live his life and enjoy his favorite activities in the best way possible. The stage will enable the patient to manage his symptoms and be an active member of the society. During recovery, the patient will receive social education and training in particular job skills that will enable him to merge well with other healthy people in the community. For instance, the patient will be taught about schizophrenia with a view to making him understand and accept his condition. Last but not least, social skills training will help the patient develop lifestyle skills such as managing frustrations, coping with situations, and good communication with other people in the society.
Conclusion
This paper has examined a hypothetical case of Mr. Dashiell, a 25-year-old patient who has just been diagnosed with schizophrenia. His management involves the laboratory and imaging investigations to rule out any other medical or neurological conditions. His treatment plan involves medication, psychotherapy, social therapy, family education, patient’s education, and recovery of the patient. The resulting therapeutic procedures involve the use of antipsychotic drugs which include olanzapine, clozapine, and chlorpromazine. Psychotherapy entails one-on-one communication with the patient to understand his situation and encourage him to undergo throughout the recovery process. It also encompasses the provision of practical and emotional support. Health education on the illness and providing advice to the patient are paramount to the management of this condition. Teaching the patient about the necessary skills required to improve the functioning of his brain will provide a good orientation to reality. Finally, offering training to his parents, guardians, and friends in the patient’s condition plays a central role in the promotion of the healing process.
Reference List
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Haslam, M. (2014). Psychiatry. Amsterdam, Netherlands: Elsevier Science.
Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Örey, D., Richter, F.,…Kissling, W. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: A multiple-treatments meta-analysis. The Lancet, 382(9896), 951-962.
Ndetei, D., Khasakhala, L., Meneghini, L., & Aillon, J. (2013). The relationship between schizoaffective, schizophrenic and mood disorders in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya. African Journal of Psychiatry, 16(2), 110-117.
Xiao, R., Bartel, R., & Brekke, J. (2017). Comparison of neurocognition and social cognition between schizoaffective disorder, mood disorders, and schizophrenia. Social Work Research, 41(3), 169-179.