Introduction
The DSM-5 used for the diagnosis of adults is also utilized to diagnose children with schizophrenia. The criteria for schizophrenia patients such as Bianca involves two or more characteristic symptoms such as hallucinations, delusions, catatonic behavior, and disorganized speech must be present in one month. Evidence that shows the presence of the disorder must be existent for at least six months and must be associated with a significant decline in social functioning (McClellan, & Stock, 2013). Bianca already shows symptoms such as the refusal to attend church service, and she refuses to bathe. The DSM-5 highlights the signs already evident in Bianca.
Does Bianca meet the Criteria for a Schizophrenia Diagnosis? Why or why not?McClellan and Stock (2013) argue that a thorough assessment and accurate diagnosis must be utilized to ascertain the presence of schizophrenia. The prognosis should be based on characteristic patterns of illness and overt signs on the mental status examination. One of the diagnoses of schizophrenia involves checking for schizoaffective disorder. The process consists of the evaluation of psychotic symptoms and mood episodes. At this point, Bianca meets the criteria for a schizophrenia diagnosis. Bianca's affect is flat and has poor interpersonal skills. These symptoms coupled with hallucinations and the lack of sleep at night ascertains that Bianca is ready for the diagnosis.
Based on her current Medication, Make a Recommendation for Change. Note the Mechanism of Action, Metabolism, and Excretion of the new Medication. What Type of Metabolic Management Strategy would you Implement? Include what you would Monitor (Physical and Laboratory) and on what Schedule you would Evaluate Metabolic Changes.
One recommendation for change that should be applied in the case of Bianca is baseline and follow-up monitoring of symptoms, side effects, and laboratory tests. The metabolic management strategy will involve physical and laboratory evaluations. I will assess any symptoms of weight gain and utilize laboratory tests to evaluate the risks of hyperlipidemia. I will use laboratory tests to evaluate long-term risks of diabetes, patient's body mass index, and document the patient's blood pressure levels and fasting glucose. The metabolic changes will be evaluated during home and laboratory visits.
What Treatment Plan would you use to Manage Bianca's Symptoms?
The best treatment plan for Bianca would be hospitalization and home visits. Admission to the hospital would be to monitor her metabolic changes such as weight gain. Home treatment will provide Bianca with the opportunity to continue with her life while undergoing treatment.
What Level of care would you Recommend?
Bianca needs to be monitored day and night to watch her symptoms closely and record any positive changes.
How would you Coordinate that care and Track her Progress?
I will work closely with Peace, and we will share duties together. I can take the day shift and provide the grandmother with time to rest while I monitor Bianca's symptoms. Peace can then takeover during nighttime.
What type of Therapy would you Recommend? Provide Rationale to Support these Recommendations.
I would recommend cognitive-behavioral therapy. Even after undergoing through antipsychotic treatment, schizophrenia patients still suffer from social impairments culminating form negative symptoms; thus, Morrison (2009) argues that these negative symptoms can be mitigated through well-designed cognitive-behavioral techniques such as activation strategies.
How would you Work the Family as a Unit?
I will first educate the family about schizophrenia, its symptoms, and treatment methods. The second step would be to orient the family about some of the ways to treat family members with schizophrenia to feel appreciated and loved.
What Issues would you prioritize and why?
First issues to prioritize would be family education and family orientation. Family members have to undertake learning sessions about schizophrenia to boost their understanding of the condition. The knowledge will enable them to have a positive perspective about the disease and realize the responsibility to take care good care of the patient.
References
McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), pp. 976-990.
Morrison, A. K. (2009). Cognitive behavior therapy for people with schizophrenia. Psychiatry (Edgmont), 6(12), pp. 32-39.
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