Schizophrenia Case Analysis

Introduction

The main reason for Andy's referral was due to the concerns that had been raised by his GP. People who live with schizophrenia exhibit persecutory delusions, auditory hallucinations, thought insertions, running commentary, passive suicidal ideation, isolative behavior, and misapprehension of control among other characteristics (Jauhar et al.2014). In the nursing psychology, DSM-IV-TR gives a precise procedure that should get followed when analyzing different cases for diagnosis of Schizophrenia. The video for the psychosis teaching provides an insight into the diagnosis method and process applied according to DSM-IV-TR.

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Part A

Andy is a 21-year-old who is seeing the psychiatrist due to the concerns which had been raised by his GP. The psychiatrist had got a call from the family doctor who explained Andy's condition. His family knew the issue with Andy through his roommates. In the past, Andy complained that his roommates had planted an MI5 in his head with the aim of controlling him. "They are putting stuff in my brain" (3:50). The history presents an individual who is delusional and also presents a case where Andy is preoccupied with the MI5, and he holds that his roommates are working with MI5 and have put the MI5 material in his head to monitor him. In a case where he says, "It is MI5" (4:15) shows a preoccupation with MI5. Passive suicidal ideation is also part of the symptoms of schizophrenia.

Andy admitted to having taken the drug and continued to take drugs. "I thought of taking some pills" (7:00). Andy also admits that he has not got into a fight with anybody. "I am not that kind of person...." (7:25) which implies that he has not turned out to be violent towards any of his roommates or anybody at home; he has never shown any visible sign of violence. Andy also has a history of Bhang and taking some pills. This indicates that Andy may have drug-induced psychosis a condition of Schizophrenia. The historical facts and the risk assessments as done by the psychiatrist suggest that Andy is undergoing hallucinations a problem which has arisen from the use of Bhang. His family had referred him to the family doctor who was also worried and saw him to the psychiatrist.

Andy has been a college student for the past four years with no other occupation presented. Andy has no prior violent behavior, and he has not engaged in any criminal activity before the interview. However, he has admitted that he has contemplated committing suicide by taking some pills. There are also no current treatments based on his condition. Andy also takes drugs as revealed by the risk assessment that finding the historical facts about his circumstances. He presents cases which are linked to the health of schizophrenia.

Part B: Mental State Examination

Andy appeared frightened, and he was also anxious. His behavior was such that he was not making the important eye contact and at the same time he was experiencing hallucinations, both the auditory hallucinations and control delusions. Andy had a disorganized behavior. He was also exhibiting a flat affect which was also characterized by debilitating traits which made him resistant to the interventions. His mood was that of a depressed individual with suicide thoughts running through his mind where he was thinking of taking some pills to end his life. Andy's speech was disorganized from the onset of the conversation. The thought form of Andy was presented by the illogicality of the things that he said denoted his derailment of speech.

The thought content exhibited by Andy was that of depressed cognition, phobias, and suicidal thoughts in his mind. His perception was such that he was showing distortion of reality with delusions about control and the auditory hallucinations about his roommates discussing him. Andy's intellectual functioning was also clouded by the misconceptions and preoccupation with the MI5. Andy's insight and judgment were that exhibits delusions and hallucinations of varying degrees. His judgment was also impaired from the case presented. In the risk assessment, Andy did not offer a violent attitude. However, he presented a suicidal part of psychosis.

Andy's appearance was that of an anxious, and his behavior was such that he had a speech which was derailed and that affected his communication. He was also afraid of making and maintaining the eye contact with the doctor. He had delusions and hallucinations in his perceptions while at the same time presenting illogical intellectual functioning which was connected with the preoccupation. The risk assessment revealed that he was not violent even though he presented the characteristics that defined him as suicidal. Andy's primary diagnosis was drug-induced psychosis which is schizophrenia. Andy, therefore, needs psychiatrist help and he requires the attention of specialists to overcome his condition. The symptoms that he has presented are those of schizophrenia (Gold et al.2013)

Part C: Care Plan

The evidence-based interventions that can be used in solving the problem include medication practices and methods, psychosocial interventions, and the information technology interventions. The first process that can be applied to the case of Andy is the disease management system and the chronic care model. The models are essential in ensuring that the patient gets the right treatment.

Application of Medications

The primary objective of the medication in schizophrenia is to eliminate the signs and symptoms of the schizophrenia. When applied to Andy the aim would be to minimize the symptoms and ultimately eradicate the delusions and hallucinations of Andy. This method, however, has side-effects to the patients. The medications that can be applied include antipsychotics including aripiprazole, asenapine, cariprazine, and clozapine (Hasan et al., 2012). The medications are either first-generation antipsychotics or second-generation antipsychotics. The difference between the first generation and second generation antipsychotics is the side-effects from the use of the medicines. The recommended medication for Andy is second-generation antipsychotics since the side effects are not as dire as in the case of first-generation antipsychotics (Demjaha et al.2012). The therapy can be achieved when applied continuously with other methods with the objective of attaining quick recovery and having control of his life.

Psychosocial Interventions

Psychosocial interventions can also manage the case of Andy. The primary objective of using psychological intervention is to enable social interaction with other individuals in the process of ensuring that Andy gets back to normal (Bustillo & Weil.,2016). Psychosocial intervention can be applied together with the medication and even after the psychosis has receded after some time (Razali et al.2000). The purpose is to stop the persecutory delusions that Andy is exhibiting. Social skills training are necessary with the objective of improving the communication by enhancing the speech of Andy. This method is important is reducing the delusions and if possible moving Andy to another location will work with the objective of bringing back the social life of Andy. Family therapy is also a psychosocial process that can make Andy to be integrated into the society and get understood in the process. The psychological method can be used to either minimize the problem or eliminate the problem.

The psychosocial methods are one of the ways that are applied in the management of the schizophrenia condition where the delusional impacts and the hallucinations are reduced (Vizzotto et al., 2015).

Electroconvulsive Therapy

The primary objective of electroconvulsive therapy is to reduce the depressions that are faced by the patient. In this method, seizures are electrically administered to the patients with the aim of reducing the condition of schizophrenia (Strip et al., 2018). Andy has experienced disorders that are considered to cause depression. Administering seizures will help in the maintenance of the depressions. The electroconvulsive therapies, however, differ from one individual to the next and also change according to the case of the individuals (Oresmus et al.2015). In the case of Andy, the depressions form part of the delusions that affect the perceptions of Andy. The electroconvulsive therapy is one of the methods that provide the evidence-based.

The electroconvulsive therapy is one method that is considered to be productive with it effective rate estimated to be 50%. However, most of the people who respond positively to the treatment show relapse within the 12 months of treatment. This shows a new trend that is much as it helps in treating the condition it also has the disadvantage of regression by those who apply the method to the management of the depression of the schizophrenic state. The case of electroconvulsive therapy is one which is essential in the management in the short run but should be followed by other methods in the management of the problem.

References

Bustillo, J., & Weil, E. (2016). Psychosocial intervention for schizophrenia. UpTo Date.

Demjaha, A., Murray, R. M., McGuire, P. K., Kapur, S., & Howes, O. D. (2012). Dopamine synthesis capacity in patients with treatment-resistant schizophrenia. American Journal of Psychiatry, 169(11), 1203-1210.

Gold, J. M., Strauss, G. P., Waltz, J. A., Robinson, B. M., Brown, J. K., & Frank, M. J. (2013). Negative symptoms of schizophrenia are associated with abnormal effort-cost computations. Biological psychiatry, 74(2), 130-136.

Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., Gattaz, W. F., ... & WFSBP Task Force on Treatment Guidelines for Schizophrenia. (2012).

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. The World Journal of Biological Psychiatry, 13(5), 318-378.

https://www.youtube.com/watch?v=ZB28gfSmz1Y

Jauhar, S., McKenna, P. J., Radua, J., Fung, E., Salvador, R., & Laws, K. R. (2014). Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. The British Journal of Psychiatry, 204(1), 20-29.

Oremus, C., Oremus, M., McNeely, H., Losier, B., Parlar, M., King, M., ... & Hanford, L. (2015). Effects of electroconvulsive therapy on cognitive functioning in patients with depression: protocol for a systematic review and meta-analysis. BMJ open, 5(3), e006966.

Stripp, T. K., Jorgensen, M. B., & Olsen, N. V. (2018). Anaesthesia for electroconvulsive therapy-new tricks for old drugs: a systematic review. Acta neuropsychiatrica, 30(2), 61-69.

M. Razali, Che Ismail Hasanah, Ali Khan, Mutusamy Subramaniam, S. (2000). Psychosocial interventions for schizophrenia. Journal of Mental Health, 9(3), 283-289.

Vizzotto, A. D., Buchain, P. C., Netto, J. H., & Elkis, H. (2015). Psychosocial Intervention in Schizophrenia. In International Handbook of Occupational Therapy Interventions (pp. 529-539). Springer, Cham.