Schizophrenia
History of Present Illness
I came across John, a 40-year-old man, who was diagnosed with schizophrenia and delusion disorders in my practicum. According to his medical records, John had never been diagnosed with the diseases before. Still, his mother and wife narrate that he might have had the problem from as early as 14 years, and it was until recently that the situation worsened. In his teenage years, the patient was delusional; he became erotomatic with a famous singer believing that the celebrity was in love with him. Gradually he became overly jealous and overprotective of the celebrity to the point that he broke down his parent’s TV when he saw the star with another man. He often got into fights over imaginary things in school, such as when he scuffled with a teacher because he thought the government sent him to spy on John.
Arguably, John has a poor grasp of reality. Schizophrenia and delusional psychotic disorders result in an unrealistic interpretation of reality, life, and the environment (Lieberman & First, 2018). The severe schizophrenia developed later on in his marriage, where he kept accusing his wife of cheating on him and colluding with government spies to hijack him. In a recent incident, he had attacked his wife and her imaginary allies, after which he went on and attempted to commit suicide. John’s case is typical for schizophrenic and delusional patients. In his case, the psychotic disorders have progressed significantly, mostly due to the late diagnosis and lack of treatment.
Clinical Impression: Diagnosis satisfactory; proceed with treatment.
Psychopharmacologic Treatments
Psychotic disorders are treated using a mix of medication and therapy. I would recommend that John start a dose of antipsychotics to treat schizophrenia and delusion disorder. According to Toto et al. 2019, First Generation Antipsychotics (FGA) were often used in recent years. Still, they have been gradually replaced by the more preferred Second Generation Antipsychotic treatments (SGA). The SGA has proven to be more efficient in treating severe cases of schizophrenia. More specifically, antipsychotics can be used to treat delusions, but the disorder requires more treatments such as mood-stabilizers and antidepressants (Toto et al., 2019). The psychopharmacologic agent I would recommend in this case is the orally disintegrating treatment, Clozapine, which is not only efficient in treating schizophrenic disorders but is also a mood-stabilizer useful in the treatment of delusions.
The present illness history describes the patient’s symptoms as suicidal thoughts, delusional erotomania, aggression, anxiety, and hallucinations. The psychopharmacologic agent’s endpoints would be to end these symptoms and help John relate to reality positively. To monitor this progress, I will use the Positive and Negative Syndrome Scale (PNSS), which is efficient in tracking patients’ response to antipsychotics. Nicotra et al. 2015 argue that the seven-point scale measures the patient’s progress; the positive sidetracks the progress of delusions, incoherent thoughts, and hallucinations, while the negative side measures the lacking cognitive aspects in schizophrenic patients. The absence of each symptom would mean that the treatment is working.
Therapeutic Treatments
John’s condition is advanced, and in addition to the medicinal treatments, he and his family should engage in therapy. There are different therapy choices available for psychotic disorders, but I would recommend that John start cognitive-behavioral therapy (CBT). The treatment aims at altering an individual’s beliefs, attitudes, and emotions, which are instrumental in triggering psychotic behavior (McFarlane, 2016). In this case, the CBT’s endpoint would be to help John overcome his fears, which would change his attitude and aggression towards his wife and the suicidal thoughts. The family should also engage in psychoeducation therapy where they are taught how to handle John, calm him down, cope with his conditions and live better lives.
Medical Management Needs
The most crucial need of patients suffering from the psychotic disorder is attention and care. John needs to know that his family is there for him and can help him get over his condition. His mother and wife should be the immediate caregivers. There are several modifying factors for his illness; during his teenage and single life, John watched too many science fiction movies, which might have influenced his delusional behavior. Furthermore, he was brought up by a single mother after his father remarried, and therefore he has lived with the fear of losing his partner or never finding true love. For John’s primary care needs, his caregivers should limit his screen time, engage him in more physical exercises, and be exposed to nature. He needs to be always but calmly reassured that he is loved and that his wife is loyal to him.
Community Support Resources and Follow-up plan
John’s condition bars his social attachment, and he may not perform well in a restricted environment due to his phobias. Therefore, his caregivers should try to support him financially and ensure his house is homely and comfortable. He should be observed and be kept away from objects that he could use to harm himself or others. Additionally, John should be included in community groups where patients with similar conditions meet, talk, and share their experiences. National mental health programs and community participation are an essential part of his recovery (Bhatia & Saha, 2017). These community agencies usually make follow-ups, create avenues for group therapies and offer additional help to the patient’s primary caregivers. Treatment for psychotic disorders takes time, and therefore I recommend that John make follow-up visits to the clinic within 30 days after his first discharge. Schizophrenia has no specific cure, but managing the symptoms through antipsychotic medications and therapy may wear out the psychotic disorders.
Reference
Bhatia, M. S., & Saha, R. (2017). Role of primary care in the management of schizophrenia. The Indian Journal of Medical Research, 146(1), 5.
Lieberman, J. A., & First, M. B. (2018). Psychotic disorders. New England Journal of Medicine, 379(3), 270-280.
McFarlane, W. (2015). Family psychoeducation for severe mental illness. Handbook of family therapy, 305-325.
Nicotra, E., Casu, G., Piras, S., & Marchese, G. (2015). On the use of the Positive and Negative Syndrome Scale in randomized clinical trials. Schizophrenia Research, 165(2-3), 181-187.
Toto, S., Grohmann, R., Bleich, S., Frieling, H., Maier, H. B., Greil, W., … & Neyazi, A. (2019). Psychopharmacological treatment of schizophrenia over time in 30 908 inpatients: data from the AMSP study. International Journal of Neuropsychopharmacology, 22(9), 560-573.