Schizophrenia Spectrum and Psychotic Disorders

Schizophrenia Spectrum and Psychotic Disorders

Select an adult or older adult client with a schizophrenia spectrum and other psychotic disorder you have seen in your practicum.

  • Describe the HPI and clinical impression for the client.
  • Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
  • Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
  • Identify medical management needs, including primary care needs, specific to this client.
  • Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
  • Recommend a plan for follow-up intensity and frequency and collaboration with other providers Schizophrenia Spectrum and Psychotic Disorders.

Schizophrenia spectrum and other psychotic disorders are among the most impairing types of psychopathology, often linked to an intense negative impact on the patient’s social, educational and occupational function. Psychosis and the precise diagnosis of schizophrenia represent a principal disorder in which an individual’s mood, behavior thoughts and perceptions are considerably altered.   This paper presents a case of an older adult person with schizophrenia, history of present illness (HPI) and clinical impression for the patient and psychopharmacological and psychotherapy treatment options for the patient. Additionally, the paper presents community resources and agencies available to assist the patient and a recommendation of a follow-up plan.

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An older adult with a schizophrenia spectrum and other psychotic disorder I have seen in my practicum

Mrs. Dorcas, a seventy-five years old female who was previously hypertensive gets admission to the hospital for assessment of changes in status and management of behavior. One week to admission, Mrs. Dorcas reported that she had suspicions that of her daughter Ivy and neighbors. She accuses Ivy attempting to snatch her nonexistent fiancé and her neighbors of breaking into her house and taking away with her possessions, even though she was not able to say what was stolen. On the day she was admitted, Ivy became bothered when Mrs. Dorcas told her that she was going to marry her fiancée that afternoon and go for honeymoon. When Ivy tried to stop Dorcas from running away from the hospital, Dorcas started biting, hitting and scratching her. The test gave results within usual ranges while brain CT scan showed a small number of scattered foci of augmented T2 signal in the periventricular white matter with Electoencephalogram being normal.

HPI and clinical impression for the patient

According to National Collaborating Centre for Mental Health (2014), a patient with schizophrenia goes through a prodromal period where the personal functioning of the patient deteriorates. Difficulties entail attention and memory problems, uncharacteristic and unusual behavior, social withdrawal and abnormal perceptual experiences, accompanied by a minimal interest in daily activities and weird ideas. An acute phase usually follows prodromal period. This phase is characterized by positive symptoms like hallucinations, delusions and behavioral disruptions such as distress and agitation (National Collaborating Centre for Mental Health, 2014). Additional history from Ivy divulged that over the past one year  Dorcas had become more forgetful and did not function well, she could not cook and manage her business.

Arciniegas (2015) notes that schizophrenia spectrum disorders vary from each other by the number, complexity, type, duration, and severity of psychotic signs and associated features defining them. Schizophrenia spectrum disorders’ symptoms include delusions, hallucinations disorganized thinking. According to Patel et al (2014), schizophrenia spectrum and other psychotic disorders disrupt and affect thoughts of the patient. The disorders usually disrupt the ability of the patient to take part in social events and promote meaningful relationships Schizophrenia Spectrum and Psychotic Disorders.

Psychopharmacological treatments for the patient

According to Sommer  et al(2014), antipsychotic medication is the only form of medication recognized for effective reduction of the severity and frequency of hallucinations and other symptoms in schizophrenia spectrum disorder Chien and  Yip (2013) argue that atypical or second-generation antipsychotics such as olanzapine, risperidone and clozapine have greater efficiency  and tolerability in reduction psychotic symptoms. The pharmacological mechanism of these drugs is blockage of receptors of dopamine D-2.  This blocking action is associated with their efficacy against disorganization and positive schizophrenic symptoms and episodes (Chien & Yip, 2013).

Psychotherapy options for the patient

According to Chien et al (2013), there are five main groups of psychosocial interventions that have been applied in community-based treatment of people with schizophrenia spectrum and other psychotic disorders, with proof of efficacy on prevention of relapse and control of symptoms. The five groups are cognitive behavioral therapy along with cognitive remediation therapy, pyscho-educational programs, social skills training as well as other coping schools, family intervention, case management and training programs Roudsari et al (2015) note that cognitive behavioral therapy that focuses on diverse features such as reasoning biases, faulty logic and anxiety have proved to be valuable for short-term improvement.

Medical management needs specific to the patient

According to Chien et al (2013), latest guidelines on the care and treatment for schizophrenia spectrum disorders have commended that adequate knowledge on the disease and its treatment as well as other approaches in person-focused and psychosocial interventions must be offered to patients along to their family carers so as to maximize their satisfaction and approval with treatments and enhance the outcomes and experiences for the patient. According to Armijo et al (2013), treatment of a patient with schizophrenia aims at supporting the patient to enable them lead independent lives, create and follow occupational goals, promote social interaction and attain a rational quality of life.

Community resources and agencies available to assist the patient

Community resources and agencies available to the patient include social health workers, mental health workers, mental health hospital, family members and support groups. Supports groups are operated by trained facilitators who teach patients coping skills, build resiliency, assist minimize anxiety and offer emotional support. Armijo et al (2013) note that psychosocial interventions entail adherence support, cognitive behavioral therapy, therapeutic support and counseling, social skills training and family interventions carried out in the community.

A plan for follow-up intensity and frequency and collaboration with other providers

Healthcare professionals must work in collaboration with patients along with their family carers, providing support, education, psychosocial care and treatment in an environment of optimism and hope (Chien et al, 2013). Psychosocial interventions that are community-based can enhance patient’s long-term outcomes. It is vital to have a universal treatment, which involves pharmacological and psychological aspects and assure the continuation of these dimensions all through the treatment procedure (Armijo et al, 2013) Schizophrenia Spectrum and Psychotic Disorders.

Conclusion

Schizophrenia spectrum and other psychotic disorders are disabling mental illnesses that disrupt cognitive, psychosocial, occupational and emotional functioning. Appropriate psychopharmacological and psychotherapy interventions can minimize psychotic symptoms, relapse as well as improve long-term outcomes of the patient such as remission, illness progression, and recovery.

References

Armijo, J., Mendez, E., & Morales, R et al. (2013). Efficacy of community treatments for schizophrenia and other psychotic disorders: a literature review.  Frontiers in Psychiatry. 4:116.

National Collaborating Centre for Mental Health. (2014).Psychosis and Schizophrenia in Adults: Treatment and Management: Updated Edition 2014. London: National Institute for Health and Care Excellence

Arciniegas, D. (2015). Pyschosis. Continuum, 21(3): 715-736.

Chien, W., Leung, S., Yeung, F., & Wong, W. (2013). Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial and patient-focused perspectives in psychiatric care.  Neuropsychiatric Disease and Treatment. 9:1463-81.

Sommer, I., Slotema, C., & Daskalakis  et al. (2014). The Treatment of Hallucinations in Schizophrenia Spectrum Disorders. Schizophrenia Bulletin, 38(4):704-714.

Chien, W., & Yip, A. (2013). Current approaches to treatments for schizophrenia spectrum disorders, part I: an overview and medical treatments. Neuropsychiatric Disease and Treatment, 9: 1311-1332.

Roudsari, M., Chun, J., & Manschreck, T. (2015). Current Treatments for Delusional Disorder. Current Treatment Options in Psychiatry, 2(2): 151-167.

Patel, K., Cherian, J., Gohil, K., & Atkinson, D. (2014).Schizophrenia: Overview and Treatment Options. Pharmacy & Therapeutics, 39(9): 638-645  Schizophrenia Spectrum and Psychotic Disorders.

 

 

 

 

 

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