Chronic Schizophrenia, Case Study Example

In this study, John Doe is a 24 year old single man admitted for the third time to a psychiatric unit. Previous outpatient treatment consisted of individualized supportive therapy with a clinical nurse specialist as well as family therapy supervised by a social worker. Psychotic behavior resumed prior to his beginning participation in a vocational rehabilitation program. His current appearance is one of being frightened, unaware, and disinterested. He believes he is invincible and that God is speaking to him and giving him powers. He also appears to be hearing other voices as well.

John is experiencing chronic psychosis, due to this being his third admission to the psychiatric unit. Because of his ability to hear voices, especially with God giving him powers, this would be considered paranoid schizophrenia. It is important the schizophrenia be treated as soon as possible before it spirals further out of control. A more immediate treatment will most likely result in a better outcome for the patient and his family.

One pharmacological option for treating the patient could be the antipsychotic drug haloperidol. This drug has shown an improvement of over 60% in various clinical studies when prescribed to schizophrenia patients who were undergoing their first episode of the illness (Boter et al., 2009). The patients prescribed low doses of haloperidol instead of amisulpride, ziprasidone, or olanzapine showed a higher response of remission during the study. The evidence indicated that the patients suffering from first-episode paranoid schizophrenia responded better to lower doses than to the doses suggested for remittent schizophrenia. This would suggest that our patient needs to be titrated with the drug according to his symptoms being that this is his third admission to the psychiatric unit (Crespo-Facorro et al., 2006; Schooler et al., 2005).

In addition to the pharmacological drug of choice in this case, it is imperative that our patient continue psychological counseling. Due to his parent’s marital issues, this might have been a trigger to his relapse. It will only be through psychological counseling with a combined treatment of pharmacological therapy that our patient has a chance of a healthy recovery in a healthy period of time.

As for the discontinuation of therapy, it is recommended that the pharmacological medication be used for at least one to two years after the disappearance of schizophrenia symptoms. After all symptoms have subsided and the one to two year mark has been met, the discontinuation of pharmacological therapy can be visited by a licensed psychiatrist if he feels this is a viable option (National Institute for Clinical Excellence, 2009). Due to the fact this is our patient’s third admission into the psychiatric facility, this will have to be something handled in a sensitive manner and with a great amount of contemplation put forth to ensure the patient will not immediately relapse at the first sign of mental stress.

As for discharge planning, it is advised that the patient first remain in the psychiatric facility until his disillusions are under control with the aid of the pharmacological intervention, haloperidol. Once that has been attained, he should be allowed to be discharged into the care of his family who will take responsibility for maintaining his prescription regimen and keeping his psychology appointments in order to ensure he returns to a normal state of mental health. He should continue the medication and behavioral therapy until stated otherwise; this will be visited at some point during the next one to two years. If there are any negative reactions to the medication or therapy, the patient should immediately report back to the psychiatric unit for further treatment.

References

Boter, H., Peuskens, J., Libiger, J., Fleischhacker, W., Davidson, M., Galderisi, S., et al. (2009). Effectiveness of antipsychotics in first episode schizophrenia and schizophreniform disorder on response and remission: An open randomized clinical trial. Schizophr Res, 115 (2-3), 97-103.

Crespo-Facorro, B., Pe´rez-Iglesias, R., Ramirez-Bonilla, M., Mart?´nez-Garc?´a, O., Llorca, J., and Luis Va´zquez-Barquero, J. (2006). A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. Journal of Clinical Psychiatry, 67, 1511–1521.

National Institute for Health and Clinical Excellence (2009). Schizophrenia: Core interventions in the treatment and management of schizophrenia in primary and secondary care, National Clinical Practice Guideline Number 82. National Collaborating

Centre for Mental Health Commissioned by the National Institute for Health and Clinical Excellence. Schooler, N., Rabinowitz, J., Davidson, M., Emsley, R., Harvey, P., Kopala, L., et al. (2005). Risperidone and haloperidol in first episode psychosis: A long-term randomized trial. American Journal of Psychiatry, 162, 947–953.