Homework Lance
Safety Plan for Schizophrenia Patients
Grand Canyon University
Abstract
Schizophrenia is a mental illness that occurs due to thought disturbances. The symptoms of this illness have been discussed and compared to those experienced by Ted in a case study in accordance to the DSM-V. A treatment plan on how I would address Ted’s symptoms of delusion, hallucinations, and depression are also outlined in this essay. Also, a possible misdiagnosis of Ted’s illness is given and an explanation as to why it would have been diagnosed. Additionally, a valid theory of treatment for Ted’s disease, with my rationale explained, is included as well as a treatment option that addresses all of his symptoms. Furthermore, the effects of religion when coping with depression and suicide are discussed.
Keywords: Schizophrenia, treatment of schizophrenia, religion
Safety Plan for Schizophrenia Patients
Schizoaffective Disorder and Schizophrenia are diagnostic categories with a high risk of suicide. There is no definitive proof showing a difference between schizophrenic and non-schizophrenic suicides, and whether or not the two groups have a joint suicide liability (McGirr & Turecki, 2008). In the case study, Ted (who is a schizophrenia patient) committed suicide after battling with the illness for twenty years. Treatment options that would have benefited him have been used to design a safety plan for another client with symptoms similar to those experienced by Ted.
Schizophrenia is a mental illness characterized by disruptions in thoughts, such as delusions and hallucinations. The diagnosis criterion of Schizophrenia Disorder in the DSM-5 is based on a combination of five typical signs and symptoms; delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms like avolition. For an individual to be diagnosed with schizophrenia, at least two of the five signs and symptoms must be reported. Furthermore, at least one of the two traits recorded must be delusions, hallucinations or disorganized speech (Dziegielewski, 2015). During Ted’s illness, he suffered from delusions of altered body states and his experiences of external agents who were often invisible and were ‘controlling’ him can be characterized as hallucinations. Delusions and hallucinations are two symptoms of Schizophrenia experienced by Ted. Some of Ted’s symptoms such as acting out, accusing personnel, being unreliable and acting pretentiously can be characterized as negative symptoms.
Since delusions are firmly held beliefs, which are not ordinary; and hallucinations are perceptions of things that do not exist outside the mind, then these two symptoms could be treated together. Therefore, I would have addressed Ted’s delusion and hallucination symptoms together. According to a journal article in the Clinical Psychology Review, Individual Cognitive Behavior Therapy is very useful in the treatment of delusions and hallucinations. Even though some areas in this approach need development, I think this would have been an effective way to approach Ted’s hallucination and delusion symptoms (Haddock et al., 1998). Moreover, I could have tried antidepressants for his depression. If the individual cognitive behavior therapy did not work, I would have tried other methods of treatment such as antipsychotic drugs or electroconvulsive therapy.
Some of the disorders in the psychosis spectrum can confuse due to their closely similar diagnostic criteria. Following Ted’s symptoms, Ted could have been misdiagnosed with Schizoaffective Disorder, bipolar type. By evaluating Ted’s signs of delusion, hallucinations, negative symptoms, and his depressive mood it likely Ted could have been misdiagnosed with Schizoaffective Disorder. Also, Ted’s attitude change from acting out to being depressed could be viewed as a symptom of Bipolar Disorder. Therefore, his misdiagnosis could have been Schizoaffective Disorder, bipolar type.
Treatment approaches of schizophrenia vary from one patient to another since what may work for one client may not work for another. In Ted’s case, the most effective treatment approach would have been a combination of pharmacological and psychological treatments. First of all, the use of medication such as antidepressants and antipsychotic drugs would have helped keep his mood and behavior in check. The method of psychological treatment would have gone a long way in improving his prognosis and prevent it from being chronic if applied during the first stages of the ailment. Five crucial aspects of psychosocial intervention would have been used namely: cognitive therapy, Cognitive Behavioral Therapy (CBT) and cognitive remediation therapy, psychoeducation programs, social skills, family intervention, case management, and training programs (Chien, 2013).
Cognitive therapy would have helped Ted to cope with his symptoms and also lead to symptomatic improvement. Furthermore, it would have helped him improve his cognitive functions. Psychoeducation programs would have educated Ted and his family about his illness. These plans would have helped them understand the disease, treatment compliance, and relapse preventions; which would have improved Ted’s mental outcomes throughout the years. This is also the case for the family interventions category. Additionally, if Ted had been equipped with skills to deal with events that were stressful, he would have been able to solve his problems and challenges. Therefore, he would not have triggered his illness when he was away from the hospital. These skills would also have made him more active in his treatment decisions and partnerships. Moreover, this dynamic role would have helped him be more independent of the hospital staff.
The more significant experience in Ted’s treatment would have assisted him in managing his illness and comprehending his disorder. The ACT case management model would have been a great help to Ted especially when he was discharged from the hospital. This model would have helped him to reduce the number of relapses and frequent visits to the psychologist or psychiatrist offices whenever he was in crises. Also, the use of group therapy would have helped Ted when he felt alone andpossessed suicidal thoughts. This form of treatment would also have helped Ted to eliminate negative symptoms such as acting out (Chien, 2013). If this approach had been used to treat Ted, his symptoms would have been treatedthus his illness would be less severe.
The least useful theory of treatment would have been the use of pharmacological approach only. People who have schizophrenia have a challenge when it comes to adhering to medication prescriptions. If this approach were used on Ted, he would have encountered problems due to non-adherence to medical advice because of challenges that Schizophrenics face. These challenges include; lack of illness awareness, social isolation, comorbid substance misuse, direct effects of symptoms, the disintegration of mental health services, and stigma. Furthermore, antipsychotic drugs would have helped in the treatment of Ted’s positive symptoms but his negative symptoms would have a slight improvement only. Non-adherence to medicine could have been the cause of Ted’s increase in relapse risk and caused persistence in his already existing symptoms (Haddad, 2014).
Every symptom has its cause and its specific method of approach and some signs may have more than one treatment technique. For Ted’s positive traits such as delusion, hallucination, and paranoia, the administration of antipsychotic medication would help manage the symptoms. Also, the antidepressant would have helped with his depressive episodes. His negative symptoms such as acting out could have been controlled by psychosocial attributes such as cognitive therapy and training in social skills. Ted’s suicidal thoughts could have been managed using medication and also group therapy. A case management model would have helped lower the number of relapses, and his social skills would have made him more independent. This model would have reduced the number of visits to the psychologist or psychiatrists and further lessened his demands for admission into hospitals.
Religion and spiritual beliefs have a significant impact on mental health and suicide risk in numerous groups of patients. Even though this is true, the possible channels of this interaction are relatively unexplored. If a client has a strong religious background, his spirituality could be fundamental to his recovery. Adolescents with constant high scores of depression who ask for great spiritual help are at a higher risk of committing suicide (Consoli et al., 2015). Religious coping activities such as seeking assistance from the clergy have shown an opposite relation to depressive symptoms. In a study conducted by Azhar and Varma, patients undergoing religious psychotherapy have exhibited significant reduction in depressive symptoms (Koenig et al., 2001). Thus religion and spirituality help to deal with depression, which can be an advantage if the client is religious. Furthermore, religious people are less tolerant of suicide than less religious people. Therefore, since religion does not support suicide, spiritual clients will be more willing to seek out and accept clinical help. This implies that religion can be used to decrease suicide rates (Koenig et al., 2001). For example, to mitigate the risk of suicide in veteran populations, spiritual functioning is being encouraged among the veterans (Kopacz et al., 2016).
The discussed symptoms and their treatments can be used to help another client with similar symptoms to Ted. These treatment suggestions can be seen as improvements on Ted’s treatment plan and therefore should be more effective. Also, if the client is religious, religion could help avoid suicide and help in the treatment of depression.
References
Chien, W. T., Leung, S. F., Yeung, F. K., & Wong, W. K. (2013). Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatric Disease and Treatment, 1463. https://doi.org/10.2147/NDT.S49263
Consoli, A., Cohen, D., Bodeau, N., Guilé, J.-M., Mirkovic, B., Knafo, A., Gérardin, P. (2015). Risk and Protective Factors for Suicidality at 6-Month Follow-up in Adolescent Inpatients Who Attempted Suicide: An Exploratory Model. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 60(2 Suppl 1), S27-36.
Dziegielewski, S. F. (2015). DSM-5 in action. Hoboken, New Jersey: John Wiley & Sons, Inc.
Haddad, P., Brain, C., & Scott, J. (2014). Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient Related Outcome Measures, 43. https://doi.org/10.2147/PROM.S42735
Haddock, G., Tarrier, N., Spaulding, W., Yusupoff, L., Kinney, C., & McCarthy, E. (1998). Individual cognitive-behavior therapy in the treatment of hallucinations and delusions: A review, 18(7), 821–838.
Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. Oxford ; New York: Oxford University Press.
Kopacz, M. S., Currier, J. M., Drescher, K. D., & Pigeon, W. R. (2016). Suicidal behavior and spiritual functioning in a sample of Veterans diagnosed with PTSD. Journal of Injury & Violence Research, 8(1), 6–14. https://doi.org/10.5249/jivr.v8i1.728
McGirr, A., & Turecki, G. (2008). What is specific to suicide in schizophrenia disorder? Demographic, clinical and behavioral dimensions. Schizophrenia Research, 98(1–3), 217–224. https://doi.org/10.1016/j.schres.2007.09.009
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