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Diagnosis and the Treatment Planning - Case Study Example

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1. Louis according to SSIS Diagnostic Code has a dual diagnosis or paranoid schizophrenia of continuous variety with alcohol dependence on inconsistent Seroquel with problems with shelter and nominal social support. He is educated, no social support network due to no contact with the family…
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Diagnosis and the Treatment Planning
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Diagnosis and the Treatment Planning (Psychology Louis according to SSIS Diagnostic has a dual diagnosis or paranoid schizophrenia of continuous variety with alcohol dependence on inconsistent Seroquel with problems with shelter and nominal social support. He is educated, no social support network due to no contact with the family. His disease is inadequately controlled and is manifested by alcohol intake and delusions. For schizophrenia, an approach of psychoanalytic psychotherapy would be the best which can be incorporated into the need-adapted approach of therapy. A psychodynamic understanding of this patient's situation is imperative. The full range of approaches would be based on establishment of a secure therapeutic relationship which may move gradually into formal psychoanalytic therapy. The motivation and life situations are important to understand since they extensively contribute to the development of psychosis, which in this case is manifested by delusions. Family interventions are not possible in this case. The need-adapted approach should be based on idiographic assessment of his needs and the type of treatment suited to these needs. Need-adapted approaches, although difficult to design, are more suitable since the overall therapy would depend on several interventions over time rather than a single approach. The therapy would thus not only aim towards reduction of psychotic symptomatology, but also would address a number of developmental trajectories, the deviations from which are responsible for the current symptomatology. For his alcohol dependency, counseling and psychotherapy again are important components of effective treatment. Although psychosocial interventions are recommended, it would take time to arrange a supportive network for this patient. In this case given his dual diagnosis, apart from psychotherapy improved drug therapy may also be employed. Psychotherapy would attempt to change his troubling thoughts, feelings, and behaviors through creation of a new understanding of his thoughts, and given his above average education and intelligence, this could be a feasible option, while drug therapy for both schizophrenia and alcohol dependency continues. The psychotherapy would address the addictive behavior, thoughts, and feelings that are feared to promote, maintain, or occur the behavior. The psychotherapy would attempt to help the patient resolve the thought problems so relief-promoting addictive substances would not be required.
2. The triad of symptoms such as cognitive deficits, easy distractibility, and expressed anxiety may be presenting symptoms of many psychiatric conditions. These may result from neurologic diseases, stress and anxiety neurosis, manic-depressive psychosis, and adult attention deficit disorder. Since the patient is presenting at the age of 43, adult attention deficit disorder may be a remote possibility. The situational stress must be ruled out, and in the relation building phase of the psychotherapy a part of it may be addressed. Before going into a definite psychotherapy approach, the psychotherapist must have a neuropsychiatric evaluation of the patient to establish the diagnosis. The psychotherapist must demonstrate an understanding of the presenting issues and then make a treatment choice. The severity of the disorder must be mapped on to the continuum from mild, moderate, to severe. the severity of the disorder must be judged by the symptoms, their intensities, and the degree of functional impairment. It is also to be remembered that a diathesis-stress biopsychosocial model is implicated in the development and maintenance of emotional disorders. Thus the therapist must enquire about the biological, psychological, and social factors that may predispose the patient to this affect and also act as stressors.
3. This senior citizen advocacy group is attempting to prevent depression in late life in individuals living in an independent living facility. Therefore, the consultation would advise the group to promote reminiscence and life review therapy in these residents. The theory behind this approach is recalling the past as a way to increase self-esteem and social connections in a group format where all individuals are encouraged to remember and share bright memories of the past through use of personal artifacts, newspapers, or music. These often stimulate memories. This would help the elderly to gain perspectives on their lives, and this form is feasible in the residential settings where normal elderly individuals tend to drift into depression. Any therapeutic approach in such situations would be useless. Life review therapy is an intensified version of reminiscence therapy, and this involves reworking on past conflicts to be able to gain better understanding and acceptance of the past. The underlying theory is that an older adult can be helped through ego integrity versus despair. The citizen advocacy group should understand that if older adults can satisfactorily formulate and accept personalized answers to existential questions, they will achieve integrity. This has been demonstrated to prevent geriatric depression. Due to the residential nature of their stay, it is difficult to develop a family therapy approach. It is also important to stress that many people of this group may have baseline dementia, so psychotherapeutic approaches in prevention of depression may be futile, rather the group must improve the biologic, psychologic, and social milieu of the residential facility. Read More
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