Treatment plan for Paranoid- type Schizophrenia - Case Study Example

?Treatment plan for Paranoid- type Schizophrenia The goals of treatment for paranoid- type schizophrenia emphasize the promotion of safety of the client and other involved people, ensuring proper nutrition, enhancing therapeutic relationship between the client and the therapist, and prevention of complications associated with medications and inappropriate social behavior. Recent developments in mental health research stress out the importance of treating the client as an individual case rather than as part of the general afflicted population. In considering the treatment plan in this particular scenario, the psychiatric diagnosis may be complicated with the consideration of the client’s current substance abuse. Since substance abuse appears to be co- morbid for this client’s case, prescription of medications should consider all aspects that could hinder the client’s adherence to the regimen. When the climax of the appearance of signs and symptoms starts to stabilize, assistance may be needed to facilitate the client’s reintegration to the society. In this phase of treatment, follow- up care should facilitate the participation of the client’s family to identify early signs and symptoms of relapse (Videbect, 2007). This paper will discuss the highlights of care provided to the client by the mental health care team. Promoting the safety of the client and others Since the client is potentially harmful to herself and others, safety should be regarded as the highest priority. Based on the initial assessment performed in the clinic, the client looked paranoid and seemed to be threatened by her new environment. At this moment, it is important that the therapist approach the client in a non threatening manner. Furthermore, the therapist should also be careful not to sound authoritarian as it may increase the client’s stress level. Space is a vital component to be considered especially in the early phase of interventions (Videbect, 2007). With the status of the client, preemptive measures should include securing a physician’s order for administering medication to control potentially injurious behaviors. Moreover, the therapist should continue to observe signs of escalating aggression such as pacing, kicking, and yelling. A quiet and less stimulating environment may be helpful in calming the client. However, seclusion and other forms of restraints may also be needed in heightened situations. Evaluation of this intervention is concurrent and does not end until the client demonstrates full recovery. The therapist should be careful in deciding whether the client has fully achieved a mental status at a functional level. Research has suggested that the client’s report of feeling a sense of well- being is never an assurance that the risk for self- injury has subsided (Videbect, 2007). Management of medications and side effects Another important aspect regarding the establishment and maintenance of safety for the client is the careful monitoring of the adverse effects of medications (Valenstein et al., 2011). Potent psychotropic drugs may affect the organ function, especially the liver and kidneys, of clients on prolonged therapy. BUN and liver enzymes monitoring should be part of the treatment regimen to ensure that the client maintains a safe level of the medication. Other minor side effects like frequent urination, constipation, dry mouth, and photosensitivity may affect the client’s adherence to prescribed therapy. Most patients initiating antipsychotic medications tend to terminate the regimen within the first few months of treatment (Olfson et al., 2007). Studies have shown that failure to follow the prescribed medications for mental health conditions is the most common cause of relapse of psychotic symptoms and subsequent hospital readmission (Videbect, 2007). With proper adherence to the prescribed therapy, the client is expected to attain a functional recovery and lead a normal life. Actually, the client’s adherence to the prescribed regimen may be facilitated by the therapist in various ways. A pill box with compartments for days of the week and times of the day may help the client to remember the schedule independently. The therapist should teach the client to increase fluid intake to alleviate constipation, apply sunscreen lotion to prevent sunburn, and suck on a hard candy to prevent dry mouth. Evaluation of the effectiveness of the interventions is reflected on the client’s perception of the situation. When the client appropriately reports adherence to medications and the side effects are effectively managed, then the interventions are considered efficient (Olfson et al., 2007). Otherwise, the therapist may need to consider other factors including cognitive and psychosocial readiness that may have affected the situation. Establishing a therapeutic relationship Establishing trust between the client and the therapist is vital in the success of the therapeutic interventions. In this case, the client demonstrated only 5 to 10 minutes of initial contact. This client data implies that establishing contact time may take longer. In fact, research suggests that the therapist’s kinesthetic movements like eye contact, posture, and facial expressions are important factors in establishing genuine trust and communication. The therapist provides explanations that are clear, direct, and easy to understand. In one study, it may be appropriate to address the client by name to maintain reality orientation (Videbect, 2007). On the other hand, the therapist should take consideration the client’s response to the use of touch. Since the client presented paranoid delusions, it may not be appropriate to exaggerate touch. Genuine concern may be shown in other ways such as consistency by the therapist and other members of the mental health team. Meanwhile, the issue of countertransference should be considered. The gradual and progressive attachment of the therapist to the client may result in countertransference. In this case, the therapist may relate to the client’s experience and eventually develop a personally biased judgment of the situation. Hence, self- awareness should be the fundamental intervention to be used by the therapist to prevent countertransference. Sometimes, it may be possible that the therapist would feel a certain degree of frustration when the client fails to follow the therapeutic regimen, or does not show any sign of progress, or even worse. It is also important that the therapist should not take responsibility for the success or failure of treatment efforts or view the client’s status as a personal success or failure. Evaluation for this particular intervention should include the analysis of the therapeutic relationship as perceived by the client. While it is possible that the client show submissiveness to the interventions presented by the therapist, the relationship should be assessed thoroughly to ensure that it is therapeutic and promote growth. Coping with alterations in thought process The alterations in the thought process are the major features of clients with schizophrenia (Klingberg et al, 2009). With paranoid- type schizophrenia, the delusions may be exaggerated and have a common theme of persecution and irrational suspicion. Thus, helping the client with delusions and hallucinations remains a fundamental element of management. The therapist should avoid reinforcing or openly arguing with the client’s delusions. Instead, it is the therapist’s responsibility to keep the client connected with reality. When the effects of antipsychotic medications become apparent with the client, the therapist may start to discuss the delusional ideas and facilitate ways that the client learns to adapt. Furthermore, delusional thinking and ideas of reference may be minimized by some techniques like distraction, positive conversation, and ignoring of delusional ideas. Effective conversations with the client facilitate the therapist’s understanding of the situation. At times, it may also be possible for the therapist to determine certain situations that precipitate the onset of delusions and hallucinations. Current researches in mental health suggest that certain situations promote delusional thinking in mentally disturbed individuals. Specifically, the therapist should consider the client’s command hallucinations and explore its contents as deemed possible. It is possible that the client hear voices that instruct her to perform self- destructive behaviors. When this happens, the client must be instructed to divert attention to activities that promote and maintain reality orientation like playing cards or listening to the radio. It is important that the client not to feel being ridiculed with the interventions suggested by the therapist. Evaluation of this intervention involves repeated assessment about the client’s mental status. While it may not be realistic to assume that the client will learn to adapt to the delusions at a short period of time, the therapist should continuously follow- up the client’s progress patiently. Promoting adequate nutrition and proper hygiene Meeting physiological needs like proper nutrition, proper hygiene, and adequate rest and sleep should be prioritized by the therapist. The client may exhibit lack of energy and concentration to perform these tasks. In fact, the client may still refuse to eat because of false beliefs of being poisoned. In this case, the therapist may need to direct the client consistently to complete bathing and grooming tasks. When the signs of hallucinations and delusions become increasingly evident, it is expected that the client will not have enough sleep. Instructions should not sound compelling and the client’s independence should be promoted as much as possible. Evaluation for this intervention requires a gradual monitoring of the client. Weight measurements may be performed once a week or as necessary to determine the degree of progress. Along with this, the status of rest and sleep should also be monitored. Conclusions General management for schizophrenia may be applied to clients with paranoid- type, with specific emphasis on safety, nutrition, and establishment of a therapeutic relationship. In this case, the therapist needs to understand the client’s situation before any interventions must take place. The safety of medications can vary widely with each client as substance abuse may be a co- morbid factor (Roncero et al., 2011). Current researches in mental health indicate differences with religious and cultural aspects of care. Thus, although clients may have similar symptoms indicating a similar pattern of mental disorder, it is the responsibility of the therapist to explore the circumstance that lead to the diagnosis without being personally involved to avoid countertransference. References Borras, L. Mohr, S. Brandt, P.Y., Gillieron, C. Eytan, A. & Huguelet, P. (2007). Religious Beliefs in Schizophrenia: Their Relevance for Adherence to Treatment. Schizophrenia Bulletin, 33 (5), pp. 1238– 1246. d oi:10.1093/schbul/sbl070 Klingberg, S., Wittorf, A., Herrlich, J. et al. (2009). Cognitive behavioural treatment of negative symptoms in schizophrenia patients: study design of the TONES study, feasibility and safety of treatment. European Archive of Psychiatry and CLinical Neuroscience, 259 (2), pp. S149–S154. DOI 10.1007/s00406-009-0047-8. Olfson, M., Marcus, S.C. & Ascher- Svanum, H. (2007). Treatment of Schizophrenia With Long-Acting Fluphenazine, Haloperidol, or Risperidone. Schizophrenia Bulletin, 33 (6), pp. 1379–13 87. doi: 10.1093/ sch bu l/sb m033 Roncero, C., Barral, C. Grau- Lopez, L. Bachiller, D., Szerman, N., Casas, M. & Ruiz, P. (2011). Protocols of Dual Diagnosis Intervention in Schizophrenia. Addictive Disorders and their Treatment, 10 (3), pp. 131- 154. Valenstein, M., Kavanagh, J., Lee, T. et al. (2011). Using A Pharmacy- Based Intervention To Improve Antips ychoti c Adher ence Among Patien ts With Serious Mental Illness. Schizophrenia Bulletin, 37 (4), pp. 727- 736. doi: 10.1093/ schbul/sbp121 Videbect, SL. (2007). Psychiatric mental health nursing (4th ed). New York: Lippincott Williams and Wilkins. Read More