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Case Formulation for Schizophrenia

The case study is about Mark, who is 28 years old and is suffering from depression and schizophrenia. Mark is war veteran and his last postings were in Afghanistan. During his last tour of Afghanistan, mark was placed on rescue mission. There were multiple fatalities and he lost one of his best friend. He started having auditory as well as visual hallucinations after that accident and was diagnosed with schizophrenia. He was relieved from the services and has been depressed since the incident that happened 4 years ago. He was advised counselling and therapy sessions. Medications were also prescribed to him to control his symptoms. These interventions helped in in getting sober post -years after the incident.

As he was not able to get a job for himself, he started drinking alcohol and overusing his medication. He was admitted to the emergency care unit one and a half year back after getting a drug overdose and was sent to a rehab facility for the same. He started having auditory as well as visual hallucinations again and was then started on the course of treatment for the same. Mark’s father also suffers from alcoholism but he was declared sober 10 years back. After that he never had any abrupt episode. His mother was also diagnosed with bipolar disorder at the age of 13 years and was into drugs as well. She was sent to a rehab facility and has been sober since the age of 18 years.

Mark’s symptoms are usually triggered by any episode of fight taking place between any two individual. He is also having an increased urge for medications, which is comparatively moderate now. The fact that his father and mother both had an inclination towards similar attitudes, genetic connection can be established between the two happenings. Ever since getting the episodes, Mark has distant himself from his friends. Prior to the event of drug overdose he was living with his parents in their basement. He was financially supported by them for his medical management. The client is however, now having mild symptoms and is showing signs of positivity as well. He is in a state of self-actualization and wants to get better and get rid of his drug and alcohol addiction.

The patient also wants to get a job and repay back to his parents for taking care of him in his difficult times. These factors can be observed as a positive indication for the patient to be ready for change and can be helpful in getting improved healthcare outcomes from him by the use of appropriate therapeutic interventions. The best possible strategy in this case can be cognitive behavioral therapy as it will be able to provide an insight as to what exactly the patient behavioral perceptions are and will be able to provide interventions in accordance with the same (Wang, 2019). This therapy will also be helpful for the patient, by analyzing the motivational factors or the driving forces that can be helpful in the case to obtain improved healthcare outcomes from the patient.

Evaluation of Schizophrenia

Brief Mental Status Exam (MSE) Form

1. Appearance

The patient is casually dressed and has proper hygiene.

2. Attitude

He is having normal attitude.

3. Behavior

No unusual behavior noted

4. Speech

He is having a normal tone, with a feeble voice

5. Affect

The patient is mildly depressed and flat

6. Mood

Depressed

7. Thought process

Patient is goal- directed

8. Though content

Patient is not having any though of suicidal or homicidal ideation

9. Perception

He is having on and off auditory hallucinations

10. Orientation

He is oriented to the place and time

11. Memory

Both sort-term as well as long-term memory is intact

12. Insight/judgment

He is having a fair sense of judgment

The mental scale examination is used in clinical settings to evaluate for the patient’s ongoing state of mind. It is also inclusive of the presentation of patient’s physical appearance as well (Sirivichayakul, 2019). Patient is in an acceptance mode regarding his present mental health. He is willing to get rid of his drug addiction and get back to normal life. The patient is although, still struggling with auditory hallucinations, which might hamper his progress. Having a fair sense of judgment can be favorable for the healthcare professionals in successfully providing him with the required guidance and counselling as well. As per his current state of mind the patient is cooperative as well in the therapy interventions provided to him.

Mental Health Risk Assessment

1. Risk of harm to self

He is at no risk to harm himself (0).

2. Risk of harm to others

He is at no risk of causing harm to others (0).

3. Level of impaired functioning

He is significantly impaired in area of social as well as occupational functioning (2).

4. Level of support currently available

He is highly supported by the help of family and healthcare professionals as well (0).

5. History of response to treatment

He has good response to treatment, with no problem at all (0).

6. Attitude to engage with the treatment

He is very constructive and has also agreed to his condition and wants a good treatment (0).

Mental health risk assessment is useful for evaluating the patient for any potential risks to himself or to the individuals in his surroundings (Glenn, 2017). This analysis helps the healthcare professional in formulating protective measures beforehand, by examining the risks and the underlying reasons for the same. Effective interventions can be useful in averting for any un-called for situations. It also reduced the risk factors reducing the end result of fatal outcomes that can be anticipated from the patient. The patient in our given case study has recovered and has also gotten very far in his recovery path. He is at no potential risk of harming himself or anyone else around him.

This assessment is also useful in our given case scenario, as the patient is being currently treated in a contained facility. It is crucial to screen him for any risk, so as to reduce the threat to him or any other person coming in contact with him, post his discharge from the care facility. His ongoing mental health condition can be fatal for people residing close in his vicinity. The patient might not pose any harm but he is significantly dependent on his family and is thus, having an impaired level of functioning. The role of family based interventions can thus, be helpful in the given case scenario (Velligan, 2018).

Nursing Interventions

The patient can be helped with multiple nursing interventions. The patient as per his given clinical symptoms can be observed to be in a residual state (Saito, 2020). This is a state of clinical diagnosis, where the patient’s diagnosis has been dully set and symptoms have subsided as well. This phase mainly involves rehabilitating the patient in way to help him get stabilize in his own comfortable environment. The patient is currently not having any symptoms and is also in remission for very long, without having any eruptive episodic event. The recovery process can be started with short steps of goals formulating, leading to additional and profound targets to be set in terms of long term goals.

It is crucial to establish a trust with the patient so that smooth conduction of services can be accomplished in this transition of care. The nurses can also help in identifying for the factors, both personal as well as environmental, that be a trigger for the patient. Thus, the patient should be kept away from the same. The nursing knowledge can also be helpful in increasing the motor and cognitive functioning of the patient (Harvey, 2018). The patient is at a very young age and is also eager to have an independent working status. By identifying for the likings and disliking’s, the patient can be promoted to be engaged in various activities. The nursing professionals can also help by evaluating for both positive as well as negative symptoms of the patient.

By analyzing the attitude and the driving forces for the patient, effective planning for future interventions can also be done. The nurses can also help in facilitating the patients with the system management to ensure medication adherence (Nagai, 2017). This is important to not only balance the symptoms, but also to avoid any drug overdose in the patient as well. Electronic dispensers with time barrier can be used for the patient to ensure that the medications are being taken by him on time. Nursing knowledge can also be useful in identifying for the main support system to be used for the patient intervention plan. In the given case scenario the patient’s family has been a constant support for him, throughout his ups and downs.

They have been physically present to tend to his needs, such as emotional, physical and as well as financial needs. Nursing can draft treatment interventions, by keeping a close consideration for including the family as an integral part of the process. They can be helpful in providing comfort and re-assurance to the patient, if he is subjected to any stressful situation. The nurses can also use methods to promote for enhancing social skills in the patient. He can be enrolled in group therapy sessions for general observation. By sharing similar difficulties faced by the others, the patient can be helped in his process of transition of care. It is also important that the patient is kept reality-oriented at all times.

This can also be attained by keeping him indulged in human contact, with the help of social interactions, seminars and workshops as well (Morin, 2017). Counselling can be provided for auditory and visual hallucinations faced by the patient. The nurse professional should work in close coordination with the patient, to ensure that he is heard and listened to through the means of active-listening. The body language during the conversations also matter, as a stern and attentive body language will provide a sense of re-assurance to the patient that he is been listened to, with care (Wang, 2019). The nurses can also take help of both verbal and non-verbal means to communications, in order to gather information and interact with him through authentic and apt means of communication.

Take-Home Lessons from Schizophrenia Case Study

The following case study was helpful in getting the following pointers to be considered upon:

  1. The role of mental state assessment is very crucial. The various sections of the assessment scale gives details about the exact overview of the pictorial presentation of the patient’s ongoing state of mind. It is an important tool to also analyze for the fact as to whether the patient is subjected to any anticipated risk of self-harm or suicidal ideation. The assessment is very specific in giving a detailed outlines of the positive as well as negative symptoms displayed by the patient (Ong, 2016). This is helpful in drafting appropriate interventions for the patients.
  2. Role of critical thinking and reflective practices is another point to be taken into consideration. The patient with mental health related issues are very challenging to handle and each patient might come with its own constrains as well. These factors can hamper the recovery process of the patient and they are thus, need to be identified, uniquely associated to the patient case scenario. This can only be done by including the practice of reflective and critical thinking in the process (Speeney, 2018). The nurses can take the aid of helping the patient, with the previous care studies they have done for patients with similar diagnosis and can then use these inferences to overcome the challenges in managing care of the patient.
  3. Role of communication is also very important in smooth facilitation of the care services for the patients. Both the means of verbal as well as non-verbal communication is effective in managing care for the patient. The communication channels between the patient and the care giver should be established in the grounds of empathy and trust. The trust of the patient should always be maintained, by the means of keeping the patient as the main consideration and by actively listening to his concerns (Harris, 2019). This is a very effective method in treating mental health patients.
  4. Role of cognitive behavioral therapy is very useful in treating patients with schizophrenia. It helps in evaluating for the behavioral responses of the individual pertaining to himself only, as per individualized basis. This is helpful in picking up peculiar responses of the patient and thus, enabling in providing them with patient-centered approach plan.
  5. Family integrated approach can be very vital in attaining improved healthcare outcomes from an individual. In cases where the patient relies largely on the family, this method can be quite effective in dispensing the exact care needed by the patient. The family can be helpful in identifying the trigger points for the patient and the interventions given in presence of the family can be very re-assuring for the individual. They can also help in smooth facilitation of the delivery of care services to the patient (Fitryasari, 2018).

References for Case Formulation

Fitryasari, R., Yusuf, A., Tristiana, R. D., & Nihayati, H. E. (2018). Family members' perspective of family Resilience's risk factors in taking care of schizophrenia patients. International Journal of Nursing Sciences5(3), 255-261.

Glenn, J. J., Werntz, A. J., Slama, S. J., Steinman, S. A., Teachman, B. A., & Nock, M. K. (2017). Suicide and self-injury-related implicit cognition: A large-scale examination and replication. Journal of Abnormal Psychology126(2), 199.

Harris, B. A., & Panozzo, G. (2019). Therapeutic alliance, relationship building, and communication strategies-for the schizophrenia population: An integrative review. Archives of Psychiatric Nursing33(1), 104-111.

Harvey, P. D., & Rosenthal, J. B. (2018). Cognitive and functional deficits in people with schizophrenia: Evidence for accelerated or exaggerated aging. Schizophrenia Research196, 14-21.

Morin, L., & Franck, N. (2017). Rehabilitation interventions to promote recovery from schizophrenia: a systematic review. Frontiers in Psychiatry8, 100.

Nagai, N., Tani, H., Suzuki, T., Ikai, S., Gerretsen, P., Mimura, M., & Uchida, H. (2017). Patients’ knowledge about prescribed antipsychotics and medication adherence in schizophrenia: A cross-sectional survey. Pharmaco Psychiatry50(06), 264-269.

Ong, H. L., Subramaniam, M., Abdin, E., Wang, P., Vaingankar, J. A., Lee, S. P., ... & Chong, S. A. (2016). Performance of Mini-Mental State Examination (MMSE) in long-stay patients with schizophrenia or schizoaffective disorders in a psychiatric institute. Psychiatry Research241, 256-262.

Saito, Y., Sakurai, H., Kane, J. M., Schooler, N. R., Suzuki, T., Mimura, M., & Uchida, H. (2020). Predicting relapse with residual symptoms in schizophrenia: A secondary analysis of the proactive trial. Schizophrenia Research215, 173-180.

Sirivichayakul, S., Kanchanatawan, B., Thika, S., Carvalho, A. F., & Maes, M. (2019). Eotaxin, an endogenous cognitive deteriorating chemokine (ECDC), is a major contributor to cognitive decline in normal people and to executive, memory, and sustained attention deficits, formal thought disorders, and psychopathology in schizophrenia patients. Neurotoxicity research35(1), 122-138.

Speeney, N., Kameg, K. M., Cline, T., Szpak, J. L., & Bagwell, B. (2018). Impact of a standardized patient simulation on undergraduate nursing student knowledge and perceived competency of the care of a patient diagnosed with schizophrenia. Archives of Psychiatric Nursing32(6), 845-849.

Velligan, D., Carpenter, W., Waters, H. C., Gerlanc, N. M., Legacy, S. N., & Ruetsch, C. (2018). Relapse Risk Assessment for Schizophrenia Patients (RASP): A New Self-Report Screening Tool. Clinical Schizophrenia & Related Psychoses11(4), 224-235.

Wang, T. T., Beckstead, J. W., & Yang, C. Y. (2019). Social interaction skills and depressive symptoms in people diagnosed with schizophrenia: The mediating role of auditory hallucinations. International Journal of Mental Health Nursing28(6), 1318-1327.

Wang, W., Zhou, Y., Chai, N., & Liu, D. (2019). Cognitive–behavioural therapy for personal recovery of patients with schizophrenia: A systematic review and meta-analysis. General Psychiatry32(4).

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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