Schizophrenia is a chronic illness that affects nearly every aspect the client. Treatment planning should focus on reducing or eliminating symptoms; maximize the quality of life and adaptive functioning; and advance and retain recovery as much as possible. The implications of an inaccurate diagnosis are potentially enormous. Thus, it is very important that the diagnosis be a process, and not the one-time result of a fixed moment in time. The treatment plan must be looked at as a work in progress especially as the diagnosis is reevaluated or because of new information becoming available concerning the symptoms, or the client.
The case study “He forgets to take his medication”, a 45-year old male with chronic schizophrenia who continually relapses after two weeks or so due to forgetting to take his prescriptions. The client does keep his appointments. Although the medications do alleviate his symptoms, he is non compliant to his prescription therapy. Therefore his psychiatrist adjusts the therapy to biweekly injections.
According to Butcher, Mineka and Hooley (2007) “anti psychotic medications are usually administered by mouth. However some patients, particularly those with chronic schizophrenia, are often not able to remember to take their medications each day” (pp. 609-610). Therefore in treatment planning the clinician is wise to identify barriers that may prevent the client’s ability to carry through with the directions of the therapy. For example if the client is severely cognitively impaired or disorganized or less than optimal environmental circumstances.
My choice of therapeutic approach is multifaceted for this client. First, I would recommend performing a medical and mental evaluation and history of these including a mental status examination, neurological, and laboratory examinations with vitals such as heart rate, blood pressure and temperature. I would also recommend a toxicology screening. If possible, and if the client gives permission, interviews with family or associates could be conducted especially if the client’s accounts are unreliable. Because he has been unsuccessful at self administering his medication, the reason for this should be assessed and included in the treatment plans. As soon as possible, so long as diagnosis is not interfered with, pharmacological treatments should be administered because of the risks associated with the symptoms of schizophrenia such as emotional trauma, the stress and disruption of the client’s life, and the possibility for self-harm.
Butcher et al. (2007) have stated: “Not all prospective clients, regardless of their need for treatment, are ready for the temporary discomfort that effective therapy might entail. In particular, a client with chronic schizophrenia and who is recently off medication or only taking it intermittently, may be too unstable for traditional psychotherapy because facing past experiences or simply to undergo any additional emotional pain could traumatize the client further. An integrated treatment program for this client will combine medications with a range of psychosocial services, social skills activities, community-based care, and possibly cognitive behavior oriented and eclectic therapy. Several factors to consider include the possibility for substance abuse, depression, and aggressive behavior. Craighead, (as cited by Butcher, et al., 2007) states Beck’s cognitive treatment therapies are highly documented to be efficacious for long-term alleviation of symptoms and relapse which for this particular case study could be promising. Cognitive behavior may help him cope with and process stresses so that full blown feelings of anxiety or panic may be averted.
In addition to educating clients and their families about schizophrenia, and dispelling unhelpful attitudes, cognitive behavior therapy could uncover false beliefs. In this regard, educating the client about the importance of participating in treatment, including medication and the relationship to stated personal goals might be able to be achieved because the client could see how behavior, cognition and emotions are directly impacted by medication. Awareness of the relationship between the consequences of schizophrenia and how it interferes with normal functioning will build connections that may improve the life experience of the schizophrenic client.
Finally, I think that treatment should involve highly structured behavior techniques and skills building, because these may positively influence the client’s increased chances of stabilization.
American Psychiatric Association. (2000). DSM-IV-TR. Arlington, VA: Author.
Butcher, J. N., Hooley, J. M., & Mineka, S. (2007). Abnormal psychology (13th ed.). Boston: Pearson Education.