Assignment 1: “Captain of the Ship” Project – Schizophrenia Spectrum

Assignment 1: “Captain of the Ship” Project – Schizophrenia Spectrum and Other Psychotic Disorders

In earlier weeks, you were introduced to the concept of the “captain of the ship.” In this Assignment, you become the “captain of the ship” once again as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a schizophrenia spectrum/other psychotic disorder. Assignment 1: “Captain of the Ship” Project – Schizophrenia Spectrum

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Learning Objectives

Students will:

• Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with schizophrenia spectrum and other psychotic disorders Assignment 1: “Captain of the Ship” Project – Schizophrenia Spectrum
• Recommend psychotherapy based on therapeutic endpoints for clients with schizophrenia spectrum and other psychotic disorders
• Identify medical management needs for clients with schizophrenia spectrum and other psychotic disorders
• Identify community support resources for clients with schizophrenia spectrum and other psychotic disorders
• Recommend follow-up plans for clients with schizophrenia spectrum and other psychotic disorders

To prepare for this Assignment:

• Select an adult or older adult client with a schizophrenia spectrum and other psychotic disorder you have seen in your practicum.

In 3–4 pages, write a treatment plan for your client in which you do the following:

• Describe the HPI and clinical impression for the client.
• Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
• Identify medical management needs, including primary care needs, specific to this client.
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

Schizophrenia: Drug and Other Supportive Management in the Adult Patient

Schizophrenia is a psychosis that is characterised by changes in cognition, perception and patterns of socialization. It is a condition that does not have signs and symptoms that are uniquely identifiable with it alone (Jameson et al., 2018, p. 3,275). Its hallmarks are delusions and hallucinations, coupled with unusual motor activity. The following is the treatment plan for a schizophrenic patient who also appears to have concomitant bipolar disorder. He is a 33 year old male, college educated, married but currently not working due to the symptoms.

The patient’s history of presenting illness (HPI) included that he started with withdrawing himself socially for some time, after which he started having auditory and tactile hallucinations a month into the symptoms. Delusions set in sometime during that first month. He withdrew from his wife and his family, and could lock himself up in the house after refusing to go to work. He did not have a history of substance abuse. Towards the end of the first month, he started showing impaired concentration. This was at the beginning. However, according to the wife, these remained present up to now; about seven months after they initially began. The only difference, according to her, is that in the last few months the patient would once in a while be suddenly very jovial. He would then withdraw himself emotionally again, just as suddenly as he had become jovial. The patient has now totally neglected his hygiene, looks unkempt and dishevelled, and is withdrawn.

Following this history, this patient was diagnosed with schizophrenia, as his clinical presentation and duration of symptoms fell within the diagnostic criteria. This diagnostic criterion is outlined in the DSM-5 Diagnostic and Statistical Manual of Mental Disorders, of the American Psychiatric Association.

The recommendation for psychopharmacologic treatments will involve both drugs and non-drug measures like counselling. It has been shown that drug treatment alone is not as effective in the treatment of schizophrenia. As such, it has to be combined with other supportive measures like social support. The drugs that would be used to control the debilitating signs and symptoms of this patient are majorly neuroleptics (antipsychotics) (Katzung, 2018, p. 511; Jameson et al., 2018, p. 3,275). These drugs are also divided into the older ones and the newer “atypical” ones. The basis for this division is chiefly due to the side effects that they cause. The new generation ones appear to have lesser side effects than the older counterparts. Some of the drugs that this patient can be put on, the antipsychotic agents, are as follows: Assignment 1: “Captain of the Ship” Project – Schizophrenia Spectrum

1. Older drugs

The most prominent one here is Chlorpromazine. It has been used for a long time to manage schizophrenia. However, it has got some debilitating side effects like sedation and orthostatic hypotension. The other one is Thioridazine. It has a similar profile to chlorpromazine.

2. Higher potency options

The most widely used here would be Haloperidol. It is very effective in the relief of symptoms. The only problem it has is the side effects. Its side effects are extra-pyramidal side effects like akinesia.

3. “Atypical” drugs

These are the new generation medications that are used to manage schizophrenia. An example here that would benefit this patient is Clozapine. It has relatively fewer side effects.

The many side effects that all these medications can bring include lethargy, weight gain, postural hypotension, constipation, and dry mouth. These are some of the therapeutic endpoints that should be looked out for and managed. The importance of this is that these therapeutic endpoints, if not properly managed, result in the patient being non-compliant to treatment and avoiding it. The other therapeutic endpoints are of course the relief of the symptoms described in the history of presenting illness – withdrawal, delusions, and hallucinations.

Other Treatment Options

As stated above, the treatment of schizophrenia with drugs alone is not sufficient. To achieve the best results in management, other measures such as counselling and psychotherapy must be roped in. This involves the patient being talked to by a professional to find out his exact thought processes. The psychotherapist will interrogate the patient, try to get his thought processes, and formulate a roadmap of behavioural treatment for the patient, so to speak. In this, counselling, psychotherapy, and cognitive treatment will go hand in hand. The therapeutic endpoints are the desirable changes in the behaviour of the patient, and the reduction of the intensity of the symptoms.

Medical Management and Primary Health Care

This patient is a patient who is mentally unstable.  He is somebody who in essence cannot make informed decisions for themselves. As a result, he has neglected his own hygiene, and is prone to amongst other things, infections that are caused by eating and drinking contaminated food. Moreover, the patient does not take care of his bodily hygiene. This is an environment that encourages the proliferation of microbes that cause disease. This patient, therefore, is a person that requires round the clock primary health care and essential medical attention. For example, they will suffer from conditions like dehydration, tinea capitis (ringworms), and a variety of skin conditions. Primary health care will thus ensure that they get the basic medications that they need to check these preventable conditions.Assignment 1: “Captain of the Ship” Project – Schizophrenia Spectrum

Support Services

            This patient will also need support in terms of housing and a network of understanding family and community members. In the case of this patient, he is married and has a family. The challenge to his holistic treatment is therefore getting his family to accept him as he is, and to support him in his journey of treatment. There are many community based organizations and support groups that both support and bring together past and present patients of schizophrenia. These also will put resources together to come to the aid of this patient, as he is now economically dependent.

Lastly is a recommendation plan that all these agencies should work together for the betterment of the patient.

References

Corey, G. (2017). Theory and Practice of Counseling and Psychotherapy, 10^th ed. Boston,             MA: Cengage Learning.

Hammer, D.G., & McPhee, S.J. (Eds) (2014). Pathophysiology of disease: An introduction to        clinical medicine, 7^th ed. New York, NY: McGraw-   Hill Education.

Huether, S.E., & McCance, K.L. (2017). Understanding pathophysiology, 6^th ed. St. Louis,           MO: Elsevier, Inc.

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2018). Harrison’s principles of internal medicine, 20^th ed. New York, NY: McGraw-   Hill Education.

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14^th ed. New York, NY:      McGraw-Hill Education.

Assignment 1: “Captain of the Ship” Project – Schizophrenia Spectrum