Safety Plan For Schizophrenic Patient With Depression And Suicidality

Symptoms of Schizophrenia and Ted’s Case

Schizophrenia is a major mental disorder effecting 1% of total population of the world. This is a serious issue, which needs to be addressed in time and continued efforts of family and care providers help reducing the risks associated with schizophrenia (NIMH » Schizophrenia, 2018). The case provides an insight into the effect of misdiagnosis and discontinued treatment that might follow with a schizophrenic patient.

Symptoms of Schizophrenia

The symptoms for schizophrenia vary from person to person, but the most common symptoms are idiosyncratic delusion, hallucination with any of the five senses, disorientation in thoughts and motor skills, word salad, unpredictability, agitation, aggression and suicidal tendencies (Wilson-d’Almeida et al., 2013).

Ted’s Symptoms

The patient in the case study Ted showed most of these symptoms like delusions, hallucination and suicidal tendencies which drove him into paranoia and ultimately compelled him to take his own life after he was discharged from the mental hospital.  Ted underwent hallucinations about being physically restrained by imaginary agents which would disappear (Modinos et al., 2013) This inflicted suicidal thoughts for which he had to transfer into the mental hospital. The symptoms minimized during his stay in the mental hospital in the beginning but his symptoms were recurrent, which made the initial asylum transfer him to a new one. The second hospital where he was assigned personal staffs to keep him comforted. Ted’s paranoia went into overdrive when he was released from the asylum and he started believing in delusions that his life was in danger and that he needed to get back to the hospital for safety. Even when the patient was in his home, he deluded himself into believing he was not safe and finally took his life two years later after the death of his care nurse (Saarinen, Lehtonen & Lönnqvist, 1999).

Possible methods to address Ted’s delusion, hallucination and depression

The treatment for schizophrenia is continued throughout life, there is no possible cure for this kind of a disorder. Medication along with recovery-based therapy reduces the adverse symptoms, but does not completely cease it (Slade et al., 2014). The treatment is usually done by regularly visiting a psychiatrist for continued therapy, medications to reduce psychosis, care under psychiatric asylum or social work centre to provide an all rounded approach to achieve better mental health.  Many anti-psychosis drugs can be administered which neurologically control the effect of dopamine on brain (Modinos et al., 2013). Psychosocial interventions help treating the psychosis by approaching the patient with an individualistic perspective. Training can be provided to the patient, which will help them improve their social skills to reduce anxiety and aggression. The engagement of family along with psychotherapy and their continued support improves the patient’s condition. Vocational training for employment can be given to the patients which will provide a sense of purpose to them and prevent existential crisis (Shepherd et al., 2014).

Treatment Options for Schizophrenia

Misdiagnosis of Ted

The practitioners in the facility centre did not take into consideration the underlying trouble that the patient could have possibly been undergoing an existential crisis and depression. The patient was also lonely which added with his delusional tendencies made him think that his life was in danger. The practitioners failed to extend the treatment, which increased Ted’s depression. He kept trying to go back to the facility because he thought his life was in danger and the practitioners did not take notice of that (Haddock et al., 2013). Ted’s family was also not involved in the care plan, which made him run away from the house. The assigned nurse’s death further enhanced Ted’s loneliness, which ultimately caused him untimely demise. The practitioner could have given Ted vocational training and involved him in group activities which would have enabled him to become self reliant and explore his artistic temperament. Incorporation of art in psychotherapy has proven to provide improved results in psychotherapy. Patients even have overcome their disorder and lead a better life, with continued therapy and practice of artistic talent (Shea, 2016).

Best and least effective Theoretical Approach for Ted 

The best model for Ted’s condition would have been implementation of recovery oriented mental health care. This model approach addresses the individual’s unique ability and provides a person-centered care. The interventions provide realistic advice respective of the patient’s condition which provides improved outcome (Slade et al., 2014). Management of attitude and teaching personal right to the patient also would have helped Ted reduce his psychosis. The model respect the personal boundary of the patient and treats them with respect without being judgmental, this stabilizes the patient’s self esteem and gives them confidence. The fundamental theory of the model is to provide a well balanced patient-therapist relationship which is aided by interpersonal communication and maintenance of privacy and safety of the patient.  Including the patient in the recovery process and gaining therapeutic consent from the patient is very important and will make the patient feel included, secure and provide purpose. Ted would have benefitted from this approach of the providers would have able to address these key factors. The practitioners failed to evaluate the importance of lifelong sustenance of schizophrenic treatment.

The least effective theory for schizophrenic treatment would have the electroconvulsive therapy. This is a very controversial method of treatment for schizophrenia or other severe mental disorders. Many have protested that the technique is unethical and almost inhuman where the patient is electric current is provided through the brain which changes the neuronal effects of brain and reverses the psychotic manifestations (Kroes et al., 2014).   

Effective and Ineffective Theories for Treating Schizophrenia

Describe treatment options for addressing all of Ted’s symptoms.

Ted could have been treated with recovery oriented treatment method which needed to be continued throughout his life. The model provides an all rounded approach to mental illness. Ted would have benefitted from depressive treatment, which would have taught him overcome his paranoia, feel included, and provided a cure for his existential crisis (Slade et al., 2014). Medications like anti-psychotics would have also helped Ted reduce the manifestations of his hallucination and delusions. The practitioners failed to address the key factor that was troubling Ted for a long time. Ted could have also benefitted from vocational training, which would have provided a purpose in his life and reduced self-harming tendencies.   

Religious and Spiritual beliefs during depression and Suicidal tendencies

The religious belief, the dependence and worship of an invisible stronger force is evident in humans ever since the stone ages. People worshipped the natural forces, which made them afraid. The belief in religions comes from an early age provided by a child’s parents and when that child grows up and realizes through his or her senses that existence of God or Almighty is debatable, their whole ideology and belief is shaken, giving the person an existential crisis (Weber & Pargament, 2014). People who are not mentally challenged can handle this logically, but for people who are already facing mental dilemma, the crisis takes shape into depression ultimately leading to suicide.

Conclusion:

Mental disorder is a critical treatment as the mind of the person is affected which induces social and physical abnormalities. The treatment of such disorders needs to more person-centric, and extended. The case of Ted could have been avoided if the practitioners identified his depression alone. 

References

Haddock, G., Eisner, E., Davies, G., Coupe, N., & Barrowclough, C. (2013). Psychotic symptoms, self-harm and violence in individuals with schizophrenia and substance misuse problems. Schizophrenia research, 151(1), 215-220.

Kroes, M. C., Tendolkar, I., Van Wingen, G. A., Van Waarde, J. A., Strange, B. A., & Fernández, G. (2014). An electroconvulsive therapy procedure impairs reconsolidation of episodic memories in humans. Nature Neuroscience, 17(2), 204.

Modinos, G., Costafreda, S. G., van Tol, M. J., McGuire, P. K., Aleman, A., & Allen, P. (2013). Neuroanatomy of auditory verbal hallucinations in schizophrenia: a quantitative meta-analysis of voxel-based morphometry studies. cortex, 49(4), 1046-1055.

NIMH » Schizophrenia. (2018). Nimh.nih.gov. Retrieved 19 April 2018, from https://www.nimh.nih.gov/health/statistics/schizophrenia.shtml#part_154880

Saarinen, P. I., Lehtonen, J., & Lönnqvist, J. (1999). Suicide risk in schizophrenia: An analysis of 17 consecutive suicides. Schizophrenia Bulletin, 25, 533-542

Shea, S. C. (2016). Psychiatric Interviewing E-Book: The Art of Understanding: A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals. Elsevier Health Sciences.

Shepherd, G., Boardman, J., Rinaldi, M., & Roberts, G. (2014). Supporting recovery in mental health services: Quality and outcomes. Centre for Mental Health, NHS Confederation.

Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., … & Whitley, R. (2014). Uses and abuses of recovery: implementing recovery?oriented practices in mental health systems. World Psychiatry, 13(1), 12-20.

Weber, S. R., & Pargament, K. I. (2014). The role of religion and spirituality in mental health. Current opinion in psychiatry, 27(5), 358-363.

Wilson-d’Almeida, K., Karrow, A., Bralet, M. C., Bazin, N., Hardy-Baylé, M. C., & Falissard, B. (2013). In patients with schizophrenia, symptoms improvement can be uncorrelated with quality of life improvement. European Psychiatry, 28(3), 185-189.