The present paper is devoted to the study of a case of schizophrenia, which manifested in a 39-year-old woman Angela during her first year at college in the form of prodromal symptoms, which caused her to drop out. She married and gave birth to a son. However, six months before her hospitalization, her husband grew disturbed with her “strange” behavior and moved out with the child. Since then, Angela stopped leaving her place and taking care of herself and turned apathetic, delusional, and paranoid. She was hospitalized to achieve stabilization, which can be promoted through medication, education, and psychotherapy interventions, most of which should be carried out into the post-discharge period.
The Goals of Angela’s Discharge Treatment Plan
Schizophrenia is a chronic illness that does not have a cure nowadays. Still, recovery is possible if a “relative success” is achieved in certain areas, including “socialization, symptoms, and community functioning” (Beebe, 2012, p. 473). Angela was enrolled in Assertive Community Treatment, the typical aims of which coincide with these guidelines (Varcarolis, 2016). Moreover, any comorbid issues of Angela, including weight loss, need to be treated because of the reduced motivation and ability of people with schizophrenia to take care of their health (Beebe, 2012). A general health promotion intervention with an emphasis on the importance of treatment adherence is also required (Ertem & Duman, 2016). To sum up, the goals of Angela’s discharge plan include sufficient improvements for symptoms, socialization, comorbid issues, and health education; an assessment can help make these goals SMART (Beebe, 2012, p. 481).
Treatment Interventions after the Discharge
People with schizophrenia often encounter multiple barriers to achieving “optimal health,” including individual (for example, the lack of relevant knowledge), health-related (symptoms like apathy), and economic (poverty) issues (Beebe, 2012, p. 473). Angela has been a housewife for the past few years. She is unlikely to have any stable income; her state indicates the lack of motivation or ability to take care of herself, and she must have extensive knowledge of her illness. Therefore, Angela needs holistic care before and after the discharge, including the recommendation of accessible health programs and educational, motivational, and lifestyle interventions (Beebe, 2012; Ertem & Duman, 2016; Varcarolis, 2016). Her mother and husband should also be involved in these activities if they are willing (Varcarolis, 2016). Medication use is also required throughout schizophrenia treatment (Beebe, 2012). Angela’s nurse should choose specific interventions after a thorough assessment of her needs and risks.
Medications for Stability and Recovery
Schizophrenia treatment requires choosing an antipsychotic medication. Beebe (2012) suggests that ziprasidone or aripiprazole can be a safe choice for patients who have never been treated with antipsychotic medication (p. 476). Still, the case may not contain important information about Angela’s treatment history. The medication choice may need to be adjusted if the treatment proves to result in more risks than benefits because of side effects. Adjunctive medications can treat comorbid issues like mood or weight problems, but the complexity of treatment needs to be controlled (Beebe, 2012; Varcarolis, 2016). Despite the importance of medication, Beebe (2012) states that schizophrenia cannot be successfully treated without other interventions, including psychotherapy, that can help Angela to learn to cope with psychological stressors (p. 481).
Psychosocial Stressors as Contributors to Decompensation
While stressors are not known to cause schizophrenia, they have been shown to contribute to its development and severity (Varcarolis, 2016, p. 307). Angela’s decompensation seems to have peaked after her husband and child left, which suggests that her family’s breakup may have been a major contributing stressor. However, the case study states that she has been exhibiting “increasingly strange behaviors,” which implies that other stressors could have been present. The case does not reveal all the details of her life, but the events of dropping out of college and leaving her job and the difficulties of her married life might have also contributed to the issue.
References
Beebe, L. H. (2012). Schizophrenia. In E. F. Perese (Ed.), Psychiatric advanced practice nursing: A biopsychosocial foundation for practice (pp. 467-509). Philadelphia, PA: F.A. Davis.
Ertem, M., & Duman, Z. (2016). Motivational interviewing in a patient with schizophrenia to achieve treatment collaboration: A case study. Archives of Psychiatric Nursing, 30(2), 150-154.
Varcarolis, E. (2016). Essentials of psychiatric mental health nursing (3rd ed.). New York, NY: Elsevier Health Sciences.