Schizophrenia Treatment and Early Intervention

This assignment discusses various aspects of schizophrenia treatment and early intervention. It highlights the importance of early intervention in risk groups for schizophrenia, including pharmacological and psychological interventions. The assignment also explores the effectiveness of social media interventions, physical activity programs, and lifestyle changes in improving mental health outcomes for individuals with schizophrenia.

Running head: CRITICAL CASE STUDY OF MENTAL HEALTH DISORDERS
CRITICAL CASE STUDY OF MENTAL HEALTH DISORDERS
Name of the student:
Name of the university:
Author note:

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CRITICAL CASE STUDY OF MENTAL HEALTH DISORDERS
Introduction:
Mental health disorders can be described as the condition that is seen to affect the
thinking, feeling as well as mood of persons. Such a situation can be seen to affect the ability of
an individual to relate to others and even functioning of everyday. It has been interesting to see
that even individuals will have different experiences although they may be diagnosed with the
same disorders (Ramsay et al. 2017). Here, the mental healthcare professionals need to consider
recovery of the patients in ways by which they would not only overcome the disorders but also
have proper social life to live a better quality life. Researchers have stated that in most cases, a
mental health condition is not the result of a single event but multiple linking causes of a large
number of events (Valmaiki et al. 2016). Often a large number of factors are responsible that
affect the mental health stability of individuals. Genetic, environment as well as lifestyle has
been seen to have major impacts on the mental health condition of individuals. Often stressful
professional as well personal lives or victims of traumatic life events are seen to be more
vulnerable to the development of mental health conditions (Kantrowitz et al. 2016). Biochemical
procedures as well as different types of circuits and basic brain structures are also contributing
factors that result in mental disorders. This assignment will mainly show about how nursing
professionals diagnose mental health disorders and how with the help of bio-psycho-social model
of healthcare, they can successfully develop care plans which will help the patients to live better
quality life.
Critical thinking conducted by healthcare professionals and development of care plan:
When the patient had reached to the hospital in the nation of United Kingdom, she was
panicking massively and wanted to kill herself to be free from ‘pain’. The nursing professionals

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communicated with her in a compassionate manner and tried to cool her down. She was not
being able to trust anyone and was searching for objects to kill her. After repeated counseling of
the patient and talking with her in compassionate manner, she finally cooled down. Throughout
the first few hours, she was seen to talk to someone whom, only she claimed to see. When she
was collected down and asked about what she is seeing, she stated that her uncle frequently
disturbs her. Her husband disclosed that her uncle mentally, physically and sexually assaulted
her until the time of 18 years. It was after her marriage with her husband, he came to understand
all the issues and to give her better life, and he had taken her to Australia. However, situations
had not been better also for them, as the patient always seems to hear the voice of his uncle
strangling her or assaulting her. The periods come back to her again and again which makes her
feel like killing herself to get rid of mental stress and pain. She had also stated that drinking
alcohol and other such drugs help her to reduce her pain and help her to release her tensions and
stress and therefore she spends most of the time on such substances. Therefore, the senior nurses
critically analyzed the situations and framed out the main reasons that had affected her. She
stated that the priority areas that need to be addressed in the patient are her extreme dependence
on substances like alcohol and other drugs that will affect her both mentally and physically.
Another priority area that also needs to be addressed by the nurses is her symptoms of
schizophrenia. She is having both auditory and visual hallucinations that are torturing her and
making her lead bad quality of life. She has high risk of harming herself to make her free from
the immense pain that the hallucinations are providing her and therefore proper care should be
taken to make her free from any sort of self-harm. Therefore, schizophrenia and alcohol and
substance abuse disorder are the identified priority areas witnessed by the nursing professionals
that need to be treated.

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CRITICAL CASE STUDY OF MENTAL HEALTH DISORDERS
Dual diagnosis:
Dual diagnosis can be defined as the condition when individuals have multiple needs that
include both physical and mental issues and have dual mental health and substance abuse
problem. They are seen to be struggling as well as unemployed and cannot hold on their job.
They could be also in abusive relationship. In the depicted case also, the patient is suffering from
dual mental health conditions of schizophrenia and substance abuse disorders and were also in
abusive relationship ("New NICE guidance on dual diagnosis is 'desperately needed'" 2018).
Therefore, the nursing professional would also incorporate bio-psychosocial model of treatment
for diagnosing the issues and developing care plans. Here, the professionals not only try to
determine the biological determiners but also try to find out whether any social or psychological
determinants of health are affecting the clients or not (Stafford et al. 2015)..
Discussion of the symptoms of schizophrenia:
Researchers are of the opinion that schizophrenia is a type of psychosis that is a type of
mental illness. In this type of mental illness, persons are not able to differentiate between the
reality and what is imagined. They seem to lose touch with reality and the entire world seem to
be a jumbled place containing different types of confusing thoughts, sounds as well as images.
The behavior of people with schizophrenia seems to be strange and shocking to the people of the
society (Vancampfort et al. 2016). A sudden change that takes place in the individuals in
behavior as well as in personality takes place when people suffering from schizophrenia are seen
to lose touch with reality is called as the psychotic episode. Similarly, in case of Maryam as well,
several psychotic episodes had take place. Researchers are of the opinion that hallucinations are

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mainly false perceptions and inaccuracies which affect the senses of patients and cause them to
see, hear, taste or smell which are not done by others. In the acute phases, people are seen to
insist that they are hearing different kinds of voices or visualizing episodes that are not heard or
seen by others (Seidman and Nodentorft 2015). Researchers are of the opinion that hallucinations
may respond to situations when the levels of stress is lessened in the patient and when treated
with antipsychotic medication. Researchers also suggest that when patients are kept busy, it
helps them in living better as remaining busy provides helpful distractions. Often experts in the
field of mental health science advise the therapists to encourage the patients to discuss in details
the times when hallucinations occur. This can help the therapists to understand that exact
triggering factors that are resulting in occurrence of the hallucination periods. The professionals
can realize the exact nature of the stress that is actually leading to the occurrence of such
episodes. Researchers also suggest that another strategy by which the healthcare professionals
can effectively handle the patients (Stafford et al. 2015). They need to point out to the patients
making them understand that they have some levels of control over their hallucinations. In
certain studies, it has been seen that patients often develop the habit of listening or seeing voices
of episodes as if they are passive recipients. Often it is seen that directing their minds to other
areas of interests and thereby helping them to recognize that they no longer wait to hear or see
incoming voices of episodes are found effective in a large number of trials. Researchers suggest
that encouragement of the patients to preserve and not to give up as well as to discuss the things
with the professionals and providing reassurance to the family are important part of the treatment
procedure of such patients.
Interventions for schizophrenia:

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After entire discussion with the healthcare team in details, the care coordinator has
appointed two experienced nurses and two junior nurses for caring of the patient. An expert was
assigned to evaluate and monitor the health of the patient on a daily basis to measure the
development of the patient. Moreover, he was also assigned the duty to counsel the patient
according to her needs so that she can gradually come out from the periods that took place during
her teenage years that comes back to her as nightmares in her lonely periods. The four nurses
planned several interventions so that proper care can be taken to her and to make her overcome
her periods of hallucinations. The for nurses ad accepted the fact in front of the patient that the
voices and visions which she sees are indeed real to the patients but they continued to explain to
her that although she heard and saw such periods but they could not see of visualize any of the
episodes. Researchers are of the opinion that healthcare professionals should stress on the words
as “your voices” or “voices that you hear”. The main rationale provided by the researchers is that
when the healthcare professionals validate that their reality does not include voices, this will
make the patient cast “doubt” on the validity of the voices that will make her question about the
reality of her imaginable voice (Stafford et al. 2015). The second intervention that was also
applied is to be alert for signs of increasing fear, anxiety as well as agitation among the patients.
This might help the nursing professionals to herald different hallucinatory activity that can be
considered as frightening to the client and on which the client might act upon like self harm or
similar other activities. The third intervention that was adopted by nurses was the explorations of
how the clients experience the hallucinations. The main rationale of this intervention is that
exploring the hallucinations and thereby sharing the experiences of the patient will help to give
the patient a sense of power. By empowering her, he would be able to undertake self-
management skills to overcome the hallucinatory visions of the voices. The fourth intervention

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that also contributed to good health of the patient is to help the client identify the needs that are
underlying the hallucinations (Larelle 2014). The main point here is to find out the ways by
which the needs of the patients can be met. Hallucinations might reflect needs for anger, power,
self-esteem and sexuality. In case of Maryam, it is seen that the incidences that had happened
with her during the times of adolescence had affected hr so deeply that the fear of the incidences
and the pain she had faced had been impregnated in her mind deeply. In the present times, her
lonely days and feeling of helplessness, isolation from the society, his habit of drug abuse and
many others are creating stress in her which are making her go through similar pains faced by
her in those days. Her loss of power, self-esteem and sexuality in earlier times are affecting her
present day life for which she is having severed hallucinations (Laruelle 2014). Her linking up of
her present condition with that of previous incidences or even feeling of insecurity had been
resulting as triggering factors for the events. The nurses had been able to recognize them and
were counseling her in ways by which she can overcome such emotional turmoil and look at the
positive and better parts of life. Another intervention that the nurses also took was to stay with
the patient and directing them to tell the voice (which they hear) to go away. Researchers have
seen that clients can indeed learn to push the voices aside when repeated instructions are given to
the patients after establishing the framework of trusting relationship (Sommer et al. 2016). On
the fourth day of the treatment, Maryam was seen to be gradually becoming successful in
showing positive results on her mental health conditions and was successfully being able to
handle herself during the times of psychotic episodes. The other interventions included the
patients in discussing simple, basic as well as reality-based topics of conversations helping the
client to focus on one idea at a time. As Maryam is stressed right now, she might had confused as
well as disorganized thinking. Therefore, in this situation the intervention had helped her lot to

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focus as well as comprehend reality-based issues. Risk assessment was done to keep her away
from the objects that would induce her hallucinatory activities. Another interesting intervention
that also provided was engaging the patient in different reality based activities like card playing,
drawing, writing, doing simple arts and crafts, listening to music and many others. The main
rationale for this intervention was that the nurses wanted to redirect the client’s energies towards
acceptable activities (Ince 2016). This is mainly because, it would help her to decrease the
possibility of acting on the hallucinations and thereby help her to distract herself from the visions
and voices. All these helped Maryam to gradually overcome her symptoms of hallucinations and
lead her towards better lives.
Causes that result in substance abuse disorders:
Often there are large numbers of factors that often lead substance abuse disorders. Often
denial and ineffective individual coping are two of the factors that may make individuals depend
on substance use. Individuals also do substance abuse when they suffer from powerlessness,
imbalanced nutrition as well as low esteem (Negar and Prinz 2015). Altered family process,
sexual dysfunction as well as deficient knowledge are also other reasons that may lead a person
to take up substance abuse. The main reason for Maryam’s taking up of such a habit is her
inability to cope up with her situation both from the past and from the present. She had taken up
the habit in her younger years as she wanted to overcome the stress caused by the physical and
mental torture done by her uncle. In the present generation also, it was also seen that loneliness
throughout the day and her social exclusion had been the main reason for her containing her
substance abuse (Thurgood et al. 2016). Moreover, her symptoms of hallucinations had also

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resulted in aggravating the substance abuse disorder symptoms, as she believed that alcohol and
other drugs helped her to live in an alternate reality that is not as stressful as her real life
(Campbell et al. 2014). All these are symptoms of her ineffective coping that had thereby
resulted in such situation.
Interventions for substance abuse:
A substance abuse counselor is to be appointed for the patient who would help the patient
by properly counseling her and providing her with effective alternatives by which she can cope
with the stress and turmoil she is having. The nursing professionals would then be determining
the social determinants of mental health that are affecting Maryam. They would be analyzing the
current situations, previous methods as well as other methods of coping with the problems of life
(Kinnibrgh et al. 2017). When the nursing professionals would investigate the issues, they will
be able to find information about Maryam’s degree of denial, acceptance of personal
responsibility, commitment to change. Maryam was set limits so that she can follow through the
behaviors that she had agreed to follow to the substance abuse counselor. Patient had learnt
manipulative behaviors through her life and for that she needed to learn new ways of getting
needs met. Therefore, if she is made a situation where she needs to follow through the
consequences of failure to maintain the limits, she would be able to change her ineffective
behavior to some extent. The nurses can also encourage Maryam’s verbalization of the feelings,
fears as well as anxiety. This would in turn help the patient to come to terms and thereby handle
many long unresolved issues successfully (Galanter et al. 2014). The nursing professionals also

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helped the patient to explore different types of alternative coping strategies. Researchers have
also stated that often patients do not have or may have little knowledge about the different
adaptive responses to manage stress. Therefore, they need to learn other options for managing
stress, feelings, pressures, loneliness, time and relationships without drugs (Donovan et al. 2015).
The nursing professionals also assisted Maryam to learn and encouraged her to use proper
relaxation skills that were guided by imagery and different visualization. These helped Maryam
to relax and develop new ways to deal with stress and solve problems that came in her way.
Discharge plan:
In the discharge plan, the nursing professionals and incorporated effective ways by which
Maryam’s social determinants of her ill health could have been addressed. He feeling of
loneliness were affecting her and making her feel insecure for which her old memories were
rushing back to her. Therefore, these situations were discussed with her husband in details as he
as quite concerned about her health. Her husband was highly supportive and he decided to
change is working schedules so that he can spend most of the time with her wife as she needed
his support. Structural diversion activity that related to the recovery was also proposed. This
included social activity where she would be introduced so that she can feel herself included by
the society (Pitschel et al. 2015). The more the patient remains included in the different
community based activities in her lone time, she will feel better and her requirements to take
drug and alcohol will eventually reduce. She can include herself in different activities like
writing, painting, different workshops and others both in her home and in the communities
(Degnan et al. 2018). These would help her overcome her perception that she would not be
accepted in society and would help her to mingle with everyone successfully. Moreover, support

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services were also suggested to her husband so that he can appoint social carer for his wife
accordingly.
Conclusion:
A case study was provided where the patient was suffering from schizophrenia and
substance abuse disorders. She was therefore suffering from complex symptoms that were
attended by nurses by identifying the symptoms, the causes and then the priorities. Proper
healthcare team composing of care coordinator, senior nurses and junior nurses, experts,
substance abuse counselors, social care workers and others were proposed. Proper bio-
psychosocial model was followed where her biological, psychological and social determinants of
health were identified and accordingly interventions were set.
References:
Bighelli, I., Salanti, G., Reitmeir, C., Wallis, S., Barbui, C., Furukawa, T.A. and Leucht, S.,
2018. Psychological interventions for positive symptoms in schizophrenia: protocol for a
network meta-analysis of randomised controlled trials. BMJ open, 8(3), p.e019280.
Campbell, A.N., Nunes, E.V., Matthews, A.G., Stitzer, M., Miele, G.M., Polsky, D., Turrigiano,
E., Walters, S., McClure, E.A., Kyle, T.L. and Wahle, A., 2014. Internet-delivered treatment for
substance abuse: a multisite randomized controlled trial. American Journal of Psychiatry, 171(6),
pp.683-690.

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Degnan, A., Baker, S., Edge, D., Nottidge, W., Noke, M., Press, C.J., Husain, N., Rathod, S. and
Drake, R.J., 2018. The nature and efficacy of culturally-adapted psychosocial interventions for
schizophrenia: a systematic review and meta-analysis. Psychological medicine, 48(5), pp.714-
727.
Donovan, D.M., Thomas, L.R., Sigo, R.L.W., Price, L., Lonczak, H., Lawrence, N., Ahvakana,
K., Austin, L., Lawrence, A., Price, J. and Purser, A., 2015. Healing of the canoe: preliminary
results of a culturally grounded intervention to prevent substance abuse and promote tribal
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Galanter, M., Kleber, H.D. and Brady, K. eds., 2014. The American Psychiatric Publishing
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Ince, P., Haddock, G. and Tai, S., 2016. A systematic review of the implementation of
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Regulation, and Competency: A comprehensive intervention framework for children with
complex trauma. Psychiatric Annals, 35(5), pp.424-430.

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Laruelle, M., 2014. Schizophrenia: from dopaminergic to glutamatergic interventions. Current
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Neger, E.N. and Prinz, R.J., 2015. Interventions to address parenting and parental substance
abuse: Conceptual and methodological considerations. Clinical psychology review, 39, pp.71-82.
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desperately-needed
Pitschel-Walz, G., Leucht, S., Bäuml, J., Kissling, W. and Engel, R.R., 2015. The effect of
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Appendix:
Patient name: Maryam Akhter
Age: 25 years
Status: Married
Diagnosis: Schizophrenia with both visual and auditory hallucination
Family member/guardian: Husband Shahbaz
Patient history: sexually abused till the age of 18 years, shifted to Australia after marriage,
substance abuse disorder
Case study:
The patient named Maryam is a 25-year-old woman who had been admitted to the mental
health ward by her husband Shahbaz. Both of them have recently shifted to United Kingdom
where most of the times her husband is seen to stay outside due to rigorous working hours at his
office. Mostly, the patient stays alone in the new place that had been affecting her in negative
ways. She is not being able to adjust to the new land and is also not being able to interact with
the society. She has a fear of not being accepted by the society for which she keeps herself aloof
from the society and prefers to live alone. She is found to be increasingly addicted to alcohol and

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other drugs that she used to take from a very early age of 15 years. She believes that it helps her
to forget her pains and help her live in an ‘alternate reality’ that is free from distress and stresses.
She suffers from poor quality life due as she is affected by auditory and visual hallucinations
which makes her vulnerable to self harm.