How to address a Schizophrenia Case Study Solved

Scenario: C.Z. is a 20-year-old Caucasian male who is in his second year of college. He is seeking treatment due to persistent fears that campus security and the local police are tracking and surveilling him. He cites occasional lags in his internet speed as evidence that surveillance devices are interfering with his electronics. His intense anxiety about this has begun getting in the way of his ability to complete schoolwork, and his friends are concerned – he says they have told him, “you’re not making sense.”

C.Z. occasionally laughs abruptly and inappropriately and sometimes stops speaking mid-sentence, looking off in the distance as though he sees or hears something. He expresses concern about electronics in the room (phone, computer) potentially being monitored and asks repeatedly about patient confidentiality, stating that he wants to be sure the police won’t be informed about his treatment. His beliefs are fixed, and if they are challenged, his tone becomes hostile.

Questions:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.

Discuss the etiology, course, and the structural/functional abnormalities of schizophrenia.
Discuss the evidence-based pharmacological and nonpharmacological treatment for this patient using the US Clinical Guidelines

SOLUTION TO CASE STUDY

Discuss the etiology, course, and structural/functional abnormalities of schizophrenia.

Schizophrenia is a mental illness that affects a person’s ability to think, feel and perceive things. Schizophrenia is solely characterized by psychosis, for instance, experiencing hallucinations and delusions. The etiology of schizophrenia is unknown, while some risk factors are associated with the high development of schizophrenia in individuals. Genetics is one of the factors associated with the cause of schizophrenia. The first relative with schizophrenia may pass it to the next generation. Some individuals or families may not possess the genome for schizophrenia, but this may occur due to new mutations. Schizophrenia and bipolar disorders are likely to overlap in genetic risk factors.

Consistent indulgence in substance abuse, for instance, marijuana, may hasten the increase of psychosis in those at high risk for developing a psychotic disorder. Physical and psychological dependence on substances drives one into psychosis, ultimately leading an individual into schizophrenia. Stress associated with life events such as divorce, grief, and physical and sexual abuse trigger psychological impairment. Stressful life events may not cause schizophrenia but can trigger its development among vulnerable persons. Persons who experience pregnancy and birth complications such as premature labor and low birth weight may alter the chemical affecting brain development.

The course of schizophrenia ranges from the prodromal stage, active stage, and residual schizophrenia. The prodromal stage is the early stage of schizophrenia characterized by unnoticeable psychotic symptoms. Behavioral and cognitive changes occur, which progress to psychosis. Active stage exhibit symptoms of schizophrenia such as; hallucinations, delusions, and paranoia. C.Z., from the case study, is presenting with active symptoms of schizophrenia (Newton et al., 2019). The residual stage of schizophrenia is when a person experiences fewer or less severe symptoms than those illustrated in the active stage. Symptoms in the residual stage include social withdrawal, flat voice, and inability to concentrate. Structural abnormalities in schizophrenia include disruption in white and grey matter. Damage to the integrity of the white matter has been associated with the development of schizophrenia. Disruptions in the gray matter results in deficits in neuronal integrity (Zhao et al., 2018)

Discuss this patient’s evidence-based pharmacological and nonpharmacological treatment using the U.S. Clinical Guidelines.

The recommended evidenced-based nonpharmacological interventions for managing C.Z. include cognitive behavioral therapy, psychotherapy, social and coping skill, family interventions, and assertive community treatment. Schizophrenia can be a lifelong illness, but one can successfully manage the symptoms to improve the quality of life. The condition can, however, present challenges such as experiencing hallucinations that impair daily life. Psychotherapy is a broad option for nonpharmacological intervention for people with schizophrenia (Tumiel et al., 2019). Psychotherapy may help the individual develop coping strategies, thought processes, and positive behaviors. Various forms of psychotherapy, such as cognitive behavioral therapy, help the person to recognize the symptoms of schizophrenia, approach the symptoms with new problem-solving skills and understand where the symptoms arise from (Keepers et al., 221). Since schizophrenia is accompanied by psychosis, cognitive behavioral therapy helps in preventing more severe symptoms of psychosis in the future.

Besides nonpharmacological interventions, medications are incorporated into the treatment of schizophrenia; antipsychotic medications help relieve symptoms associated with psychosis. Antipsychotic medications used in managing schizophrenia include risperidone, olanzapine, quetiapine clozapine, and aripiprazole. Atypical antipsychotics have advanced efficacy and significantly reduced extrapyramidal side effects in the psychopathology of schizophrenia. Concomitant treatments such as benzodiazepines, lithium, carbamazepine, valproic acid, and glutamate agonists help relieve the symptoms associated with schizophrenia. Treatment of schizophrenia involves a combination of different types of drug use, such as antipsychotics and antidepressants, to achieve immediate efficacy. Mood stabilizers such as lamotrigine and lithium stabilize the patient’s mood. A robust support system is vital in helping the client adhere to medications.

References

Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., & (Systematic Review). (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry, 177(9), 868-872.

Zhao, C., Zhu, J., Liu, X., Pu, C., Lai, Y., Chen, L., & Hong, N. (2018). Structural and functional brain abnormalities in schizophrenia: a cross-sectional study at different stages of the disease. Progress in Neuro-Psychopharmacology and Biological Psychiatry, pp. 83, 27–32.

Tumiel, E., Wichniak, A., Jarema, M., & Lew-Starowicz, M. (2019). Nonpharmacological interventions for treating cardiometabolic risk factors in people with schizophrenia—a systematic review. Frontiers in Psychiatry, 10, 566.

Newton, R., Rouleau, A., Nylander, A. G., Loze, J. Y., Resemann, H. K., Steeves, S., & Crespo-Facorro, B. (2018). Diverse definitions of the early course of schizophrenia—a targeted literature review. npj Schizophrenia, 4(1), 1-10.

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