Paranoid Schizophrenia

1 January 2017

Positive symptoms or overt behavior not normal in normal individuals include delusions (beliefs that are not reality based), hallucinations (visual and or auditory; sometimes weighted in the individual’s unique cultural experiences), and incongruent or illogical language (Kohn, n. d. ). Negative symptoms or absent behaviors associated with normal individuals include “flat” affect or mood, social isolation or withdrawal, and lack of spontaneity (Kohn, n. d. ). This disorder has four sub-types, all of which has its own prominent feature.

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The subtypes are Catatonic (marked by bizarre motor behavior), Paranoid (marked by a significant suspiciousness and a strong sense of persecution), Disorganized (fragmented or illogical speech), and Undifferentiated (having mixed or more than one symptom) (Kohn, n. d. ). 2. Briefly describe the client’s background. Valerie had a normal childhood and was good at work and school. She went to college and graduate school and got married. In Valerie’s late 20’s she began developing delusions of persecution, reference, and grandeur. Because of these delusions Valerie’s husband and church pastor had her committed to a mental institution.

Valerie was placed on different medications, and after more than eight years Valerie was able to accept her diagnosis of schizophrenia. Once she accepted the diagnosis doctors could stabilize her medications. Valerie is able to hold a steady job since she is medicated properly and has her symptoms under control. Valerie once had dreams of traveling and getting her PhD, but she is now content just going to work and going home (where she lives with her parents). She has no interest in being in an intimate relationship (Kohn, n. d. ). 3. Describe any factors in the client’s background that might predispose him or her to the disorder.

Predisposition can be attributed to the Diathesis-Stress Model (Kohn, n. d. ). This model states that genetics, biology, and stress can be determining causal factors. Valarie and her family relocated numerous times before she began college. She described herself as a social outcast. She grew up in the church as her parents were teachers in the church; therefore her core was church and religion based. Valerie stated that when she and her husband married, her husband made two distinct agreements with her that he did not uphold. The agreements were to have children and to relocate.

These disregarded agreements appeared to be significant stressors for her (Kohn, n. d. ). In the interview, Valarie reported she was the only family member with mental health issues; therefore no genetic causal factor was noted. She stated her delusions and hallucinations associated with religion. Delusions and hallucinations are often associated with an individual’s culture. Citing she was a social outcast is a symptom of abnormal behavior that impairs social and emotional functioning. She reports the onset of Schizophrenia with delusions at age 28 during a time when her marriage was unstable (broken agreements) and she was unhappy (Kohn, n. . ). These stressors are causal factors in the onset or erupting of the disorder. Observations 1. Describe symptoms that you observed that support the diagnosis of the individual. When Valerie spoke of her memories and the occurrences that she experienced they supported the diagnosis, although at the time of the interview she showed no readily apparent indications of paranoid schizophrenia. Valerie spoke of the delusions that she experienced in her late twenties where she believed that people were plotting against her and that she was a martyr for her church and her beliefs (Kohn, n. . ). When she was institutionalized, she believed that she was actually imprisoned and that her captors were going to experiment on her. She described how terrified she was the time she thought that people in the hospital were going to surgically remove her breasts. She was connected to the church and believed that people were infiltrating the church and trying to destroy it; making matters worse, when she expressed this fear to her husband and the church leader, she was taken to a Catholic hospital to be institutionalized which only affirmed her fears of the Catholics (Kohn, n. . ). She thought the medicine that she was being given was in the hospital was actually poison and that the hospital personnel would kill her in her sleep or that the medication would kill her while she was sleeping. On one occasion she tried to smother her roommate in the hospital with a pillow (Kohn, n. d. ). 4. Describe symptoms or observations that are inconsistent of the disorder. Valerie seemed very functional and articulate, and did not present as being disconnected from reality. She was clearly able to meet the ordinary demands of life.

Her thoughts, moods, and perceptions did not seem distorted; she was not illogical or incoherent in her ability to communicate. Valerie was likeable and animated. She had specific recall about experiences that she enjoyed, especially when she described the enjoyment she experienced when she studied abroad. She expressed her happiness in finishing graduate school before becoming mentally ill (Kohn, n. d. ). She seemed to have a clear understanding of her disorder and was able to employ coping strategies, function in society, help others, and hold a job.

She expressed her frustration with the doctor’s disregarding her complaints about the medication, and felt she was not treated with a high degree of respect and did not like not having any privacy (Kohn, n. d. ). She seemed very connected to reality and to her memories; she was able to provide insight to her background in a matter of fact manner that was very descriptive. Although she stated that she is mentally ill, she did not present herself as mentally ill. Valerie did not typify one’s expectations of a paranoid schizophrenic although her references to her past affirmed the correct diagnosis. . Describe any information you observed about the development of the disorder. She started to have some gradual changes that led in to the diagnosis of Schizophrenia. At the onset of her disorder she started to believe that there were individuals that were starting to infiltrate the church and try to take over. She told her husband who went to the church leader at the time which was a priest and they both concluded to get her admitted to the psychiatric unit for some help, this was her first admission.

When this first incident started to occur, she had a strained marriage and was around the age of 29. Her marriage was strained because her husband who earlier in the relationship had agreed to moving from Southern California and to having children after she was done her Graduated School decided that he did not want to follow his agreement. This was a devastating event to her and is what started the downward trend in her in her mental health. She feels that the stress of the strained marriage is what brought out her diagnosis of Schizophrenia.

While on the psychiatric ward she had fears that the staff there were out to kill her, and she felt the medicine they were giving her was poison, and that she was caught trying to smother her roommate. She had hallucinations while in the psychiatric admission, that the staff there were going to do a surgery to remove her breast, and the medications would put her in such a deep sleep that this procedure could be done without her knowing. She has had auditory hallucinations, and also she had visual hallucinations with this disorder.

While off her medications since she believed she did not have a mental illness she started to have delusional thoughts. While she was not taking her medications she had delusional thoughts that the cars in the United States were on a computer systems and if she did not drive for hours upon hours people in her family would die. Throughout the interview you can see she has had very delusional thoughts over the years that she has had been diagnosed. She has also had the two types of positive symptoms of delusions and hallucinations.

She also described that she felt that she was going to be persecuted for many different reasons throughout her years of diagnosis which can be described as Paranoid Sub-type. Therapeutic Intervention 1. In your opinion, what are the appropriate short-term goals for this intervention? Paranoid schizophrenia is a chronic condition that requires lifelong treatment, even during periods when you feel better and your symptoms have lifted. You may feel as if you don’t need treatment, and you may be tempted to ignore treatment recommendations. In my opinion, the appropriate short term goals would be for Valerie to continue taking the drug Haldol.

Valerie has had great success with taking this drug she has taken it for several years and it has managed her symptoms. If at some point her medication stops working she can have her dosage increased. 2. In your opinion, what are the appropriate long-term goals for this intervention? In my opinion, the appropriate long term goal for Valerie would be psychotherapy. Valerie would benefit from the emerging techniques in psychotherapy. Psychotherapy with a skilled mental health provider can help Valerie learn ways to cope with the distress and daily life challenges brought on by paranoid schizophrenia.

Cognitive therapy will help Valerie overcome her attention difficulties. The social skills training and the milieu therapy can teach her more socially acceptable behaviors. In turn these skills should allow her to keep stress levels down thereby reduce her risk of a relapse. 1. Which therapeutic strategy seems most appropriate in this case? Why? Based on the case study patient Valerie there were some significant factors that helped her to achieve success in her battles with schizophrenia. The first step was her acceptance of her disorder.

Once she realized that she did have a mental illness she began to take steps to help in her recovery process. She then coupled herself with the best provider she could. This provider committed himself to gradually walking her through the process. Instead of starting her on heavy doses of psychotherapeutic drugs, he started her on a lower dose with gradually increases to reduce her symptoms and decrease side effects. Because of the gradual process Valerie was able to start taking interest in fulfilling activities in her life such as working, and having a social life. 6.

Which therapeutic modality seems most appropriate in this case? Why? Patients who suffer from schizophrenia no longer need to live their life in an asylum being subject to electro-shock treatments, or lobotomies. There has been a significant amount of success with the use of neuroleptic drugs. Thorozine, Haldol, Prolixin drastically minimize the effects of schizophrenia. These drugs alter the dopamine neurons. These are neurons that directly impact mood, thoughts, and feelings. The use of these drugs can also reduce psychiatric symptoms and assists patients with the ability to lead normal and active lives.

However, there can be side effects such as: uncontrollable shaking, muscle tightening, or involuntary eye movement. These side effects can exist in 20%-40% of patients and can be permanent. Another important technique is psychotherapy. These techniques include: cognitive therapy, social skills training, and milieu training. Overall, 30% of patients treated significantly recover and avoid reoccurrence for many years. Kohn, A. (n. d. ). Paranoid Schizophrenia. Retrieved March 22, 2012, from Faces of Abnormal Psychology: Interactive: http://www. mhhe. com/socscience/psychology/faces/bigvid. swf

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