What is your first priority in this case? Why?
As a matter of priority, one will assess safety before engaging with the client to isolate and explore the stressor or changes that have led to the decompensation. Issues of safety are also very critical in assessing treatment options. Evaluating the level of decompensation with the cooperation of the wife will determine the next course of action. Consideration for the type of hospitalization will be determined from the visit. The identification of changes or stressor will inform the next line of action towards treatment. Stress is believed to be the number one causes of decompensation (Carey & Carey, 1999). Another important thing that leads to decompensation is changes in a person’s life that act increase stress. Things changes might be finances, living community, and relationships. The impact of stressors in decompensation cannot be ruled out in such a case.
The reason why it is important to engage the family and the client is that the chance of identifying the stressors is high. This engagement with the household members will help in getting the client back to the baseline of treatment. Without understanding the changes or stressors, the decompensation will repeat and even lead to relapse. Furthermore, suggestions to the client on methods of care that have succeeded in managing such conditions may help. One will also attempt to reintroduce the client to treatment by finding out what has led to decompensation.
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What type of treatment would you suggest? Why?
The best type of treatment that one will suggest for the client is a combination treatment of pharmacological therapy. The first and second generation of antipsychotics will be considered. However, the second generation drugs are better because of their reduced levels of adverse effects on the client. Also, there are better in preventing relapse. Thus, short duration cognitive or behavioral therapy is necessary at this stage with a counseling session in-between. And because the success of such treatment is collaboration with other professionals, it will be suggested to the client to allow for such inputs.
What types of therapy might help this client stay on track? Why?
A combination therapy that consists of Cognitive Behavior Therapy (CBT), Psychoeducation, psychotherapy, and family therapy will help this client from progressing to a full mental condition that requires full hospitalization. The family is central to the overall treatment outcome. The understanding by the family members about the nature of the disease is necessary for treatment and family relationship. This involvement of household is often coupled with psychoeducation which helps the family members to understand the condition and the expectations. The family can assist in encouraging adherence to medication and management of stress. Also, social stigma and emotional issues can be adequately controlled if the family is partaking in the treatment process. Cognitive behavioral therapy is the first line of treatment that has been found to be useful in managing such illnesses. Its combination with family therapy has produced more success (Morrison, 2009). It is recommended that CBT is first applied before medication in less severe cases.
The reason why this combination therapy is recommended is that mental conditions such as this require a multifaceted approach within the medical team. The family, therapists, and other behavioral professionals have to assist in treating such individuals.
References
Carey, M. P., & Carey, K. B. (1999).Behavioral Research on the Severe and Persistent Mental Illnesses. Behavior Therapy , 30 (3), 345–353. http://doi.org/10.1016/S0005-7894(99)80014-8
Morrison, A. K. (2009). Cognitive Behavior Therapy for People with Schizophrenia. Psychiatry (Edgmont), 6 (12), 32–39.
