Treatment of Schizophrenia and Schizoaffective Disorder

Respond to your colleagues by providing constructive feedback concerning their presentations of their client groups and by recommending alternative therapeutic approaches that may be used with the groups. Support your feedback with evidence-based literature and/or your own experiences with clients.

1 hour ago

Meena Abraham 

Main Discussion Post.

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The psychotherapy group I worked with this week is a CBT group. The group consisted of 7 members. The individuals carried diagnosis of schizophrenia and schizoaffective disorder. The level of participation ranged from active to minimal. The group meets once in a week and it was the sixth session. Based on wheeler (2014) the 12 therapeutic factors can be applied to all groups. The clients were at different stages in their treatment and many newer clients found encouragement from the positive impacts on the other clients. Many have experienced the feeling that they are not alone and they explored their past experience as a child and adolescent, behaviors, feelings and learn to identify and avoid the non-helpful behaviors. They helped each other supported and remained as great resources of information and practiced new behaviors in a safe environment.

However, Mr. J.J who is a 18-year-old male with schizoaffective disorder, bipolar type showed minimal participation in group activities. He does not have an insight about his disorder. He always believes that he is doing well and others need to change. He showed less interest in sharing his life experiences and would like to sit in the corner of the treatment room during the therapy. He is non-compliant to his medicine and is not showing any signs of improvement. He is still agitated and violent towards his peers unprovoked. During the CBT group session, he attempted to physically assault a peer due to his paranoid delusions. According to Curran, Gaughran,, Lally, & Timms, (2016) up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic antipsychotics and they are called treatment resistant schizophrenia. However, MR JJ is not compliant to his medications as well as his psychotherapy groups and there fore can not be labeled as treatment resistant.

The therapeutic approaches are mainly process oriented where the group focused on experience, sharing with one another and thereby they make connections. Here the group discussions dominated rather than a set agenda. Mainly discussions were about the current relationships and the current problems. It also included psychodrama where members acted out significant portion of their life to provoke emotions.

These therapeutic approaches were intended to make a good insight in MR JJ about his disease condition and negative thoughts which can be swapped with positive thoughts through teaching strategies, to reduce his psychotic and mood symptoms to make changes in his behaviors. Along with pharmacological treatment, CBT group therapy can bring reduction in the symptoms of MR JJ such as aggressive and violent behaviors, paranoid delusions, auditory hallucinations and his disorganized thoughts. He is also expected to maintain hygiene and interact well with peers. According to Gentile,  & Niemann, (2006) it is important to conceptualize the treatment  as being multimodal, by incorporating pharmacotherapy, psychotherapy, and community support technologies

Additional information about the group is that except MR JJ others are gradually showing some improvements in their symptoms, however they have a fear of being assaulted when MR JJ is in the group which indirectly affect the growth of other member . Therefore, the group needs to have additional security persons in terms of protection for the group as a whole. The security staff are not present inside the room as there is always a concern on the confidentiality of the group.          

References

Curran, S. R.., Gaughran, F., Lally, J., & Timms, P (2016). Treatment-resistant schizophrenia: current insights on the pharmacogenomics of antipsychotics. Pharmacogenomics and personalized medicine, 9, 117–129. https://doi.org/10.2147/PGPM.S115741

Gentile, J. P., & Niemann, P. (2006). Supportive psychotherapy for a patient with psychosis: schizophreniform disorder. Psychiatry (Edgmont (Pa. : Township)), 3(1), 56–61.

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

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