Collaborative Care in a Schizophrenia Scenario

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Table of Contents

Introduction
Assessing the Needs of the Patient
Constructing an Interprofessional Team
Finding a Psychotherapeutic Approach
Conclusion
Reference List

Introduction

This scenario concerns a young man with schizophrenia, which manifests in paranoia and delusions. The case patient, Simon, has been sectioned on two previous occasions, first for observation and then for treatment. After his release, he took anti-psychotic drugs and attended meetings with a community psychiatric nurse, but abandoned both practices after the latter’s retirement, causing his condition to deteriorate. His mother intervened to place Simon in the care of an interprofessional team, which improved his symptoms with medication despite his reluctance. It was then decided to transition to a talk-based approach. While there is currently no cure for schizophrenia, patients can lead fulfilling lives (Jakes, 2018). The effort to improve Simon’s condition must extend beyond controlling psychotic symptoms to meeting his physical, mental, and social needs. A comprehensive, collaborative care package is needed, but its success will depend on the active cooperation of medical professionals from different disciplines, Simon himself, and his family members.

Assessing the Needs of the Patient

Schizophrenia is a chronic mental disorder characterized by psychotic (hallucinations, delusions), negative (depression, social withdrawal), and cognitive symptoms. The severity of the symptoms varies between individuals and tends to fluctuate between periods of remission and relapse (Fall et al., 2017). While outcomes can vary drastically, most patients suffer some degree of damage to their quality of life, especially with regards to social functioning and physical health (Lloyd et al., 2017). Anti-psychotic medication is the dominant form of treatment, delivering symptom control. Still, its variable effectiveness and occasionally debilitating side-effects have prompted interest in psychotherapeutic approaches that may complement or replace it (Schaub et al., 2016). The biopsychosocial paradigm, which informs the commonly accepted modern view of schizophrenia, acknowledges the influence of biological and environmental factors on its emergence (Sexton and Lebow, 2016). For example, the double-bind hypothesis suggested that schizophrenia may develop in response to dysfunctional, contradictory family communications (Fall et al., 2017). The current understanding emphasizes the primacy of genetic causes while acknowledging the psychosocial stressors’ ability to cause or exacerbate the condition. An effective intervention must address the biological and psychosocial aspects.

Simon’s case appears to present a typical example of schizophrenia symptoms interfering with the patient’s physical, social, and emotional wellbeing. The condition manifests primarily in paranoid delusions that complicate his relationships with his mother, neighbors, the police, and health care providers. Combined with his lack of knowledge, this paranoia complicates treatment by making Simon less likely to comply with instructions. The patient’s tendency for social avoidance may also indicate the presence of negative symptoms. Simon’s eating and sleeping problems are likewise well-known outcomes of schizophrenia (Lloyd et al., 2017). To lead a fulfilling life, Simon would need to reclaim his ability to understand and interact with reality and sustain meaningful relationships with others (Fall et al., 2017). He will also need to maintain a standard of physical wellness. The collaborative care package must address all of those needs to ensure Simon’s compliance and deliver the best possible outcome.

Constructing an Interprofessional Team

Addressing different aspects of Simon’s wellbeing requires the cooperation of medical professionals from various disciplines. While the psychiatrist inevitably plays a central role in determining the course of treatment for a mental illness, the participation of other professions is indispensable for holistic care (Smart and Auburn, 2018). The family general practitioner is responsible for Simon’s overall health and knows his medical history. Regular observation and care fall under the purview of the psychiatric nurse. The social worker’s primary role is to support Simon’s everyday social functioning and reintegration into society. The pharmacist will provide expertise on the anti-psychotic medication and aspects such as its possible interference with other aspects of treatment or different drugs. Simon’s problems with eating and sleeping suggest that he would benefit from the assistance of more narrowly focused specialists such as a dietician or a somnologist. The objective is to avoid any service gaps that could lead to ineffective or counterproductive courses of treatment.

The team must organize effective communications across professional lines. That requires clarifying the roles, functions, and areas of responsibility for all team members (Smart and Auburn, 2018). Interprofessional collaboration requires sharing the expertise provided by different professional perspectives to enable informed decision-making (Kebe et al., 2020). For example, the social worker will be in a position to emphasize the human dimensions of the problem, such as Simon’s preferences and social aspirations (Ambrose-Miller and Ashcroft, 2016). Since collaborative care requires their full cooperation to be effective, the communications arrangement must include Simon and his family, providing them with information and soliciting their feedback. The nurse and the social worker will play an essential part in these communications due to their roles as educators and patient advocates. Conflict resolution mechanisms should be agreed upon to address any problems or disagreements that may arise in the course of treatment. They must be rooted in the premise of shared purpose and mutual respect (Ambrose-Miller and Ashcroft, 2016). Effective and ethical communications are essential for securing trust, which is critical for long-term success.

Finding a Psychotherapeutic Approach

Since Simon’s condition appears to respond to medication without noteworthy side effects, the care package should combine pharmacological and psychotherapeutic methods. Multiple psychotherapeutic approaches have been shown to improve schizophrenia patient outcomes when used alongside or instead of antipsychotic drugs (Haram et al., 2018). Cognitive-behavioral therapy for psychosis (CBTp) tries to reduce distress and modify behaviors by altering patients’ perspectives. While this therapy is popular, the current evidence for its efficacy compared to other methods is not strong (Jones et al., 2018; Laws et al., 2018). However, CBTp techniques can be used in other therapies, such as coping-oriented programs, which combine them with psychoeducational elements (Schaub et al., 2016). Family therapy, which focuses on establishing an informed family support network, can also effectively integrate CBTp techniques (Burbach, 2018). Combining cognitive-behavioral, psychoeducational, and family therapy approaches may be the optimal approach given the presence of Simon’s mother. Regular CBTp sessions will seek to stop specific harmful behaviors such as undereating or social withdrawal. Meanwhile, education on schizophrenia and coping techniques will empower Simon and his relatives to manage his symptoms in everyday life, while encouraging compliance with the treatment.

Conclusion

The objective of the proposed collaborative care package is to enable Simon to lead a normal life with minimal interference from schizophrenia symptoms. The guidelines outlined above should make it possible for representatives of different medical disciplines to collaborate seamlessly with each other, the patient, and his family to develop and implement an optimal course of treatment. Addressing the patient’s varied needs in a way that respects his individuality should help the team ensure his compliance and enhance his general wellbeing. In addition to keeping the symptoms under control, the combined pharmacological and psychotherapeutic intervention will support Simon’s physical and emotional wellbeing and help in his social reintegration and the creation of meaningful relationships. Such an approach should make him more resilient to the effects of schizophrenia during periods of relapse. By constructing a lifelong support network, the collaborative care package will make it easier to address any unanticipated complications. Mutual trust and a readiness to engage in constructive dialogue will allow the course of treatment to be adjusted over time, possibly reducing or discontinuing its pharmacological component.

Reference List

Ambrose-Miller, W. and Ashcroft, R. (2016) ‘Challenges faced by social workers as members of interprofessional collaborative health care teams’, Health & Social Work, 41(2), pp. 101-109.

Burbach, F. R. (2018) ‘Family therapy and schizophrenia: a brief theoretical overview and a framework for clinical practice’, BJPsych Advances, 24(4), pp. 225-234.

Fall, K. A., Holden, J. M. and Marquis, A. (2017) Theoretical models of counseling and psychotherapy. 3^rd edn. Abingdon: Routledge.

Haram, A. et al. (2018) ‘Psychotherapy in schizophrenia: a retrospective controlled study’, Psychosis, 10(2), pp. 110-121.

Jakes, S. (2018) Loss of self in psychosis: psychological theory and practice. Abingdon: Routledge.

Jones, C. et al. (2018) ‘Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia’, The Cochrane Database of Systematic Reviews, 2018(11).

Kebe, N. N. M. K. et al. (2020) ‘Variables associated with interprofessional collaboration: a comparison between primary healthcare and specialized mental health teams’, BMC Family Practice, 21(1), pp. 1-11.

Laws, K. R. et al. (2018) ‘Cognitive behavioural therapy for schizophrenia – outcomes for functioning, distress and quality of life: a meta-analysis’, BMC Psychology, 6(1), p. 32.

Lloyd, J. et al. (2017) ‘Treatment outcomes in schizophrenia: qualitative study of the views of family carers’, BMC Psychiatry, 17(1), p. 266.

Schaub, A. et al. (2016) A randomized controlled trial of group coping-oriented therapy vs supportive therapy in schizophrenia: results of a 2-year follow-up. Schizophrenia Bulletin, 42(1), pp. 71-80.

Sexton, T. L. and Lebow, J. (eds.) (2016) Handbook of family therapy: the science and practice of working with families and couples. Abingdon: Routledge.

Smart, C. and Auburn, T. (eds.) (2018) Interprofessional care and mental health: a discursive exploration of team meeting practices. London: Palgrave Macmillan.

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