RachelBiancaMallari
Case Study
J.Z. is a 45 year old single Hispanic male. The patient was admitted in Manhattan Psychiatric Center (MPC) on October 15 of 1993. The client is currently diagnosed with the following:
AXIS I- Schizophrenia, Chronic Undifferentiated Type 295.90, Polysubstance abuse (crack/cocaine, PCP, glue sniffing, MJ 304.80, in partial institutional remission).
AXIS II- V 62.89 Borderline Intellectual Functioning.
AXIS III-Hyperlipidemia/Dyslipidemia
AXIS IV- Moderate-homelessness, substance abuse, chronic mental illness stressors: PEC, mother’s death in past years.
AXIS V- Current GAF 35.
Since 1980, at the age of 20 the client have had been psychotic after using PCP which led to five admissions in Bellevue Harlem and Metropolitan Hospital and ten OMH hospitals. He started to have delusional thoughts, hear voices, and has been hostile and threatening to family members particularly when using drugs.
The patient was born in Honduras on April 10 1960. His family migrated in the U.S. when he was at the age of eight and settled in New York City in the Bronx. J.Z. has five siblings which of one is his twin brother who died at eighteen months. Two of his brothers abused street drugs. Patient’s father has a serious drinking problem and frequently violent towards children. His mother has history of epilepsy. At the age of fourteen, patient’s parents separated.
It is reported that the patient graduated in High school from Dewitt Clinton H.S. The patient has no close friends or social activities. At the age of nineteen, J.Z. fathered a son. However, his girlfriend took their son and left him. Client does not have a meaningful work history. He was employed as a salesman when he was young adult. Upon Mr.J.Z.’s first psychiatric admission, he began receiving financial assistance through a welfare agency in New York City.
His strengths include calm and cooperative behavior with treatment and medication. Client state that he loves computer. He also likes to sing and dance which is his often contribution to treatment meetings. According to his chart he does best in non-verbal groups such as Art, Music and Model Apartment.
The patient is currently under medication of Olanzapine 20mg, Valproic Acid 500mg and BenztropineMesaylate 1mg. The nurse said that his medications appeared to benefit him since he has made fewer verbal references to delusional ideas. J.Z. has also been responding well in his social skills group where he has shown improvement in relating with others.
Anticipated discharge date is on March 28 of 2006 in a supervised, structured Mica residence.
DSM-IV Code 295.90 Undifferentiated, Schizophrenia-Meets Criterion A Of Schizophrenia.
DSM-IV Criteria / Mr.J.Z.A. Hallucinations may occur in any sensory modality (e.g., auditory, visual, olfactory, gustatory, and tactile), but auditory hallucinations are by far the most experienced. / Pt reports hearing voices. He verbalizes persecutory delusions and paranoid ideation. He thinks that medication is poisoning him. His thoughts are often disorganized and irrelevant.
B. Substantial degree of the morbidity associated with the disorder (affective flattening, alogia and avolition . / J.Z. is sometimes depressed and affect is mostly flat and occasionally inappropriate.
C. Dysfunction in one or more areas of functioning (e.g., interpersonal relations, work or education, or self-care. / Pt is reported to have problems relating with others. He has difficulty initiating a conversation and responding verbally to others. He is socially isolated at times. He often interacts in a childish manner.
The client’s major goal is to live in a residential home and work as a custodian in MPC. Mr.J.Z. displays adequate gross motor and fine motor skills. He has good flexibility and mobility. He is able to stand, sit and ambulate without difficulty. He can perform independent ADL skills. He is able to select matching and appropriate attire without assistance. Grooming and personal hygiene such as brushing teeth and combing hair is well performed. He has ample skills in showering and bathing. He is able to feed himself.
J.Z. exhibits sufficient IADLs. He is knowledgeable of using public transportation and communication device such as telephones. He can prepare his meal and clean up. He can also follow safety precaution when instructed. However, He isn’t capable of caring for others let alone raise up a child.
Client has low cognitive functioning. At the age of ten he was placed in a Special Education program. At the age of twenty he can only read at a second grade level. However, this writer opposes this idea since the client graduated in High school. Client claims not to be interested in raising his educational attainment.
J.Z. has worked at vocational programs during past hospitalizations. He has worked at the Rehab Patient Worker Program (PWP) and Rehab Sheltered Workshop. He is currently working two hours a week in MPC as a janitor.
Play would be beneficial for J.Z. since he has cognitive impairment. He can engage in various types of board games that will help him improve his cognitive and social skills.
J.Z. presents satisfactory leisure skills. He enjoys singing, dancing, watching t.v. and listening to music during leisure periods. It was noted in his chart that during his free time he goes to CasaVerde (MPC’s mini garden) to relax.
Client needs improvement in his social participation. He seldom interacts with other patients. However, most of the time he follows the therapists around. Initially, his mother and other family members visited him in the hospital. However, ever since his mother passed away the rest of the family neglected him. Thus, there isn’t interaction between the client and the family.
J.Z. has a significant deficit in process skills and communication/interaction skills. He has short attention span, poor decision making skills as evidence by his repeated hospitalizations and limited problem solving skills. In a structured ward environment, J.Z. demonstrates satisfactory impulse control and frustration tolerance. However, in an unstructured environment, he displays disorganization and agitation towards peers and therapists.
The client relates strongly with his Hispanic culture and background. Therefore, being placed in a Hispanic Ward is significant to him. He can associate with the language, music and food. The client is of Catholic faith but there is only minimal spiritual affiliation. In terms of the social context, his relationship with other individuals is satisfactory. He gets along well with peers. However, he has difficulty on initiating conversations and he is socially isolated at times. Also, he interacts in a childish manner.
In the client factors, the specific mental function poses as a major area where the client has deficits. Memory function, attention to detail and perceptual factors are the client’s major cognitive impairment.
The activity demands that may present as a problem to the client is the required actions. Client has inadequate performance skills particularly in the areas of communication/interaction and process skills. Client is having difficulty in adjusting to changes in the working environment. Also, there is insufficiency in organizing and coordinating social behaviors.
The type of treatment setting offered in MPC is a long term in patient care. J.Z. is currently participating in a structured daily schedule of group sessions, which involves Social Skills training, ArtTherapy, Sensory Awareness, Community Living Skills Training, Leisure Education, Substance Abuse Prevention Education Program and Communication Skills. The treatment goals that are mainly addressed by the Occupational Therapists for the this particular client is to increase social participation and acquire skills that promotes independence in the community setting. The Rehabilitation Counselor is primarily concerned with providing counseling regarding substance abuse problems and learning preventive measures. The Social Worker prepares the clients for discharge and educate them on how to avail various programs available in the community upon discharge. The Art therapists’ major concern is to engage the client in a meaningful and self-expressive form of therapy. The Nurse administers the client’s intake of medication and monitors side effects. The psychologists makes the arrangement in the type of residence the client will go to after being discharged. The psychiatrist prescribes medications to the client and decides whether that patient can be on the discharge list. Also, educating the patient regarding medications and target symptoms while emphasizing consistent compliance with medications to avoid decompensation is part of the responsibilities of the psychiatrist.
RachelBiancaMallari
Case Study
Long term goal:
Patient will demonstrate coping skills such as talking to someone in dealing with day to day problems by 1 year prior to discharge. By January of 2006 the client must be able to appropriately express feelings of anger and frustration through positive coping activities. Client will also be presented with variety activities such as walking, going to the gym and dancing.
Short term goals:
Client will vacuum and dust once a week by 1 month. This will enable the client to enhance skills pertinent to community living and his goal to be a custodian in MPC. Client will attend Model Apartment and Community Living Skills weekly. The social worker noted in J.Z.’s chart that he responds better in a structured environment. The therapist must coach the client with skills necessary to carry out a task that is significant to the client’s goal.
Client will initiate a conversation 3 times a week by 2 months. This will improve patient’s ability to relate with peers and increase his ability to express thoughts and ideas. Client will attend Social Skills and Interpersonal Skills twice a week. Also, the client will be encouraged by the therapist to communicate and interact with fellow patients in the day room. Client will be asked a question in the beginning of the group session. Thus, the client will have to respond. The group environment would be structured. The therapist must be an active listener and sensitive to the client’s request and needs. Also, the therapist must demonstrate a sense of immediacy. The patient will need immediate feedback in order for him to be aware and focus on the skills that he has to acquire in order to function successfully in the community. The therapist must serve as a good role model and a motivator for the client to be enthused in group activities and social interaction.
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