Case With Management on Schizophrenia

Schizophrenia Disorder
Presented by Tamsila Sajjad

‫‪Presenting complaints‬‬
‫‪Visual hallucinations‬‬ ‫‪4 years‬‬
‫ط‬
‫نآےتںیہ‬
‫ےھجمزبرگ ر‬
‫ھجمےساکیریفییھبےنلمآیتیہ‬
‫ھجمےس‪5‬نجےنلمآےتںیہ‬
‫‪Auditory hallucinations‬‬ ‫‪4 years‬‬
‫ھجمےسنجابںیت رکےتںیہ‬
‫ھجمےساویینیلمابںیترکیتےہ‬
‫زبرگےتہکںیہےھجمداینوکاچبانےہ‬
‫‪Olfactory hallucinations‬‬ ‫‪2 years‬‬
‫ےھجماویینیلیکوبشخااجیتےہبجوہاےنوایلوہ‬
‫‪Suicidal ideation‬‬ ‫‪2 years‬‬
‫ریمادلرکاتےہےھجمرماجاناچےیہ‬
‫اسزدنیگےسدلرھبایگےہ‬
‫‪Bizarre delusions‬‬ ‫‪4 years‬‬

‫ےھجمسیپسپشانبرکداینےکولوگںوتاسںیمرھبرکےلرکاجانےہ‬
‫اںیہنداینےکمتخوہےنےسےلہپاچبانےہ‬
‫‪Asocialty‬‬ ‫‪4 years‬‬

‫ےھجمولوگںےسانلمدنسپںیہن‬
‫ںیمیلمیفنشکنفںیمیھباجووتراےتسےسزربدیتسواسپآاجاتوہں‬
‫‪Anhedonia‬‬ ‫‪4 years‬‬
‫ےھجمیسکیھبزیچںیموخیشوسحمسںیہنوہیت‬
‫اتگلےہزدنیگںیمھجمرپتہبوبھجےہ‬
Bio Psycho Social
Auditory, visual and olfactory
Non compliance to medicines hallucinations, Loss of interest in daily
Presenting complaints Bizarre delusions, suicidal activities, social withdrawal
ideation
2nd degree relatives have High expectations from oneself, No friends, study involvement
Predisposing Factors schizophrenia Introvert type personality traits and no time for co-curricular
e.g. Unable to express feelings. activities,
Perfectionist attitude High parental expectations.
Precipitating Factors Health issues e.g. physical Depressive feelings, CSS Failure,
weakness Guilt, (Negative schemas about Forced marriage
oneself ) Hallucinations,
delusions
Perpetuating Factors continued hallucinations and High parental expectations,

Noncompliance to psychiatric delusions, stress, decreased Conflicting relationship with
medicines. concentration, distractibility wife.
Cognitive distortions that
continued:
All or none thinking style,
overgeneralize the failure,
Protective Factors Above average intelligence Good memory Highly educated, Good rapport
Insight present building,
Family support
12 Days management plan
on (Psychoticism) Schizophrenia
Disorder
Reference book: The complete Adult Psychotherapy Treatment Planner
Author: Arthur E. Jongsma, Jr., Series Editor (5th edition)
Presented by: Tamsila Sajjad

Session 1
• Psycho-education regarding the therapeutic process.
• Provide behavioral, emotional, and attitudinal information toward an
assessment of Specifiers relevant to a DSM e.g. with catatonia or
without.
• Diagnosis (If the client have the capacity to understand)
• The efficacy of treatment, and the nature of the therapy relationship.
• Importance of Client’s cooperation.
• Explain in detail about the Disorder e.g. About Hallucinations,
Delusions, positive and negative symptoms.
Session 2
• Assess the client’s level of insight(syntonic versus dystonic)toward the
“presenting problems” (e.g., demonstrates good insight into the
problematic nature of the "described behavior,” agrees with others’
concern, and is motivated to work on change.
• Insight building is continued.
• Ask the client about the previous session information and then again
paraphrase the words for better insight orientation.
• Assess for the severity of the level of impairment to the client’s
functioning to determine appropriate level of care (e.g. The behavior
noted creates mild, moderate, severe, or very severe impairment in
social, relational, vocational, or occupational).
Session 3
• Identify internal and environmental triggers of psychotic symptoms.
• Help the client identify specific behaviors, situations, thoughts,

and feelings associated with symptom exacerbations.
Different Worksheets (Base line charts)
1) Date Situation Thought Feelings Behavior Effect
• 2) Date Sleep-time Wake-up time

Session 4
• Identify internal and environmental triggers of psychotic symptoms.
Activating Event Behavior Consequences
Example,
Event (I see Buzurg, he command me that I have to save the world)
Thoughts ( I have to save the world through reading books, making
computer, making spaceship),
Behavior (start Reading multiple books, social isolation etc.)
Consequences (Stress, impulsivity, stress leads to more hallucinations )
Session 5
• Identify current reactions to the symptoms and their impact on self and
others. Help the client identify his/her emotional and behavioral reactions
as well as other consequences of psychotic symptoms toward the goal of
increasing his/her understanding of these reactions and how they impact
functioning adaptively or maladaptive
Example,
Symptom Reaction Impact

• Social withdrawal Isolation Loneliness
• “I can smell Avelyine” Fear Social withdrawl
• (olfactory hallucination)
Session 6
• Allow family members to participate in the assessment of the condition.
• Request that a family member provide information about the client’s
history of psychotic behaviors. Conduct a family-based intervention
beginning with psycho-education emphasizing the biological nature of
psychosis, the need for medication and medication adherence, risk factors
for relapse such as personal and interpersonal triggers, and the
importance of effective communication, problem-solving, early episode
intervention, and social support.
• Help the client and family draw up a “relapse drill” detailing
• Roles and responsibilities e.g., who will call a meeting of the family to
problem-solve potential relapse; who will call the client’s physician.
Session 7
• Learn and implement skills that increase personal effectiveness and
resistance to subsequent psychotic episodes. Tailor cognitive behavioral
strategies so the client can restructure psychotic cognition, learn effective
personal and interpersonal skills, and develop coping and compensation
strategies for managing psychotic symptoms.
• Desensitize the client’s fear of his/her hallucinations by allowing or
encouraging him/her to talk about them, their frequency, their intensity,
and their meaning.
• Apply In-Vivo Desensitization e.g. Expose with IR (Real or imagery)
Example,
Hallucination Emotion Healthy Reaction
Avelyine threats me Fear Use of rational copying statements
“I know you can’t do anything”
Session 8
Use of BT AND CBT Techniques
• Continued work on IN-VIVO Desensitization
• Cognitive-behavioral strategies to teach the client coping and
compensation strategies for managing psychotic symptoms e.g.,
calming techniques: Deep breathing, PMR, Guided Imagery
• Realistic self-talk; realistic attribution of the source of the symptom.
(How to react to your symptom with realistic talk),
• Cognitive Rehearsal e.g. Pre-programming (How to face auditory,
visual, olfactory hallucinations).
• Reinforcement
Session 9
working on Delusions
Use of REBT Techniques
To hit the Delusional beliefs (ABCDE worksheets)
Activating event Belief Consequences Disputing Effect
Use of Disputing Techniques such as,

Functional dispute, disputing that disturbs goal, Empirical dispute involve evidence,
Firstly, Identify ABC’S
Then Dispute
Use Socratic Style
• Use education such as Bibliotherapy, technique of REBT (Use of Articles, knowledgeable
materials to educate the client regarding disease ).
Session 10
Continued work on main symptoms,
• Identifying and changing the self-talk and beliefs that interfere with
recovery. Use Cognitive Therapy techniques to explore biased self-talk
and beliefs that contribute to delusional thinking; assist the client in
identifying and challenging the biases, generating alternative
appraisals that correct biases, building confidence, and improving
adaptation.
• Guided Discovery (Find the benefits at the End).
• Write Advantages and Disadvantages of Changing the Beliefs
(Referenting Technique of REBT)
Session 11
• Group therapy, focused on improving social effectiveness.
• Provide or refer the client to a Cognitive Remediation,
Neurocognitive Therapy program that uses repeated practice of
cognitive tasks and/or strategy training to restore cognitive function
and/or teach compensatory strategies for cognitive impairments and
improve cognitive, emotional, and social functioning. Ask different
questions regarding the hygiene, self-care etc.
• Take feedback of Group therapy.
• Participate in a training program to build job skills e.g. Painting,
drawing, stitching, Sports etc. according to client’s interests.
Session 12
• Debreifing about the Termination
• Practice and strengthen skills learned in therapy. Prescribe in- and
between-session exercises that allow the client to practice new skills.
• Suggesting a client (or family members) to Participate in a

psychoeducational program with other families.
• Refer the client to a support group for individuals with a mental

illness with the goal of helping consolidate their new approach to
recovery and gain social support for it.
Long Term Goals
1. Control or eliminate active psychotic symptoms so that functioning is positive
and medication is taken consistently.
2. Eliminate acute, reactive, psychotic symptoms and return to normal
functioning.
3. Increase goal-directed behaviors.
4. Focus thoughts on reality.
5. Normalize speech patterns, which can be evidenced by coherent statements,
attentions to social cues, and remaining on task.
6. Interact with others without defensiveness or anger.
7. Achieve and maintain an active, personally effective recovery approach.
8. Compliance to Medication
Thank you

Case With Management on Schizophrenia

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Schizophrenia Disorder

Presented by Tamsila Sajjad

‫‪Bizarre delusions‬‬ ‫‪4 years‬‬

‫‪Asocialty‬‬ ‫‪4 years‬‬

Perpetuating Factors continued hallucinations and High parental expectations,

Presented by: Tamsila Sajjad

• Help the client identify specific behaviors, situations, thoughts,

1) Date Situation Thought Feelings Behavior Effect

• 2) Date Sleep-time Wake-up time

Activating Event Behavior Consequences

Symptom Reaction Impact

Activating event Belief Consequences Disputing Effect

Use of Disputing Techniques such as,

• Suggesting a client (or family members) to Participate in a

• Refer the client to a support group for individuals with a mental

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