Journal for Two Families

1 Journal for Two Families Client information S.C, a 20-year-old Caucasian is currently residing at his hostel room. He is a believing Christian.

He does casual jobs on and off.

Chief complaints S.C was brought into the emergency room 3 weeks earlier by close family members with violent conduct complaints towards his family. He reports hearing voices unheard by other family members. He claims to be a prophet from God. The above problems have lasted for the past 2 months.

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History The above bizarre changes in S.C’s behavior are a new occurrence. However, the patient reports having been hearing voices of his late granddad conversing with him several times before this admission. He even reports the voices being more than one person discussing him and directing him to cause harm his family members. He denies at any point having any suicidal ideations or desire to harm him. He claims to possess supernatural powers from God to help the world. He confesses to having used marijuana several times while in college and takes alcohol quite often.

He is currently on risperidone 4mg once a day and reports improvement Past psychiatric illnesses S.C reports neither history of previous mental illness nor admissions Medical history He reports no recent hospital admissions for neither medical nor surgical illnesses.

Medication He is now on risperidone 4mg once a day and olanzapine 5mg once a day.

History of illegal drug Use S.C has had a history of marijuana and alcohol consumption frequently.

Developmental history He denies any history of developmental challenges.

Family history of psychiatric illnesses No known family case Social history

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He recently engaged with his fiancée for 3 years and had no major social challenges before joining college. He has no reported incidents of abuse or trauma.

Systemic review Neurological; exhibits headache on a few occasions. The other systems are normal.

Physical examination General parameters; BP 126/72, HR 79, SPO2 95, temperature 37.2, RR 19, Weight 58, height 1.65M. Cardiovascular; normal heart sounds, no murmurs heard Respiratory; the chest is clear Central nervous system; alert Abdomen; non-tender Mental status examination S.C, a 20-year-old Caucasian male with schizophrenia, cannabis-induced psychosis, and alcohol use disorder. The client exhibits hallucination, delusion and bizarre behavior and violent conduct. He is oriented to place, time, and person. He has no suicidal ideations. Has good memory and good insight.

Differential diagnosis Schizophrenia The patient exhibits hallucinations whereby he reported hearing voices directing him to cause harm to others. He also reports voices discussing things concerning him. The client also experiences the delusion of granddad elevating himself to a special agent. Furthermore, he exhibits abnormal behavior where he desires to harm others. The symptoms have lasted for two months. He also acknowledges significant social constraints from the illness.

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Alcohol use disorder He admits alcohol consumption of alcohol on several occasions with its possible side effects and withdrawal symptoms. Reports he has a great deal of social, academic, and economic malfunctioning.

He uses marijuana despite knowledge of its effects. Hallucinations, delusion, and violent conduct could be because of the effect of cannabis withdrawal.

Client R.D Biodata R.D is a 33 year old black American female currently staying at her late husband’s farmhouse.

Chief complaint Reports having been on follow up for schizophrenia for the last 3 years. Currently came in with complaints of hearing her late husband’s conversing with her. She reports occasionally sighting him in the farmyard.

R.D, who is currently on clozapine 25mg once a day, reports the above complaints 2 weeks after running out of her medication. She does not smoke cigarettes and marijuana; neither does she take alcohol. She acknowledges that life has been hard for her and, on 2 occasions, attempted to end her life. She does no desire to harming others. She knows that she needs help to overcome these problems.

Past psychiatric history She reports having been admitted many times over the last 3 years due to the same problems.

Medical history None Medications

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Clozapine 5mg once a day Substance use None Developmental history None No reported history of family psychiatric illnesses.

Psychological history She has had a good relationship with her late husband. No familial major psychosocial issues.

No history of abuse or trauma.

Review of systems Her cardiovascular system is intact in systemic review, with good blood pressure control of 125/75 and an HR of 86. The rest of the system is intact.

Mental status examination The 33-year-old is a known schizophrenic patient on clozapine 25mg once a day with hallucinations and suicidal thoughts. He is, however, oriented to place, time, and the person has a good memory and good insight, where she acknowledges she needs help to regain her social wellbeing.

Schizophrenia

She has been on follow up for schizophrenia for the last 3 years and is on clozapine 25mg once a day. She presented with new-onset hallucinations, both auditory and visual. Her symptoms have lasted for a long time, and she acknowledges suffering significant disturbance in her social life.

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Schizoaffective disorder This diagnosis is made since the patient presented with evidence of the poor perception of life and with thoughts of suicide as evidence for a major depressive disorder.

Solution-Focused Therapy versus Cognitive Behavioral Therapy Solution-focused therapy is a tool that attempts to enable clients to develop abilities to solve daily challenges. It is majorly future-oriented than past-oriented. ( Deshpande et al., 2020) Cognitive-behavioral therapy attempts at the introduction of positive thoughts to help eradicate negative clients’ thoughts. It is useful in the management of schizophrenic, schizoaffective, and substances use disorders.

Unlike solution-focused therapy, CBT attempts to assess and address the problem's genesis while still focusing on the outcome. Therefore, it is the superior of the two in this scenario (Zebroski et al., 2020).

Expected Outcome CBT will help improve the bizarre behavior in the first client by attempting to inculcate positive thoughts, which will reduce use of substances and eliminate violent conduct and thought disturbances in both patients. It is expected to clear the suicidal thought in the second client as well (Ponterotto, 2017) Legal and Ethical Implications of Counseling This protects both the client and service provider. It grants the client the utmost right to confidentiality and dignity and the right to legal suit (Jain et al., 2017). Both ethically and legally, the clients are protected from harm. Therapists are expected to be qualified to prevent any harm to their clients. Ethics also eradicates transference as well as countertransference in counseling (Padmanaban et al., 2020).

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References Deshpande, S. N., Mishra, N. N., Bhatia, T., Jakhar, K., Goyal, S., Sharma, S., ... & Jadhav, S. (2020). Informed consent in psychiatry outpatients. The Indian Journal of Medical Research, 151(1), 35.

Jain, S., Kuppili, P. P., Pattanayak, R. D., & Sagar, R. (2017). Ethics in psychiatric research: issues and recommendations. Indian Journal of Psychological Medicine, 39(5), 558.

Padmanaban, H., Simiyon, M., Thilakan, P., & Ravichandran, K. (2020). Knowledge about confidentiality among medical students from a tertiary care teaching hospital in South India. Indian Journal of Psychiatry, 62(6), 749.

Ponterotto, J. G. (2017). Ethical and legal considerations in psychobiography. American Psychologist, 72(5), 446.

Zebrowski, J. P., Cawkwell, P. B., McCoy, T. H., Taylor, J. B., & Beach, S. R. (2020).

Psychiatry resident attitudes toward practice habit data. Academic Psychiatry, 1-5.