Assessing Client Family

Assessing Client Family

Treatment modality and efficacy of approach

The main goal of the treatment is to enable proper social and psychological well-being of
Angela which is relatively portrayed by her family’s well doing. Thus, the treatment is aimed at
helping her cope well with her conditions and as well manage her schizophrenic symptoms
which are the causes of the disturbance at home. The initial step of treatment is to educate and
emphasize on the importance of adhering to treatment for Angela and the advantages of follow
up as per the doctor’s scheduling. The reason is because she started developing behaviour once
she chose to quite two of her doctor’s appointment.
The treatment is a three-fold modality; for helping her follow up with her doctor,
enabling her adhere to medication plan, and improvement of her household environment through
proper communication with their children and enhancing trust between the parents and children.
After educating her on the importance of medication as it helps her adhere to work and home
environment without any difficulty and symptoms, she and her husband Carlos must be educated
on the need for maintaining good communication with their children. They do not seem to
understand the relevance of explaining to the children schizophrenia and how it is manifested. It
enables them understand their mother and learn to cope with her instead of fearing her and
resenting her. The third strategy is to increase unity in the family by creating family activities
that involve all members.

Progress towards client goals

Assessment of the achievement of goals I based upon a three month follow up of the case
study to identify how Angela fairs with her medication and response in her work place and at
home. Additionally, there will be regular check up to identify if she attends her clinics. Her

husband Carlos will also be monitored occasionally at their home environment to determine if he
taught the children about what has been their mother’s problem. The visits are also intended on
determining if the kids, Matha and Luka feel safe at home and how they interact with their
parents. Further follow up is initiated for the children to determine if their performance in school
is improved following their traumatizing experiences and if they are attending teaching on
schizophrenia and how it had affected their mother negatively. Their evaluation is aided by their
school teachers.

Modification of the treatment plan

Based on her management plan, the treatment for Angela was well adherent and she
responded well. However, there were some changes that needed to be made as schizophrenia is
not an episodic illness that requires short term management but is a lifelong condition that is
managed throughout one’s life. Treatment should always continue even when the symptoms
subside and not ceased as compared to many medical illnesses. One of the changes made during
her management was change in her medication from first line antipsychotics to the second line.
The reason being she was well responsive and the signs and symptoms were mild or disappeared.
Additionally, the first line antipsychotics were very strong and thus caused severe adverse effects
unlike the second ones which cause mild effects and the patients can well cope while under
medications. Chlorpromazine was replaced by clozapine (clozaril) 12.5mg per oral BD, and
Haloperidol replaced by Risperidone (Risperdal) 90mg per oral OD (Lam 2018).
Apart from the medication changes made, there were other components of management
that were integrated; psychological and psychosocial interventions. One of the interventions was
individual therapy which is a component of psychosocial that enables the patients to control
mood, stress, and emotions and can easily detect any abnormal changes and signs of relapse and

take action appropriately (Sripada et al.,2016). Another one is the social training skills that helps
improve the patient’s ability to cope within the social setting and actively take part in social
activities. Family therapy was continued to support the husband and the children in
understanding and coping with schizophrenia. Vocational rehabilitation and supported
employment was continued to help support Angela with her job.
Clinical impressions

Schizophrenia is a severe condition that affects how people think and perceive (Green et
al.,2015). Thus, there are certain characteristic features which are identical only to the illness.
The aim of a mental status examination is to determine if the illness affecting the patient is
schizophrenia through ruling out of any other mental illness. The hallmark symptom of the
illness is psychosis such as experiencing hallucinations and delusions that result in change in
behaviour and mannerism of the patients (Keil et al.,2016).
The signs and symptoms of schizophrenia are broadly categorized into four; positive
symptoms, negative symptoms, cognitive symptoms, and mood symptoms. The positive
symptoms include psychosis such as hallucinations and delusions. The patient may present with
auditory hallucinations with a series of disorganized speech and behaviour. Some of the negative
symptoms may be changes in emotional range, loss of interest in social activities, lack of drive,
poverty of speech, and they patients normally do lack inertia. One of the cognitive symptoms is
neurocognitive defects for example problems with memory and attention when performing
executive functions, and inability to organize their abstract thoughts (Graham et al.,2015). The
patients also have difficulty in understanding cues and expressions by the clinician. For their
mood, the patients may become overly cheerful or excessively moody in a way that is not easy to

According to the diagnostic and statistical manual of mental disorders, fifth edition
(DSM-5), the patient is supposed to portray at least two of the following symptoms just like in
the case of Angela: delusions, hallucinations, disorganized speech, negative symptoms, and
disorganized or catatonic behaviour.
A physical examination and mental health exam was performed on Angela and there was
positive change as she had no positive signs of schizophrenia. Additionally, her behaviour and
mannerism was well in cognitive and she responded well to everything her psychiatrist wanted to
know. She agreed to continue with her therapy, both medical and cognitive behavioural therapy.
Though she experienced a challenge with the cost of medication, the husband medical insurance
coverage was able to cater for the expenses as he was a member of the military.
She was enrolled on the telemedicine program with other schizophrenic patients so that
they could help one another in sharing their experiences and also consult anything from their
psychiatrist without necessarily having to go to the clinic. Both Angela and her husband were
comfortable and approved that she continues her clinic without missing. Issues on her child
abuse experiences and traumatizing events were best left at bay as they were one of the
provocative factors that could easily lead to her relapse. Instead, she continued with psychosocial
therapy where she underwent counselling and was able to respond well.
Privileged psychological note

The Health Insurance Portability and Accountability Act (HIPAA) protect the
psychologists and psychiatrists from any form of privacy breech by the patient or insurance
company as they are not allowed to view their psychological notes (Moore & Frye 2019). They
are documented pieces that explain the experience with every session by the patient/client.


NAME: Angela Thompson LaRue
Date Observation
17/06/2019 Patient brought in the company of the husband, not oriented *3, she is violent,
speech is disorganized, poor thought process, and not well kempt.
18/06/2019 Second visit after the initiation of treatment, patient is moody and silent, she is

neat and tidy, and well oriented to place, time, and person.

19/06/2019 Better affect, well organized speech and thought process. The mannerism is very

appropriate. Treatment seems to be effective.

20/06/2019 Patient’s doing very fine, scheduling clinic to 1/52. We discuss on cognitive
behavioural therapy and psychotherapy commencement.




Graham, K. A., Keefe, R. S., Lieberman, J. A., Calikoglu, A. S., Lansing, K. M., & Perkins, D.
O. (2015). Relationship of low vitamin D status with positive, negative and cognitive
symptom domains in people with first‐episode schizophrenia. Early intervention in
psychiatry, 9(5), 397-405.
Green, M. F., Horan, W. P., & Lee, J. (2015). Social cognition in schizophrenia. Nature Reviews
Neuroscience, 16(10), 620.
Keil, J., Roa Romero, Y., Balz, J., Henjes, M., & Senkowski, D. (2016). Positive and negative
symptoms in schizophrenia relate to distinct oscillatory signatures of sensory
gating. Frontiers in human neuroscience, 10, 104.
Lam, Y. F. (2018). Inflammation and clozapine concentrations. The Brown University
Psychopharmacology Update, 29(4), 2-3.
Moore, W., & Frye, S. A. (2019). A Review of the HIPAA, Part 1: History, PHI, and Privacy and
Security Rules. Journal of nuclear medicine technology, jnmt-119.
Sripada, R. K., Bohnert, K. M., Ganoczy, D., Blow, F. C., Valenstein, M., & Pfeiffer, P. N.
(2016). Initial group versus individual therapy for posttraumatic stress disorder and
subsequent follow-up treatment adequacy. Psychological services, 13(4), 349.