Changes in persistent delusions in schizophrenia using guided self-determination: a single case study

Delusions in persons with schizophrenia who have limited insight have been targeted with different treatment modalities with equivocal results. Working with the Guided Self-Determination method used in shared decision-making and problem solving, a 55-year-old male diagnosed with schizophrenia gained insight into his own delusions during a period of six weeks with individual training. The case study is based on qualitative data, reflection sheets, and interview and field notes from the Guided Self-Determination training. The patient's new insight developed in a process from resistance to receptiveness and then from doubt to reaching a new system in his thoughts.     

TIPS: telephone intervention--problem solving for persons with schizophrenia

A prospective experimental design was used to examine whether face-to-face meetings designed to establish rapport had an effect on the verbal responses of persons with schizophrenia in subsequent Telephone Intervention--Problem Solving (TIPS). Verbal responsiveness was operationalized as length of telephone conversation, number of feeling statements expressed, and number of one-word responses. Experimental participants met with the TIPS provider twice during hospitalization, while controls did not meet with the TIPS provider. All subjects received TIPS weekly from a psychiatric nurse for six weeks after hospital discharge. Compared to controls, experimental participants conversed longer at every measurement point, and significantly longer during weeks one through three. Experimental participants were approximately twice as likely to make a feeling statement as those in the control group. These data suggest that psychiatric nurses who would like to employ TIPS to support clients in the community should plan for at least two face-to-face interventions to establish rapport prior to initiating TIPS.     

Art psychotherapy in a consumer diagnosed with borderline personality disorder: A case study

This case study reviews 11 sessions of art psychotherapy with a consumer diagnosed with having borderline personality disorder. A consumer who reported difficulty in communicating her lived trauma verbally and engaged in self‐harming behaviour was offered individual art therapy sessions following a consultation between an art therapy student and clinical nurse consultant in an attempt to understand her experiences and to collaboratively engage her. Notes were taken after each session by the art therapy student, reflecting conversations with this consumer while they were engaged in art making, which were subsequently explored within formal clinical supervision sessions with a mental health nurse consultant. An art portfolio is reproduced. It illustrates the expressive power of image creation. The key features of the images were that of lived trauma, the externalization of thoughts and feelings, and intense emotional expression. The results of this chronological art portfolio case study indicated therapeutic benefits from the intervention for this consumer. Further investigations of this type of intervention are warranted within the mental health setting.     

Health promotion in persons with schizophrenia: atypical medications

Nearly 2 million Americans suffer from schizophrenia, which is considered the most chronic and disabling of the severe mental disorders. In addition to psychotic symptoms, cognitive deficits, and social impairments, persons with schizophrenia are faced with multiple barriers to the achievement of optimal health. Psychiatric nurses must assess physical and psychological risk factors, monitor medication responses and side effects, and provide health promotion strategies for persons with schizophrenia. After providing a brief summary of the diagnostic criteria and clinical features of schizophrenia, this article reviews medication management with atypical agents and serious drug reactions.     

Social cognition and atypical antipsychotic agents in the treatment of persons with schizophrenia: preliminary data from a naturalistic study

Schizophrenia is a chronic disorder that begins in adolescence or in early adulthood. In schizophrenic disorder there are relevant deficits in social interaction. The aim of this study was to evaluate the efficacy of atypical antipsychotic drugs compared to a conventional antipsychotic in the treatment of psychotic symptoms and on cognitive functions of a group of people affected by schizophrenia. Effects of novel antipsychotic drugs on social functioning improvement, regarded as improvement in the ability to represent mental states, were thoroughly assessed. Our study was conducted in the form of naturalistic observation of a sample of 45 people affected by schizophrenia treated with haloperidol, clozapine and risperidone. Our results show that after one year of treatment there were significant positive results in social competence abilities in the group of people being treated with risperidone. Theses results may have a relevant impact on the improvement of quality of life in people affected by schizophrenia.     

Hypnotic analgesia for chronic pain in persons with disabilities: a case series

Thirty-three adults with chronic pain and a disability were treated with hypnotic analgesia. Analyses showed significant pre- to posttreatment changes in average pain intensity that was maintained at 3-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain but not in pain interference or depressive symptoms. Hypnotizability, concentration of treatment (e.g., daily vs. up to weekly), and initial response to treatment were not significantly associated with treatment outcome. However, treatment-outcome expectancy assessed after the first session showed a moderate association with treatment outcome. The findings support the use of hypnotic analgesia for the treatment of pain in persons with disabilities for some patients but not the use of pretreatment measures of hypnotizability or treatment-outcome expectancy for screening patients for treatment.     

Treatment of Gilles de la Tourette syndrome using behavioural psychotherapy: a single case example

Treatment of Gilles de la Tourette syndrome using behavioural psychotherapy: a single case example. This paper describes the clinical condition of Gilles de la Tourette syndrome (TS) and outlines some of the causes for the condition and its possible treatments. It describes a single case demonstrating the effectiveness of one type of treatment, namely habit reversal. Finally the implications of the condition's classification as a psychiatric disorder are discussed as is the possibility that other health care professionals may be able to help in the treatment of such cases.     

Developing a context-based performance measure for persons with schizophrenia: the test of grocery shopping skills.

OBJECTIVE: This article describes how authenticity and directness, desired characteristics of performance measures, were applied to the development of a context-based Test of Grocery Shopping Skills (TOGSS) for persons with schizophrenia. METHOD: The steps used in developing the measure included interviewing consumers with schizophrenia to identify issues in grocery shopping, conceptualizing how authenticity and directness could be applied to shopping performance, and selecting grocery items to be used in the test. The two forms of the TOGSS were administered to 26 persons with schizophrenia or schizoaffective disorders to evaluate reliability (stability, equivalence, interrater) and validity (convergent, generalizability) of the TOGSS. RESULTS: The correlations between the two forms of the TOGSS over two different testing periods were significant, ranging from .64 to .83. Subscale scores were moderately correlated (R = .52 to .94) with a similarly constructed test of drugstore shopping. CONCLUSION: A systematic method can be used to develop a context measure of performance. The TOGSS has beginning evidence of reliability and validity. With further study, the test will be useful in assessing the independent living skill of grocery shopping in persons with psychiatric disorders.     

"Moving along" in psychotherapy with schizophrenia patients

Current treatment of the schizophrenic patient relies primarily on psychopharmacological management, psychoeducation, and family work. If individual psychotherapy is an adjunct, it is generally supportive. Recent focus on determinants of change in classical psychoanalysis suggests that noninterpretive mechanisms may have an impact at least equivalent to that of the well-timed transference interpretation. The author argues that the same noninterpretive mechanisms may be even more important for change in patients in a supportive process. A case study is used to illustrate that such an application of psychoanalytic principles and developmental research can be used to help even the most disturbed patients.     

Critical reflections on end-of-life care for people with intellectual disabilities: a single case study approach

People with intellectual disabilities (ID) are enjoying increasing longevity, but are simultaneously having to cope with the additional health problems associated with ageing. Even though people with ID are reported to have worse health than the rest of the population, resulting in greater health-care needs, they also have poorer health care than the average person, including including-end-of-life care. The aim of this paper is to explore the challenges to providing effective end-of-life care for a person with an ID by using critical reflection from a nursing care perspective on an illustrative case study. Death never occurs in a vacuum but rather occurs in a social context, and the social context here was crucial to providing appropriate end-of-life care. It is hoped that the paper will promote discussion both around end-of-life care generally and in relation to this marginalized population.     

High-intensity cycling exercise after a stroke: a single case study

Aerobic exercise training has demonstrated positive effects after brain injury. However, therapists express concern regarding the use of effortful exercise in individuals presenting with spasticity or involuntary muscle activity. This study aimed to address this concern and to evaluate whether an intervention of maximal intensity cycling exercise impaired an individual's ability to actively extend his hemiparetic elbow. Using a single case design, it was shown that active elbow extension improved during the period of this investigation, and was not impaired immediately following maximal cycling exercise.     

Having a sibling with schizophrenia: a phenomenological study

Limited attention has been paid to experiences of individuals with siblings diagnosed with schizophrenia. The purpose of this article is to address this gap by exploring the impact of having a brother or sister with schizophrenia. The lived experience of 6 individuals with a sibling with schizophrenia was explored using van Manen's (1997) Hermeneutic Phenomenology. Four themes were identified: struggling to understand, struggling with the system, caring for the sibling, and seeing beyond the illness. Health care providers need to re-evaluate current approaches for assisting individuals to cope with having a sibling with schizophrenia. Inclusion in the plan of care and recognition of their struggle is essential for individuals having a sibling with schizophrenia.