As people become older, they become susceptible to various chronic illnesses and this includes mental health and psychiatric illnesses. The country is continuing to have better health services due to increase in research and health technology. This has led to a situation where life expectancy has increased. As such, the number of elderly persons has increased in the country and it is still on the rise. This aging population still has significant vulnerabilities like cognitive decline and this means that psychotherapists need to be cognizant of effective ways of dealing with the mental health and psychological needs of this population (McGuire, 2009). Because of the complicate nature of the needs that aging people have including multiple comorbidities, it may be challenging to have the expected outcomes when counselling them and this could be discouraging. However, there is need to utilize evidence and learn from experience in order to ensure that elderly persons are taken care of to the end and that the expected outcomes are sustainably achieved.
In the facility, there have been a number of elderly persons, most of who are treated for cognitive decline. In one case, an elderly woman was introduced by her son and the problem was that she was having delusions and hallucinations. She had also started to become incoherent while speaking and she could not function normally. Notably, these are symptoms that suggest a case of schizophrenia according to the Diagnostic and Statistical Manual (American Psychiatric Association, 2013). In the treatment of this disorder, both pharmacological and non-pharmacological interventions can be used. Antipsychotic drugs are always administered. In addition, cognitive behavioral therapy may also be used like it was in this case where both interventions were integrated. Cognitive behavioral therapy is used with a view of countering some negative symptoms and improve the insight of the patient (Hany, Rehman, Azhar & Chapman, 2020). It was expected that the cases of acute psychosis could be effectively managed and the drugs could be changed based on the guidelines in order to reduce cases of relapse.
For a while, it was clear that there were improvements. She started to show emotional expression, something that she was staring to find hard to. She also started to become organized and her speech became increasingly coherent. However, this happened only for a short while. She started to experience the psychotic symptoms again. When this happened, a second antipsychotic drug was used and the symptoms started to improve. This round, the hallucinations and the delusions also reduced for a while. Even with the cognitive behavioral therapy, there was relapse for the second time. It became clear that this was a case of treatment resistance schizophrenia. This is a serious problem and up to 40 percent of patients that are diagnosed with this disorder have inadequate response to antipsychotic treatment (Lowe et al., 2018).
One thing that was important about this client is that she was smoking and drinking regularly. When she started being treated, it was important to inform her caregivers at home that she had to stop drinking and smoking. According to the son, drinking was not a problem but she could not stop smoking. Smoking may interfere with the efficacy of antipsychotic drugs and this could be a reason why she was not getting better. In order to improve the outcomes of this client, there is need to specifically focus on her and she needs to be given keen attention. This could be done in a nursing home if she consents and if the family is okay with that. Clozapine may be introduced first but she needs to be given close attention and the smoking should stop.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub
Hany, M., Rehman, B., Azhar, Y. & Chapman, J. (2020). Schizophrenia. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539864/#article-28759.s7
Lowe, P., Krivoy, A., Porffy, L., Henriksdottir, E., Eromona, W., & Shergill, S. S. (2018). When the drugs don’t work: treatment-resistant schizophrenia, serotonin and serendipity. Therapeutic advances in psychopharmacology, 8(1), 63-70
McGuire, J. (2009). Ethical considerations when working with older adults in psychology. Ethics & Behavior, 19(2), 112-128.
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