Randy Schizophrenia Case Study

Diagnosis: Explaining Randy’s Schizophrenia—please write in complete sentences in this section!

1. What genetic factors may have played a part in Randy’s schizophrenia?

Randy’s father was never diagnosed with a mental disorder, but he was known for his paranoia and eccentric behaviors. In addition, his brother committed suicide which infers that he may have had depression. These genetic factors may have played a part in Randy’s schizophrenia.

2. What biochemical abnormalities might account for Randy’s symptoms?

Certain neurons that use the neurotransmitter, dopamine, fire too often and transmit too many messages, thus producing signs of schizophrenia. Abnormalities in brain structures such as enlarged ventricles (brain cavities containing

CSF) is related to schizophrenia. These biochemical abnormalities might account for Randy’s symptoms of schizophrenia.

3. What might have been the role of family stress in Randy’s disorder?
Randy’s parents may have created family stress. His parents displayed conflict, had great difficulty communicating with each other, and were more critical with their children than other parents. When Randy’s dad became violent, his mother learned to be quiet in order to appease her volatile husband. They rarely communicated with each other, and when they did, it usually ended up in an argument. When a neighbor suggested that Randy to go to a mental health clinic; Randy's father forbade it, saying “no son of mine is going to a shrink...shrinks are for sissies."

4. What does the sociocultural view of schizophrenia contribute to our understanding of Randy’s case?
In addition to the role of family stress, according to the sociocultural view of schizophrenia, downward drift is present. This is when the disorder causes victims from higher social levels to fall and remain at lower levels. Randy only works small jobs occasionally and therefore he does not receive an income; however Randy is currently living off of the money he inherited from his aunt.

Legal—you may need to jump ahead and skim parts of Chapter 19 to answer these questions

1. Assume that you have been asked by the court to conduct psychological evaluation on Randy. What two legal issues need to be addressed?
Two legal issues that need to be addressed when conducting a psychological evaluation on Randy is determining whether or not Randy has any mental diseases and is responsible for the crime and if Randy is capable of defending himself in court and able to understand the charges against him.

2. How will you go about addressing these legal issues? What type of assessments might you use?
I would use the criminal commitment which is a legal process by which people are accused of a crime are instead judged mentally unstable and sent to a mental health facility for treatment. Determining when people are mentally unstable is key; whether it is at the time of their crime or at the time of their trial.

3. In order to address Randy’s legal problems, what do you need to know about Randy’s current condition and his state of mind on the evening of his arrest? What do you need to know about his state of mind on his first night in jail?
In order to arrive at a just punishment, the courts need to know if the patient is responsible for the crime they committed. Some people with mental illnesses may not be accountable for their crimes and therefore should not be punished in the ordinary way. The psychologists need to know Randy’s state of mind on the night of his arrest in order to determine whether or not he is responsible. If it is determined that he was mentally unstable at the time of the crime they may plead not guilty by reason of insanity. In addition, psychologists need to know Randy’s state of mind on his first night in jail in order to determine if he is mentally unstable. If he is mentally unstable at the time of the trial he will be considered unable to understand the trial procedure and unable to defend himself in court. Therefore, Randy would be committed for treatment until they are capable to stand trial.

Treatment: Treating Randy

1.

Assume that instead of being jailed for his offenses, Randy is referred to a community mental health center for treatment planning. You are assigned to be his caseworker. What kind of assessments will you need to do before you begin Randy’s treatment planning?

As Randy’s case manager, the kinds of assessments I would use before beginning Randy’s treatment planning is assessing his problem-solving and social skills, determining what medications are being taken and if they are being taken appropriately, and I would be aware of all possible health care needs. I would also assess the need for community services and the services he is currently receiving.

2. Answer the following concerning Randy’s treatment plan.

a. Does Randy need medication? Why or why not? If he needs medication, what type will you recommend?

Antipsychotic drugs decrease symptoms in about 65 percent of schizophrenic patients and therefore I believe the calming effect of antipsychotic drugs could help Randy. For the reason that atypical antipsychotic drugs appear to be more effective than the conventional drugs, I would start Randy on one atypical antipsychotic drug to improve his condition.

b. What treatment modalities would be helpful to Randy in addition to

medication?
Cognitive-behavior therapy and community support would be helpful treatment modalities in addition to medication.

Even though cognitive-behavior therapy will not get rid of delusions and hallucinations, they may help Randy fix his irregular thought patterns. Community support will assist Randy in receiving services that he needs and present him with social support to get him back on path. Also, family therapy can help Randy’s treatment. Randy’s family and all individuals involved in his life should agree to this treatment, it may be difficult because he walked out on his family however, it would be beneficial to Randy if his family was supportive.

c. What services other than mental health treatment might be beneficial for Randy?

Services other than the mental health treatment that would be beneficial for Randy are sheltered workshops, community support, and supervised residency. “People recovering from schizophrenia handle every day duties, leadership in decision making, teaching in social skills, residential supervision, and vocational counseling, a combination of services sometimes called assertive community treatment” (Comer 466) . Some important features of effective community care programs are coordination services, short-term hospitalization, partial hospitalization, supervised residencies, and occupational training.

d. Randy asks you to tell him when he can expect to get better so he can stop taking his medications. How might you respond to this

question?
I would inform Randy that schizophrenia is a chronic disease and that relapse has a high chance of occurring if medication is stopped. In addition I would tell Randy that many people take antipsychotic medication long term to allow them to continue to feel better. I could tell Randy that if he becomes involved with other treatments, reassessing his medication dosage would be a possibility.