A 22-year-old woman is brought to the emergency department by her father due to "strange behavior." Earlier that day, the patient insisted that a television newscaster was talking directly to her about the risks of "poison rays" from the moon. Her father says that she has "not been herself" for the past year. He is upset about her declining grades, along with increasing conflicts with her younger siblings and social isolation from her friends. A month ago, the patient abruptly quit the part-time job that she had previously enjoyed because she believed that her coworkers were spying on her. In the emergency department, she is agitated and the decision is made to admit her to the psychiatric unit. After a comprehensive evaluation, the patient is diagnosed with schizophrenia. She is stabilized on risperidone over a period of 3 weeks, and discharge plans to return home are discussed. Her father asks what can be done to decrease the likelihood of rehospitalization. In addition to maintaining risperidone, which of the following measures would be most helpful for this patient?

Question

A 22-year-old woman is brought to the emergency department by her father due to "strange behavior."  Earlier that day, the patient insisted that a television newscaster was talking directly to her about the risks of "poison rays" from the moon.  Her father says that she has "not been herself" for the past year.  He is upset about her declining grades, along with increasing conflicts with her younger siblings and social isolation from her friends.  A month ago, the patient abruptly quit the part-time job that she had previously enjoyed because she believed that her coworkers were spying on her.  In the emergency department, she is agitated and the decision is made to admit her to the psychiatric unit.  After a comprehensive evaluation, the patient is diagnosed with schizophrenia.  She is stabilized on risperidone over a period of 3 weeks, and discharge plans to return home are discussed.  Her father asks what can be done to decrease the likelihood of rehospitalization.  In addition to maintaining risperidone, which of the following measures would be most helpful for this patient?

Quizplus · Accepted Answer

Although antipsychotic medication is the primary treatment for schizophrenia, integrating psychosocial interventions into a broader treatment program can improve outcomes. Family interventions, including psychoeducation and family therapy, have proved to be high-yield interventions in schizophrenia that reduce the risk of rehospitalization. Family intervention consists of a collaborative process that educates the patient and family about the symptoms and course of schizophrenia with the goal of reducing family stress and conflict (eg, educating the family that the patient's social isolation and declining grades are not "laziness"; they are negative symptoms of schizophrenia). Patients with schizophrenia who have critical, hostile, or overinvolved family members have a higher risk of relapse; patients in a home atmosphere that is stable and supportive, with family stressors kept to a minimum, have a decreased risk of relapse. (Choice A) Employment can help provide a sense of purpose and worth; however, asking this patient to resume employment shortly after a psychotic episode in which she felt paranoid about her coworkers would be unnecessarily stressful and could increase the risk of relapse. Structured employment programs that provide on-the-job support can be helpful for patients with serious mental illness. (Choice B) Although returning to school would provide structure and goals for this patient, she is unlikely to be successful immediately after a psychotic episode. A gradual return with a reduced schedule would be a more appropriate recommendation. (Choice C) Having family members supervise the patient at all times is likely to be experienced as intrusive and stressful. Overinvolved family-patient interactions are associated with worse outcomes. (Choice E) Insight-oriented psychotherapy focuses on uncovering unconscious patterns originating in childhood experiences; it is not indicated for patients with schizophrenia because it may initially cause increased anxiety that can destabilize those recovering from an acute psychotic episode. In contrast, cognitive-behavioral therapy, which combines cognitive approaches and social skills training, is a helpful adjunct to medication in the treatment of schizophrenia. Educational objective: Family psychosocial interventions are indicated for patients with a recent psychotic episode who have significant ongoing contact with family members. Minimizing conflict and stress in the home decreases the risk of relapse in patients with schizophrenia. References: Family interventions in schizophrenia: promise and pitfalls over 30 years. (http://www.ncbi.nlm.nih.gov/pubmed/22437626) Treatments for schizophrenia in adults: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/29537779)

A 22-Year-Old Woman Is Brought to the Emergency Department by Her