ABSTRACT
The authors present a case report of a patient who was treated by a case manager, a member of a Croatian Community Mental Health (CMH) Team, following the recommendations of WHO 2004 as well as the IRIS guidelines and the Basic Standards for Management of Patients with Serious Mental Illness in the Community (Agius 2005) and using the elements of Clinical case management (Muser 1998), Assertive community treatment model (Burns 1995, Scott 1995, Wolfsan 1990), the personal strength model (Rapp 1988) and Rehabilitation model (Anthony 1993). In order to emphasize the importance of the therapist-patient relationship in the treatment of chronic schizophrenic patients (Ivezic 2001) and creating the group atmosphere a Croatian model of case management is created where the patient's needs and risks are assessed by a multidisciplinary team which also conducts the recommended psychosocial interventions plan. The majority of interventions are conducted in groups. The case manager develops a confident relationship with a patient, nourishes the positive transference and aids the delivery of the treatment. The main goals of the interventions are empowerment of the patient, improvement of his abilities and decreasing of disabilities. The case manager also carries out a full assessment of the needs of the patient's family so that the family or carers are also included in the treatment or support if necessary (Gruber 2006). A case report of a patient and the work of her case manager as well as the case manager's diary (Gruber 2007) and the Croatian model of case management is presented in this article.
Subject(s)
Case Management/organization & administration , Community Mental Health Services/organization & administration , Patient Satisfaction , Schizophrenia/rehabilitation , Schizophrenic Psychology , Adult , Caregivers/psychology , Chronic Disease , Cognitive Behavioral Therapy , Combined Modality Therapy , Cooperative Behavior , Cost of Illness , Croatia , Female , Health Services Needs and Demand , Humans , Occupational Therapy , Patient Care Planning , Patient Care Team/organization & administration , Physician-Patient Relations , Rehabilitation, Vocational , Schizophrenia/diagnosis , Therapy, Computer-AssistedABSTRACT
This paper describes a case of co-morbid panic disorder and psychosis with a focus on the successful treatment of the panic disorder via a CBT approach. The patient has had only one episode of psychosis. The cognitive model of panic disorder is used as a template to consider this young man's psychotic experiences, in the context of some types of delusional beliefs, especially those involving the catastrophic and atypical misinterpretation of the physiological sensations associated with anxiety. This case emphasises the therapeutic value for certain patients of focussing therapy on the non-psychotic symptoms once the acute psychotic state has been managed.
Subject(s)
Agoraphobia/therapy , Cognitive Behavioral Therapy , Panic Disorder/therapy , Psychotic Disorders/therapy , Adult , Agoraphobia/diagnosis , Agoraphobia/psychology , Antipsychotic Agents/therapeutic use , Atenolol/therapeutic use , Benzodiazepines/therapeutic use , Combined Modality Therapy , Desensitization, Psychologic , Diazepam/therapeutic use , Hospitalization , Humans , Male , Olanzapine , Panic Disorder/diagnosis , Panic Disorder/psychology , Paroxetine/therapeutic use , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Reality Testing , SocializationABSTRACT
BACKGROUND: During a four-month period, the authors provided group psychotherapy combining psychodynamic, supportive and psycho-educational approaches. The aim was to investigate whether this approach would enable parents of patients with schizophrenia to re-establish their psychic balance and the balance of the whole family system by reducing high expressed emotion. METHODS: The following tools were administered: a socio-cultural questionnaire, MMPI and PIE psychological tests and two questionnaires for group evaluation. RESULTS: The socio-cultural questionnaire showed that the group of parents is heterogeneous. MMPI profiles showed truthful answers and well organized thinking; there were no psychopathological symptoms. The PIE test showed increased dimensions of sociability and trust. The dimensions of fear, sorrow and anger were decreased. Combinations of primary emotions (marked sociability and high self-protection) show that the parents are cautious, responsible and tend to feel guilt. The parents evaluated the group work as interesting and helpful and the group as a place where the parents can overcome the stigma of the disease that affects them, get information, find help and friends and find a way out of their social isolation. CONCLUSION: This combined approach changes the emotional profile of parents, reduces high expressed emotions (fear, sorrow and anger) in parents and helps re-establish their psychic balance and the balance of the whole family system.