MEETING ACUTE AND LONG-TERM SCHIZOPHRENIA MENTAL HEALTH CHALLENGES

Patient Scenario: Joseph, Age 27. Full time car mechanic. SBAR: Situation: • Joseph is a 27-year-old single man. He has a son who is 3 years old who lives with his expartner, Joseph sees his son for 2 weekends a month. • He works as a full-time car mechanic. • Because of his employment he does not have time to visit the community mental health outpatient service, so you visit him every 2 weeks at his place of work to administer his intramuscular depot injection. Which works well for Joseph, but it does mean that his colleagues are aware. • He often goes to the gym as he enjoys keeping fit and wants to stay in shape. Background: • He was diagnosed with paranoid schizophrenia when he was 20 years old, at this time he was formally detained under the Mental Health Act for 18 months. • He has type 1 diabetes. • He has a history of using illicit substances and still occasionally uses cannabis as he says it helps him relax with his friends. Current Medication: Zuclopenthixol Decanoate 200mg every 14 days. NovoRapid (Insulin Aspart) 4-10ui after meals. Lantus (Insulin Glargine) 12ui nocte. Assessment: You meet Joseph at work in the afternoon as arranged. He says work has been stressful but that he is enjoying it. He is looking forward to seeing his son at the weekend and is going to get his hair cut afterwork. He agreed to accept the depot medication and to meet again the same time in a couple of weeks. MSE: Appearance and Behaviour: Wearing appropriate clothing for work. Clothes are stained and hands are dirty. Clean shaven. Engaging in conversation. Able to build rapport. Appeared relaxed Speech: Speech is normal for Joseph Rate, tone, volume, rhythm and quantity of speech is appropriate. Mood: Joseph reports that his mood is fine, that he is sleeping okay, and his energy and concentration is fine. He says he has increased appetite but puts this down to the medication. His affect was reactive. Thoughts: Thought form appears to be intact. 2 | P a g e MEETING ACUTE AND LONG TERM HEALTH CHALLENGES He said he is worried about his physical health and he is finding this distressing. Perceptions: He reports no abnormal perceptions and did not appear to be experiencing any. Cognition: He appears orientated to time, place and person and does not appear to have any abnormalities with his cognition. Insight: Joseph has insight and agreed to accept his depot. He said that he is not currently experiencing any symptoms. He did say that he occasionally gets shaky hands at work and thinks that this might be a side effect of the medication, he finds it frustrating because he can hinder his work.