Clinical Case Study II


EDITOR’S NOTE: The following article is a clinical case study compiled by Staff Psychologist Mirasol Laureta, under the supervision of the Clinical Department Manager.

Hector is a 38 year old male who was admitted in SELF in January 29, 2007 due to substance abuse, paranoia and hallucinations. He has been abusing shabu (methamphetamine), on and off for the last 10 years. In 2005 he was diagnosed with substance-induced psychosis at Cardinal Santos Hospital where he was prescribed Zyprexa. During his outpatient status, Hector did not take the medications that he was prescribed.Hector comes from a poor family in the Visayas region. In 1987 he left for Manila where he found work at the Trader’s Hotel. In 1991 Hector met a male friend and decided to live in with him. A year later his partner died of a stroke causing him to be depressed.

In 1993 he made new friends, was introduced to shabu, and soon got hooked on the substance. This went on until 1997 when he lived in with a new male partner. This new friend was wealthy and was able to convince him to stop taking drugs. He smothered him with material comforts and influenced him to establish a business. Thus, Hector was able to abstain from taking drugs for about five years until they separated in 2003.

Devastated by the separation, Hector went back to taking drugs and in 2005 he developed hallucinations and became violent. His condition worsened in the following years and in January 2007, he was brought to SELF.

Initial Interventions

Upon admission, Hector was uncooperative, adamant and exhibited signs of paranoia. Due to his condition, it was impossible to obtain an Intake Interview. For the next few days, he was made to settle down until he agreed to be subjected to medical, psychological and psychiatric assessments. Hector was then diagnosed as having a schizo-affective disorder with psychotic features and was prescribed Olanza¬pine, Biperiden and Risperidone.

Under these medications, he was encouraged to accomplish simple household chores and observe group therapy sessions. For the next two and a half months, he also underwent frequent counseling sessions along with art and writing therapy.

On his third month, Hector started showing interest in the morning orientation discussions conducted in the Pre-admission Department (PREAD). It was also around this time that he expressed willingness to join the TC program. Following this development Hector was briefed about the TC process and the rules of the house. After two weeks, he joined the TC program. After a month of adjustment, he began participating in community activities, group therapy sessions and was particularly receptive during individual counseling sessions.

Breakthroughs

On his sixth month, Hector was exposed to the normal intensity of the TC confrontation process and exhibited no lapses. He dealt with his Learning Experiences openly and insightfully. The following month, he surprised everyone when he disclosed his bisexual preferences to the SELF Family.

In November 2007, after consistent progress, Hector was promoted to the Senior Phase where he successfully handled several family dialogues. He was assigned demanding tasks and handled them responsibly. He experienced a job demotion and was able to handle the attendant frustrations positively. His thought processes developed remarkably such that he was able to distinguish reality from his hallucinations. By January 2008 his paranoia and hallucinations ceased completely and his dosage of Risperidone was tapered off from 2 mg to 1 mg per day.

During his Case Conference in July 2008 he was observed to be lucid and insightful. He claimed to appreciate the support of his peers and recognized the importance of having regular counseling sessions. Having responded satisfactorily under the pressures of the Senior Phase, he was sent-off to the Reentry Phase where he now works as a trainee in the administration kitchen. Risperidone was further reduced to 0.5 mg per day and it is expected that within the next six months, Hector will be taken off medication completely.

Conclusion

This is a classic case of Drug-Induced Psychosis that has been effectively addressed with SELF’s Dual Approach Program. Having been able to address both disorders at the same time, Hector benefitted from both behavior and clinical therapy to treat his psychosis and drug-taking behavior, allowing the tapering off of his medications during the advanced stages of his recovery program.

EILEEN P. SIMBULAN
Managing Psychologist, SELF
November 2008