as some of you may already know i work on an adolescent unit in a psych hospital. as with any job in psych it can get very frustrating... not to mention depressing. well the staff and i are dealing with a big problem right now. we have a male patient who has been diagnosed with schizophrenia. he's 15. he has been seen by several psychiatrists, who all agree that he needs to be treated rather aggressively (medication). he can be assaultive, although he keeps to himself most of the time. he has to be watched like a hawk, because he likes to sneak in the shower room and annoy the other male patients, and he'll walk up and poke at his peers, which evokes a fight about 75% of the time. he has strange repetitive rituals, he will not touch door handles, or the drinking fountain... he refuses to take oral medications, because he is convinced that he's not mentally ill, and he doesn't need them, and that the meds. will cause terrible side effects. he demands ativan rather than cogentin for the "shaking" he experiences, despite the fact that i have read through the side effects of ativan with him, and told him that for the problem he's having, ativan isn't going to help as well as the cogentin. he refuses to bathe, and the other boys complain about it, so he has to be assisted, and usually the staff ends up as wet as him. he was on a schedule of prolixin dec. injections q 2 weeks which was the only way that he was actually getting any medication on a regular basis. (he would flat out refuse, or cheek the p.o. meds)
it is so sad to watch a boy drift away like this. you can see it in his eyes.
here's our problem. his mother refuses to believe that there's anything wrong with him. she is angry with everything that we have done, nothing seems good enough. she was angry that he was getting the prolixin dec. and i believe she told him he didn't need it. we can't do anything without a fight. we are treating her, as much as him.
don't get me wrong, i know if he were my son, i may be in denial...but i truly feel that we are doing a dis service to him by not treating him as prescribed. i wish for once she would let her guard down, and listen when we try to tell her that we are all on the same side, we all want what's best for him.... to get better.
any advice as to how to handle this situation??? any words of wisdom or ideas would be appreciated. thanks!
In the begining, about 12 months ago, she WAS consulted, along with the father, but it didn't work, despite the team's many attempts. She was, and still is angry with the father for bringing him to us.
In the begining, about 12 months ago, she WAS consulted, along with the father, but it didn't work, despite the team's many attempts. She was, and still is angry with the father for bringing him to us.
A complicated and taxing situation indeed. I suspect that without individual psychological treatment for mom herself - as in totally outside this setting, and perhaps under the guise of stress management for herself - not much progress will be made. I agree with previously noted concerns about the meaning the son's illness has for mom.
Clearly in this situation it is also important to recognize one's personal and professional boundaries and limits concerning both patients and families. One of the things I sometimes have to say to clients is that when I became a nurse, and later a psychologist, I didn't give up my rights to respectful treatment. Being very clear in teaching people how they can and cannot interact with you is a useful, and therapeutic skill. Perhaps some behavioral management, limit setting, careful documentiation, and a deliberate plan for staff-directed (with a view to specific areas for her input under appropriate conditions) may help. Good luck.
A complicated and taxing situation indeed. I suspect that without individual psychological treatment for mom herself - as in totally outside this setting, and perhaps under the guise of stress management for herself - not much progress will be made. I agree with previously noted concerns about the meaning the son's illness has for mom.
Clearly in this situation it is also important to recognize one's personal and professional boundaries and limits concerning both patients and families. One of the things I sometimes have to say to clients is that when I became a nurse, and later a psychologist, I didn't give up my rights to respectful treatment. Being very clear in teaching people how they can and cannot interact with you is a useful, and therapeutic skill. Perhaps some behavioral management, limit setting, careful documentiation, and a deliberate plan for staff-directed (with a view to specific areas for her input under appropriate conditions) may help. Good luck.
I've seen some very good input to the problem. Now days you deal so much more with behavior disorders that a real psychotic patient can be difficult to deal with. I prefer them to the behavior disorders. Every one is trying to make sense out of the situation and deal with it in a sensible matter. Remember Psychosis=Crazy. Crazy don't make sense, that's why its crazy. That being the case, what can be done about it, how can family and patient get invested in treatment. Sure Mom may have guilt issues. Unfortunately not every problem can be fixed. When the person is ready, the instructor appears.
Hmmmmm! Just wondering --- Any possiblity that this kid is the "Identified Patient" in this very complex and dysfunctional clinical picture????
I worked Child/Adolescent psych. for a number of years, the parents and the potential return of the kids to those parents was one of the reasons I think I quit working Child/Adolescent.
Apples don't fall very far.........you know the rest!!!!!!!!!!
You said this particular pt does not like taking medications. What about street drugs, marijuana, xanax, pcp, ectacy ect? This could be very important in his treatment. What about a treatment team meeting. All disciplines meet and discuss strategy. This meeting should at some point include the parents and the resident so, that whatever treatment plan is decided on everyone is on the same page. Good luck
Keep up the good work in trying to get advise for this unfortunate boy (and family). It is so hard to treat schizophrenics and the mom does sound very confused about the son's diagnosis, possibly guilt for some reason, Munchausens shouldn't be ruled out either, keep an eye on what she's feeding him. This family needs plenty of therapy and soon. Best of luck.
the new girl
52 Posts
In the begining, about 12 months ago, she WAS consulted, along with the father, but it didn't work, despite the team's many attempts. She was, and still is angry with the father for bringing him to us.