The family of a patient with schizophrenia who has been stable for a year reports to the community mental health nurse that the patient reports feeling tense and having difficulty concentrating
He sleeps only 3 to 4 hours nightly and has begun to talk about creatures called "volmers" hiding in the warehouse where he works and undoing his work each night. This information most likely suggests: a. medication nonadherence.
b. a need for psychoeducation.
c. the chronic nature of his illness.
d. relapse of his schizophrenia.
D
Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping, increased withdrawal, increased bizarre or magical thinking, and a general worsening of the patient's residual symptoms or a return of previous symptoms. The patient is more symptomatic, and medication nonadherence may be a contributing factor, but there is no information to indicate that the patient has been nonadherent (relapse can occur even when the patient is taking medication regularly). A lack of understanding of one's illness and treatment would not itself lead to the presentation described here, and psychoeducation is better delivered when the patient's symptoms are stable. In this case, the symptoms have worsened and/or new symptoms have been added; this suggests a change is occurring rather than the continued presentation of chronic symptoms.
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