Creating an Evidence-Based Treatment Plan for Schizophrenia

Schizophrenia is a mental health condition characterized by the presence of delusions, hallucinations, disorganized speech, lack of motivation, and difficulty articulating thoughts. Affecting less than 1% of adults in the U.S., schizophrenia can significantly impair daily functioning when symptoms are active. However, with appropriate treatment, individuals often experience improved quality of life and a reduction in symptom frequency. Continue reading to learn how to create an Evidence-Based Treatment Plan for Schizophrenia.

Researchers are continually exploring the root causes of schizophrenia to better understand this complex condition. Known contributing factors include genetics, prenatal complications, environmental influences, and structural abnormalities in the brain, all of which can increase the risk of developing schizophrenia.

Schizophrenia is frequently misunderstood and is often incorrectly associated with aggression and violence. In reality, individuals with schizophrenia are more likely to be victims of violence or exploitation due to their condition rather than perpetrators.

Like other mental health conditions, schizophrenia presents uniquely in each individual, with symptoms and their severity varying widely. Some common symptoms experienced by those living with schizophrenia include:

  • Positive symptoms: Examples of positive symptoms include the presence of hallucinations, paranoia, and exaggerated or distorted perceptions, beliefs, and behaviors.
  • Negative symptoms: Negative symptoms refer to the absence of characteristics, which could mean that an individual has a flat affect, a decrease in speech output, a disinterest in socializing, and a lack of pleasure in their life.
  • Disorganized symptoms: This can include confusion and disordered thinking and speech, along with difficulties thinking logically and having bizarre behaviors or abnormal movements.

Similar to other mental health concerns, there is no cure for schizophrenia. However, many individuals can achieve a good quality of life with minimal symptoms when they are actively engaged in treatment. Treatment typically includes the use of antipsychotic medications and psychotherapy, such as cognitive behavioral therapy and supportive therapy. These therapies focus on daily living skills, reducing stress, improving social skills, and providing support for those seeking or maintaining employment. For individuals who continue to struggle with symptoms, living in a treatment home or participating in vocational work programs can enhance their functioning and promote greater independence in their daily lives.

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Setting Goals and Objectives With Clients in Your Treatment Plan for Schizophrenia

The first step in developing a treatment plan for schizophrenia is to confirm that schizophrenia is indeed what your client is experiencing. Diagnosing schizophrenia can be straightforward in some cases, while in others, it may be more complex. For instance, it can be challenging to distinguish symptoms of schizophrenia from those caused by substance abuse or to differentiate it from a manic episode, which can present similar symptoms.

A comprehensive assessment is essential for diagnosing schizophrenia. This may include psychological assessments, clinical interviews, medical examinations, and lab tests. Examples of diagnostic tools that may be used include:

  • Structured Clinical Interview for DSM-5 (SCID-5)
  • Mini International Neuropsychiatric Interview (MINI)
  • Positive and Negative Syndrome Scale (PANSS)
  • Brief Psychiatric Rating Scale (BPRS)
  • Scale for the Assessment of Positive Symptoms (SAPS)
  • Scale for the Assessment of Negative Symptoms (SANS)
  • MATRICS Consensus Cognitive Battery (MCCB)
  • Physical Exam
  • Global Assessment of Functioning (GAF)

By utilizing these tools, clinicians can gather comprehensive information to accurately diagnose schizophrenia and develop an effective treatment plan tailored to the individual’s needs. Depending on your client’s presentation, it may be appropriate to use a Mental Health Risk Assessment, like the one available from TherapyPatron.com.

What to Include in a Treatment Plan for Schizophrenia + Sample

As we move through the remainder of this article, we will be following a customizable treatment plan outline available with TherapyPatron with our example of a treatment plan for schizophrenia.  We have a hypothetical case for a man named John, who has been admitted to inpatient psychiatric symptoms for what appears to be active schizophrenia symptoms.

John’s example:

John S., a 28-year-old male, was recently admitted to an inpatient psychiatric program due to active symptoms of schizophrenia. Over the past six months, John has experienced significant changes in his behavior and functioning. He has exhibited auditory hallucinations, frequently hearing voices that others do not, which have been distressing and commanding in nature. John has also shown delusional thinking, firmly believing that he is being monitored and persecuted by government agencies, despite no evidence to support this. These symptoms have led to severe paranoia, making him increasingly isolated and distrustful of those around him. John’s speech has become disorganized, often difficult to follow, with frequent derailments and tangential thoughts. His family reported that he had neglected his personal hygiene and daily responsibilities, spending most of his time confined to his room. Additionally, John has demonstrated marked negative symptoms, including a lack of motivation (avolition), reduced expression of emotions (flat affect), and an overall withdrawal from social interactions and activities he once enjoyed. John’s family indicated that he is not involved with any mental health agencies or organizations, but he does see a primary care physician regularly. His occupational functioning has significantly declined, leading to his inability to maintain employment.

Agencies Involved and Plans for Care Coordination

In John’s case, there are several professionals that you could coordinate with if he has already established care. This can include a primary care physician, community mental health providers, and educational or vocational providers. In this case, John’s family reported that he is only working with a primary care physician at this time. 

 Example for John:

Other Agency: Primary Care Physician, Doctor Smith

Plan to coordinate: Coordinate with his PCP and inform of admission. With a signed consent, you can release information about his diagnosis and treatment plan.

Clinical Diagnoses

The clinical team, following DSM-5 criteria, has diagnosed John with schizophrenia, as his symptoms have been persistent for more than six months and have substantially impaired his social and occupational functioning.  The specific symptoms that support this diagnosis include:

  • Delusions
  • Hallucinations
  • Disorganized thinking
  • Grossly disorganized or abnormal motor behavior
  • Negative symptoms
  • Impaired functioning in important areas of life
  • His symptoms are not the result of other mental health conditions or substance abuse

Example for John:

Diagnosis: Schizophrenia, unspecified F20.9

Supporting Assessments: Positive and Negative Syndrome Scale (PANSS) score of 56

Current Medications and Responses

Antipsychotic medications can help alleviate positive symptoms such as hallucinations, delusions, and disorganized thinking, as well as manage negative symptoms and improve overall functioning. The choice of medication and dosage would be determined by John’s prescribing psychiatrist based on factors such as his specific symptoms, medical history, potential side effects, and individual response to treatment. His prescribing physician would continually monitor his symptoms for necessary adjustments to medication to optimize John’s treatment outcomes.

Example for John:

Medications prescribed:

  • Risperidone Xmg
  • Olanzapine Xmg
  • Lorazepam  Xmg
  • Benztropine Xmg

Presenting Problem and Related Symptoms

This section of your treatment plan serves to highlight your client’s symptoms, impairment, and the underlying factors shaping their treatment. Here, you’ll develop a clinical summary with your conceptualization and outline the focus of your intervention. Your narrative should delve into specific details, offering a comprehensive foundation for the treatment plan included in later sections.

Example for John:

John S., a 35-year-old male, has been admitted to an inpatient psychiatric program due to active symptoms of schizophrenia. His symptoms include auditory hallucinations, delusions, disorganized speech, and significant social and occupational dysfunction. John has been experiencing these symptoms for the past eight months, significantly impairing his ability to maintain employment and relationships. His insight into his illness is limited, and his recent history includes episodes of agitation and paranoia, making his current inpatient stabilization a priority. His family is active in his life and supports him when he is home.

Goals and Objectives

Goals for John should be individualized and specific to his current concerns. Since he has active symptoms, his treatment would likely focus on stabilization services, and later be adjusted once he has had a decrease in his symptoms. Keep in mind that goals can always be adjusted, so if you come to find that his goals are not meeting him where he is, you can modify them to better reflect his current needs and level of functioning.

Example for John:

Goal 1: Stabilize and Reduce Psychotic Symptoms

  • Objective 1: Regularly Monitor and Adjust Medication
  • Objective 2: Engage in Individual Therapy for Reality Testing
  • Objective 3: Participate in Group Therapy to Reduce Isolation

Goal 2: Enhance Daily Functioning and Coping Skills

Goal 3: Prepare for Transition to Outpatient Care

  • Objective 1: Create a Comprehensive Aftercare Plan
  • Objective 2: Connect with Outpatient Mental Health Resources
  • Objective 3: Engage in Family Therapy for Support

Specific Interventions to Be Used

Listing out the interventions that you will use in your schizophrenia treatment plan can serve as a quick reference for you before sessions. Evidence-based interventions tend to be more effective when used appropriately. If you find that your interventions are not having the effect you had expected or hoped for, make the needed adjustments so you can continue working towards your goals. 

Example for John:

Intervention/Action: Cognitive restructuring to reframe delusional beliefs

Responsible Person: Counselor A

Intervention/Action: Behavioral activation to increase engagement in activities and social functioning

Responsible Person: Counselor A

Intervention/Action: Psychoeducation about schizophrenia, symptoms, treatment options, and the importance of medication adherence

Responsible Person: Counselor A

Family Involvement

In John’s case, it sounds as though his family has an active role in treatment. Because of this, they would likely benefit from psychoeducation and supportive counseling to focus on supporting them with their experiences.

Example for John:

Family and psychoeducation sessions for his family to provide them with information about schizophrenia, treatment, and how they can support John in his recovery.

Additional Services and Interventions

Additional services and interventions may be more appropriate at a later stage of his mental health journey. At this time, the core focus of John’s care is crisis stabilization services, and helping him get back to his baseline functioning. Since your treatment plan can be adjusted throughout a client’s treatment episode, this can be modified or updated as he nears the end of his treatment with you.

Example for John:

None at this time

Estimation for Completion

This section of your treatment plan can be and should be, modified if you feel as though your client needs more or less time. A 2022 study indicated that the average length of time of hospitalization for individuals who are experiencing active schizophrenic symptoms was 43.9 days, ranging from 32 to 45 days for their sample.  Several factors would influence John’s duration of care including the severity of symptoms, response to medication, and other therapeutic interventions.

Example for John:

Duration of inpatient psychiatric care of 45 days, to be adjusted based on his progress and response to interventions. 

Aftercare Plans

Aftercare plans should outline the recommended steps if John were to terminate treatment today. Given that treatment can end prematurely for various reasons, it is essential to be prepared, especially in cases that involve serious conditions and severe impairment. These plans can be adjusted throughout the treatment process to ensure they remain accurate and effective in providing ongoing support.

Example for John:

Immediate follow-up with a mental health professional to assess for clinical needs and establish care. Additionally, John should meet with his primary care physician as soon as possible for medication management services.

Final Thoughts On Creating a Treatment Plan for Schizophrenia

Thank you for reading this resource on creating an evidence-based treatment plan for schizophrenia. Working with clients who have schizophrenia requires a thorough understanding of the disorder and a compassionate approach to care. Schizophrenia is a complex, chronic mental health condition that affects each individual uniquely, necessitating personalized treatment plans and consistent support.

Key components to be mindful of include developing safety and building a strong therapeutic relationship, especially for clients who may have had negative experiences with mental health professionals in the past. Conducting a comprehensive assessment is crucial to ensure the treatment plan addresses the full scope of your client’s needs. Focusing on providing compassionate and effective care can have a lasting positive impact on your clients as they navigate this challenging mental health condition.

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and help your clients be their best selves.

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Resources:

Kayla VanGuilder, MA, LCMHC
Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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