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Case study; Lisa

Lisa is a 34-year-old single female. She is a high school graduate and completed 1 year of
college. She was raised in an upper-middle-class family where academic and career success
was very important. She was the second of two children. Lisa was a good student, hard
working and somewhat self-critical. She was shy but had several friends and dated
occasionally. After graduation from high school Lisa went out of state to college. She
received passing grades her first year but began to experience auditory hallucinations and
delusions. She began to act in bizarre ways and withdrew from people. She was hospitalised
at age 18 for 1 month and dropped out of college. In the past 16 years she’s been hospitalized
12 times. Her family supported her financially when she has been unable to work for long
periods because of inpatient treatment in a psychiatric hospital. Her diagnosis was
schizophrenia, undifferentiated type. She took 500 mg of Thorazine daily and was medication
compliant. She used to live with her parents, but in the last 5 years she has lived alone in a flat
with opportunities to get help and support from……………as part of her discharge plan to
help her adapt to the demands of community living and manage her illness.
Cognitively she experienced auditory persecutory hallucinations and delusions as well as
frequent cognitions like, "I'm no good," "I can't do anything," "I'll always be this way."
Affectively she had flat affect and anxiety related to interpersonal situations and tasks and the
content of the hallucinations and delusions. Interpersonally she was withdrawn and socially
isolated. Behaviourally she was inactive, unable to work or live independently. Her basic self-
care was severely limited.
Lisa’s psychosocial functioning was significantly impaired by the interaction of her illness
and her methods of coping the hallucinations, delusions and cognitions interfered with her
functioning. Lisa’s difficulties in managing stress, anxiety and her symptoms led often to
inactivity. Lisa would spend much of her time in bed, watching TV and smoking. She often
failed to get up in the morning, to eat properly and to take care of her personal hygiene (take
showers, clean at home, do the laundry and the dishes). When she would consider doing some
activity or was requested by her parents to do something, she would become anxious and
hallucinations and delusions would increase. She would think that the task was too much for
her. She coped with the stress of her symptoms by apathy and withdrawal. Her coping
methods of avoidant behavior toward tasks and interpersonal situations in turn increased
anxiety, negative cognitions and psychotic symptoms.
Social situations were a major source of stress in her life. Many problems in social relations
were due to errors in social perceptions of self and others. Lisa frequently had problems
reading social cues and would interpret them by overgeneralizing, personalizing, and selective
abstraction. Lisa took a class at the community college and worked together with a few other
people with common diagnoses and under supervision 10 hours a week at a horse stable.
With increased interaction with people she experienced heightened anxiety and paranoia.
Even thou Lisa made major progress in various areas of her life, she frequently experienced
anxiety, fears and hopelessness regarding relapse. Lisa’s self-esteem was also impaired by
frequent self-criticism and negative comparison to other non-ill individuals. Selective
perception and attributions of negatives to oneself and positives to others were common. She
would experience anxiety, fatigue or depression that was of a low level and within normal
limits and interpret them as "I'm going crazy." Her experience of vulnerability and issues of low frustration tolerance, overgeneralizing and catastrophizing contributed to this problem. Lisa interests were painting and crafts. She was also interested in music. Her goals in life were to find and to share a normal life with a husband and to establish a family together with him. Questions for group discussions: 1.What kind of economical support and maintenance can Lisa get? 2.Can we try to improve Lisas daily-life situation by offer her support regarding social services? 3.Is it possible to exercise some sort of collaboration between medical care and social services efforts for Lisa?

Source: http://www.ensa-network.eu/meetings_files/ensa%20Dis_Arzignano/Case%20study.pdf