Objective of this Assignment: To prepare a response to a

Case Study: Bianca Chandler Begin Today, you see Bianca Chandler (she, her, hers), a 15-year-old Black teenager who lives with her maternal grandfather, Patrick Chandler (he, him, his), age 70, who is her legal guardian. Bianca was diagnosed with schizophrenia 2 years ago during a series of three psychiatric admissions when she was experiencing auditory hallucinations and paranoid delusions. She was placed on Risperdal (risperidone) 2 mg BID. Patrick’s Transcripts Part 1 Patrick: We here ’cause Bianca ain’t doin’ so good. She been havin’ more of them auditory hallucinations and ain’t gettin’ no sleep at night. I know she ain’t tryna go nowhere. Lately, she ain’t e’em goin’ to church. And our family been goin’ to the A-M-E (African Methodist Episcopal) since before Black people got free from slavery. Round here, goin’ to church on Sunday mornings ain’t somethin’ you just skip. That’s what I told her when she need to move in wit me. I got Miss Angie from next door to come round this mornin’ and help Bianca get cleaned up for this meetin’, but Doc, she ain’t took a shower in days. Miss Angie told me when she left that she been prayin’ hard for Bianca. Miss Angie works, so she can’t come through too often. And it’s hard for me take care of Bianca the way she do. So most days she drag around the house lookin’ raggedy. I was thinkin bout it just this mornin’. Bianca been livin’ with me for ’bout 5 years now. Her Momma, bless her soul, passed away from an overdose. ‘Bout 2 years ago, Bianca started seein things, or what y’all callin’ “paranoid delusions. ” That’s when she got diagnosed with the schizophrenia and had to be put in the hospital a few times. I wanna keep her close at home, but sometimes she too far gone for me to care for her I like I know she need. Hard for me to say aloud, but some of the worst hallucinations she be havin’—she say she seein’ a room covered in blood wit a bloody kitchen knife on the floor. Or, or she say she seein’ a deer all torn apart, and a lamb that been slaughtered and left to rot in the back the house. Doc, it’s just too much. Things like that be scary to the both of us, in ways I can’t e’em put into words. An’ big piles of, human skulls all bloody. Now I’m havin’ trouble sleepin’. how can you help us, Doc? I never thought things would get this bad. Part 2 Doc, I ain’t so sure. I mean, Bianca ain’t hurtin’ nobody. Ain’t hurtin’ husself neither. It ain’t like when she was up in the hospital, all drugged up, couldn’t e’em speak to me for weeks. Now, you know, at least she’s goin’ to school sometimes, watchin’ TV, and all that. I’ont know how just yet, but I reckon I could get Miss Angie to come ’round more often, help her clean husself up more, you know? I feed her. Make sure she got someone to talk to. Vitals: BP: 121/81 P: 86, R: 18, T: 97.4 Height 5′ 4″, weight: 165 pounds, increase of 16 pounds in 6 months Biracial, Black and White Birth sex: Female Self-identified gender identity: Girl Preferred name: Bianca or Bee Poor dental hygiene noted on physical exam History of Hyperlipidemia, asthma Family history: Mother was addicted to alcohol and Oxycontin and died from an overdose 3 years ago. Father was a drug addict; current information and whereabouts unknown but suspected to be in prison. Social history: Lived with biological mother for about 7 years, then was in foster care because of her mother’s drug use and severe neglect. Has lived with maternal grandfather for 5 years, in a very stable and supportive home. Grandfather is retired and can provide full-time oversight. She frequently stays in her room all day and misses school. In elementary school, she was an above average student, but now gets Cs and Ds because she doesn’t turn in a lot of homework. Not involved in any school or outside activities. Spends time watching tv and TikTok endlessly. She denies smoking, drinking, and drug use. Psych history: Bianca had three psychiatric admissions within 2 months when she experienced overwhelming auditory hallucinations and paranoid delusions. During the third one, she was diagnosed with schizophrenia and placed on Risperdal (risperidone) 2 mg BID. No hospitalizations or therapy since last admission “about 18 months ago.” Meds: Risperdal (risperidone) 2 mg BID Albuterol inhaler as needed HPI: SI/HI: None present or past Mood swings: No, just depressed. Psychosis: Hears voices telling her she’s not good enough, she’s ugly, she can’t do anything right. Most frequent visual hallucination is seeing blood and bleeding animals and body parts. Paranoid or fearful someone is going to hurt her. Sleep: Trouble falling asleep because of the voices talking to her. Anxiety: Worries about everything. Depression: Extreme Appetite: Always hungry, has gained a lot of weight since starting the Risperdal. Bianca has poor interpersonal skills and does not interact much with you but will answer direct questions. Her affect is flat and presents as depressed. She speaks in a monotone with a flat affect; her face is expressionless. She will sit and stare then suddenly become agitated. At times, start acting like a much younger child. Delusions confusing television with reality. Her grandfather monitors her medication and assures you that Bianca is taking it as directed. To confirm the diagnosis, you assess Bianca with the Positive and Negative Syndrome Scale (PANSS). Her score is 136. 1. What techniques can you use with Bianca, who doesn’t talk much and has active psychosis? Is relying solely on Patrick’s report good practice? Because Bianca is in active psychosis, you tell them that she should be placed in an inpatient treatment facility again. Bianca just shrugs when you ask what she thinks she needs. 2. How do you discuss Patrick’s response and explain your recommendation to Patrick and Bianca? What medication changes would you expect to happen in a program? 3. What type of therapy do you recommend? What’s your rationale. 4. How do you work with the family as a unit? What issues would you prioritize and why? 5. How do you coordinate her care and monitor her progress? 6. Locate at least two inpatient programs for teenagers like Bianca in your area (Maryland, zipcode 20772). Who do they accept (age, diagnoses, behaviors, insurance, and so on)? How long is the current waiting list?

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