“Mary”
Mary's case is recounted by Alice Medalia, PhD, and Nadine Revheim, PhD, in Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities: A Handbook for Families and Friends of Individuals with Psychiatric Disorders.
Background and Goal
Mary was first hospitalized at age twenty and diagnosed with schizophrenia. Since then she has been in the hospital four more times and has lived in three community residences.
Her therapy includes attending a three-day-per-week continuing day treatment program and taking 4 mg of the atypical antipsychotic risperidone per day. She chose the treatment program over permanent residence in an adult home. She wants to volunteer at her local library, something compatible with her education, which includes two years of college.
Essential
Mary and her parents used the useful technique of identifying small problems and breaking their solutions into small steps. These exercises were designed to prepare Mary for improving her abilities so she can accomplish a specific, realistic goal. Remember: don't try to deal with schizophrenia as a whole. Break it down and attack the parts.
Mary shows signs of mild negative and cognitive problems that worry Mary and her parents. With the aid of a National Alliance on Mental Illness family group, her parents are beginning to learn how they can help their daughter overcome these challenges so she can attain her goal of working in the library.
Identifying Problems
Mary has four easily identified problems:
Difficulty getting out of bed in the morning
Neglect in caring for herself
Forgetfulness that causes her to miss doctor appointments, forget to take her medication, and forget other tasks
Speaking very little
Mary knows that her illness has dulled her thinking ability. Cognitive tests of her memory confirm her impression.
Taking Advantage of Therapy
Mary is working to improve her ability to concentrate and remember things, illustrated by her interest in taking part in a program offered at her part-time treatment program. The “Laughing and Learning” session promotes socializing with others. It uses exercises in the form of games that are designed to let her practice her ability to process information. This type of cognitive therapy has been shown to help people whose intellectual abilities have been affected by schizophrenia. This program has the added benefit of encouraging social interaction, another subject of therapy from which many patients benefit.
Improving Living Skills
Working with counselors, Mary is trying other approaches to improve enough to attain her goal of volunteering at her local library. To do this, she will have to develop more skills required for independent living. She'll have to get up on time, make herself presentable, and learn and remember tasks at the library. Her therapist helped Mary start a day planner. It includes lists of tasks Mary can check off throughout the day as they are completed.
Her therapist suggests that one of her tasks should be to review the next day's schedule. Other recommended tasks in the planner include setting her alarm clock for getting up in the morning and looking at her day planner. Her to-do list includes writing sticky notes to remind herself to tend to her personal hygiene: showering, brushing her teeth, and combing her hair. Sticky notes could also help her remember to take her risperidone once a day.
Fact
To compensate for her cognitive problems, Mary has been taught to use reminder aids to help her in her daily activities. These are not unlike the organization techniques used by busy people everywhere. The tasks and goals included in Mary's planners are appropriate for her current abilities. Keeping the items on her to-do list at the right level of difficulty will help keep her from getting frustrated.
If these habits are practiced, reinforced, and eventually adopted, Mary will be closer to living more independently. This will relieve the pressure on her parents, who will be freed from the task of frequently reminding Mary what she has to do.
Memory Aids
Mary's therapists encourage her to repeat any instructions she is given. This helps her comprehend verbal instructions and remember details, two cognitive abilities she knows she will need to work in a library. It also helps broaden her social skills.
Mary may be improving her problem solving and other cognitive skills by practicing on the family's computer. This activity exercises her memory because she needs to follow sequential steps when typing in computer commands and navigating the Internet, and it may help Mary develop the skills she needs to gain a more independent life with a part-time volunteer position.
