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Case Formulation and Intervention for Resistant Schizophrenia

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Introduction - Resistant Schizophrenia Case Formulation

A case formulation of a patient has been discussed which has been collected from the work experience will be discussed in this essay. Mr P suffers from resistant Schizophrenia with an acute worsening of voices and potential tactile hallucination relating to the head.

The overall evaluation of the case scenario is based on the 25 years old boy who has been suffering from mental health issues for 4 years. The boy's name is P and he was living with his mother and brother. All of the risk factors, complications, and intervention planning for his issues have been evaluated through this analysis.

As per the case formulation, the biological, psychological and social factors of the Bio psychosocial model (Engel, 1980) that affect Mr P's condition will be discussed. In criteria 2, intervention for the management of all those needs factors will be identified. After that, in criteria 3, the effectiveness of the interventions will be determined with the help of CPA, Person-Centred Approach etc. At last, the legal and ethical issues will be discussed. For the maintenance of the confidentiality of the Patient consent needs to be performed with the NMC code of conduct.

Criteria 1

The term service formulation of the service user can be referred to as the process of making a hypothesis regarding the cause and the possible influencers of the psychological condition, interpersonal condition, and behavioral issues of the patient.

The study will shades upon the Bio-psychosocial model for the formulation of the service users, which is based on the chosen case scenario. Engel first proposed this model in the year of 1980. This model is based on the health and sickness associated with the mental side of a patient. Therefore, this model is based on the identification of the biological needs, psychological needs as well as social needs of the patient for the formulation of the service user.

The study is going to formulate a framework for service users based on the Bio-psychosocial model regarding the provided case scenario of Mr. P.

Biological needs

The Bio-psychosocial model helps in the formulation of the hypothesis based on the biological needs of the mental health of the patient (Engel G 1980). The patient in the case study, Mr. P, is aged 25 years old and is suffering from several mental health disorders. He went through an incomplete COAST assessment in the past due to a lack of missed appointments and a gradual lack of clinical necessities. The biological needs of Mr. P. are visual hallucinations, auditory hallucinations, excessive headache, and taking an extra dose of medicine. Therefore, the biological needs of Mr. P. are caused by his poor mental health condition of this patient. There are some factors are present in society that acts as biological factors which help in the development of schizophrenic symptoms within a person. One of the main biological factors, which help in the development of symptoms by making changes in two neurotransmitters named dopamine and serotonin. The imbalance within these two neurotransmitters creates the mental disorder, which creates the mild symptoms of schizophrenia if it is left untreated then it converts into severe schizophrenic symptoms.Sometimes the concept of the biological factors represents the fact that the changes in the configuration of the genes can create changes in the normal mechanism of the neurotransmitters which is the main reason behind the development of the symptoms of schizophrenia within a person.

Psychological needs

The psychological needs of the patient are based on several mental and psychological health-associated disorders (Engel G 1980). The patient in the case scenario was suffering from persistent schizophrenia, psychosis, anxiety, aggression, and several episodes of hallucination, which are the risk factors. Therefore, these poor mental health symptoms increase anxiety, fear, low mood, deterioration of mental health, and deterioration in physical functioning. These symptoms are caused due to lack of treatment due to negligence, and improper medication in the past phase. Therefore, the other causes are associated with poverty and lack of family support for the betterment of the mental health condition (Sharma et al. 2019). Therefore, as per the case study, the lack of the proper treatment plan and the implication of the treatment plan results in the deterioration of the mental health condition of Mr. P. The psychological needs of the patient in the case scenario are caused due to severe headache that leads to verbal hallucination and visual hallucination, which make the patient unconscious and sometimes aggressive.

Social needs

The Bio-psychosocial model also focuses on the social needs of the patient for the development of the service user framework. Therefore as per the case study, the patient is suffering from a severe social crisis. On the other hand, he also attempted suicide a time in the past. His family had stated that he was getting angry due to no specific reason. Different social factors play an important role in the development of schizophrenic symptoms in a person who has been suffering from a mental disorder for a long time. Social adversity or the social factors plays an important role in the development of stress as a result these stress factors help to develop severity and the proper expression of schizophrenia. Based on these factors it can be said that poor social skills and different kinds of abnormalities within the behaviours can be observed as the negative impact of the social factors within a person.

Criteria 2

This section of this study will focus on the development of the biological interventions, psychological interventions, and social interventions of the patient in the case scenarios based on the needs.

The biological intervention of Mr. P is based on his biological needs. The main biological tissues of the patient are headaches and mental health disorders. Therefore, these biological conditions are caused due to poor mental health; the intervention planning should be based on the development of mental health to solve the biological tissues of the patient. The doctors, as well as nurses and the healthcare provider, have an important role to improve the mental health condition of this patient through the proper medication and treatment along with effective communication with the patient. “Person-based cognitive therapy” care is essential for the development of the biological condition of the patient as this is effective for the betterment of voice using voice therapy (Dannahyet al. 2011).

The psychological intervention is based on the risk factors for psychological needs. The risk factors are lack of proper relation with the family, lack of self-realization, lack of treatment, lack of relationship with the siblings, and trust issues. Thai risk factors can be developed by evolving the treatment process and the planning. Therefore, person-centered care can play an essential role in the betterment of psychological issues. Therefore, effective communication and the proper medication need to be incorporated. The betterment of the relationship with the family and the family's efforts is essential for the management of the risk factors for the betterment of the condition. Psychological intervention is a non-pharmacological intervention. The “Positive Psychology Interventions” is an effective intervention tool that implies positive cognition through positive psychotherapy. "person-based cognitive therapy" is person-centered care that will have an impact on the betterment of behavioral issues, aggression, and depression-like mental health disorders (Chadwick et al. 2006). This is person-centered intervention care. This intervention will result in the enhancement of happiness, and positive thoughts. Therefore as per the study, the effect of this intervention will be longer if applied appropriately.

Social intervention is based on the risk factors for social needs. The risk factors for social needs are poor communication, poor relation with family members, behavioral issues, schizophrenia aggression, as well as a mental health disorder.


Psychologists play an important role to treat people who have been suffering from schizophrenia. Psychologists are not able to prescribe any kind of medicine to patients who have been suffering from schizophrenia. They can properly diagnose people who have been suffering from the symptoms of Schizophrenia. Psychologists mainly focus on cognitive rehabilitation and remediation which helps the patient to recover quickly.

Occupational treatment is another option for those who have been suffering from different mental disorders like schizophrenia (Ventriglioet al.2020). The aim behind the use of this therapy is to help the patients to improve their social activity. This therapy is also helpful for schizophrenic patients because it helps them to take part in meaningful activities which keep them active rather than reducing the symptoms, unlike the other treatments.

Criteria 3

From the analysis of the case scenario, it can be stated that Mr.P, which includes aggregation, self-harm, unpredictable behaviour, and problems in social interaction and communication has faced some major risk factors. All of those risk factors can negatively influence his treatment process.

Based on that reason, he needs effective care from his family or organization. He that can help in improving his treatment process has addressed several kinds of effective care. Mainly the “integrated care evaluation frameworks' ' that are part of the “CPA (care program approach)” have been recognized by multiagency and professionals. This framework helps in supporting the intervention, which is parent, delivered for family-centred care (Franck and O'Brien, 2019). By using this framework, the patient can get effective care that helps in improving his health condition. As he was avoiding any kind of appointment and feared coordinating with the monthly depot's injection due to that reason, this framework helps in giving a motivation for reviewing his plan by learning socialism through effective communication and coordination. Apart from this, as he has been feared for engaging any kind of community team, so he made him isolated from them. This kind of intervention framework helps in giving some encouragement through counselling for joining in the social and group engagement. By using this approach, the improvement of this mental health or reduction of hallucination problems can be done. Moreover, the distress level and unpredictable behaviour deterioration also can (World Health Organization, 2019). Another part of this process is the monitoring process. By using this framework, it can be monitored that he has faced some low mood, disorders, sleeping changes, and some psychological dysfunctioning has been observed. Due to that reason, by using this intervention plan, support can be given to Mr. P that helps in reducing all of those issues in his treatment plan. The high degree of collaboration and effective communication among healthcare professionals helps in identifying the need of the patient that helps in recognizing a fixed intervention for the mental health illness.

Client’s view:

For that reason, Mr. P that helps in deducting the concerned risk after returning home has assured effective care. Along with this, it also helps in downsizing the associated risks like distress, aggression, and some behavioral issues. Based on that approach, the service user that is Mr. P helps in recognizing some significant exchange of mental health. For that reason, Mr. P has assured the slow development of his mental health and the stability of his mental health can be raised.

What has worked well?

The doctor used clozapine for the treatment of Mr. P, for the reduction of his schizophrenia.

Current risks:

As a result, he grew some side effects like “stigmatization from the society, difficulty in breathing, headache, and high blood pressure” which made some difficult for him (Clarke and Nicholls, 2018).

Criteria 4

Legal issues

The evidence-based practice or EBP model in this case study is based on care that helps in integrating the best value with patients' values and clinical expertise through modernizing the community services for improving mental health intervention. In this case, Mr. P has faced some distress and sleeping issues in the hospital (Singer et al. 2019). This method helps in improving the recovery model that helps in reducing mental health illness and mainly the distress level.

In this case, the study analyses the policy and ethical issues mainly the vision of a “national mental health policy" helps in promoting mental health and helps in preventing illness, and recovering the mental illness (Langellieret al. 2019). As Mr. P has faced behavioral issues, this policy helps in ensuring the inclusion that is based on the socioeconomic of Mr. P by providing affordable and quality health improvements.

The main problem that has been faced by Mr. P is communicating and socializing with the community. For addressing this problem, mainly some of the guidelines need to be addressed by the hospital and services that help in reducing this problem. In that case, mainly the service providers try to connect with Mr. P, which helps in giving support for mental wellbeing. However, the guideline of the mental health well-being approach helps in learning about making social connections (Zisman-Ilaniet al. 2021). This learning helps in reducing unpredictable behavior and social isolation, which helps in reducing his distress and hallucination level.

Apart from this, the organization also needs to implement mental health legislation that helps in reducing all of the complications that have been observed in this case study analysis. Mainly in the UK, the "Mental health act (1983)" helps in reducing mental health problems. This act helps in giving them some rights for treatment and assessments within the hospital and treatment within the community that helps in reducing the problems that have been faced by them (Keown et al. 2021).

Ethical issues

For addressing all of the ethical issues, the providers related to mental help live out some of the specific ethical principles like justice, respect, and beneficence in their efforts for appreciating, understanding, and emphasizing the value of Mr. P that helps in giving the excellent service for improving the patient cares (Peters et al. 2020). All of those practices help in addressing the issues in mental health that help in improving mental health development. However, all of those also help in denoting some of the ethical considerations within the case. Therefore, this kind of consideration has been controlled with the designing and planning for this major intervention. For that reason, Mr. P can be addressed as one of the most effective case studies for demonstrating the health deliverables and some interest and collaboration have been involved in the patient-management band performance development.


The study can conclude that a suitable service user model for this case scenario is the Bio-psychosocial model. By adopting this model, the study focused on the identification of the biological needs of the delivered case scenario of Mr. P. according to this model it can be concluded that the patient in the case scenario is suffering from several mental health disorders. This model is also beneficial for identifying the physiological needs of the patients that are based on their poor physiological health. As per the model, the patient is suffering a social crisis such as a lack of attachment with family and community. That is why as per the model the condition of the patient also demands social needs.

Conclusively, it can be framed that the incorporation of the hazard appraisal in this mental health illness profits in decreasing the association of threats that assists in enhancing care involvement and person-centered care planning. The effectiveness of the intervention helps in improving the mental health, and social health of Mr. P. the study can conclude that the biological intervention is based on “Person-based cognitive therapy” which is considered the important factor in the case scenario for mitigating the biological needs of Mr. P. In this concluding section of the overall study, it can be stated,“Positive Psychology Interventions' ' can be the essential intervention that can mitigate the psychological needs of the patient in the case scenario. The study also found that Art therapy can impact positively adopt the social needs of the patient as well. The study also concluded, that "integrated care evaluation frameworks” which is a particularsection of CPA can reduce the negative impact of the chosen intervention process and can make it more effective. Conclusively it can be stated that ethical principles, justice, and respect can improve the service care of the patient. There are different types of legal activities also involved with schizophrenic patients because they have some different kinds of issues that create many unsocial activities, which are harmful to their families as well as to society. This is the reason the legal and ethical issues are also involved in this particular case study. Overall, this article involves the symptoms and the proper way of treatment, which is completely aligned with the case scenario of Mr. P.


Clarke, I. and Nicholls, H., 2018. Third wave CBT integration for individuals and teams: Comprehend, cope and connect. Routledge.

Franck, L.S. and O'Brien, K., 2019. The evolution of family-centered care: From supporting parents?delivered interventions to a model of family integrated care. Birth defects research, 111(15), pp.1044-1059.

Keown, P., Murphy, H., McKenna, D., and McKinnon, I., 2018. Changes in the use of the Mental Health Act 1983 in England 1984/85 to 2015/16.The British Journal of Psychiatry, 213(4), pp.595-599.

Langellier, B.A., Yang, Y., Purtle, J., Nelson, K.L., Stankov, I. and Diez Roux, A.V., 2019. Complex systems approach to understand drivers of mental health and inform mental health policy: a systematic review. Administration and Policy in Mental Health and Mental Health Services Research, 46(2), pp.128-144.

Peters, D., Vold, K., Robinson, D. and Calvo, R.A., 2020. Responsible AI—two frameworks for ethical design practice. IEEE Transactions on Technology and Society, 1(1), pp.34-47.

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Singer, J.B., Erbacher, T.A. and Rosen, P., 2019. School-based suicide prevention: A framework for evidence-based practice.School Mental Health, 11(1), pp.54-71.

Ventriglio, A., Ricci, F., Magnifico, G., Chumakov, E., Torales, J., Watson, C., Castaldelli-Maia, J.M., Petito, A. and Bellomo, A., 2020. Psychosocial interventions in schizophrenia: Focus on guidelines. International Journal of Social Psychiatry66(8), pp.735-747.

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