การพยาบาลผู้ป่วยจิตเภทที่มีโรคร่วม: กรณีศึกษา

Abstract

Objective: To report a case of a patient with schizophrenia complicated by comorbid substance use, recurrent relapse, and community-based management.

Methods: A case review was conducted based on medical records, with coordination among the multidisciplinary healthcare team, local administrative authorities, and police agencies to support patient care and community safety.

Results of the study: The patient was a 45-year-old Thai male diagnosed with schizophrenia for 13 years. He had a history of poor treatment adherence, frequent missed appointments, and concurrent substance use, resulting in seven relapse episodes. The patient had previously experienced suicidal ideation and attempted self-harm. He was admitted to the hospital due to exacerbation of symptoms, including increased irritability, talking to himself, and visual hallucinations. During hospitalization, psychiatric medications were administered, and behavioral restriction was implemented during periods of severe agitation and aggression.

After symptom stabilization, the patient was discharged with a long-acting injectable antipsychotic (Fluphenazine 50 mg intramuscularly once monthly), oral Perphenazine, and Trihexyphenidyl, with scheduled follow-up appointments. Following discharge, intermittent methamphetamine use was reported; however, urine testing for methamphetamine was negative. The patient continued to exhibit verbal aggression toward his parents but did not display physical violence. No auditory hallucinations were reported, sleep quality improved, and the patient was maintained on Perphenazine and Trihexyphenidyl for ongoing outpatient management.

Conclusion: In patients with schizophrenia and comorbid conditions, poor medication adherence, missed follow-up appointments, substance use, inadequate social support, and maladaptive coping strategies are significant factors associated with recurrent relapse. Therefore, effective management should adopt an integrated and holistic approach, addressing both biological and psychosocial dimensions, while promoting the active involvement of families, community networks, and relevant agencies. Such an approach is essential to enhance continuity of care, reduce relapse risk, and improve long-term quality of life.