George Watkins is a 47-year-old African American male who was admitted to the psychiatric unit this morning. He was diagnosed with schizophrenia at age 20. He is dishevelled looking, with long, dirty, stringy hair. His clothes are mismatched and dirty. Although it is summer, he is wearing an overcoat and a winter hat pulled down over his ears. This is George’s fourth hospitalization for out-of-control schizophrenia. The last severe episode occurred 4 years ago. Sheri Watkins, George’s wife, states that he quit his job as an assembly line supervisor about 2 weeks ago. He has also quit coaching softball and soccer games. Sheri and George have been married since they were both 18. Their marriage is basically strong but has had its difficult times, especially when George’s schizophrenia is active. About 3 to 4 weeks before each hospitalization for psychosis, he stopped taking his antipsychotic medication. He has taken different antipsychotic medications over the course of his schizophrenia, but none has proved to be successful over a long period. George and Sheri have two children: Toby, who is 14, and Felecia, who is 10. Both children do well in school, have many friends, and are active in several organizations and sports. As the children get older, they realize that “something is not quite right” with their father. They have never been told of their father’s mental illness. The children worry that they will catch whatever it is that causes their father’s erratic behavior. George’s parents and four siblings live in the same town. George, his father, and his two brothers worked at the same manufacturing plant. His other two siblings are teachers in the local school system, as is Sheri. Mr. and Mrs. Watkins, George’s parents, tell you that their son had a “normal” childhood. He was active in sports, starred on the high school football team, was an honor student, was a Boy Scout, and had many friends. They have always enjoyed many social occasions with their large extended family. George is always welcome at family gatherings, but relatives tend to avoid him when his behavior becomes bizarre. They all know he has schizophrenia but do not fully understand the implications of the diagnosis.
1. What are the most likely reasons George gives for discontinuing his medication?
2. What clues do his family and friends have that would indicate that his schizophrenia may be getting out of control?
3. What can be done to prevent George’s schizophrenia from getting out of control in the future?