NU 674 Unit 8 longitudinal case file example

Longitudinal Case File, January to September 2026: A Man With Schizophrenia Through a Severe Episode and Six Months After, and Where the Early Formulation Held or Failed

Student Name

Department of Nursing, Herzing University

NU 674: Psychiatric Mental Healthcare II

Instructor Name

September 24, 2026

Longitudinal Case File, January to September 2026: A Man With Schizophrenia Through a Severe Episode and Six Months After, and Where the Early Formulation Held or Failed

1. Opening Formulation, January 2026

Written after the team meeting on January 15, when Mr. W., a composite man of 36 with schizophrenia, had just left the hospital after his second admission in 18 months and lost his housing with his mother. The formulation then held three claims. First, his relapses were driven mainly by stopping medication he found intolerable, especially because of weight gain; his longest stable period came on aripiprazole, which he tolerated. Second, cannabis use and housing instability each made relapse more likely and were worth addressing alongside medication. Third, he was not a person who refused treatment in general; he refused particular treatments for particular reasons, notably injections after a forced injection years earlier. The evidence for the first claim was his record: every relapse followed stopping an antipsychotic, and relapse after stopping antipsychotic treatment is several times more likely than with continued treatment (Robinson et al., 1999).

2. Trajectory Through the Severe Episode

Mid-January to early February: he restarted aripiprazole with daily team support and moved into supported housing, consistent with a housing-first approach that places people in housing without requiring prior treatment adherence (Tsemberis et al., 2004). He took it consistently for about two weeks.

Late January: he stopped aripiprazole, saying he felt fine. Within about a week, his relapse signature appeared: short sleep, missed groups, and suspicion of his neighbor. Daily visits were accepted, crisis residential care was declined, and on the eighth day he was found dehydrated, refusing food and water in the belief that it was poisoned. He was placed on a 72-hour hold for grave disability, certified for 14 days, accepted aripiprazole in hospital, and was discharged on February 26 to the same apartment, which the team had protected.

March to September: he wrote a relapse plan with the team, chose daily oral aripiprazole, kept a cannabis limit of nothing before 5 p.m. most weeks, attended peer group twice a week, and began working 12 hours a week at a hardware store in June. In July, he asked for the monthly injection, on the condition that the same team nurse give it each time and that he choose the arm. He has received three injections since. He has had no hospitalizations or emergency visits since February.

Measures Across the Period

The same measures were recorded at each quarterly review, so that change could be read across the whole period rather than reconstructed from notes.

His Mother's Place in the File

His mother appears in the file from the first team meeting, where she asked for long-term hospitalization, to September, when she and her son have dinner together twice a month. In March, he agreed that she could be told his warning signs but declined a joint meeting. By June, he invited her to one. She said she now understands that his stopping medication is often about feeling well, not defiance, and that knowing the warning signs has made her less afraid. The file records this change because family relationships are part of the trajectory, not background to it.

3. Where the Early Formulation Held

The third claim held most clearly. Given control over how it was done, he chose the injection he had refused, which supports the reading that he refused particular treatments for particular reasons. The injectable form is associated with fewer relapses and hospitalizations than oral medication in maintenance treatment (Kishimoto et al., 2021), and he arrived at it on his own terms. The second claim also held: stable housing kept the team in contact through the severe episode, and his apartment was waiting for him at discharge, which shortened his recovery.

4. Where It Failed

The first claim failed in an important way. The formulation predicted that he stopped medication because of side effects, and that a tolerable medication would be taken consistently. In late January, he stopped aripiprazole, a drug he had tolerated for years,, because he felt well and saw no reason to continue. The formulation underweighted the role of feeling well itself, a common reason people with schizophrenia stop maintenance treatment, and it overweighted tolerability. The relapse plan written in March addresses this directly: he and the team agreed that feeling fine is an expected reason to want to stop, and that any wish to stop will be discussed rather than acted on alone. The injection, which he later chose, also removes the daily decision.

5. What Was Learned About the Process

Three lessons carry forward. The relapse signature, written down in January, did its job: it identified the episode two weeks before it became dangerous, even though the least restrictive options offered in those two weeks did not prevent the hold. The protected housing mattered more than expected; returning to the same apartment after discharge meant that he lost neither his home nor his progress. And the shared decision process in March, which accepted his refusal of the injection, preceded his own request for it four months later. Accepting a refusal can be what makes a later yes possible.

6. Current Status and Forward Plan

Status in September 2026: housed for eight months, working part-time, on monthly aripiprazole injections, cannabis use reduced by his own count to evenings on about four days a week, no admissions for seven months, and his relapse plan unchanged. Plan: continue the injections with the same nurse; review the relapse plan with him every three months; revisit the cannabis goal if his use rises; and support his stated next goal, to take one community college class in the spring. The file will be reviewed in six months against the same question: which parts of the current understanding hold, and which do not.

References

Kishimoto, T., Hagi, K., Kurokawa, S., Kane, J. M., & Correll, C. U. (2021). Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: A systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. The Lancet Psychiatry, 8(5), 387-404. https://doi.org/10.1016/S2215-0366(21)00039-0

Robinson, D., Woerner, M. G., Alvir, J. M. J., Bilder, R., Goldman, R., Geisler, S., Koreen, A., Sheitman, B., Chakos, M., Mayerhoff, D., & Lieberman, J. A. (1999). Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Archives of General Psychiatry, 56(3), 241-247. https://doi.org/10.1001/archpsyc.56.3.241

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651-656. https://doi.org/10.2105/AJPH.94.4.651