Simon is a 27 year-old male who is diagnosed with schizophrenia. He had his first psychotic episode at 21 during which he believed aliens were sucking out his blood. At that time he was prescribed an atypical antipsychotic (Zyprexa). Since his initial psychotic break he has experienced 5 more episodes of decompensation, including one depressive episode. After this episode, a mood stabilizer was added to his medication and the anti-psychotic changed to Risperdal. It appears that some of the psychotic episodes were related to the use of marijuana and/or speed. However, he also has trouble remembering to take his medications.

Simon's mental health care is currently managed by a private psychiatrist and community-based social worker. Currently, Simon receives disability income and lives in a subsidized supportive apartment complex for the mentally ill. He gets emotional and financial support from his family and has a few friends, but generally finds it hard to relate to others. He has been employed twice but has been asked to leave on both occasions for being "too slow" and taking too much sick leave.

In the last 4 months, the social worker has noticed Simon's self-care worsening - normally fastidious about his appearance, his clothes are now dirty and he rarely makes an effort to "look nice". His avoidant behavior towards the basic tasks of daily living is increasing and negative symptoms (avolition, apathy) more apparent. Any request from his parents to undertake a particular task leads to anxiety and the feeling that he cannot cope - in response, Simon lays about for hours watching television and smoking or goes to bed.

He is no longer cooking meals but living on fast-food and admitted to be very anxious that the residential manager keeps "harassing him" regarding the lack of upkeep of the apartment. He is increasingly having trouble managing his money and undertaking tasks that require higher level planning. Simon's relationship with his family appears to be deteriorating as his requests for money become more frequent and increasingly abusive. The social worker also indicates concern about Simon's continued weight gain - he has been steadily gaining weight and now weighs close to 300 lbs.

1. Create a list of Simon's most pressing symptoms and psycho-social stressors.