Schizophrenia
Schizophrenia
A Case Analysis on
SCHIZOPHRENIA
Submitted to:
Submitted by:
Criteria
Rationale/Personal Profile---------------------------------------------------------------------__/5%
● MSE------------------------------------------------------------------------------------------/10%
Psychodynamics
● Risk Factors-----------------------------------------------------------------------------
__/15%
● Symptomatology--------------------------------------------------------------------------/15%
● Differential Diagnosis-----------------------------------------------------------------__/10%
● Medical Management/Drug Studies/Therapies--------------------------------__/10%
● NCP---------------------------------------------------------------------------------------__/20%
● Prognosis/Recommendation --------------------------------------------------------__/5%
● Bibliography------------------------------------------------------------------------------__/5%
● Mechanics/Promptness/Format-----------------------------------------------------__/5%
3
Table of Contents
Introduction ………………………………………………………………….........(page 4)
Goals and Objectives……………………………………………....................... (page 6)
Biographical/Clinical Data & Brief History ………………………………………(page 7)
I. Introduction
According to data gathered from 10 government hospitals and four private hospitals
for Johnson & Johnson's Philippine Health Information System on Mental Health
Conditions (PHIS-MH), schizophrenia is the most common brain illness in the
5
The implications of this case in nursing education are that it will improve the
groundwork and broaden the expertise of student nurses in relation to the illness
being highlighted, which will serve as a weapon and tool in caring for clients with
similar conditions. It can serve as a guide and a foundation in nursing practice when
providing services, management, or treatments to clients diagnosed with
schizophrenia, especially therapeutic communication, in order to achieve successful
delivery of optimum health care to them. Finally, in nursing research, it can be a
method for conducting additional studies that will assist potential researchers in
developing new theories and hypotheses that will benefit and enhance the nursing
profession, especially in the field of psychiatric nursing.
6
At the end of this psychiatric nursing rotation, the BSN 3H, Group 3, Subgroup 2 will
acquire and enhance the knowledge, skills and attitudes related to the maladaptive
patterns of behavior concept. The group will be able to better recognize and
comprehend the factors that affect a client's health and overall well-being, especially
in the case of schizophrenia, as well as develop skills relevant to the delivery of
interventions and management of the condition by applying the concepts and
theories developed in delivering high-quality care, and thereby develop compassion
and empathy in dealing with psychiatric patients.
Personal Data
Name: Patient X
Nickname: X
Age: 33
Sex: Male
Ordinal rank: 5th
Birthdate: May 17, 1987
Birthplace: Baybay Malalag Davao Del Sur
Civil Status: Single
Address: Baybay Malalag, Davao Del Sur
Current Address: Punta Biao, Digos City
Religion: Islam
Educational Attainment: Elementary level
Occupation: None
Date of Admission: 2011
Physician: Davie Janine S. Padillo, MD
sedative drugs for him. In 2013, he was taken to Southern Philippines Medical
Center as his condition worsened. This includes inflicting violence over his
family members. In 2015, along with his father they went back to Southern
Philippine Medical Center, Institute of Psychiatry & Behavioral Medicine for a
medical check-up conducted by Davie Janine S. Padillo, MD. He was
prescribed with Olanzapine 10 mg to be taken once a day and Amlodipine 10
mg taken once a day.
Family History
He is currently living with his mother and his siblings. When he was 22
years old he could not accept the fact that his parents separated. As time
passed by, he managed to adapt with his current situation. He established a
good relationship with his father and his current partner.
Personal History
Childhood History
a. School History
b. Religious Background
c. Occupation
9
A. General Appearance
The client was properly dressed,
/ moderately groomed, he appears to
1. Grooming and be wearing baggy clothes; shirt and
dressing pants.
2. Hygiene
a. Note evidence of
body or breath odor
b. Condition of /
The patient’s skin is dry. His
skin, fingernails
fingernails and toenails are
c. Disheveled
untrimmed.
d. Untidy
a. Perform
10
accurate
measurements
a. Intermittent
/
b. Occasional and He rarely maintains eye contact.
fleeting
c. Sustained and intense
d. No eye contact
B. General Mobility
2. Gait patterns
retardation
● Agitation
● Tremors (hands, legs,
continuous, at specific
time
● Tics
● Jerky or spastic The patient’s stereotypical
movements movements are raising his hands
● Stereotypical often, pointing up and talking by
Movements / himself.
● Mannerisms and He always rubs his fingers.
Gestures
/
● Aggressiveness
● Echopraxia
● Bradykinesia
● Pacing and Rocking
● Somnambulism
● Anchoring
● Anergia
● Anhedonia
● Regression
● Compulsions
D. Behavior/ Nurse
patient Interaction
g. Impulsive
h. Negativistic
i. Indifferent
j. Angry/hostile
k. Evasive
l. Withdrawn He seemed warm during the interview
/
m. Warm because he easily answered the
n. Distant questions that were given to him.
o. Guarded/Suspiciou
p. Dependent
q. Distracted
a. Character
Note for:
● Slowness or rapidity
● Intonation
● Volume
● Stuttering, hoarseness,
slurring
● Spontaneous
● Blocking The patient easily answered the
/
● Deliberate questions, but when I repeat a question
● Pressured he blocks out and cannot answer the
● Aphasia question.
B. Organization of Talk/Form
c. Incorrect
questions in one word.
d. Flight of Ideas
e. Loose association
f. Circumstantiality
g. Tangentiality
h. Neologism
i. Concrete Thinking
j. Clang Association
k. Word Salad
l. Perseveration
m. Echolalia
n. Mutism
o. Bradylalia
p. Poverty of Speech
q. Glossolalia /
r. Coprolalia
s. Verbigeration
t. Condensation
III. EMOTIONAL
STATE AND Mark Description/Verbatim Quotes
REACTIONS
A. Mood
a. Euthymic
The patient lacked energy during the
b. Depression/despairing
/ interview which indicates anergia. He
c. Euphoria
also has a depressive face, but when
d. Elation
I start asking he suddenly shifts his
e. Fearful
mood and laughs.
f. Irritable
g. Anxious
h. Guilty
i. Labile
15
B. Affect
IV. THOUGHT
Mark Description/Verbatim Quotes
CONTROL/ PROCESS
B. Suicidal Thought/ideation
F. Poverty of Content
Perceptual
Disturbances:
The patient said, “I see things,” but it
Hallucination is unclear at this point whether what
the patient is referring to. However,
a. Hypnagogic
there was obvious evidence of the
b. Hypnopompic
/ patient seeing people or objects. His
c. Visual
parents observed that their son has
d. Auditory
been talking with someone that they
e. Tactile
cannot see, and sometimes he would
f. Olfactory
talk to his shadow. Therefore, it could
g. Gustatory
indicate visual hallucination.
h. Trailing Phenomenon
i. Micropsia (Lilliputian)
j. Marcopsia
17
Illusions:
a. Visual
b. Auditory
c. Tactile
d. Olfactory
e. Gustatory
Depersonalization
a. Derealization
Preoccupation
a. Ruminations
Déjà vu
a. Jamais vu
Impulse Control
a. Ability to
control
The patient is still affectionate toward
impulses
his previous person of interest.
b. Aggression
Sometimes the patient would bring up
c. Hostility
sexual intention such as sexual
d. Fear
assault and thought of killing.
e. Guilt
f. Affection /
g. Sexual feelings /
V.
Mark Description/Verbatim Quotes
NEUROVEGETATIV
E DYSFUNCTIONS
18
A. Sleep
D. Weight
VI. GENERAL
Mark Description/Verbatim Quotes
SENSORIUM AND
INTELLECTUAL
19
STATUS
Describe
impaired or
unimpaired
B. Memory
C. Attention Span
E. Abstract Thinking
Ability
20
VII. INSIGHT
Mark Description/Verbatim Quotes
1. Awareness of illness
Adaptive/Maladaptive
use of coping
mechanism
A. Disturbances in:
( ) Presentation
( ) Stream of Talk
( ) Emotional State and
21
Reactions
( ) Thought Processes
( ) Neurovegetative
Dysfunctions
( ) Sensorium and
Intellectual Status
( ) Insight
B. Diagnostic Category
(DSM IV : Diagnostic and
Statistical Manual of Mental
Disorders
V. Psychodynamics
a. Risk Factors
Certain drugs,
particularly cannabis,
cocaine, LSD or
amphetamines, may
trigger symptoms of
schizophrenia in people
who are susceptible.
Using amphetamines or
cocaine can lead to
psychosis, and can
cause a relapse in
people recovering from
an earlier episode.
hallucination, but
hallucinations can
occur in any
context.Command
hallucinations are
voices demanding
that the
client take action,
often to harm the self
or others, and are
considered
dangerous.
● Physical Examination
● Psychological Functions
The doctor or therapist then determines whether the person's symptoms point to a
specific disorder as defined by the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), which is the standard reference book for recognized mental
illnesses and is published by the American Psychiatric Association. An individual is
diagnosed with schizophrenia if they have two or more core symptoms for at least
one month, one of which must be hallucinations, delusions, or disorganized speech,
according to the DSM-5.
● Medical Diagnostics
Schizophrenia
be an irritable mood.)
33
4. Insomnia or hypersomnia /
- The patient’s relative stated
nearly every day.
that the patient is having
difficulty in sleeping at night
because of his hallucination
because the patient will say
“dong patuloga sa ko dong.”
even if he has no one beside
him.
5. Psychomotor agitation or X
retardation nearly every day - There is no psychomotor
down).
34
DELUSIONAL DISORDER
A. THERAPIES
PSYCHOSOCIAL THERAPY
38
b. Family Therapy
Family counseling is a method of assisting the client and the family in dealing with
the illness. It entails a series of informal meetings over a six-month span.
Meetings may include:
c. Self-Help Groups
To continue focusing the client’s social skills start by enrolling them in community
care and outreach programs. For example, the National Alliance on Mental Illness
(NAMI) is a support group that provides a free peer-to-peer service. It consists of ten
workshops for adults with mental illness who wish to learn more about their illness
from those who have been through it or who have gone through it with a loved one.
d. Rehabilitation
Schizophrenia most often manifests during the years that we are establishing our
careers. As a result, work therapy, problem-solving assistance, and money
management instruction can all be part of the recovery process.
This is for those who are having their first psychotic episode. It's a multidisciplinary
approach that incorporates medicine and psychotherapy. It provides social and job
programs, and it makes every effort to include the family. The aim is to change the
course of the disease and its prognosis by identifying it early on.
This therapy focuses on assisting the individual in setting and achieving goals as
well as cultivating hope and positive values about themselves and others.
h. Art Therapy
Some people feel that using the arts to express themselves in a nonverbal way will
give them a new perspective on schizophrenia and help them develop new ways of
relating to others. In certain people, arts therapies have been shown to help with the
negative effects of schizophrenia.
PSYCHOTHERAPY
CBT helps to assist in identifying the thinking habits that are causing to experience
unpleasant emotions and behaviors, as well as learning to replace these thoughts
with more rational and beneficial ones.
One may be taught to recognize examples of delusional thought, for example. One
will then be offered assistance and guidance on how to avoid acting on one’s
feelings. The majority of people need a series of CBT sessions spread out over
many months. CBT sessions are normally an hour long.
b. Individual Psychotherapy
A therapist or counselor may teach the individual how to manage their emotions and
behaviors during sessions. They'll gain a better understanding of their condition and
its consequences, as well as how to say what's true and what's not. It can also assist
them in managing their daily lives.
Cognitive remediation is another name for this form of therapy. It teaches people
how to enhance their concentration, memory, and ability to coordinate their thoughts
by teaching them how to identify social cues, or triggers. It integrates group sessions
with computer-based brain training.
B. NURSING THEORIES
41
Self-Care Deficit Nursing Theory is the correct terminology for Orem's general
nursing theory (SCDNT). The Self-Care Deficit Nursing Theory is made up of three
minor interconnected theories: self-care, self-care deficit, and nursing systems
theory. To begin, self-care is described as the act of initiating and carrying out
activities on one's own behalf in order to preserve one's life, health, and well-being.
Orem's self-care deficiency theory helps nurses in assessing which aspects of
patient care they should concentrate on in a given situation, thus emphasizing the
importance of patients retaining control over their own self-care processes. Patients
are more able to heal when they have some control of their own self-care, according
to Orem's self-care deficiency theory.
Orem’s self-care theory can be beneficial for a schizophrenic patient who has
difficulties maintaining self-care. Patients who are unable to care for themselves
should be given nursing care, according to the guidelines. This theory can be
applicable to people who, as a result of their illnesses, overlook self-care needs such
as protection, hygiene, relaxation, and nutrition. This theory can be related to our
patient, he is able to do his activities of daily living (ADL) however he is unable to do
this by himself therefore, needing assistance. So as nurses, it is our duty to help the
client to help them attain self-care independently.
42
Since the nurse is not focused on "fixing" issues, but rather on seeing the
patient as a whole individual living experiences in his or her environment, the idea
helps nurses to build a better nurse-patient relationship. Parse’s nursing theory of
human becoming is used in psychiatric nursing practices. According to this theory,
the nurse’s role is to guide individuals to explain the meaning of their own
experiences, and this theory recommends that individuals’ experiences, not their
problems, should be the focus in community mental health nursing. As nurses, it is
our duty to see our patients not in different aspects but to understand and look at
them as a whole and by accepting them; only then we are able to create a good
patient-nurse relationship and we will also be able to help them.
43
C. DRUG STUDY
A. Antipsychotics
Pharmacologic: Butyrophenones
Haloperidol Decanoate
Metab: hyperpyrexia.
PO (Geriatric Patients):
Antihypertensive—Initiate therapy at 2.5
mg/day, ↑ as required/tolerated (up to
10 mg/day); antianginal—initiate therapy at
5 mg/ day, ↑ as required/tolerated (up to 10
mg/day).
Derm: flushing
Pharmacologic:
Thienobenzodiazepines
PO (Adults—Debilitated or
Nonsmoking Female > Patients 65
yr): Initiate therapy at 5 mg/day.
IM (Adults—Debilitated or
Nonsmoking Female Patients > 65
yr): Initiate therapy at 150 mg every 4
wk.
tachycardia.
Hemat: AGRANULOCYTOSIS,
leukopenia, neutropenia.
Metab: dyslipidemia.
Neuro: tremor.
minimize constipation.
Diagnosis: Schizophrenia
Subjective: P Disturbed thought processes By the end of our 1. Be sincere and honest when 2
related to neurological psychiatric nursing communicating with the client.
The patient’s E
dysfunction as evidenced by rotation the client will Avoid vague or evasive
relative
R visual hallucinations be able to; remarks.
verbalized that
“naa syay C a. establish contact RATIONALE:
kadula permi with reality;
niya gina E Rationale: Delusional clients are extremely
b. will express sensitive about others and can
estorya” Disturbed Thought Processes
64
- short
I
attention span 3. Have the patient write his/her
T Wayne G., (2017). Disturbed name periodically; keep this
Thought Processes Nursing record for comparison and
I Care Plan. Retrieve March 10, 3
report differences.
65
RATIONALE: 4
RATIONALE:
66
6. Be consistent in setting
expectations, enforcing rules,
and so forth.
7
RATIONALE:
RATIONALE:
9
The patient may feel threatened
and may withdraw or rebel.
RATIONALE:
2.
Diagnosis: Schizophrenia
Subjective: S Risk for other-directed By the end of our 1. Use a calm and firm approach. 1
violence related to psychiatric nursing rotation
The patient’s A RATIONALE:
psychotic disorder as the client will be able to:
relative
F evidenced by verbal Provides structure and control for a
verbalized a. verbalized control of
threats against others client who is out of control.
that the E feelings;
patient is
T b. will refrain from
sometimes
Rationale: provoking others to 2. Frequently assess client’s behavior
saying “
Y physical harm, with the aid for signs of increased agitation and 2
“unsa man, Violent behavior was
70
hallucination directed.
I RATIONALE:
- threatening
O Short attention span limits
verbalization Reference:
understanding to small pieces of
N
-poor Harford T., Chen C., information.
frustration Kerridge B., Grant B.
tolerance (2019). Self- and Other-
directed Forms of 4. Decrease environmental stimuli
- frowning
71
RATIONALE:
RATIONALE:
RATIONALE: 8
IX. Recommendation
For the individual, they have an option to live independently, so they must undergo
psychiatric rehabilitation because this helps them manage their lives, make effective
treatment decisions, and improve their quality of life. Because mental health
promotion helps to give the client the ability to bounce back and manage obstacles in
life.
For the family and community, since patients with schizophrenia are no longer
hospitalized, then it is recommended that once they return to the community and
their families, they they can either live with them, or be in a residential program,
enroll in a family or group therapies, be aware of community support programs, and
case management services.
b. METHOD
antipsychotic medicines.
times a week.
Treatment Settings/Options
TREATMENT
- Crisis Residential Program. A
program wherein the patient is
relocated to a home-care facility.
Helpful for relapse cases.
group therapy.
- Always go to counselling
sessions. Never stop attending.
Discuss with the counsellor for
any concerns.
of schizophrenia.
X. Prognosis
Onset of Illness
While the onset can be sudden or
subtle, most clients experience signs
and symptoms over time, such as social
isolation, erratic activity, lack of interest
in school or at work, and poor grooming.
When a person starts to exhibit more
actively optimistic signs of delusions,
hallucinations, and disordered thought,
they are diagnosed with disordered
thinking (psychosis). The implications
for most clients and their families are
significant and long-lasting, regardless
of where and how the disorder occurs or
the form of schizophrenia. Where and
how the disease manifests seems to
have an effect on the result. The client's
age at the time of onset tends to be a
significant factor in how well he or she
86
does.
Patient X, who has schizophrenia, has been going through check ups a
couple of times to various psychiatric institutions. Correlating his condition, Patient X
may have a bad prognosis since he has not been taking his medicine Olanzapine,
and is not undergoing any therapies to help his condition.However, he also had a
group of people who acted as a social support for her condition. Patient X could have
a good prognosis if he continually takes his medicine as well as undergo therapies
for the disease, thus it is recommended to continuously attend treatment modalities.
XI. References
Bhandari, S., MD. (2019, April 09). What to eat when you have schizophrenia.
Retrieved March 11, 2021, from
https://www.webmd.com/schizophrenia/ss/slideshow-best-nutrition-for-
schizophrenia
Exercise and schizophrenia. (2018, August 17). Retrieved March 10, 2021,
from https://livingwithschizophreniauk.org/information-sheets/exercise-
schizophrenia/
https://www.sciencedaily.com/releases/2016/08/160812073654.htm#:~:text=Su
mmary%3A,according%20to%20a%20new%20study.
Mayo Clinic. (2020, January 07). Schizophrenia. Retrieved March 10, 2021,
from https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-
causes/syc-20354443
R. K. J., & Hodgson, K. (2018). Saunders Nursing Drug Handbook 2019 (1st
ed.). Saunders
91
Schizophrenia (discharge care) - what you need to know. (2021, March 4).
Retrieved March 8, 2021, from https://www.drugs.com/cg/schizophrenia-
discharge-care.html
Siris, S., & Braga, R. (2020). Depression in Schizophrenia. Retrieved March 10,
2021, from https://www.uptodate.com/contents/depression-in-schizophrenia
Vallerand, A., & Sanoski, C. A. (2018). Davis's Drug Guide for Nurses
(Sixteenth ed.). F.A. Davis Company.