Schizophrenia Case Study

Case Study Analysis of Sally

Sally is a young girl suffering from schizophrenia. Schizophrenia is a psychotic disorder, or a group
of disorders represented by a severe impairment of individual thought process, and behavior
(TheFreeDictionary, 2012). According to Meyer, Chapman, and Weaver (2009) it may be more
accurate to refer to schizophrenia as a family of disorders rather than a singular disorder. (p. 90).
Untreated patients suffering from schizophrenia are normally unable to filter various sensory stimuli,
and exhibit enhanced perception of color, sound, and other environmental factors. In most cases, a
patient suffering from schizophrenia will gradually withdraw from personal interactions, and loose
the ability to care for his or her individual basic needs (TheFreeDictionary, 2012). Schizophrenia is
considered to be one of the top ten illnesses resulting in long-term disability, and accounts estimate
that approximately 1% of the world population is affected by the illness (TheFreeDictionary, 2012).
The following analysis is designed to provide and analysis of the patients history, and events that
resulted in her hospitalization. The analysis will provide the specifics of the patients biological,
behavioral, cognitive, and emotional components that factor into her illness.
Schizophrenia
Schizophrenia includes three different subtype, and two over subtypes. The main subtypes include
the classifications of paranoid, disorganized, and catatonic, and each of these subtypes displays
unique characteristics or symptoms (Hansell, & Damour, 2008). Patients suffering from paranoid
schizophrenia will usually display symptoms of hallucinations or delusions. Patients suffering from
disorganized schizophrenia are subject to an inappropriate effect, and disorganized speech patterns.
Patients suffering from catatonic schizophrenia display symptoms of strange or bizarre sensory motor
function (Hansell, & Damour, 2008). Individuals who display symptoms of schizophrenia but lack
any symptoms of the three primary classifications are likely to be diagnosed into one of two alternate
classifications: residual or undifferentiated schizophrenia (Hansell,& Damour, 2008). Symptoms of
schizophrenia are classified into two primary categories. These two categories relate to positive and
negative symptoms. Patients displaying positive symptoms exhibit pathological excesses including
hallucinations, irrational thinking, and irrational behaviors, whereas patients displaying negative
symptoms will exhibit pathological deficits including withdrawal and isolation from social
interactions, and poverty of speech capabilities ((Hansell, & Damour, 2008).
Schizophrenia is a complex illness that affects both men and women on an equal level. The illness
usually starts around the age of ten, or in young adulthood. However, cases of childhood-onset
schizophrenia indicates that the illness can start as young as five years of age. This is a more rare
case of schizophrenia that can difficult to diagnose in relation to other childhood developmental
problems (PubMedHealth, 2012). While researchers have yet to discover the cause of schizophrenia,
many suspect genetics to be a major contributor (PubMedHealth, 20120).
Patient History
The patients case study indicates that she has a history of eccentricity. Medical notations indicate
that the patent's mother was an avid smoker, consuming approximately two packs of cigarets daily
before and during pregnancy. Further notations include that the patients mother suffered from a very
severe case of the flue during her fifth month of pregnancy. As a child, the patient showed signs of

slower developmental skills, and was diagnosed as suffering from hyperactivity in early childhood.
Records indicate that the patient experienced a turbulent home life because of ongoing conflicts
between her parents that resulted in separation, and reconciliation. Because of her apparent
developmental disabilities, her parents devoted time to the patient however, the patient did receive
criticism from her father for her behavioral dysfunctions.
As the patient matured, she displayed signs of being socially awkward and isolated from her peers,
and in early adulthood started to display worsening symptoms like talking to herself, and displaying
unusual behavior like stating at the floor for long periods. Her first documented schizophrenia
episode requiring hospitalization occurred shortly after the additional symptoms started to be
displayed. During her examination, the patient displayed signs of unresponsiveness, and waxy
flexibility that allowed her limbs to be easily positioned (Meyer, Chapman, & Weaver, 2009). After
the initial hospitalization, the patient was returned home to facilitate a quicker recovery. that was
short lived because the patient failed to follow the prescribed treatment regimen which, resulted in a
secondary episode shortly after her return to college. Further home-based treatments proved
unsuccessful as the patient slowly declined, resulting in unresponsiveness, and displaying
hebephrenic symptoms like unprovoked giggling, and rocking movements (Meyer, Chapman, &
Weaver, 2009).
The patients second hospitalization and treatments started to show positive results, and she was
taken back to her home environment. She was able to obtain a part-time position at work, and
maintain daily household chores. However, the patient failed to follow the prescribed treatment
regimen. Following the death of her father, and additional stressors resulting from her mothers
added dependency, the patient suffered from a third regression of the illness. Her third hospitalization
resulted from local law officials discovering her walking in a local pond while incoherently
mumbling to herself.
Components of the Schizophrenic Episodes
The primary component of the patients episodes appear to be related to stress as the primary factor.
However, biological factors resulting from her mothers illness and smoking during pregnancy, and a
genetic predisposition related to her grandfather's eccentricity are viable underlying factors resulting
in the patients illness. In addition to the primary stressor, and the underlying genetic and biological
factors, it is possible that the emotions of the patient also contributed to her condition. Further
documentation indicates that interfamilial expressed emotion, and communication deviance are
probably contributors that appear to be operative in the patients case (Meyer, Chapman, & Weaver,
2009). The first of these factors, expressed emotion would be explained by the turbulent relationship,
combined with her mothers over protective nature conflicting with her fathers over critical reactions
to the patients behavioral issues (Meyer, Chapman, & Weaver, 2009). The second of these factors,
communication deviance resulted from the patients inability to focus and maintain normal dialog
with others (Meyer, Chapman, & Weaver, 2009).
Cognitive factors are a viable consideration for this patients case. Meyer, Chapman, and Weaver
(2009) suggest that prodomal pruning theory may be one example of a cognitive factor. Prodomal
pruning theory suggests that the human brain deletes unnecessary synapses to allow the brain to
function properly during the change from adolescence to adulthood (Meyer, Chapman, & Weaver,
2009). Behavior is another factor relating to the patients repeated hospitalization. The patient
displayed behavior deficiencies in regard to compliance to prescribed treatment regimens, and
involvement in situations that could produce high level stressors in her life.
Conclusion

Because illnesses like schizophrenia relate to various and different factors, each person effected by
the illness will show differences in ability to function in a normal environment. The various
classifications of schizophrenia, ability to receive treatments, and the consideration of various
influences and base-line factors help researchers determine what classification a patient falls into. In
this particular case, the patient displays symptoms of catatonic schizophrenia. She is able to function
in environments that do not produce high levels of demand or stress on the individual. However, the
underlying assumptions would indicate that the combination of outlined biological, emotional,
cognitive, and behavioral were in-place, and waiting for the appropriate stressor to trigger her
symptoms.
Nursing Case Study Paranaoid Schizophrenia
1. 1. PARANOID SCHIZOPHRENIANursingcasestudy.blogspot.com
2. 2. TABLE OF CONTENTSChapter 1
. Introduction Theoretical
Framework Personal Data History of present Illness Past Personal
History Family HistoryChapter 2
General appearance Motor
behavior Sensorium and Cognities Perception Attitude and Behavior
Defense Mechanism Affective State Speech Thought Process and
ContentChapter 3 .
Psychopathology Related Literature and Studies Drug StudyChapter 4
. Process Recordings
Prioritized Psychiatric Nursing DiagnosesChapter 5
Psychotherapies
Implemented
3. 3. CHAPTER 1Introduction Paranoid schizophrenia is the most common type
of schizophrenia in most partsof the world. The clinical picture is dominated
by relatively stable, often paranoid,delusions, usually accompanied by
hallucinations, particularly of the auditory variety,and perceptual
disturbances. Disturbances of affect, volition, and speech, and
catatonicsymptoms, are not prominent. With paranoid schizophrenia, your
ability to think and function in daily life maybe better than with other types of
schizophrenia. You may not have as many problemswith memory,
concentration or dulled emotions. Still, paranoid schizophrenia is a
serious,lifelong condition that can lead to many complications, including
suicidal behavior.(http://www.mayoclinic.com/health/paranoidschizophrenia/DS00862) Patients who have paranoid schizophrenia that has
thought disorder may beobvious in acute states, but if so it does not prevent
the typical delusions or hallucinationsfrom being described clearly. Affect is
usually less blunted than in other varieties ofschizophrenia, but a minor
degree of incongruity is common, as are mood disturbancessuch as
irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms
suchas blunting of affect and impaired volition are often present but do not
dominate theclinical picture. The course of paranoid schizophrenia may be
episodic, with partial or completeremissions, or chronic. In chronic cases, the

florid symptoms persist over years and it isdifficult to distinguish discrete

episodes. The onset tends to be later than in thehebephrenic and catatonic
forms. (http://www.schizophrenia.com/szparanoid.htm) According to the World
Health Organization, It describes statistics about mentaldisorders of year
(2008). Schizophrenia is a severe form of mental illness affecting about7 per
thousand of the adult population, mostly in the age group 15-35 years.
Though theincidence is low (3-10,000), the prevalence is high due to
chronicity. According to the
4. 4. facts it reveals Schizophrenia affects about 24 million people
worldwide.Schizophrenia is a treatable disorder, treatment being more
effective in its initial stages.More than 50% of persons with schizophrenia are
not receiving appropriate care.90% ofpeople with untreated schizophrenia are
in developing countries. Care of persons withschizophrenia can be provided
at community level, with active family and communityinvolvement.
Schizophrenia affects men and women with equal frequency. Schizophrenia
oftenfirst appears in men in their late teens or early twenties. In contrast,
women are generallyaffected in their twenties or early thirties. In the U.S.,
mental disorders are diagnosed based on the Diagnostic andStatistical
Manual of Mental Disorders, fourth edition (DSM-IV).
(http://www.howstuffworks.com/framed.htm?
parent=schizophrenia.htm&url=http://www.nimh.nih.gov/health/publications/t
he-numbers-count-mental-disorders-in-america.shtml) In the Philippine
setting, the disability survey done in 2000 by the NationalStatistics Office
(NSO) found out that mental illness was the 3rd most common form
ofdisability in the country. The prevalence rate of mental disorders was 88
cases per100,000 population and was highest among the elderly group. This
finding was supportedby a more recent data from the Social Weather Station
Survey commissioned by DOH in2004. It reveals that 0.7 percent of the total
households have a family member afflictedwith mental disability. The
Baseline Survey for the National Objectives for Health in2000 stated that the
more frequently reported symptoms of an underlying mental healthproblem
were sadness, confusion, forgetfulness, no control over the use of cigarettes
andalcohol, and delusions. The most recent study on the prevalence of
mental health problems wasconducted by the National Epidemiology Center
(DOH-NEC) in 2006 which showedrevealing results though the target
population was limited only to government employeesfrom the 20 national
agencies in Metro Manila. Among 327 respondents, 32 percent were
5. 5. found to have experienced a mental health problem at least once in their
lifetime. Thethree most prevalent diagnoses were: specific phobias (15 %),
alcohol abuse (10%),depression and schizophrenia (6%). Mental health
problems were significantly associatedwith the following respondent
characteristics: ages 20-29 years, those who have bigfamilies, and those who
had low educational attainment. The prevalence rate generatedfrom the
survey was much higher than those that were previously reported by 17
percent.(http://72.14.235.132/search?q=cache:sGhNeA_KcUJ:home.doh.gov.ph/ao/ao20070009.pdf+epidemiology+of+schizophrenia+in+the+philippines&cd=6&hl=tl
&ct=clnk&gl=ph) Currently, there is no method for preventing schizophrenia

and there is no cure.Minimizing the impact of disease depends mainly on

early diagnosis and, appropriatepharmacological and psycho-social
treatments. Hospitalization may be required tostabilize ill persons during an
acute episode. The need for hospitalization will depend onthe severity of the
episode. Mild or moderate episodes may be appropriately addressed
byintense outpatient treatment. A person with schizophrenia should leave the
hospital oroutpatient facility with a treatment plan that will minimize
symptoms and maximizequality of life. This introduced psychiatric case was
chosen primarily because it is the mostinteresting amongst the cases that
were encountered by the group members. It postsrelevant manifestations
that are psychiatric in nature and the entire case is highly possibleto be
studied comprehensively within the limited time available.Theoretical
Framework Maslows hierarchy of needs is predetermined in order of
importance. It is oftendepicted as a pyramid consisting of five levels: the first
lower level is being associatedwith physiological needs, while the top levels
are termed growth needs associated withpsychological needs. Deficiency
needs must be met first. Once these are met, seeking tosatisfy growth needs
drives personal growth. The higher needs in this hierarchy onlycome into
focus when the lower needs in the pyramid are met. Once an individual
hasmoved upwards to the next level, needs in the lower level will no longer
be prioritized. If
6. 6. a lower set of needs is no longer being met, the individual will temporarily
re-prioritizethose needs by focusing attention on the unfulfilled needs, but
will not permanentlyregress to the lower level. For instance, a businessman at
the esteem level who isdiagnosed with cancer will spend a great deal of time
concentrating on his health(physiological needs), but will continue to value
his work performance (esteem needs)and will likely return to work during
periods of remission. The lower four layers of the pyramid are what Maslow
called "deficiency needs"or "D-needs": physiological, safety and security, love
and belonging, and esteem. Withthe exception of the lowest (physiological)
needs, if these "deficiency needs" are not met,the body gives no physical
indication but the individual feels anxious and tense.
(http://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs)
7. 7. Personal Data Name of the Patient: Mr. X Age: 40 years old Gender: Male
Address: Nueva Ecija Civil Status: Single Nationality: Filipino Religion: Roman
Catholic Birthday: Date admitted: January 31, 2009 (2:35 pm) Admitting
Diagnosis: Paranoid SchizophreniaHistory of Present Illness Patient has
previous admission at Mariveles Mental Hospital. He was dischargedfrom
male ward on December, 2007. He had 1-2 consultations with Dra. Medina.
Hisparents cannot afford to bring him in Cabanatuan. Upon discharge he
resumed smoking and after few months he resumed alcoholintake and he
became suspicious and verbally assaultive when not giving cigarettes. After
few hours upon admission, he heard his female cousin and a neighbortalking
to each other and felt rejuvenated. He went down the house and with
carrying anice pick. He stabbed at his cousin who sustained several abrasions
in the forearm and shegot a scar on the head and on her right lower quadrant
of abdomen. The neighbor placedhim in restraints and informed his father
who was out in the farm.History of Previous Illness The patient was first

admitted on October 4, 200 at Mariveles Mental Hospitalwith chief complaints

of poor appetite, cannot able to sleep and hears a female voice onhis ear. A
year prior to admission, the patient used illegal drug such as shabu. After
usingshabu, few months prior to admission he was engaged to abused
substances like alcohol
8. 8. and cigarettes. He started to become violent and shouts to his parents.
Few hours uponadmission, he was saw laughing by him only, becomes
aggressive and always shouting.His father took him to MMH hence the reason
for his admission. His condition becomes better and he was discharged on
August 19, 2001. But hewas then readmitted on November 15, 2002 for the
reason of he took things from thestores and insisted that it was his property.
On the nest seven succeeding years, he was inand out of MMH with an
admitting diagnosis of Undifferentiated Schizophrenia. Butearly this year,
January 9, 2009, he was again readmitted with a new diagnosis ofParanoid
Schizophrenia.Family Health and Psychiatric History
9. 9. Chapter 2MENTAL STATUS ASSESSMENTA. General Appearance Criteria Day
1 Day 2 Day 3 Day 4Good grooming Appropriate facial expression
Appropriate posture Maintains eye contact During nursepatient interaction, the patients grooming was not good prior tomorning care
but on the later part he improves and shows good grooming. Most of thetime,
he exhibited appropriate facial expressions and posture during interactions.
At first,he cannot display eye contact which may show lack of focused and
interest on the topic.As days passes by student nurse established trust on the
patient and he maintains goodeye contact.B. Motor Behavior Criteria Day 1
Day 2 Day 3 Day 4Automatism HyperkinesthesiaWaxy
FlexibilityCataplexyCatalepsyStereotypeCompulsionPsychomotor
RetardationEchopraxiaCatatonic StuporCatatonic excitementTics and
spasmsImpulsivenessChoreiform movements Automatism is defined as
repeated purposeless behaviors often indicative ofanxiety, such as drumming
of fingers, twisting of locks of hair or tapping of foot. All
10.10. through out the 4 day nurse-patient interaction, the patient presented
automatism. Noother motor behaviors were noted.C. Sensorium and
Cognitive Criteria Day 1 Day 2 Day 3 Day 4Orientation Time
Place Person Concentration Memory
Remote Recent Immediate retention
Sensorium and cognities consist of the assessment of orientation,
concentration,and memory. Orientation refers to the clients recognition of
person, place and time. Thatis, knowing who and where he or she is and the
correct day, date and year. (Videbeck,Psychiatric Mental Health Nursing).
Memory is an organisms mental ability to store,retain and recall information
which is divided into recent and remote memory. Short-termmemory allows
recall for a period of several seconds to a minute without rehearsal.Long-term
memory can store much larger quantities of information for
potentiallyunlimited duration (sometimes a whole life span). During the 4 day
nurse-patient interaction, patients orientation and memory arestable. He can
recall memories from the past and aware of the place, who is he, time,
day,and year. Based from the above definition of memory, he has an intact

recollection of thepast events in his life.D. Perception Criteria Day 1 Day 2

Day 3 Day 4Hallucination Visual Olfactory Auditory Tactile Gustatory Liliputian
11.11. IllusionsDelusions In the most recent Diagnostic and Statistical
Manual of Mental Disorders, adelusion is defined as a false belief based on
incorrect inference about external realitythat is firmly sustained despite what
almost everybody else believes and despite whatconstitutes incontrovertible
and obvious proof or evidence to the contrary. The belief isnot one ordinarily
accepted by other members of the persons culture or subculture. From the
1st up to 4th day of nurse-patient interaction, the patient manifestpresence
of delusions wherein he always claims that he was the husband of
SherylCosim. Other perceptions were not noted.E. Attitudes and Behavior
Criteria Day 1 Day 2 Day 3 Day 4Cooperation Outgoing
WithdrawnEvasiveSarcasticAggressivePerplexedApprehensive
ArrogantDramaticSubmissiveFearfulSeductiveUncooperativeImpatientResista
ntImpulsive Attitude is a position of the body or manner of carrying oneself. It
is a position orposture of the body appropriate to or expressive of an action,
emotion The patient exhibited cooperation in the whole duration of duty and
able toanswers all questions asked to him and participates in all activities. It
was also observed
12.12. that he was outgoing with other patient and student nurse. He also
showsapprehensiveness throughout the interaction.F. Defense Mechanism
Criteria Day 1 Day 2 Day 3 Day 4Denial
RepressionSuppressionRationalization Reaction
FormationSublimationCompensationProjectionDisplacementIdentificationInterj
ectionConversionSymbolizationDissociationUndoingRegressionSubstitutionFan
tasy Defense mechanisms are psychological strategies brought
into play by variousentities to cope with reality and to maintain self-image.
Healthy persons normally usedifferent defenses throughout life. An ego
defense mechanism becomes pathological onlywhen its persistent use leads
to maladaptive behavior such that the physical and/or mentalhealth of the
individual is adversely affected. The purpose of the Ego DefenseMechanisms
is to protect the mind/self/ego from anxiety, social sanctions or to provide
arefuge from a situation with which one cannot currently cope. The patient
manifests fantasy from day 1 to day 4 and shows also denial andreaction
formation on the later days of interaction.G. Affective State Criteria Day 1
Day 2 Day 3 Day 4Euphoria
13.13. Flat affect
BluntingElationExultationEcstasyAnxietyFearAmbivalenceDepersonalizationIrr
itabilityRageLabilityDepression Affect is a grouping of physic phenomena
manifesting under the form ofemotions, feelings or passions, always followed
by impressions of pleasure or pain,satisfaction or discontentment , liking or
disliking, joy or sorrow.(/www.cerebromente.org). Flat affect: A severe
reduction in emotional expressiveness. People withdepression and
schizophrenia often show flat affect. A person with schizophrenia maynot
show the signs of normal emotion, perhaps may speak in a monotonous
voice, havediminished facial expressions, and appear extremely apathetic.
(www.medterms.com) The patient sometimes shows flat affect during the

whole interaction.H. Speech Criteria Day 1 Day 2 Day 3 Day

4VerbigerationRhymingPunningMutismAphasiaUnusual rates of
speechUnusual Volume of speechUnusual IntonationUnusual Modulation
Speech refers to the processes associated with the production and perception
ofsounds used in spoken language.
14.14. During the interaction, the patient does not show any alteration in his
speechpattern. He did not experience verbigeration, aphasia, other speech
problems.I. Thought Process and Content Criteria Day 1 Day 2 Day 3 Day
4BlockingFlight of IdeasWord
SaladPerserverationNeologismCircumstantialityEcholaliaCondensationDelusio
n PhobiaObsession Hypochondriac During the first part of
our nurse-patient interaction, the patient shows delusion.He also manifested
obsession wherein he keeps on insisting that his wife is Sheryl Cosimwho is a
famous news anchor.
15.15. Chapter 3Psychopathology Book-Based
16.16. Client-Based
17.17. Related Literature and Studies
18.18. What is Schizophrenia? It is a mental illness which affects one person in
every hundred. Schizophreniainterferes with the mental functioning of a
person and, in the long term, may causechanges to a persons personality.
First onset is usually in adolescence or early adulthood. It can develop in
olderpeople, but this is not nearly as common. Some people may experience
only one or morebrief episodes in their lives. For others, it may remain a
recurrent or life-long condition. The onset of illness may be rapid, with acute
symptoms developing over severalweeks, or it may be slow, developing over
months or even years. During onset, theperson often withdraws from others,
gets depressed and anxious and develops extremefears or obsessions.
Although an exact definition of schizophrenia still evades medical
researchers, theevidence indicates more and more strongly that
schizophrenia is a severe disturbance ofthe brains functioning. In The Broken
Brain: The Biological Revolution in Psychiatry,Dr. Nancy Andreasen states
"The current evidence concerning the causes ofschizophrenia is a mosaic. It is
quite clear that multiple factors are involved. These include changes in the
chemistry of the brain, changes in the structure ofthe brain, and genetic
factors. Viral infections and head injuries may also play arole....finally,
schizophrenia is probably a group of related diseases, some of which
arecaused by one factor and some by another." (p. 222). There are billions of
nerve cells in the brain. Each nerve cell has branches thattransmit and
receive messages from other nerve cells. The branches release
chemicals,called neurotransmitters, which carry the messages from the end
of one nerve branch tothe cell body of another. In the brain afflicted with
schizophrenia, something goes wrongin this communication system.
Sometimes schizophrenia has a rapid or sudden onset. Very dramatic
changes inbehaviour occur over a few weeks or even a few days. Sudden
onset usually leads fairly

19.19. quickly to an acute episode. Some people have very few such attacks in a
lifetime; othershave more. Some people lead relatively normal lives between
episodes. Others find thatthey are very listless. depressed, and unable to
function well. In some, the illness may develop into what is known as chronic
schizophrenia.This is a severe, long-lasting disability characterized by social
withdrawal, lack ofmotivation, depression, and blunted feelings. In addition,
moderate versions of acutesymptoms such as delusions and thought disorder
may be present in the chronic disorder.What are the symptoms of
schizophrenia?Major symptoms of schizophrenia include: Delusions - false
beliefs of persecution, guilt or grandeur or being under outside control.
People with schizophrenia may describe plots against them or of think they
have special powers and gifts. Sometimes they withdraw from people or hide
to avoid imagined persecution. Hallucinations - most commonly involving
hearing voices. Other less common experiences can include seeing, feeling,
tasting or smelling things which to the person are real but which are not
actually there. Thought disorder - where the speech may be difficult to
follow; for example, jumping from one subject to another with no logical
connection. Thoughts and speech may be jumbled and disjointed. The person
may think someone is interfering with their mind.Other symptoms of
schizophrenia include: Loss of drive - where often the ability to engage in
everyday activities such as washing and cooking is lost. This lack of drive,
initiative or motivation is part of the illness and is not laziness. Blunted
expression of emotions -where the ability to express emotion is greatly
reduced and is often accompanied by a lack of response or an inappropriate
response to external events such as happy or sad occasions.
20.20. Social withdrawal - this may be caused by a number of factors including
the fear that someone is going to harm them, or a fear of interacting with
others because of a loss of social skills. Lack of insight or awareness of
other conditions - because some experiences such as delusions and
hallucinations are so real, it is common for people with schizophrenia to be
unaware they are ill. For this and other reasons, such as medication sideeffects, they may refuse to accept treatment which could be essential for
their well-being. Thinking difficulties - a persons concentration, memory,
and ability to plan and organise may be affected, making it more difficult to
reason, communicate, and complete daily tasks.What causes schizophrenia?
No single cause has been identified, but several factors are believed to
contribute to theonset of schizophrenia in some people:Genetic factorsA
predisposition to schizophrenia can run in families. In the general population,
only 1per cent of people develop it over their lifetime. If one parent suffers
from schizophrenia,the children have a 10 per cent chance of developing the
condition - and a 90 per centchance of not developing it.Biochemical
factorsCertain biochemical substances in the brain are believed to be
involved in this condition,especially a neurotransmitter called dopamine. One
likely cause of this chemicalimbalance is the persons genetic predisposition
to the illness.Family relationships
21.21. No evidence has been found to support the suggestion that family
relationships cause theillness. However, some people with schizophrenia are
sensitive to any family tensionwhich, for them, may be associated with

relapses.EnvironmentIt is well recognised that stressful incidents often

precede the onset of schizophrenia.They often act as precipitating events in
vulnerable people. People with schizophreniaoften become anxious, irritable
and unable to concentrate before any acute symptoms areevident. This can
cause relationships to deteriorate, possibly leading to divorce
orunemployment. Often these factors are then blamed for the onset of the
illness when, infact, the illness itself has caused the crisis. It is not, therefore,
always clear whether stressis a cause or a result of illness.Drug useThe use of
some drugs, especially cannabis and LSD, is likely to cause a relapse
inschizophrenia.Source: www.mental-health-matters.comParanoid
Schizophrenia People with paranoid schizophrenia, the most common form of
the disorder,mainly experience hallucinations. They tend to believe that
others are poisoning,harassing, or plotting against them. They may also hear
voices, which order them to dothings. Contrary to popular belief, people
suffering from this type of schizophrenia areactually not prone to violence; in
fact, they generally prefer to be left alone.Common Symptoms of Paranoid
Schizophrenia For people with paranoid schizophrenia, the primary symptoms
are delusions orauditory hallucinations. People with paranoid schizophrenia
usually do not have thoughtdisorder, disorganized behavior, or affective
flattening.
22.22. People with paranoid schizophrenia have grandiose delusions. For
example, they maybelieve that others are deliberately: Cheating them
Harassing them Poisoning them Spying on them Plotting against them
or the people they care about.Auditory hallucinations can include hearing
"voices" that may: Comment on the persons behavior Order him or her to
do things Warn of impending danger Talk to each other (usually about the
affected person).Paranoid Schizophrenia and Violence People with paranoid
schizophrenia are not especially prone to violence and oftenprefer to be left
alone. Studies show that if people have no record of criminal violencebefore
they develop schizophrenia and are not substance abusers, they are unlikely
tocommit crimes after they become ill. Most violent crimes are not committed
by peoplewith paranoid schizophrenia, and most people with schizophrenia
do not commit violentcrimes. Substance abuse almost always increases
violent behavior, whether or not theperson has schizophrenia. If someone
with paranoid schizophrenia becomes violent, their violence is mostoften
directed at family members and takes place at home.Source:
http://schizophrenia.emedtv.com
23.23. Drug Study Name of Date Route/ General Indication Clients drug ordered/
Dosage/ action/mechanis / response to Date Frequency of m of action
Purpose medicine with started/ administration actual s/e Date
changedGeneric Date Route of Chemical For AdministratioName: Ordered:
Administration: Effect: patients n of the drug January 31 Per Orem May act by
with acute was notClonazepam 2009 facilitating manic actually Date Dosage
and effects of episodes, observed Started: Frequency: inhibitory panic January
31 2mg HS neurotransmit disorders, 2009 ter or GABA. seizures. Date
Therapeutic Ended: Effect: -------------- Prevents or -------- stops seizure
activity.NURSING RESPONSIBILITIES:BEFORE: Explain the importance and
action of the drugs. Tell the possible reaction or side effects of the drugs.

Monitor patient for any adverse reaction.DURING: The client may sip small
amount of water Stay with the client for at least 15-30 minutes after giving
the drug Be alert for adverse reaction and drug interaction
24.24. Name of Date Route/ General Indication/ Clients drug ordered/ Dosage/
action/mechanism Purpose response to Date Frequency of of action medicine
with started/ administration actual s/e Date changedGeneric Date Route of
Chemical Effect: This is AdministratioName: Ordered: Administration: May
block given to n of the drug January Per Orem postsynaptic the patient was
notHaloperidol 31, 2009 dopamine with actually Date Dosage and receptors
in brain. chronically observed Started: Frequency: Therapeutic psychotic
January 5mg tab tid Effect: disorder 31, 2009 Decreases who needs psychotic
prolonged Date behaviors. therapy. Ended: ----------- ---------- NURSING
RESPONSIBILITIES: BEFORE: Explain the importance and action of the drugs.
Tell the possible reaction or side effects of the drugs. Monitor patient for
any adverse reaction. DURING: Stay with the client for at least 15-30
minutes after giving the drug Monitor patient for tardive dyskinesia, which
may not appear until months or years later and may disappear spontaneously
or persists for life despite stopping use of drug.
25.25. CHAPTER 5PSYCHOTHERAPIES IMPLEMENTEDPsychotherapy- treatment of
mental disorders and behavioral disturbances using verbaland nonverbal
communication, as opposed to agents such as drugs or electric shock, toalter
maladaptive patterns of coping, relieve emotional disturbance, and
encouragepersonality growth. Also called psychotherapeutics.Individual
Psychotherapy- Through one-on-one conversations, this approach focuses
onthe patients current life and relationships within the family, social, and
work.Group Psychotherapy- Group psychotherapy is a special form of therapy
in which asmall number of people meet together under the guidance of a
professionally trainedtherapist to help themselves and one another. Group
therapy helps people learn aboutthemselves and improve their interpersonal
relationships. It addresses feelings ofisolation, depression or anxiety. And it
helps people make significant changes so theyfeel better about the quality of
their lives.REMOTIVATION THERAPYDefinition: A simple group therapy which
aims to bridge the fantasy- world of thePsychotics to the real world. Is a
technique of simple group therapy, objective in nature,used with a group of
patients in an effort to reach the unwounded areas of eachpatients
personality & to get them back into reality.
26.26. Title of the poem: Ang Bulaklak The short poem describes the importance
of flower in our nature.Goals: To stimulate patients to be fellow explore the
real world. To develop their ability to communicated and share ideas and
experiences with the other people. To develop feelings of acceptance. To
promote group harmony and identification.Role of the nurse: To be a
facilitator in the activity To encourage clients feeling about the topic To
present the reality to the client about the poem.NEWSPAPER
THERAPYDefinition: Newspaper therapy is giving information to the clients
about events and whatis happening outsideNewspaper therapy is cutting
clippings from newspaper and sharing this information tothe clients and

knowing their feelings and ideas about the information given. Providingbasic
information about places/events may motivate the clients to follow the
medicalregimen to be well. The facilitator let the clients to read the topic,
then ask themquestions.Title of the cut news: Boxing The news was all
about boxing competition held in Araneta Coliseum & who wonfor that
competition.
27.27. Goals: To give information to the clients on what is happening outside
and to give latest news today. To encouraged emotions and reactions about
the newsRole of the Nurse: To introduce topics that will encourage clients
participation/cooperation To assess level of intelligence of the clients To
encourage the clients to express/verbalize feelings/ideas regarding to the
topicPLAY THERAPYDefinition: A form of psychotherapy used to help them
express or act out theirexperiences, feelings, and problems by playing with
dolls, toys, and other play material.Name of the Play: Ball
catchingProcedure:The clients are instructed to catch the ball with their
respective partners.Goals: To establish rapport since it is the first
recreational activity of the client To encourage release/ express clients
emotions To let the client learn on how to cooperate To let the client play
freely and activelyRole of the Nurse: To be the facilitator of the game To
let and encourage the clients to participate on the play
28.28. DANCE THERAPYDefinition Dance is the most fundamental of the arts,
involving direct expression throughthe body. Dance /movement therapy
effects changes in feelings, cognition, physicalfunctioning, and behavior.Title
of the dance song: Cha-Cha-Cha Facilitators are in the front, dancing different
steps, in able for the client to followeasily the facilitators.Goals: To encourage
release/ express clients emotions To let the client learn on how to dance in
simple steps To let the client dance freely and activelyRole of the Nurse:
To be the facilitator of the game To let and encourage the clients to
participate on the danceSONG THERAPYDefinition: A kind of recreational
therapy under the music category, which connects uswith our creativity,
innate wisdom and our vast inner resources for growth and well-being. It has
a soothing and pleasing effect and provides for emotion and release.Title of
the song: Tag-ulanProcedure:
29.29. Using the visual aids that has the written lyrics, the patients read it
first. The nurse sings the song with the use of guitars. Nurses, together
with the patients, sing the song. Lastly, let the patients sing to the tune of
guitars.Goals: Develop patients ability to read and reflect. Develop
patients listening skill. To encourage them to participate and cooperate.
Patients will learn to express emotions and feelings.Role of the Nurse:
Explain the procedure to the patients. To be a good facilitator. To be an
active participant too. To promote trust.ART THERAPYDefinition: is the use
of art materials for self-expression and reflection.Name: House-TreePersonProcedure: Patients are provided with crayons and 3 pieces of paper
as drawing materials. They are then asked to draw a house, afterwards a

tree, and lastly, a person on each of the papers with the use of crayons.
Series of questions constitute the post drawing interrogations.
30.30. During post drawing phase, paients are given opportunity to define,
describe, and interpret the objects drawn.Goals: To obtain data concerning
patients progress. To aid in the establishment of rapport between the nurse
and the patient. Help the patients gain insight through interpretations.
Measure patients self perception and attitudes.Role of Nurses: Explain the
procedure of the activity. Provide the means of the therapy (crayons,
papers). Interrogate patients during post drawing phase. Assessing and
interpreting answers based on Bucks HTP interpretation. Develop a deeper
nurse-patient relationship through building of trust.OCCUPATIONAL
THERAPYDefinition: Any activity, mental or physical, prescribed and guided to
aid an individualsrecovery from diseases or injury. This activity excludes
competition and pressure. Thereis opportunity for creativeness and produce
something tangible out of patients ownthinking and imagination. Self
confidence and personal achievements are alsoexperienced.Title: Designing
Picture FrameProcedure: Designing Picture Frame Nurses play a great role in
making this therapy successful. Nurses give picture frame.
31.31. Different shapes of cut cartolina & different styles of stickers are also
given along with the glue. Patients are asked to design their picture frame
wherever they like.Goals: Expose patients hidden abilities in designing and
pasting. Increase patients self confidence. Assess patients motor and
intellectual functioning.Role of Nurses: To select the most useful activity.
To facilitate the activity successfully. To assist the patients. To promote
positive personality growth
32.32. BIBLIOGRAPHYVidebeck, Psychiatric Mental Health Nursing, Third
EditionShives, Isaacs, Basic Concepts of Psychiatric-Mental Health
NursingRebraca et. al., Psychiatric Mental Health Nursing, 5th EditionNurses
Dictionary, Second Edition7th Edition Nursing Diagnosis Handbook: A Guide
to Planning Care by Betty J Auckley and GailB.
Ladwighttp://www.answers.com/topic/psychosishttp://www.emedicine.com/me
d/byname/brief-psychoticdisorder.htmhttp://www.hawaii.edu/hivandaids/Philippines_Mental_Health_Cou
ntry_Profile.pdfhttp://en.wikipedia.org/wiki/Psychotic_disorder