Case Presentation On Undifferentiated Schizophrenia

Submitted by:

Layugan, Daphnie Mikaela Macarubbo, Joy Anne Maestre, Mikael Regin Maningas, Yvanna Celine Martinez, Laurlynne Niel Miguel, Jake Albert Melad, Myka Joana Narag, Mark Anthony Karen

PATIENTS PROFILE PERSONAL DATA: CODE NAME: RC AGE: 37 SEX: Female BIRTHDAY: October 12, 1972 BIRTHPLACE: San Manuel, Echague Isabela CIVIL STATUS: Married NATIONALITY: Filipino RELIGION: Roman Catholicism EDUCATIONAL ATTAINMENT: High school graduate OCCUPATION: None PRINCIPAL DIAGNOSIS: Schizophrenia, undifferentiated, chronic in relapse DATE OF AMISSION: year 1999 DATE OF RE-ADMISSION: March 04, 2008 ATTENDING PHYSICIAN: Dr. Sagabaen ADMISSION COMPLAINT: o o o o aglabus labus-removing clothes in public sabali ibagbaga-unusual statements agsasau na maymaysa-talks to self sabsabali-acts strangely

INTRODUCTION Definition: Schizophrenia (from the Greek roots skhizein ("to split") and phrn, phren- ("mind")) is a severe mental illness characterized by a variety of symptoms including but not limited to loss of contact with reality. Schizophrenia is not characterized by a changing in personality; it is characterized by a deteriorating personality.(Keltner, 2007). Schizophrenia is characterized by a broad range of unusual behaviors that cause profound disruption in the lives of the patients suffering from the condition and in the lives of the people around them. Schizophrenia is a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. (webmd.com) It is a life-long disease that cannot be cured, but usually can be controlled with proper treatment. (webmd.com) Types:

Paranoid schizophrenia People with this type are preoccupied with false beliefs (delusions) about being persecuted or being punished by someone. Their thinking, speech and emotions, however, remain fairly normal.

Disorganized schizophrenia People with this type often are confused and incoherent, and have jumbled speech. Their outward behavior may be emotionless or flat or inappropriate, even silly or childlike. Often they have disorganized behavior that may disrupt their ability to perform normal daily activities such as showering or preparing meals.

Catatonic schizophrenia The most striking symptoms of this type are physical. People with catatonic schizophrenia are generally immobile and unresponsive to the world around them. Very rigid and stiff, and unwilling to move. These people have peculiar movements like grimacing or assume bizarre postures. Or, they might repeat a word or phrase just spoken by another person.

Undifferentiated schizophrenia This subtype is diagnosed when the person's symptoms do not clearly represent one of the other three subtypes.

Residual Schizophrenia In this type of schizophrenia, the severity of schizophrenia symptoms has decreased. Hallucinations, delusions, or other symptoms may still be present but are considerably less than when the schizophrenia was originally diagnosed.

Onset Onset may be abrupt or insidious but most clients slowly and gradually develop signs and symptoms such as social withdrawal, unusual behavior, loss of interest in school or work or neglected hygiene. Age at onset appears to be an important factor in how well the client fares: Those who develop the illness earlier show worse outcomes than those who develop it later. Approximately one third of clients with schizophrenia relapse within one year of an acute episode. Symptoms of Schizophrenia Not everyone who has schizophrenia experiences every symptom. Some people experience a few symptoms, some many. The severity of symptoms varies with individuals and also varies over time. The most common symptoms of schizophrenia can be grouped into three categories: Positive symptoms, disorganized symptoms, and negative symptoms. Positive Symptom Word positive does not mean "good." Rather, it refers to obvious symptoms that are not present in people without schizophrenia. Symptoms which are sometimes referred to as psychotic symptoms, include: o Delusions Strange beliefs that are not based in reality and that the person refuses to give up, even when presented with factual information. For example, the person suffering from delusions may believe that people can hear his or her thoughts, that he or she is God or the devil, or that people are putting thoughts into his or her head. o Hallucinations Involve perceiving sensations that aren't real, such as seeing things that aren't there, hearing voices, smelling strange odors, having a "funny" taste in your mouth, and feeling sensations on your skin even though nothing is touching your body. Hearing voices is the most common hallucination in people with schizophrenia. The voices may comment on the person's behavior, insult the person, or give commands. Disorganized Symptoms Disorganized symptoms of schizophrenia reflect the person's inability to think clearly and respond appropriately. Examples of disorganized symptoms include: Talking in sentences that do not make sense or using nonsense words, making it difficult for the person to communicate or engage in conversation. Shifting quickly from one thought to the next.. Writing excessively but without meaning. Repeating movements or gestures, such as pacing or walking in circles.

 Negative Symptoms The word negative does not mean "bad," but reflects the absence of certain normal behaviors in people with schizophrenia. Negative symptoms of schizophrenia include: Lack of emotion and expression or emotions, thoughts, and moods that do not fit with situations or events (for example, crying instead of laughing at a joke). Lack of motivation. Loss of pleasure or interest in life. Moodiness (being very sad or very happy, or having swings in mood). Catatonia (a condition in which the person becomes fixed in a single position for a very long time). Causes The exact cause of schizophrenia is not yet known. It is known, however, that schizophrenia -- like cancer and diabetes -- is a real illness with a biological basis. It is not the result of bad parenting or personal weakness.

Genetics (heredity) Schizophrenia tends to run in families, which means the likelihood to develop schizophrenia may be passed on from parents to their children.

Brain chemistry People with schizophrenia may have an imbalance of certain chemicals in the brain. They may be either very sensitive to or produce too much of a brain chemical called dopamine. Dopamine is a neurotransmitter, a substance that helps nerve cells in the brain send messages to each other. An imbalance of dopamine affects the way the brain reacts to certain stimuli, such as sounds, smells, and sights and can lead to hallucinations and delusions.

Environmental factors Evidence suggests that certain environmental factors, such as a viral infection, poor social interactions, or highly stressful situations, may trigger schizophrenia in people who have inherited a tendency to develop the disorder. Schizophrenia more often surfaces when the body is undergoing hormonal and physical changes, such as those that occur during the teen and young adult years. How Is It Diagnosed? According to the DSM-IV, the person needs to meet only one (rather than two) of the above criterion when: Delusions are bizarre. Bizarre delusions would involve a belief which is completely implausible, such as believing that an alien surgically removed the persons heart and put another one inside the persons body in its place. The patient is hearing at least two voices talking to each other, or is hearing a voice which is giving an ongoing commentary on the persons activities or thoughts.

Treatment and Care Schizophrenia treatment involves medications and therapy to reduce the risk of future psychotic episodes and improve relationships. Medication o Antipsychotic medications Proven effective in treating acute psychosis and reducing the risk of future psychotic episodes. The cornerstone in the management of schizophrenia. Do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook. The choice and dosage of medication is individualized and is best done by a physician who is well trained and experienced in treating severe mental illness. The treatment of schizophrenia thus has two main phases: An acute phase When higher doses might be necessary in order to treat psychotic symptoms, followed by a Maintenance phase Usually life-long. Dosage is gradually reduced to the minimum required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary increase in dosage may help prevent a relapse. Some patients, however, do not respond to medications, and a few may seem not to need them. Therapy In spite of successful antipsychotic drug treatment, many patients with schizophrenia have difficulty with motivation, activities of daily living, relationships, and communication skills. In these cases, the psychosocial treatments help most, and many useful treatment approaches have been developed to assist people suffering from schizophrenia.
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Individual psychotherapy Involves regular sessions between just the patient and a therapist focused on past or current problems, thoughts, feelings, or relationships. Rehabilitation Rehabilitation may include job and vocational counseling, problem solving, social skills training, and education in money management. Thus, patients learn skills required for successful reintegration into their community following discharge from the hospital.

Family education Research has consistently shown that people with schizophrenia who have involved families fare better than those who battle the condition alone. Insofar as possible, all family members should be involved in the care of your loved one.

Self-help groups Outside support for family members of those with schizophrenia is necessary and desirable. The National Alliance for the Mentally Ill (NAMI) is an in-depth resource. This outreach organization offers information on all treatments for schizophrenia, including home care. Community care and outreach programs are very helpful in avoiding relapse, non-compliance, legal problems, and repeat hospitalizations.