Case Study of a Schizophrenic Patient Case Study

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Mental Health Case Study Connect

Key issues in this Case Study

A review of patient information reveals the following major issues;

Schizophrenia Disorder: This seems to be in relation to her daughter (aged one) being placed in a foster care facility by the Department of Family Services.

Substance/drug abuse: Patient overdosed on prescribed medicines -- Quetiapine and Sodium Valproate (nearly two weeks' dosage). She smoked an average of ten cigarettes a day, consumed marijuana, used intravenous (IV) amphetamine, and overindulged in drink for several years previously.

Suicidal tendency/attempts: Patient admits to consuming nearly two weeks' dosage of Quetiapine and Sodium Valproate (prescribed drugs) with suicidal intent; she also resorted to cutting her left wrist using a sharp knife. Old scars on her wrists are proof of earlier suicide attempts, as are overdosing on medicines, running at moving cars, and an attempt to swim at night in the sea.

Unipolar disorder with self-harming behaviors and psychotic characteristics

5. Mood swings also pointing to the disorder

Step 2 - question

Needed additional information

None

Step 3 - investigate

The disorder presented in this scenario

This case displays a primary schizophrenic disorder, which is an acute, chronic, disabling disorder of the brain, suffered by individuals throughout history. Roughly 1% of U.S. citizens have been inflicted by it. Affected persons may keep hearing voices that nobody else hears, and may feel that others can rule and dominate their thoughts, read what's in their minds, or even contrive to hurt them, thereby terrifying affected individuals and making them overly restless and distressed, or introverted. Schizophrenics may not talk sensibly and may remain without talking or moving for hours together. Schizophrenics, at times, appear to be perfectly alright, until they begin voicing their real thoughts (National Institute of Mental Health, 2009).

Clinical manifestations associated with this disorder?

The key characteristics of schizophrenia comprise distinctive symptoms and indications which have been occurring for an appreciable span of time within a month (or shorter if treated successfully); some schizophrenia signs persist for a minimum of half a year. There is no sole indicative symptom for the ailment. Rather, there may be numerous psychological realms of symptoms, like ideation, perception (hallucinations), reality testing (misapprehensions), feeling (inappropriate affect, flatness), thinking (loose associations), concentration, attention, judgment, behavior (disorganization, catatonia), and motivation (impaired intention, planning, and a volition) (Lehman, et al., 2010).

Schizophrenia's symptoms can be divided broadly into 3 categories, namely, positive, negative and cognitive.

Positive symptoms

These are psychotic conducts not viewed among healthy individuals; those suffering from symptoms of this category typically end up "getting out of touch" with reality. The symptoms may appear and disappear. They can be severe at times, and barely discernible during other times, based on whether or not the affected person is being treated for the malady. Positive symptoms include:

Hallucinations: these are things seen, felt, heard or smelt by a particular individual, and nobody else, at that point of time. Schizophrenics most commonly "hear voices," which may speak to the individual regarding his/her conduct, command him/her to do something, or give warnings of danger. The voices even speak among themselves, at times. Affected individuals may be having these hallucinations for long periods before the problem is noticed by friends and family members (National Institute of Mental Health, 2009).

Negativism: implies reluctance of a patient to cooperate, when no ostensible reason, relating to annoyance, distrust, exhaustion or depression, exists for non-cooperation. Negativism can also be manifested as a reluctance to heed when requested to make a bodily movement -- the patient might just, in extremely severe cases, do the exact opposite. They may, for instance, lower an arm when requested to raise it (Cancro & Lehmann, 1980).

Delusions: these represent unchangeable, false beliefs not belonging to an individual's culture. Affected individuals believe in their delusions despite them being proven to be erroneous or illogical. Schizophrenics can have seemingly strange delusions (e.g. a belief that their behavior can be controlled by neighbors via magnetic waves), and may imagine people on TV sending them special messages, or feel that their thoughts are being broadcasted out loud by radio stations. They sometimes think they are somebody else (for instance, some famous person in history). Their unreasonable delusions (termed as "delusions of persecution") may lead them to believe that other people are attempting to harm them, by hatching a plot against them and their loved ones, spying on them, cheating, harassing, or poisoning them (National Institute of Mental Health, 2009).

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Negative symptoms

These symptoms are linked to troubles with ordinary behaviors and emotions. Identifying them as symptoms of schizophrenia is difficult; they may be taken for conditions like depression. Negative symptoms include:

"Flat affect" (wherein an individual's face doesn't move or the individual speaks in a monotone or a dull voice)

Not taking pleasure in the small things of everyday life

Inability to initiate and carry on planned activities

Little talk, even if forced to mingle.

Those suffering from negative schizophrenia symptoms require assistance with routine activities. Often, they disregard simple personal hygiene; while others may perceive them to be indolent or reluctant to take care of themselves, these are actually symptoms of schizophrenia.

Cognitive symptoms

These are subtle symptoms, and it may be hard to identify them as schizophrenia symptoms. They are normally discovered only upon performance of other tests. They include:

Inadequate "executive functioning" (i.e. the ability to understand information and employ it in decision-making)

Problems with concentration / taking notice

Working-memory-related issues (or inability to instantaneously apply information learned).

These symptoms usually bring difficulties in jobs and leading normal lives. They may trigger intense emotional anxiety or pain

Common treatment options for this disorder

Schizophrenia treatment components that have proven successful include: antipsychotic medications, community treatment units, family education, psychosocial remedial treatment (clubhouses, planned peer support), case management, and supported housing and employment (Rosenberg, 2009).

Antipsychotic medicine, which is capable of facilitating a swift decline in symptoms' severity, is the foremost means to treating schizophrenic hallucinations. No more than 8% first-episode schizophrenics continue experiencing hallucinations of mild-moderate severity following continued treatment for a year. Drugs like amisulpride, olanzapine, quetiapine, and ziprasidone show equal effectiveness against the problem of hallucinations; haloperidol, however, can be a little less effective (Sommer, et al., 2012).

The ailment, schizophrenia comes under the category of brain diseases, rather than psychological complaints, and therefore, the fundamental course of treatment followed here is use of medication. However, research reveals that a treatment plan combining psychosocial therapy with medicines is more effective with respect to prevention of relapse, as compared to routine care (medicine, observation, and rehab access). An integrated treatment approach for facilitating assuagement of psychotic symptoms can include:

Administering antipsychotic drugs with monitoring

Motivational interviewing to encourage the patient towards committing to change

Social skills development and community-based rehabilitation

Cognitive-behavioral therapy (CBT) for lessening hallucinations and delusions

Family psychotherapy

Schizophrenia therapy has typically dealt with reducing negative symptoms of patients. Physicians now seek to expand treatment and concentrate on patients' independent-functioning ability in everyday tasks like eating, cleaning, cooking, working, shopping, and doing laundry. Detection of the problem at early stages and timely treatment result in better outcomes. Strong proof exists with regards to benefits of treatment in early stages. First-episode patients who are administered antipsychotic medication and other therapy are less likely to be admitted to hospitals in the five years that follow, and may need less time to control their symptoms compared to patients who come in for help at a later stage of the disorder (Simon, 2013).

Step 4 - construct

Nursing interventions and clinical skills required for this Case Study

Goal:

A workable goal must be established with schizophrenic patients, along with required outcomes. Desired standards for families having schizophrenic members must also be established.

Client safety concerns with regard to the given Case Study:

Nursing Interventions for Ruth;

Withdrawal and isolation

1. Adopt a self-therapeutic.

2. Plan an interaction to be carried out with the patient; it must be frequent, short and undemanding.

3. Organize basic one-on-one activities.

4. Ensure reliability and sincerity in interactions.

5. Gradually encourage the patient to mingle with peers in non-threatening settings

6. Offer training in social skills development/improvement.

7. Conduct numerous activities to improve self-esteem.

No clear pattern of communication

1. Ensure one's communication is easy to understand.

2. Be consistent in verbal as well as nonverbal communication.

3. Clarify any aspect in nurse-client interaction that is vague or hazily connected with client communication

Suspicious

1. Forge a professional bond; over-friendliness may be perceived as a threat.

2. Take care with touch, as this may also be perceived as a threat.

3. Allow the client as much independence and control as possible within therapeutic bounds.

4. Gain client trust via short interactions which convey respect and concern.

5. Explain medications, therapies, and lab examinations prior to beginning.

6. Take care not to concentrate on, or reinforce, delusional beliefs or suspicions......

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