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8/13/2019 Sample Psyc

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Tarlac State UniversityCOLLEGE OF NURSING

Lucinda CampusTarlac City

A CASE STUDY

On

ARANOIDSC!I"O !RENIA

resented #y$

Espin%sa& Rac'ael Ann ()Granad%*in& C'enee L)

Tapni%& Reselda

April ++& +,,-


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TABLE OF CONTENTS

Chapter 1 .

IntroductionTheoretical Framework Personal DataHistory of present IllnessPast Personal HistoryFamily History

Chapter 2

eneral appearance!otor "eha#ior $ensorium and Co%nitiesPerception&ttitude and 'eha#ior Defense !echanism&ffecti#e $tate$peechThou%ht Process and Content

Chapter ( .

Psychopatholo%y)elated *iterature and $tudiesDru% $tudy

Chapter + .

Process )ecordin%sPrioriti,ed Psychiatric -ursin% Dia%noses

Chapter

Psychotherapies Implemented


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C!A TER .

Intr%ducti%n

Paranoid schi,ophrenia is the most common type of schi,ophrenia in most parts

of the world. The clinical picture is dominated "y relati#ely sta"le/ often paranoid/

delusions/ usually accompanied "y hallucinations/ particularly of the auditory #ariety/

and perceptual distur"ances. Distur"ances of affect/ #olition/ and speech/ and catatonic

symptoms/ are not prominent.

0ith paranoid schi,ophrenia/ your a"ility to think and function in daily life may

"e "etter than with other types of schi,ophrenia. ou may not ha#e as many pro"lemswith memory/ concentration or dulled emotions. $till/ paranoid schi,ophrenia is a serious/

lifelon% condition that can lead to many complications/ includin% suicidal "eha#ior.

http344www.mayoclinic.com4health4paranoid5schi,ophrenia4D$66782 9

Patients who ha#e paranoid schi,ophrenia that has thou%ht disorder may "e

o"#ious in acute states/ "ut if so it does not pre#ent the typical delusions or hallucinations

from "ein% descri"ed clearly. &ffect is usually less "lunted than in other #arieties of

schi,ophrenia/ "ut a minor de%ree of incon%ruity is common/ as are mood distur"ancessuch as irrita"ility/ sudden an%er/ fearfulness/ and suspicion. :-e%ati#e: symptoms such

as "luntin% of affect and impaired #olition are often present "ut do not dominate the

clinical picture.

The course of paranoid schi,ophrenia may "e episodic/ with partial or complete

remissions/ or chronic. In chronic cases/ the florid symptoms persist o#er years and it is

difficult to distin%uish discrete episodes. The onset tends to "e later than in the

he"ephrenic and catatonic forms. http344www.schi,ophrenia.com4s,paranoid.htm 9

&ccordin% to the 0orld Health ;r%ani,ation/ It descri"es statistics a"out mental

disorders of year 26679. $chi,ophrenia is a se#ere form of mental illness affectin% a"out

< per thousand of the adult population/ mostly in the a%e %roup 1 5( years. Thou%h the
http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862http://www.schizophrenia.com/szparanoid.htmhttp://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862http://www.schizophrenia.com/szparanoid.htm


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incidence is low (516/6669/ the pre#alence is hi%h due to chronicity. &ccordin% to the

facts it re#eals $chi,ophrenia affects a"out 2+ million people worldwide.

$chi,ophrenia is a treata"le disorder/ treatment "ein% more effecti#e in its initial sta%es.

!ore than 6= of persons with schi,ophrenia are not recei#in% appropriate care.>6= of

people with untreated schi,ophrenia are in de#elopin% countries. Care of persons with

schi,ophrenia can "e pro#ided at community le#el/ with acti#e family and community

in#ol#ement.

$chi,ophrenia affects men and women with e?ual fre?uency. $chi,ophrenia often

first appears in men in their late teens or early twenties. In contrast/ women are %enerally

affected in their twenties or early thirties.

In the @.$./ mental disorders are dia%nosed "ased on the Diagnostic and

Statistical Manual of Mental Disorders, fourth edition (DSM-IV) .

http344www.howstuffworks.com4framed.htmA

parentBschi,ophrenia.htm urlBhttp344www.nimh.nih.%o#4health4pu"lications4the5

num"ers5count5mental5disorders5in5america.shtml9

In the Philippine settin%/ the disa"ility sur#ey done in 2666 "y the -ational

$tatistics ;ffice -$;9 found out that mental illness was the (rd most common form ofdisa"ility in the country. The pre#alence rate of mental disorders was 77 cases per

166/666 population and was hi%hest amon% the elderly %roup. This findin% was supported

"y a more recent data from the $ocial 0eather $tation $ur#ey commissioned "y D;H in

266+. It re#eals that 6.< percent of the total households ha#e a family mem"er afflicted

with mental disa"ility. The 'aseline $ur#ey for the -ational ;" ecti#es for Health in

2666 stated that the more fre?uently reported symptoms of an underlyin% mental health

pro"lem were sadness/ confusion/ for%etfulness/ no control o#er the use of ci%arettes and

alcohol/ and delusions.

The most recent study on the pre#alence of mental health pro"lems was

conducted "y the -ational Epidemi%l%/y Center D;H5-EC9 in 2668 which showed

re#ealin% results thou%h the tar%et population was limited only to %o#ernment employees


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from the 26 national a%encies in !etro !anila. &mon% (2< respondents/ (2 percent were

found to ha#e e perienced a mental health pro"lem at least once in their lifetime. The

three most pre#alent dia%noses were3 specific pho"ias 1 =9/ alcohol a"use 16=9/

depression and schi,ophrenia 8=9. !ental health pro"lems were si%nificantly associated

with the followin% respondent characteristics3 a%es 2652> years/ those who ha#e "i%

families/ and those who had low educational attainment. The pre#alence rate %enerated

from the sur#ey was much hi%her than those that were pre#iously reported "y 1< percent.

http344


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mo#ed upwards to the ne t le#el/ needs in the lower le#el will no lon%er "e prioriti,ed. If

a lower set of needs is no lon%er "ein% met/ the indi#idual will temporarily re5prioriti,e

those needs "y focusin% attention on the unfulfilled needs/ "ut will not permanently

re%ress to the lower le#el. For instance/ a "usinessman at the esteem le#el who is

dia%nosed with cancer will spend a %reat deal of time concentratin% on his health

physiolo%ical needs9/ "ut will continue to #alue his work performance esteem needs9

and will likely return to work durin% periods of remission.

The lower four layers of the pyramid are what !aslow called :deficiency needs:

or :D5needs:3 physiolo%ical/ safety and security/ lo#e and "elon%in%/ and esteem. 0ith

the e ception of the lowest physiolo%ical9 needs/ if these :deficiency needs: are not met/

the "ody %i#es no physical indication "ut the indi#idual feels an ious and tense.

(http://en.wikipedia.org/wiki/Maslow !"s#hierarch$#of#needs)


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Personal Data

Name %2 t'e atient$ !r. LA/e$ +6 years old

Gender$ !ale

Address$ -ue#a Eci a

Civil Status$ Sin/le

Nati%nality$ Filipino

Reli/i%n$ )oman Catholic

(irt'day$

Date admitted$ 3anuary 4.& +,,5 6+$47 pm8

Admittin/ Dia/n%sis$ Paranoid $chi,ophrenia

!ist%ry %2 resent Illness

Patient has pre#ious admission at !ari#eles !ental Hospital. He was dischar%ed

from male ward on Decem"er/ 266


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sha"u/ few months prior to admission he was en%a%ed to a"used su"stances like alcohol

and ci%arettes. He started to "ecome #iolent and shouts to his parents. Few hours upon

admission/ he was saw lau%hin% "y him only/ "ecomes a%%ressi#e and always shoutin%.

His father took him to !!H hence the reason for his admission.

His condition "ecomes "etter and he was dischar%ed on &u%ust 1>/ 2661. 'ut he

was then readmitted on -o#em"er 1 / 2662 for the reason of he took thin%s from the

stores and insisted that it was his property. ;n the nest se#en succeedin% years/ he was in

and out of !!H with an admittin% dia%nosis of @ndifferentiated $chi,ophrenia. 'ut

early this year/ anuary >/ 266>/ he was a%ain readmitted with a new dia%nosis of

Paranoid $chi,ophrenia.

Family !ealt' and syc'iatric !ist%ry


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C'apter +

9ENTAL STATUS ASSESS9ENT

A) General Appearance

Criteria Day 1 Day 2 Day ( Day +ood %roomin% M

&ppropriate facial e pression M M M M

&ppropriate posture M M M M!aintains eye contact M M

Durin% nurse5patient interaction/ the patientNs %roomin% was not %ood prior to

mornin% care "ut on the later part he impro#es and shows %ood %roomin%. !ost of the

time/ he e hi"ited appropriate facial e pressions and posture durin% interactions. &t first/

he cannot display eye contact which may show lack of focused and interest on the topic.

&s days passes "y student nurse esta"lished trust on the patient and he maintains %ood

eye contact.

() 9%t%r (e'avi%r

Criteria Day 1 Day 2 Day ( Day +&utomatism M M M MHyperkinesthesia0a y Fle i"ilityCataple yCatalepsy$tereotypeCompulsionPsychomotor )etardationEchopra iaCatatonic $tupor Catatonic e citementTics and spasmsImpulsi#enessChoreiform mo#ements

&utomatism is defined as repeated purposeless "eha#iors often indicati#e of

an iety/ such as drummin% of fin%ers/ twistin% of locks of hair or tappin% of foot. &ll


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throu%h out the + day nurse5patient interaction/ the patient presented automatism. -o

other motor "eha#iors were noted.

C. $ensorium and Co%niti#e

Criteria Day 1 Day 2 Day ( Day +;rientation M M M M Time M M M M Place M M M M Person M M M MConcentration M M M M!emory M M M M )emote M M M M )ecent M M M M Immediate retention M M M M

$ensorium and co%nities consist of the assessment of orientation/ concentration/and memory. ;rientation refers to the clientNs reco%nition of person/ place and time. That

is/ knowin% who and where he or she is and the correct day/ date and year. Oide"eck/

Psychiatric !ental Health -ursin%9. ! em%ry is an or%anismKs mental a"ility to store/

retain and recall information which is di#ided into recent and remote memory. $hort5term

memory allows recall for a period of se#eral seconds to a minute without rehearsal.

*on%5term memory can store much lar%er ?uantities of information for potentially

unlimited duration sometimes a whole life span9.

Durin% the + day nurse5patient interaction/ patientNs orientation and memory are

sta"le. He can recall memories from the past and aware of the place/ who is he/ time/ day/

and year. 'ased from the a"o#e definition of memory/ he has an intact recollection of the

past e#ents in his life.

D) ercepti%n

Criteria Day 1 Day 2 Day ( Day +Hallucination Oisual ;lfactory &uditory Tactile

ustatory *iliputian
http://en.wikipedia.org/wiki/Mentalhttp://en.wikipedia.org/wiki/Mental


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IllusionsDelusions M M M M

In the most recent Dia%nostic and $tatistical !anual of !ental Disorders / a

delusion is defined as a false "elief "ased on incorrect inference a"out e ternal reality

that is firmly sustained despite what almost e#ery"ody else "elie#es and despite what

constitutes incontro#erti"le and o"#ious proof or e#idence to the contrary. The "elief is

not one ordinarily accepted "y other mem"ers of the personKs culture or su"culture.

From the 1 st up to + th day of nurse5patient interaction/ the patient manifest

presence of delusions wherein he always claims that he was the hus"and of $heryl

Cosim. ;ther perceptions were not noted.

E) Attitudes and (e'avi%r

Criteria Day 1 Day 2 Day ( Day +Cooperation M M M M;ut%oin% M M M M0ithdrawnE#asi#e$arcastic&%%ressi#ePerple ed

&pprehensi#e M M M M&rro%antDramatic$u"missi#eFearful$educti#e@ncooperati#eImpatient)esistantImpulsi#e

Attitude is a position of the "ody or manner of carryin% oneself. It is a position or

posture of the "ody appropriate to or e pressi#e of an action/ emotion

The patient e hi"ited cooperation in the whole duration of duty and a"le to

answers all ?uestions asked to him and participates in all acti#ities. It was also o"ser#ed
http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disordershttp://en.wikipedia.org/wiki/Culturehttp://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disordershttp://en.wikipedia.org/wiki/Culture


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that he was out%oin% with other patient and student nurse. He also shows

apprehensi#eness throu%hout the interaction.

F) De2ense 9ec'anism

Criteria Day 1 Day 2 Day ( Day +Denial M M)epression$uppression)ationali,ation M M)eaction Formation$u"limationCompensationPro ection

DisplacementIdentificationInter ectionCon#ersion$ym"oli,ationDissociation@ndoin%)e%ression$u"stitutionFantasy M M M M

De2ense mec'anisms are psycholo%ical strate%ies "rou%ht into play "y #arious

entities to cope with reality and to maintain self5ima%e. Healthy persons normally use

different defenses throu%hout life. &n e%o defense mechanism "ecomes patholo%ical only

when its persistent use leads to maladapti#e "eha#ior such that the physical and4or mental

health of the indi#idual is ad#ersely affected. The purpose of the E%o Defense

!echanisms is to protect the mind4self4e%o from an iety/ social sanctions or to pro#ide a

refu%e from a situation with which one cannot currently cope.

The patient manifests fantasy from day 1 to day + and shows also denial andreaction formation on the later days of interaction.

G) A22ective State

Criteria Day 1 Day 2 Day ( Day +Euphoria


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Flat affect M M'luntin%ElationE ultationEcstasy

&n ietyFear &m"i#alenceDepersonali,ationIrrita"ility)a%e*a"ilityDepression

&ffect is a %roupin% of physic phenomena manifestin% under the form of

emotions/ feelin%s or passions/ always followed "y impressions of pleasure or pain/satisfaction or discontentment / likin% or dislikin%/ oy or sorrow.

4www.cere"romente.or%9.

Flat a22ect$ & se#ere reduction in emotional e pressi#eness. People with

depression and schi,ophrenia often show flat affect. & person with schi,ophrenia may

not show the si%ns of normal emotion/ perhaps may speak in a monotonous #oice/ ha#e

diminished facial e pressions/ and appear e tremely apathetic. www.medterms.com9

The patient sometimes shows flat affect durin% the whole interaction.

!) Speec'

Criteria Day 1 Day 2 Day ( Day +Oer"i%eration)hymin%Punnin%!utism&phasia@nusual rates of speech

@nusual Oolume of speech@nusual Intonation@nusual !odulation

Speec' refers to the processes associated with the production and perception of

sounds used in spoken lan%ua%e.
http://www.medterms.com/script/main/art.asp?articlekey=342http://www.medterms.com/script/main/art.asp?articlekey=470http://www.medterms.com/script/main/art.asp?articlekey=470http://en.wikipedia.org/wiki/Speech_productionhttp://en.wikipedia.org/wiki/Speech_perceptionhttp://en.wikipedia.org/wiki/Soundshttp://en.wikipedia.org/wiki/Spoken_languagehttp://www.medterms.com/script/main/art.asp?articlekey=342http://www.medterms.com/script/main/art.asp?articlekey=470http://www.medterms.com/script/main/art.asp?articlekey=470http://en.wikipedia.org/wiki/Speech_productionhttp://en.wikipedia.org/wiki/Speech_perceptionhttp://en.wikipedia.org/wiki/Soundshttp://en.wikipedia.org/wiki/Spoken_language


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Durin% the interaction/ the patient does not show any alteration in his speech

pattern. He did not e perience #er"i%eration/ aphasia/ other speech pro"lems.

I) T'%u/'t r%cess and C%ntent

Criteria Day 1 Day 2 Day ( Day +'lockin%Fli%ht of Ideas0ord $aladPerser#eration

-eolo%ismCircumstantialityEcholalia

CondensationDelusion M M MPho"ia;"session M M M MHypochondriac

Durin% the first part of our nurse5patient interaction/ the patient shows delusion.He also manifested o"session wherein he keeps on insistin% that his wife is $heryl Cosimwho is a famous news anchor.


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C'apter 4

syc'%pat'%l%/y(%%1:(ased


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Client:(ased


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Related Literature and Studies


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0hat is $chi,ophreniaA

It is a mental illness which affects one person in e#ery hundred. $chi,ophrenia

interferes with the mental functionin% of a person and/ in the lon% term/ may cause

chan%es to a personKs personality.

First onset is usually in adolescence or early adulthood. It can de#elop in older

people/ "ut this is not nearly as common. $ome people may e perience only one or more

"rief episodes in their li#es. For others/ it may remain a recurrent or life5lon% condition.

The onset of illness may "e rapid/ with acute symptoms de#elopin% o#er se#eral

weeks/ or it may "e slow/ de#elopin% o#er months or e#en years. Durin% onset/ the

person often withdraws from others/ %ets depressed and an ious and de#elops e tremefears or o"sessions.

&lthou%h an e act definition of schi,ophrenia still e#ades medical researchers/ the

e#idence indicates more and more stron%ly that schi,ophrenia is a se#ere distur"ance of

the "rainKs functionin%. In The 'roken 'rain3 The 'iolo%ical )e#olution in Psychiatry/

Dr. -ancy &ndreasen states :The current e#idence concernin% the causes of

schi,ophrenia is a mosaic. It is ?uite clear that multiple factors are in#ol#ed.

These include chan%es in the chemistry of the "rain/ chan%es in the structure of

the "rain/ and %enetic factors. Oiral infections and head in uries may also play a

role....finally/ schi,ophrenia is pro"a"ly a %roup of related diseases/ some of which are

caused "y one factor and some "y another.: p. 2229.

There are "illions of ner#e cells in the "rain. Each ner#e cell has "ranches that

transmit and recei#e messa%es from other ner#e cells. The "ranches release chemicals/

called neurotransmitters/ which carry the messa%es from the end of one ner#e "ranch tothe cell "ody of another. In the "rain afflicted with schi,ophrenia/ somethin% %oes wron%

in this communication system.

$ometimes schi,ophrenia has a rapid or sudden onset. Oery dramatic chan%es in

"eha#iour occur o#er a few weeks or e#en a few days. $udden onset usually leads fairly


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?uickly to an acute episode. $ome people ha#e #ery few such attacks in a lifetime others

ha#e more. $ome people lead relati#ely normal li#es "etween episodes. ;thers find that

they are #ery listless. depressed/ and una"le to function well.

In some/ the illness may de#elop into what is known as chronic schi,ophrenia.

This is a se#ere/ lon%5lastin% disa"ility characteri,ed "y social withdrawal/ lack of

moti#ation/ depression/ and "lunted feelin%s. In addition/ moderate #ersions of acute

symptoms such as delusions and thou%ht disorder may "e present in the chronic disorder.

;'at are t'e sympt%ms %2 sc'i*%p'renia

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