A Case Study
Presented to the Faculty of
The Ateneo de Davao University
College of Nursing
A Case Study on
Schizophrenia Undifferentiated
Submitted to:Mrs. Anabel Bauzon, RN, MN
Clinical Instructor – Panelist of the Case StudySubmitted by: [Group 1]
Abarquez, Eva Rica V.
Ampilanon, Rae Maikko M.
Ausa, Ryan S.
Balboa, Tessa Marie R.
Batuhan, Katherene P.
Beltran, Maribel S.
Bulosan, Von Rainier S.
Cabonita, Kristi Ann J.
Campaner,Marie Allexis I.
BSN-3H
TABLE OF CONTENTS
Acknowledgement………..…..3
Introduction…………...……….…4
Objectives (General & Specific)………..……….….6
Personal Data………...……….9
Genogram……….………11
Anamnesis……….…...12
Theories of Development………...…24
Etiology and Symptomatology….……….……44
Psychodynamics………..………62
Mental Status Exam……….…..68
Multi Axial Assessment………..78
Nurse Patient Interaction ………..81
Complete Diagnosis………...…….101
Differential Diagnosis………....…104
Anatomy and Physiology……….…..……115
Doctor’s Order………...………126
Drug Study……….……130
Nursing Care plan ………..………149
Prognosis………..……...……176
Recommendations………..………...…………180
Significance of the Study………...………182
Appendices………..………...……183
ACKNOWLEDGEMENT
The group wishes to express their deepest gratitude and warmest appreciation to the following people, who, in any way gave us the possibility making this case study a success:
First of all, to the Almighty God, who never cease in loving us and for the continued guidance and protection.
To the group’s clinical instructor, Mrs. Apple V. Guiao, R.N,M.N for her guidance and support in the duration of the study and during the psychiatric nursing exposure , whose help, stimulating suggestions and encouragement helped us in all the time of making this case study. To Mrs. Zenaida Lagrosa RN, Mrs. Anabel Bauzon RN and Mr. Richard Cheng,RN for their unlimited patience, guidance and being with us during our psychiatric nursing exposure . Finally to Ms. Melba Irene Gabuya RN for imparting knowledge and learning experience during our lectures on Psychiatric nursing. Without their encouragement and constant guidance, our Psychiatric Nursing exposure would not have been a very meaningful learning experience.
The group also wishes to acknowledge the invaluable assistance and cooperation of the staff nurses of the Davao Mental Hospital (DMH), for allowing us to conduct this study, for essential assistance in reviewing the patient files and giving us the opportunity to care for the mentally-ill patients.
Special appreciation is extended to the client subjected for this study and other informants for their selfless cooperation, time and entrusting personal information needed for this study.
To the group, we would like to show our endless gratitude to each other by specifying our names; Maikz, Eva, Allexis, Kat, Bel, Kitty, Ryan, Tessa and Von; for the understanding, believing in each other, and teamwork. May we continue working hard for future studies.
And lastly, to our parents who have always been very understanding and supportive both financially and emotionally.
INTRODUCTION
Schizophrenia (from the Greek roots skhizein ("to split") and phrēn, 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. Simply stated, schizophrenia is one of the most profoundly disabling illnesses, mental or physical, that the nurse will ever encounter (Keltner, 2007). There are 5 subtypes of schizophrenia naming; paranoid, disorganized, catatonic, undifferentiated, and residual. Schizophrenia undifferentiated is the type of schizophrenia wherein characteristic symptoms (delusions. Hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms) are present, but criteria for paranoid, catatonic, or disorganized subtypes are not met.
Schizophrenia is not a terribly common disease but it can be a serious and chronic one. Worldwide about 1 percent of the population is diagnosed with schizophrenia. About 1.5 million people will be diagnosed with schizophrenia this year around the world. (mentalhelp.net). Ninety-five percent (95%) suffer a lifetime; thirty-three percent (33%) of all homeless Americans suffer from schizophrenia; fifty percent (50%) experience serious side effects from medications; and ten percent (10%) kill themselves (Keltner, 2007). According to study done 697,543 out of 86,241,697 of Filipinos or approximately 0.8% are suffering from schizophrenia (cureresearch.com). Here in Davao, Dr. Padilla said that the Davao Mental Hospital receives an average of eight to 10 patients a day suffering from schizophrenia, depression and bi-polar illnesses (Positivenewsmedia.net).
Schizophrenia Ranks among the top 10 causes of disability in developed countries worldwide (World Health Organization, www.who.int) Schizophrenia is a disease that typically begins in early adulthood; between the ages of 15 and 25. Men tend to get develop schizophrenia slightly earlier than women; whereas most males become ill between 16 and 25 years old, most females develop symptoms several years later, and the incidence in women is noticeably higher in women after age 30. The average age of onset is 18 in men and 25 in women. Schizophrenia onset is quite rare for people under 10 years of age, or over 40 years of age (schizophrenia.com).
The group 1 of BSN-3H was given opportunity to have a hospital exposure in Davao Mental Hospital last January 19 – 30, 2010 for their psychiatric exposure. It was on that said dates that the group found a creditable case sensible to be presented as case presentation as suggested their Clinical Instructor Apple V. Guiao, R.N. M.N. and was agreed by whole group.
The patient, Bob, not his real name, was one of the patients admitted to the Crisis Intervention Unit of Davao Mental Hospital due to Schizophrenia Undifferentiated. The group chose Bob as their subject primarily because his case posed as a very intricate case requiring due understanding and knowledge. Making this case is a good avenue to broaden the proponents’ knowledge about the mental illness involved.
OBJECTIVES
General Objective:
The main goal of the group is to be able to present an extensive and comprehensive case study of our chosen client that would present a comprehensive discussion of Schizophrenia Undifferentiated to yield important information for the case study.
Specific Objectives:
In order to meet the general objective, the group aims to: Cognitive:
• interpret the pertinent data gathered from the patient and his significant others;
• present the anamnesis by thorough gathering of the client’s pertinent personal data, appro-priate selection of informants, and familial history tracing;
• evaluate the developmental stage of the patient according to the theories of Erikson, Freud and Piaget;
• determine the etiology factors (precipitating and predisposing) of the mental disorder;
• evaluate the presence or absence of signs and symptoms seen in the patient in relation to the mental disorder;
• present the psychodynamics of the client’s diagnosis by recognizing its predisposing and precipitating factors with appropriate rationales; To track down the significant events dur-ing the client’s developmental stage as shown in the psychodynamics;
• Interpret and analyze nurse-patient interaction taken through spontaneous and effective use of therapeutic communication;
• thoroughly define the complete diagnosis of the patient;
• come up with a differential diagnosis with accord to the client’s maladaptive behaviors; • discuss thoroughly the Anatomy and Physiology of the involved organs and organ systems
in accord to the final diagnosis;
• present the doctor’s order with its rationalization;
• formulate effective, specific, measurable, attainable, realistic and time-bounded nursing care plans base on identified actual and potential nursing problems;
• arrive to a general realistic prognosis drawn from the information gathered and factors af-fecting the patient’s condition;
• provide the significance of the case study;
Psychomotor:
• gather pertinent data about the client through detailed chart taking, and effective therapeutic communication and interaction with the client and his significant others;
• commence the patient with his personal data and present and past health history;
• trace the health history of the client and family illnesses (past and present) through a genogram;
• assess client’s mental status thoroughly during the orientation and termination phase as well as the Multi-Axial diagnosis;
• present the medications given to the client, including their respective modes of action, indi-cations, contraindiindi-cations, side effects, adverse reactions, nursing responsibilities, and im-portance to the client’s condition;
• impart appropriate recommendations to the client, his significant others and community, medical world, and the group as a part of the nurse’s holistic care.
Affective:
• establish rapport to the patient and the patient’s significant others; and
• establish a trusting nurse-patient relationship with the client and his significant others through provision of holistic care toward the client and use of appropriate verbal and non-verbal therapeutic communication skills with the client and significant others during the data gathering;
PATIENT’S DATA PERSONAL DATA:
CODE NAME: Bob AGE: 40
SEX: Male
BIRTHDAY: April 9, 1969
BIRTHPLACE: Cagayan de Oro City
ADDRESS: Prk. 1 Rizalian, Bayugan Agusan del Sur Tulip Drive, Matina, Davao city ORDINAL RANK: 1st
CIVIL STATUS: Single NATIONALITY: Filipino RELIGION: Catholic
EDUCATIONAL ATTAINMENT: 2nd Year College undergraduate OCCUPATION: None
NUMBER OF CHILDREN: 0
NUMBER OF BROTHERS: 2 NUMBER OF SISTERS: 2 MOTHER: Aina
AGE: 58
EDUCATIONAL ATTAINEMNT: college undergraduate OCCUPATION: Businesswoman
FATHER: Danni
OCCUPATION: Businessman CLINICAL DATA:
WARD/SERVICE: Crisis Intervention Unit/Psychiatry
ADMITTING PHYSICIAN: GIOIA FE D. DINGLASAN, M.D ADMITTING DIAGNOSIS: Schizophrenia, undifferentiated PRINCIPAL DIAGNOSIS: Schizophrenia, undifferentiated DATE OF AMISSION: January 19, 2010
DATE OF DISCHARGE: January 21, 2010 INSTITUTION: Davao Mental Hospital
10 Legend: L - Male -- Female
∞
- schizophreniaΩ
- hypertension-
Ѳ
Diabetes†-
deceased Angelit o†
11 Legend: L - Male -- Female
∞
- schizophreniaΩ
- hypertension-
Ѳ
Diabetes Angelit o†
GENOGRAM Legend: L - Male -- Female
∞
- schizophreniaΩ
- hypertension-
Ѳ
Diabetes†-
deceased Super Lolo Ω†
Angelit o†
Super Lola†
as Angeli ta†
Apolinari o†
Watusi Ω†
Apolin aria Ω†
Watus a†
Gran Pa†
Gran Ma†
Lolo Al†
Lola Al Ω†
Emman 39 years old Dennz 26 years old Bob 40 years old∞
Carmz 31 years old Yose 20 years old Jeorgin o Aina 58 years old Fielit a Ѳ Ronan RonanaΩ
Danni 59 years old Leo†
LeaANAMNESIS A. INTERVIEWS
Informant #1 Name: Aina Age: 58
Address: Purok 1, Rizalian, Bayugan, Agusan del Sur Sex: Female
Civil Status: Married
Relationship to Client: Mother
Length of Time Known by the Patient: Since Birth up to Present (40 years) Apparent Understanding of the Present Illness of the Client:
According to Aina, her son, Bob, started having the condition when he stopped schooling in late August of 1987 and went back to Agusan because he thought lessons in school are becoming too difficult for him. Bob also verbalized that something is wrong with him and that he needed a psychological check-up. Yet, Aina did not pay attention to what he said; until two days after, Bob’s tongue shrunk, hindering his speech. This event forced Aina to bring Bob to San Pedro Hospital for a check-up. In San Pedro, no diagnoses indicating any mental illness resulted and they were asked to come back for a follow-up check up the following month. On November 1987, Aina brought Bob back to Davao City for a check-up but transferred to Davao Mental Hospital. There, Bob was diagnosed with Schizophrenia Catatonic Type and was admitted for two weeks; after which, he was discharged and was asked to go back to the hospital once a month for psychiatric evaluation and for monthly doses of a depot.
Aina says that Bob at times would show extreme hostility and wild behavior. She believes that Bob’s wild behavior which is the reason for his second admission in December 2007 and
current admission this January 2010 is due to Bob’s incompliance with the advices of the doctor to stop drinking coke, alcoholic beverages and smoking.
The current admission of Bob is already his third admission. Bob and Aina were only at the Davao Mental Hospital to have Bob’s monthly dose of his depot but Bob shouted at the doctor without any apparent reason, exhibiting extreme hostility and wild behavior. This action convinced the doctor that Bob may need a three-day admission at the CIU for observation. After which, he was then discharged
Characteristics and Attitude of Informant:
Sincerity and concern regarding the condition of the patient is highly evident in the verbal and non verbal cues of the informant during the interview. She looks straight to the eyes and is very cooperative all throughout the interview, trying her best to recall all events that took place in connection to the condition of her son.
Informant #2 Name: Emman Age: 39
Address: 162 Interior Tulip Drive, Matina, Davao City Sex: Male
Civil Status: Married
Relationship to Client: Brother
Length of Time Known by the Patient: Since Birth up to Present (39 years) Apparent Understanding of the Present Illness of the Client:
Emman said that the illness began when Bob went to Bukidnon in August 1987 to fetch him and go home with him to Agusan. On the night of Bob’s arrival, he started having a convulsion and
was given paracetamol. Hours later, Bob was caught eating his own feces and drinking urine from a potty. After the incident, they went home to Agusan. Since then, Bob started to think and talk illogically, displaying disorganized speech and delusions. Weeks later Bob was brought to Davao for a check-up, first as San Pedro then at DMH. Since then, Bob has always been visiting Davao Mental Hospital and was even admitted two times, one in November 1987 then in December 2007, prior to the recent admission.
Emman sees Bob’s condition rooted from that convulsion which took place in Bukidnon. As to the reason of the convulsion and the events that took place prior to the convulsion, the brother does not claim any knowledge.
Characteristics and Attitude of Informant:
Emman was very open and receptive to the group during the interview. He had shown efforts to recollect all salient points regarding the condition of his brother.
Informant #3 Name: Carmz Age: 18
Address: 162 Interior Tulip Drive, Matina, Davao City Sex: Female
Civil Status: Single
Relationship to Client: Sister
Length of Time Known by the Patient: Since Birth up to Present (18) Apparent Understanding of the Present Illness of the Client:
Mae understands Bob’s condition because she is a student nurse. According to her, Bob’s manifestations are indeed characteristics of schizophrenia. She believes that Bob’s condition will be
best improved if Bob follows all medication orders of the doctor and strictly avoid everything that the doctor prohibits him to take.
Characteristics and Attitude of Informant:
The informant was very responsive in the conversation, showing strong desire to tell the group everything that she knows about the illness of the patient.
Informant #4 Name: Mimi Age: 39
Address: 162 Interior Tulip Drive, Matina, Davao City Sex: Female
Civil Status: Married
Relationship to Client: Sister-in-law
Length of Time Known by the Patient: Since Marriage up to Present (20 years) Apparent Understanding of the Present Illness of the Client:
According to Mimi , the patient has been isolated and withdrawn since she first met him when she married his brother, Emman wayback in May of 1990, the patient was 21years old by then. She noted that Bob is irritating to the family members at times because there are instances wherein he seems to act like a child. She cited incidents wherein he wakes them up in the midnight because he was hungry and asks them for something to eat or drink. Bob also occasionally asks his mother to sleep with him at night. Taking this information to consideration, the sister-in-law concluded that, somehow, Bob is a burden to their family. She can see that the siblings of Bob have been exhausted in trying to understand him. Yet, in spite this, the family still show their invaluable support and love to Bob.
Characteristics of the informant:
The informant was open and hospitable to the group. She made ways for the group to contact the family and talk to other members of the family in order to gather data that she could not provide. The warm and welcoming attitude of the informant made it possible for the group to know more about the patient.
Informant #5 Name: Boy Age: 18
Address: 162 Tulip Drive, Matina, Davao City Sex: Male
Civil Status: Single
Relationship to Client: Nephew
Length of Time Known by the Patient: Since Birth up to Present (18) Apparent Understanding of the Present Illness of the Client:
Boy says that Bob’s condition was not improving. He said that what Bob’s actions now are the same as what he does in the past. He was always isolated, self-preserved and indifferent with others. He could even go for a whole day without talking to anybody and just watch TV. Boy also says that Bob’s strange actions like talking to the television, flight of ideas and hostile behaviors are not unusual of Bob anymore.
Characteristics of the informant:
Boy was at the first visit unresponsive to the questions asked by the group. However, on the next home visit, he volunteered to talk about what he knows about his uncle in a warm manner.
B. FAMILY HISTORY
a. Maternal and Paternal Lineage
Direct bilateral lineage of the patient show no conditions of mental illness. On the pater-nal side, prominent family illnesses only concern some members having hypertension. Aside from the condition, no other illnesses run the family. On the maternal line, no ill-ness were reported to run in the family, except one family member having diabetes mel-litus type 2, an illness condition occurring singularly to be considered familial. General-ly, no mental illness can be traced on both sides of the family.
b. Father
The father is 59 years old; a known small time businessman in their place at Agusan; owning a small rice mill enough to support the needs of his family. He is a Civil Engi-neering Undergraduate and was able to finish only until 3rd year of the above course, due to his early fatherly obligation. He impregnated the patient’s mother, when he was only 19 years old, then eloped with her, thwarting him to finish his studies then at the Univer-sity of Mindanao.
As a father, he was lenient in his relationship with his children. Most of his time is spent in their rice mill and would only go home in the afternoon or at night. Moreover, he is a kind of father who would not spank or scold his children and he seldom verbal-izes what he feels. He would only speak to his children wherever they do something in-correct.
c. Mother
The mother helps in their small rice mill. Pregnant at the age of 18, she was unable to finish her college education at the University of Mindanao. She was in her second year in college when she dropped out of her Chemical Engineering course.
The mother says that she brought her children up in discipline and love; she said she doesn’t spank her children because it does them no good. Like the father, she doesn’t also believe in punishing her children through spanking and the like when they do some-thing wrong.
However, as she states, she left her children to the care of nannies when they were young. And put her children in their house in Davao City to pursue their education from elementary school, leaving them, still with a nanny, and visiting them once a week. Ac-cording to her, this is the best way for her to offer the best education and life to her chil-dren and help improve their business in Agusan.
d. Siblings
The family is composed of five siblings; Bob being the eldest, followed by the sec-ond informant, Emman, then by Carmz, Denns and then Yose .
His relationship with his siblings is not so good. As a child, although they were the only ones that he would play with, he would still isolate himself when with them. He never shares his thoughts with them. Furthermore, when they grew up and the illness took place, the siblings gradually got irritated with him because of his hostility towards others.
III. Personality History a.) Prenatal
Being the result of the early pregnancy of his mother, the patient was an un-expected child. Only 18 when she was impregnated, the mother was not ready and did not know what to do, so she eloped with the patient’s father without giving her parents the knowledge as to the reason why she ran away. The mother stayed with the father’s family in Cagayan for the whole duration of her pregnancy.
On course of nine months, the mother has adequate prenatal check-ups at a nearby health center. Moreover, she was able to eat adequately because the parents of her husband supported them. They provided her with enough support for her preg-nancy.
b. Birth
Bob was born in the Provincial Hospital in Cagayan de Oro City on the 9th of April 1969 through Normal Spontaneous Vaginal Delivery. No complications took place in the delivery. The mother, Aina, described that her labor was very long, she started having labor pains in the morning and delivered in the afternoon. She did not also breastfeed the patient because she is having pain breastfeeding him and as re-ported, no breast milk would come out; so instead, she bottle fed the patient with a
formula milk in a timed manner. Moreover, she hired a nanny named Nena to look after the baby because she did not have any experience in taking care of a baby, con-sidering her age.
c. Infancy and Childhood Characteristics
After the birth, in June of 1969 Aina went back to Agusan to talk to her par-ents. She told them that she ran away because she was pregnant and apologized for everything that she has done. Her parents did accept her apology and welcomed her back. On the August of 1969, Aina and Danni married each other and decided to re-side in Agusan. Trying their luck in a new business, the couple got busy with their rice mill that they decided to leave Bob in the care of Nena, Bob’s nanny since birth, while they attend to their business.
The nanny was very caring to the child, cuddling him always and looking af-ter him. However, when Bob was almost five months, Nena went home to her prov-ince and was replaced by another nanny named Ging-ging.
Moreover, Aina instructed her nanny to continue the timed bottle feeding routine every three hours, a routine which continued until the patient was three years old. She instructed to feed the baby every three hours, believing that this would help the nanny attend to other tasks while taking care of the baby. In cases that the baby would cry Ging-ging would just give him a pacifier for him to stop crying.
Bob was toilet trained when he was 2 years old. Toilet training was mostly implemented by the nanny Ging-ging, and she is not strict in it. As he had a nanny, Aina instructed the Ging-ging to teach him to urinate and defecate in a potty because
it irritates her to find urine and stool just anywhere. Aina is very strict in toilet train-ing. But on instances that Bob would pee or defecate anywhere, Ging-ging would just clean the mess, not correcting Bob. Bob started talking when he was a year old and started walking on that certain age more or less as reported.
As to the strategies and the relationship of the nanny to the child, the mother did not exactly describe because according to her, she changed nannies several times. According to her, the relationship of the nanny was not so important to her as long as the needs of her children are met and her children’s safety is not harmed. She care-fully instructed the nannies to give to the children everything they want to keep them from having tantrums that could hinder the nanny from doing other household chores.
The mother could not remember whether or not the patient’s immunization is complete; but what she does remember is that the patient had measles before he was one year old.
d. Psychosexual History
The patient’s sexual awareness started when he was 16 years old, on his 4th year in high school. It was on this time that he started having a crush and actually had a girl-friend who after sometime broke up with him. This break-up with his only girlgirl-friend bagged down his self esteem. In addition, his mother also keeps on teasinf him that his girlfriend’s teeth resembles that of a rat which further decreased his self-confidence and esteem as he tried to compare himself with the boys of his age.
e. Play Life
Bob does not engage so much in cooperative play and prefers solitary play. He would only sit by himself and play alone in a corner. His playmates were his siblings and would choose to play only in their yard. As a child, he is not talkative, he is uncoopera-tive and becomes aggressive when forced to play with other kids. Furthermore, he likes being a follower in a game rather than a leader.
f. School History
The patient began preschool in June of 1974, when he was five years old where he was sent to Davao to study at Assumption up to second grade. He stayed in their resi-dence in Davao which is in 162, Interior Tulip Drive, Matina, Davao City. He stayed in Davao together with his brother Emman and their nanny. The first days in school were terrible for Bob, he would cry inside their classroom and would not separate from his nanny. In his third grade, he was transferred to Our Lady of Fatima School, which he did not really approve that he cries in between classes just to be sent home. He is withdrawn from the rest of his classmates and would talk only to a few people. His grades were also affected by his isolation, he did not perform well in school and was not interested in studying.
He spent his high school days still at Fatima. In June of 1982, when he is 13 years old, he entered first year highschool, where he formed new set of friends which he grew much attached to. These friends of him were not of good influence because when they started hanging out, he began cutting classes, extorting money from his parents and hav-ing low grades. He started drinkhav-ing and smokhav-ing. Also, he started ushav-ing marijuana.
His bad school records started worsening when his girlfriend in his fourth year high school broke up with him, these events pulled his confidence down, that he started iso-lating himself and increased his use of marijuana, drinking and smoking. Yet he is able to graduate from high school in the March of 1986.
Troubles in school were rampant, being evident even when he is already in college. He was occasionally caught brawling with classmates. Furthermore, his mother was once called by the Guidance Office because he threw an eraser to his teacher because the eras-er hit him when the teacheras-er threw the eras-eraseras-er at his classmate. He was also suspected of using marijuana during this time but is persistently denying the accusations, although it was really true. Peer pressure can be seen as a great contributing factor in his use of mar-ijuana because his friends would tease him when he refuses to use marmar-ijuana.
In his college days, he spent his two years of college education at the University of Mindanao, in the Civil Engineering course. However, he did not have good grades and still continued cutting classes and indulging in his vices. On his second year, he fi-nally decided to stop, claiming that he is already having difficulty catching up with the lessons.
g. Religious and Social Adaptability
The family is Roman Catholic. However, when he was in college, their family con-verted to Seventh-day Adventists. However, the patient still follows the Catholic Faith and does not go to Seventh-day Adventist religious celebrations.
When the patient stopped studying during his second year in college, late in the Au-gust of 1987, he stayed in Agusan and helped in their rice mill business. There, he would help in the loading and unloading sacks of rice and also in operating the mill. Bob doesn’t get regular salary because what he gets is ten percent of the day’s income.
i. Marital History
The patient is single. However, he is looking forward to marrying someday. Accord-ing to his verbalizations, he wants to be married so badly that he would even marry their maid at home. According to him, he already told the maid that he wanted to marry her, but unfortunately, after telling her, the maid ran away.
j. Onset of the present illness
The recent admission is already the third admission of Bob. Recurrence of hostile be-havior is the primary reason why Bob was admitted for three days in the CIU of Davao Mental Hospital. He suddenly shouted at a doctor in the hospital upon having his month-ly depot injection and check-up.
THEORIES OF DEVELOPMENT
These are just a few of the fascinating aspects of the field of “human development”: the science that studies how we learn and develop psychologically, from birth to the end of life. This very young science not only enables us to understand how each individual develops, it also gives us profound insights into who we are as adults. Each theory has its own perspective on the development of man.
ERIK ERIKSON’S PSYCHOSOCIAL STAGES OF DEVELOPMENT
The Psychosocial Stages of Development developed by Erikson enumerates eight stages though which healthily developing human should pass from infancy to late adulthood. Every stage describes a task to be accomplished. These development stages can be seen as a series of crisis and each stage forms on the successful accomplishment of the earlier stages. Successful resolution of these crises supports a healthy self-development. Failure to resolve the crises damages the ego and maybe expected to reappear as problems in the future.
LIFE STAGE INDICATORS OF POSITIVE RESOLUTION INDICATORS OF NEGATIVE RESOLUTION ASSESSMENT JUSTIFICATION Infancy (birth to 1 year) Central task: Trust vs. Mistrust
The first stage, centers on the infant's basic Learning how to trust others Mistrust, withdrawal, estrangement
Mistrust Aina, his mother, did not breastfeed Bob because she is
having pain
breastfeeding him and as reported and no breast milk would come out; so instead, she bottle fed the patient in a
needs being met by the parents. The infant depends on the parents, especially the mother, for food, sustenance, and comfort. If the parents expose the child to warmth and dependable affection, the infant's view of the world will be one of trust. But if the caregivers are neglectful, the infant instead learns mistrust- that the world is
in an
unpredictable and an unsafe place.
timed manner. She would feed the baby every three hours, believing that this would train the baby to be disciplined.
Moreover, she hired a Yaya Nena to look after the baby because she did not
have any
experience in taking care of a baby, considering her age. After 5 months on the service, Yaya Nena left and Yaya Ging-ging took over her place in taking care of Bob. Because Bob was given not enough attention and left under a care of a nanny he had built a sense of mistrust to his parents. He has not been fed well since he’s being fed in a timed manner, he hasn’t feel the
sense of comfort since his parents haven’t been there for him to cuddle him when he’s crying or to play with him when necessary.
Early Childhood (2 to 3 years) Central task: Autonomy vs. Shame & Doubt If caregivers encourage self-sufficient behavior, child develops a sense of autonomy- a sense of being able to handle many things on their own. But if caregivers
demand too
much too soon, refuse to let children perform tasks of which they are capable; children may instead develop Self- control without loss of self –esteem; ability to cooperate and express oneself Compulsive self-discipline Or compliance; willfulness and defiance
Shame and doubt The patient started talking when he was 1 year old and started walking on that age as well. The patient was toilet trained when he was 2 years old. As he had a nanny (Yaya Ging-ging),
the mother
instructed Yaya Ging-ging to teach him to urinate and defecate in a potty because it irritates his mother to find urine and stool just anywhere, she was too demanding that the child will learn how to toilet train right away. On the other hand, Yaya Ging-ging doesn’t
shame and doubt about their ability to handle things.
train him well; she has not disciplined the child well if the
child pees
anywhere because of the unstrict training Yaya Ging-ging implemented on Bob. The child was unable to master this kind of task in this stage, since he developed the sense of shame and doubt in which he was unable to handle things because of the different
implementation of the nanny and his mother. Late Childhood (4 to 6 years) Central task: Initiative vs. Guilt During this stage, the child learns to take initiative and get
ready for Learning degree of assertiveness and purpose influence the environment; begins to evaluate one’s own behavior. Lack of self confidence; pessimistic and over restriction of own activity
Guilt The client does not
engage much
cooperative play and prefers solitary play. He would only sit and play alone in a corner. According to his mother and brother, he’s a silent type of person, he’s not
leadership and goal achievement roles. If adults encourage and support children’s efforts, while also helping them make realistic and proper choices, children develop initiative- independence in planning and undertaking activities. But if, adults discourage the search of independent activities,
children develop guilt about their
needs and
desires.
talkative. He likes playing with his bike and would play only in their yard together with his siblings.
As verbalized by the mother, when playing, he was a follower. School Age (7 to 12 years) Central Task: Industry vs. Inferiority Developing sense of competence and perseverance Sense of being mediocre; withdrawal from peers and school.
Inferiority He attended his nursery until Grade 2 in Holy Cross of Davao College. When he was grade 3, he transferred at
At this stage, children are eager to learn and accomplish more complex skills: reading, writing, telling time. If children are encouraged to make and do things and are then praised for their accomplishments , they begin to demonstrate industry by being diligent, persevering at tasks until completed and putting work before pleasure. If children are instead ridiculed or punished for their efforts or if they find they are incapable of meeting their teachers' and
Our Lady of Fatima School. There, he again developed a separation anxiety, as he needed to leave his old friends, teachers and classmates. He was a silent type of person and not very cooperative and expressive. He withdraws himself with his classmates, he only have few friends due to lack of interaction with them. He also displays poor performance in school and uninterested with his studies. He has not met the expectations of his parents from him, which is to do well in his studies.
parents' expectations, they develop feelings of inferiority about their capabilities. Adolescence (13 to 19 years) Central Task: Identity vs. Role Confusion The adolescent is newly concerned with how they appear to others. The sense of central identity appears through sexual, emotional, educational, ethnic, cultural, and vocational discovery. The adolescent person also develops coherent sense of self and plans to actualize one’s abilities. The sense of self can
Sense of self and plans to actualize one’s abilities Feelings of confusion, hesitancy, and possible antisocial behavior
Role Confusion At this stage the client had his first year high school at Holy Cross College of Davao and later
on, they’ve
transferred to Cebu, he enrolled himself to Cebu Avillana High School, and there, due to being a shy type, he had not gained new friends. A certain group of people make friends with him but they were bad influence. He started drinking and smoking because of peer pressure. Also, he started using marijuana, when they have group sessions he’s cutting his class and
be confused if a core identity does not solidify. Feelings of confusion, hesitancy, and possible antisocial behavior may also emerge.
because of his vices he always got low grades. When he was 4th year high school (16 years old), he met his first love and became his girlfriend, but when he brought her at home, her girlfriend was being criticized by his mother to have big front teeth which are similar to a rat, this incident bagged down his self-esteem. He spent his two years of college education at the University of Mindanao, in the Civil Engineering course. However, he did not have good grades and still continued cutting classes and indulging in his vices and finally stopped studying when he was in 2nd year high school
due to difficulty in catching up with his lessons. Early Adulthood (20 to 34 years) Central Task: Intimacy vs. Isolation Once people have established their identities, they are ready to make long-term commitments to others. They become capable of forming intimate, reciprocal relationships and willingly make the sacrifices and compromises that such relationships require. If people cannot form these intimate relationships--a sense of isolation may result. Intimate relationship with another person and has a sense of commitment to work and relationships Avoidance of relationship, career or lifestyle commitments
Isolation After the
relationship he had, though crushing with other girls, he never developed another intimate relationship with another woman. He had not form intimate
relationships with friends, though he considers people to be his friends, he didn’t trust them enough. He felt that he’s being envied by his friends. He continues to isolate himself from others.
Adulthood ( 35 to 65 years) Central task: Generativity vs. Stagnation During middle age the primary developmental task is one of contributing to society and helping to guide future generations. When a person makes a contribution during this period, perhaps by raising a family or working toward the betterment of society, a sense of generativity- a sense of productivity and accomplishment- results. In contrast, a person who is self-centered and towards the betterment of the society; being productive productivity; not helping society to move forward productive due to his illness. He’s being dependent to his family, though generating small income for helping in the Rice Mill, but still he’s not being productive because the little money he earned is being wasted for buying what is being prohibited for him to be used, like marijuana and cigarettes that contributes in worsening his illness. He has no own family to support that’s why he wasted his money for his own wants.
When he had free time, he went to the plazas or parks to eat or drink. He also loves to watch television shows. The client
unable or unwilling to help society move forward develops a feeling of stagnation- dissatisfaction with the relative
lack of
productivity. A person in this stage should have time for companionship and recreation. He also knows his
responsibilities and knows that he is accountable of whatever actions he takes.
also adapt to his physical changes in his body and accepted this as part of him, about his disease, he hasn’t understand this fully and needs further explanation for him to understand. And as a Filipino citizen, he has done his part in becoming a good citizen, he is a registered voter and planned to vote for Noynoy Aquino in the coming election period, in a way
he’s being
productive because he has done his duty for the betterment of the country. But still, he’s not helping the country to move forward since he had violated the Republic Act 6425 or the Dangerous
Drug Act of 1972, Article III, Sec. 8 which is regarding the usage of the prohibited drugs.
SIGMUND FREUD’S PSYCHOSEXUAL THEORY
The concept posits that from birth human have intellectual sexual appetites (libido) which unfold in a series of stages. Each stage is characterized by erogenous zone that is the source of libidinal drive during that certain stage.
LIFE STAGE CHARACTERISTICS IMPLICATIONS ASSESSMENT JUSTIFICATION Oral (Birth to 1
1/2 year)
The center of pleasure is the mouth; it is the major source of
pleasure and
satisfaction and exploration. The child’s primary need is security or safety. Major conflict: weaning Feeding produces pleasure, a sense of comfort or ease and safety. Feeding should be pleasurable, it should be provided when necessary. NOT ACHIEVED Though the mother, Aina, doesn’t breastfed her child because she felt that it is painful, still he feds Bob through bottle-feeding but in a timed manner which is every 3 hours. ANAL (1 1/2 to 3 years) The sources of pleasure are the anus and the bladder (sensual satisfaction, self control).
Major conflict: toilet training.
Controlling and expelling feces give pleasure and sense of comfort. Toilet training should be a pleasurable experience. NOT ACHIEVED Toilet training was not strict. Bob was toilet trained by his nanny which was instructed by his mother to instruct him to defecate in
a potty. Her nanny, Yaya Ging-ging was not able to implement well the instructions of her Ma’am Aina, the mother of Bob, Bob was still urinating and defecating everywhere. Yaya Ging-ging was not able to discipline Bob well when it comes to toilet training. PHALLIC (4-6 years)
The genitals are the center of gratification. Masturbation offer pleasure to the child. Other actions include fantasy,
experimentation with peers, and questioning of adults about sexual issues or sexual matter.
Major conflicts: the Oedipus Complex (refers to the male child's attraction for
The child
determines together with the parent of the opposite sex and later takes on a love relationship outside the family.
ACHIEVED At this stage, he was able to learn that a boy is for a girl, and a girl is for a boy.
his mother and unfriendly attitudes towards his father) and Electra Complex (refers to the female's attraction for her father and sees her mother as her rival), which resolves when the child identifies when the child identifies with parent of same sex.
LATENCY (6
years to
puberty)
Energy is heading for
physical and
intellectual activities. Sexual impulses tend to be repressed. Develop relationships between peers of the same sex.
Encourage child with physical and intellectual pursuits. Encourage sports and other activities with same-sex peers. NOT ACHIEVED He started to go to school by this time; he had gained few
friends and few playmates
because he
prefers himself to be alone. He isolates himself to his peers. He had
not been
performing well to school and uninterested to study his lessons. Genital
(puberty and after)
Energy is directed toward full sexual maturity and function
Encourage separation from parents, being NOT ACHIEVED He is not independent, until now , he still
and development of skills needed to cope with the environment.
independent and able to make right and good decisions
lives with his parents and being dependent to them, especially when it comes to his basic needs and as well as to meet his personal needs to gratify his desires, like asking money to have sexual gratification together with some GROs and to buy marijuana or cigarettes. He’s not matured when it comes to his sexuality.
JEAN PIAGET’S STAGES OF COGNITIVE DEVELOPMENT
This theory pertains to the nature and development of human intelligence.
LIFE STAGE CHARACTERISTICS ASSESSMENT JUSTIFICATION
Sensorimotor Thought (birth-2years)
• In this stage, in-fants build an un-derstanding of the world by coordi-nating sensory
ex-ACHIEVED The client as an infant was not being breastfed by her mother; he was fed with the use of the
periences (such as seeing and hear-ing) with physical, motoric actions. Infants gain knowledge of the world from the physical actions they perform on it. An infant pro-gresses from re-flexive, instinctual action at birth to the beginning of symbolic thought toward the end of the stage.
• Thought derives from sensation and movement.
• The child learns that he is separat-ed from his envi-ronment and that aspects of his en-vironment contin-ues to exist even they may be out-side the reach of his senses.
bottle, when giving the bottle, the infant Bob grasp it as a response of his hungriness. The mother, at times, gives him a pacifier when the child is crying thus fulfilling the child’s wants.
Preoperational Thought (2-7 years)
• Thinking is still egocentric: has
ACHIEVED At this age, was fond of drawing that
difficulty taking the point of view of others.
• The children begin to represent the world with images and words. Sym-bolic thought goes further than con-nections of senso-ry information and physical action.
• Objects are classi-fied in simple ways, especially by significant fea-ture; the child isn’t able to conceptual-ize abstractly.
represents his ideas. He also draws to show what is inside of him, to express his feelings through images that he creates.
Concrete Operational Thought (7-12 years)
• The child starts to think abstractly and conceptualize, forming logical structures that ex-plains his or her physical experi-ences.
• Children can exe-cute operations and logical reason-ing replaces intu-itive thought as
NOT ACHIEVED Bob does not know how to arrange his things systematically or in order depending on its size, shape or
any other
characteristics; he’s disorganized when it comes to his things.
long as reasoning can be applied to specific or con-crete examples. • Children show thinking is decen-tered -they consid-er multiple aspects of the problem (e.g. understand-ing the signifi-cance of height and width). They focus on the dy-namic change in the problem. And, most importantly, they show the re-versibility of true mental operation. Formal Operational
Thought (12 years and above)
• The person is ca-pable of deductive and hypothetical reasoning.
• The logical quality of the adolescent's thought is when children are more likely to solve problems in a tri-al-and-error fash-ion.
ACHIEVED During this stage, the client was able to understand what love means .He shared about his plans about getting married in the future if given a chance; he really wanted to marry their helper, according to him. Though he never courted the girl, he
• During this stage the young adult is able to understand such things as love, "shades of gray", logical proofs and values.
• During this stage the young adult begins to entertain possibilities for the future and is fascinated with what they can be.
• At this stage, they can also reason logically and draw conclusion from what information is available.
just directly asked her to marry him but the woman refused to answer him and went home to their hometown.
In addition to that, when asked, “Kung makakita ka ug pitaka na punog kwarta, unsaon man nimo ang pitaka, iuli o gastuhon ang kwarta?”; he then replied “Iuli nako, kay basig kailangan sa tag-iya ang kwarta.” He was able to draw conclusion from the given situation available.
ETIOLOGY AND SYMPTOMATOLOGY
A. ETIOLOGY
Predisposing Factors
Present/ Absent Rationale Justification
Family History Absent Individuals with
schizophrenia seem to inherit a predisposition to the disorder because schizophrenia runs in families. The relatives of
individuals with
schizophrenia have a greater incidence of the disorder than chance would allow. Although an amazing amount of resources have been directed at finding the
genetic cause of
schizophrenia, the results are far from specific. In fact, almost every
Schizophrenia is not present in any of the family members of the patient in both paternal and maternal lineages.
chromosome has been linked with schizophrenia. Keltner, N. Psychiatric Nursing. Chapter 4.
Neurostructural Anomalies
Absent The theorists have
proposed that
schizophrenia, is a direct
effect of three
nuerostructural defects. Ventricular enlargement, brain atrophy and dysfunctional cerebral blood flow. These anatomical anomalies in the brain play a major role in the illness.
Keltner, N. Psychiatric Nursing. Chapter 4.
The patient’s chart did not show any laboratory results to confirm the existence of such anomalies if such are present in the patient.
Precipitating Factors
Present/ Absent Rationale Justification
Intake of drugs,
substances or
chemicals which increase levels of dopamine.
Present Dopamine is known to be the neurotransmitter which is prominently affecting the occurrence of schizophrenia. In patients
The patient admittedly takes marijuana since he was thirteen. All informants also concur that the patient is
with schizophrenia, dopamine levels are invariably high. Therefore, intake or use of drugs, substances and chemicals which promote the elevation of dopamine levels in the brain would trigger schizophrenia. Example of these are levodopa, ampethamines and marijuana. Keltner, N. Psychiatric Nursing. Chapter 4. indeed using marijuana.
Perinatal Factors Absent Some researchers believe that schizophrenia can be linked to perinatal exposure to influenza, birth during winter, exposure to lead, minor malformations during early gestation, exposure to viruses from house cats and complications of pregnancy, particularly
The mother did not
report any
abnormalities and complications during her pregnancy and birth. The mother also verbalized no exposure to any infections during her pregnancy.
during labor and delivery. Keltner, N. Psychiatric Nursing. Chapter 4.
Developmental Factors
Present Developmental factors include the internal reaction of an individual to life stressors or conflicts. Three theorists could be considered here: Meyer, Freud and Erikson. For Meyer, events in early life can cause problems that are as severe as schizophrenia. For Freud, developmental factors include poor ego boundaries, fragile ego,
inadequate ego
development, superego dominance, regressed or id behavior, ambivalent relationships and arrested psychosexual
development. Furthermore, Erikson believed that
There are some stages of development according to Erikson that the patient did not successfully meet.
eight-stage model of human development starting from Trust Vs. Mistrust highly influences development of the
condition. The
accomplishment or failure in the levels affect a person’s developmental aspect.
Keltner,N. Psychiatric Nursing. Chapter pp. Convulsion Present Convulsion, in medicine,
series of involuntary con-tractions of the voluntary muscles. The eyeballs fre-quently roll upward or to one side during a convul-sion; breathing appears la-bored, and saliva oozes from the mouth. The teeth usually are tightly clenched, sometimes caus-ing serious bites to the
The patient had a convulsion when he was 18 years old. Informants have attested that after the incident, the patient started having odd
behavior and
disturbance in thought process.
tongue and the cheeks. Convulsions are a common symptom of epilepsy. They also occur in young chil-dren as a part of the reac-tion of the body to infec-tion. Such convulsions, called febrile convulsions, usually last only a few minutes and are not dan-gerous. Other causes of convulsions are virus in-fections; brain tumors or hemorrhages; toxemias, such as uremia or lead or cocaine poisoning; chemi-cal disorders, such as hy-poglycemia; and acute or chronic alcoholism. A doc-tor should be notified whenever a convulsion oc-curs. Until the arrival of a physician, emergency treatment is directed
to-ward protection of the vic-tim from biting or other forms of self-injury. Anti-convulsant drugs include diazepam, phenobarbital, and phenytoin.
A convulsion may have a significant effect in an in-dividual due to restriction of brain oxygenation in the occurrence of the convul-sion. Damage to brain tis-sues range from mild to se-vere depending on the type of convulsion and how long. Furthermore, brain cell damage is irreversible. Microsoft ® Encarta ® 2009. © 1993-2008 Micro-soft Corporation. All rights reserved.
B. SYMPTOMATOLOGY
nt
OBJECTIVE SIGNS
A. Alterations in Personal Relationships Decreased attention to appearance and social amenities related to introspection and autism.
Present Frequently, patients become less concerned with their appearance and might not bathe without persistent prodding. Table manners and other social skills might diminish to the point that the patient becomes disgusting to others.
Keltner, N. Psychiatric Nursing.
The patient has troubled relationship with other people.
Inadequate or inappropriate communication
Present Patients with schizophrenia have troubled personal relationships. Often, these problems develop over a long period, well before schizophrenia is diagnosed, and become more pronounced as the illness progresses. It is not uncommon to hear that a person was asocial, loner or a social misfit before being diagnosed.
Keltner, N. Psychiatric Nursing.
Communication skills of the patient show constant incoherent statements,
circumstantiality, tangentiality and the like which are highly indicative of inadequate and inappropriate communication.
Hostility Present Hostility can also be a common theme, which distances patient from others.
Keltner, N. Psychiatric Nursing.
As the illness progresses the hostility became ap-parent in the patient. The patient has tantrums, confronting people with no apparent reason, tum-bling tables and chairs and wants to hit people. Withdrawal Present Patients with schizophrenia
withdraw, which further
compromises their ability to engage in meaningful activities.
Keltner, N. Psychiatric Nursing
As the informant could remember the patient prefers solitary play in his childhood. Moreover in his adolescence he would hangout with a few friends. Patient has diminished or lost inter-est in communicating with people.
B. Alterations in Activity Psychomotor
retardation
Absent Psychomotor retardation, the markedly slow speech and body movements which occurs as a symptom of schizophrenia
Keltner, N. Psychiatric Nursing
The patient did not exhibit this symptom. Catatonic rigidity Absent Patients with schizophrenia also display
alterations of activity. They may be too active or they may be inactive or catatonic.
The patient did not exhibit this symptom
Keltner, N. Psychiatric Nursing
SUBJECTIVE SIGNS
A. Altered Perception
Hallucinations Present Hallucinations which are false sensory perceptions, which can be auditory, visual, tactile, gustatory or somatic . Hallucinations are
probably caused by
hyperdopaminergic state in the limbic areas.
Keltner, N. Psychiatric Nursing
Hallucinations, espe-cially those which are auditory in form is highly evident in the verbalizations of the patient and also in his actions as described by the informants.
Illusions Absent Illusions are misinterpretations of stimuli. Like hallucinations, illusions also occur as a result of hyperdopaminergic state in limbic areas.
books.google.com.ph/books? isbn=0471245313
The patient does not ex-hibit this symptom.
Paranoid thinking Present Suspiciousness of others and their actions also occur as a symptom of schizophrenia which happens due to the alteration of the normal perceptual pattern of an individual
In connection to perse-cutory delusions of the patient, he is becoming suspicious and distrust-ful of people around
affected by the condition. www.asialink.unimelb.edu.au
him. He is in deep be-lief that people are out there trying to kill him, thus, he becomes para-noid.
B. Alterations of Thought
Loose associations Present This is the stringing together of unrelated topics with vague connection. This occurs as a result of the altered thought process in individuals with schizophrenia.
Keltner, N. Psychiatric Nursing.
Loose associa-tions can be traced in many of the state-ments made by the patient in conversations. Details which do not have anything to do with the topic are being men-tioned by the patient. Retardation Absent Retardation is the slowing of mental
activity, which is also a direct effect of thought process alterations in individuals affected by schizophrenia.
This symptom is not exhibited by the patient.
Keltner, N. Psychiatric Nursing.
Blocking Present Blocking is the interruption of a thought and inability to recall it. Blocking may be caused by the intrusion of hallucinations, delusions or emotional factors.
Keltner, N. Psychiatric Nursing.
Blocking is ap-parent in con-versations with the patient. There are sev-eral instances wherein he would sudden-ly stop right in the middle of a conversation. Ambivalence Absent Ambivalence is a state in which two
opposite strong feelings exist simultaneously. Schizophrenic patients may be immobilized by their ambivalence regarding a matter as simple as deciding whether to drink an apple juice or an orange juice.
Keltner, N. Psychiatric Nursing.
This symptom is not exhibited by the patient.
Delusions Present Delusions are fixed false beliefs and can take many forms. Delusions are defined as false belief firmly held by a person even
Persecutory delusions are highly evident
though other people recognize the belief as obviously untrue. For example, a person who truly believes he is Napoleon Bonaparte is delusional. Religious beliefs or popular conceptions, such as the belief that people have been abducted by aliens, are not delu-sions because they are widely held beliefs. Delusions are a type of psychotic symptom that indicate a person has lost contact with reality (see Psychosis).
There are many different types of delusions. A person with a paranoid delusion believes that others—such as the FBI, CIA, or the Mafia—are trying to harm or plot against him or her. A person with a delusion of ref-erence believes that events or people refer specifically to him or her when they do not. For example, a woman with schizophrenia may believe that a television news broad-caster is talking personally to her rather than to the entire viewing audience. A grandiose delusion is a belief that one is extremely fa-mous or that one has special powers, such as
in the patient’s verbalizations and actions de-scribed by the informants.
the ability to magically heal people Keltner, N. Psychiatric Nursing. en.wikipedia.org/wiki/Delusion
Poverty of Speech Absent Poverty of speech is manifested by the inability to formulate and articulate thoughts that are relevant to the discussion at hand. This is also highly connected in the alterations of thought process taking place in individuals with schizophrenia.
Keltner, N. Psychiatric Nursing.
This is not manifested by the patient.
Ideas of Reference
Absent Ideas of reference and delusions of reference involve people having a belief or perception that irrelevant, unrelated or innocuous phenomena in the world refer to them directly or have special personal significance. In psychiatry, delusions of reference form part of the diagnostic criteria for psychotic illnesses such as schizophrenia during the elevated stages of mania.
Keltner, N. Psychiatric Nursing.
This is not ex-hibited by the patient.
Autism Absent Autism occurs when patients are so introspective that they are distracted from external events. Patients become preoccupied with themselves and may be
This is not manifested by the patient
oblivious to the reality around them.This results in a personalized view of reality. Keltner, N. Psychiatric Nursing. C. Altered Consciousness
Confusion Present Confusion is an anxiety-producing symptom that is associated with psychosis. Keltner, N. Psychiatric Nursing.
Disorientation to time is evi-dent in the tient. The pa-tient is obvi-ously confused as to the time and chronolog-ical arrange-ment of events in his life. Incoherent Speech
Present Like confusion, incoherent speech is also a direct effect of schizophrenia in the functioning of an affected individual.
Keltner, N. Psychiatric Nursing.
The patient displays inco-herent speech as evidenced by the disorga-nization of thoughts and flight of ideas which are il-logical to
fol-low.
D. Alterations in Affect Inappropriate,
blunted, flattened or labile
Absent Affective flattening, inappropriateness, lability are affective symptoms sometimes associated with schizophrenia. They often respond to antipsychotic drug. Flat affect is a cardinal symptom of negative schizophrenia and may only respond to an atypical antipsychotic drug.
Keltner, N. Psychiatric Nursing.
This is not manifested by the patient.
Apathy Absent Apathy is another symptom associated with the affective alterations brought about by schizophrenia. It can be defined as a lack of concern or interest. It is the inability to generate a normal response to people, situations or the environment.
Keltner, N. Psychiatric Nursing.
This is not manifested by the patient.
Overreaction Present Because of emotional limitations, the schizophrenic patients overreact to normal events to overcome mental and social inertia. Keltner, N. Psychiatric Nursing.
The patient overreacts to normal situa-tions. The in-formants ver-balized that the
patient overre-acts even in simple televi-sion shows. Anhedonia Absent Anhedonia is the inability to experience
pleasure which is highly associated with the detrimental effects of schizophrenia in the affect of individuals suffering from schizophrenia. Keltner, N. Psychiatric Nursing.
This is not manifested by the patient.
