Paranoid Schizophrenia - Case Study

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Paranoid

Schizophrenia

A Case Study

Presented to the Faculty of College of Nursing and Midwifery Bataan Peninsula State University

In Partial Fulfillment

For the Requirement in the Degree of Bachelor of Science in Nursing

Alonzo, Mizzy Anne Angulo, Louie Anne Antonio, John Andrew

Barros, Hazelyn Joy Buenaventura, mark Richard

Cortez, Romieline Crisostomo, Florina Mae

De Mesa, Alvin De Silva, Janelle Dela Torre, Mariel Kim Diego, Lorenz Anthony

Fajardo, Camille Felipe, Yvette

Group11 ThFs

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TABLE OF CONTENTS

UNIT 1

I. Dedication and Acknowledgement………..

II. Personal Data………

III. Chief Complaint……….

IV. Health History………

a. Past health history……… b. Present health history………... c. Family history………... i. Social history……… ii. Childhood………. iii. Adolescence……….. iv. Adulthood………. a. Sexual history………... UNIT 2

Mental Status Assessment / Analysis and Interpretation………

UNIT 3

a. Psychopathology……….. b. Related Literature………

UNIT 4

a. Nursing Care Plans………... b. Pharmacology………... UNIT 5 Psychotherapy……….. UNIT 6 Glossary……… UNIT 7

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Reference………...

UNIT 8

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UNIT I

(Dedication, Acknowledgement, Introduction, Personal Data,

Chief Complaints and Health History)

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This work is dedicated to our parents, family relatives and friends. Without their patience, understanding, support

and most of all love, the completion of this work would

not have been possible.

Also, it is dedicated to our colleagues who will conduct the

same studies in the future.

And lastly, to our GOD who provide us knowledge and

strength in making this work.

ACKNOWLEDGEMENT

First and foremost, we would like to thank to our Almighty God,

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pursuing this comprehensive

case study.

And also to our family who gave all the emotional and financial

support and motivations at all times and

they also serves as our

inspiration.

We would like also to acknowledge our clinical instructor

Sir Ronald Tyron dela Rosa for the support,

patience, knowledge, and contributions

to finish this comprehensive

case study.

We would like also to thank Sir Ronnell Dela Rosa

and Ma’am Irish Lee for helping and giving

some encouragement to make our duty

possible and able to enjoy

our stay in Mariveles.

II. INTRODUCTION

Schizophrenia is a mental disorder characterized by the disturbances in thoughts, sensory perception and deterioration in psychosocial functioning. It is also characterized by a weak ego. The common defense mechanisms used by individual are regression, projection,

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withdrawal and denial. There are four A’s to acknowledge in having schizophrenia, first, the associative looseness, the blunted affect, ambivalence and the autistic thinking.

Paranoid schizophrenia is the most common type of schizophrenia in most parts of the world. The clinical picture is dominated by relatively stable, often paranoid, delusions usually accompanied by hallucinations particular auditory variety, and perceptual alterations. Disturbances of affect, volition and speech, and catatonic symptoms are not prominent. Paranoid Schizophrenia is manifested primarily through impaired thought processes, in which the central focus is on distorted perceptions or paranoid behavior and thinking. Delusions are in most cases grandiose, persecutory or both. (WHO 2005)

With paranoid schizophrenia, the ability to think and function in daily life is better compare with other types of schizophrenia. It may not have as many problems with memory, concentration or dull emotions. Still, paranoid schizophrenia is a serious, lifelong condition that can lead to many complications, including suicidal behavior.

Those individuals who diagnosed with paranoid schizophrenia are not especially prone to violence; often prefer to be alone. Studies show that if people have no record of criminal violence prior to develop schizophrenia and are not substance abusers, then they are unlikely to commit crimes after they become ill. Most violent crimes are not committed by people with paranoid schizophrenia, and most people with schizophrenia do not commit violent crimes. Substance abuse always increases violent behavior, whether or not the person has schizophrenia.

If someone with paranoid schizophrenia becomes violent, their violence is most often directed at family members and takes place at home. These individuals may spend an extraordinary amount of time thinking about ways to protect themselves from their persecutors.

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In the US paranoid schizophrenia reports issued by Centers for Disease Control and Prevention (CDC) for 2000 revealed 121,000 diagnoses of paranoid schizophrenia in non-Federal, short-stay hospitals (73,000 men and 47,000 women). Most individuals (62,000) were between the ages of 15 and 44; none were under age 15; 37,000 were between 45 and 64; and 21,000 were 65 or older. According to geographic distribution, the highest prevalence is in the South and Northeast regions of the US with the lowest prevalence in the West and Midwest are almost equal. (Medical Disability Advisor, 2010)

The onset of the disorder is usually later than catatonic or disorganized schizophrenia. Men have earlier onset, and more frequent than women. Women have a bimodal onset with peaks in their 20’s and early 40’s. One study demonstrated within subtype age of institutionalization gender differences only for paranoid schizophrenia (Salokangas et al., 2003).

The present etiology of the paranoid schizophrenia are the following, genetics it is known because people believed that mental disorder can be inherit. Other causes are decreased dopamine, stress, alcohol abuse and substance abuse.

Prognosis of the disease is good when there is no familial history of the disease, the patient has good social and professional adjustment prior to onset of symptoms, if the disease come suddenly and the disorder is treated early, quickly, consistently. And onset symptoms occur at later years of life and there is an absence of symptoms between psychotic episodes.

Paranoid schizophrenia is usually treated with a combination of therapies, tailored to the individual's symptoms and needs. Anti-psychotic medications can reduce hallucinations and disordered thinking, but do not affect the social withdrawal that is common among those

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with paranoid schizophrenia. Failure to take medication even during remission periods can result in a relapse. Psychotherapy is used to address the emotional and social issues that result from paranoid schizophrenia. Group therapy can be especially helpful, because it creates opportunities for socialization for individuals with paranoid schizophrenia.

The reason of choosing paranoid schizophrenia as study is to add knowledge, and to know different contributing factors in developing the said illness. Perhaps to correct the misconception of not all people who have mental illness are violent and dangerous. While this may be true in some cases, the generalization has been made far too widely.

These attitudes contribute to a significant amount of prejudice against the mentally ill, which may prevent people from seeking help. Stigma may also affect people’s recovery, contributing to low self-esteem and decreased social contact. In contrast to physical health issues, most people in our community avoid even discussing the subject of mental illness, dancing around the issue in the shadow of these pervasive misconceptions.

Moreover, the preferred client had a superficial manifestations which seen directly to the clients experiencing the said mental illness. And the client was cooperative and provided primary information that we needed in conducting this study.

III. Personal Data

Name: J.M

Age: 44

Sex: Male

Citizenship: Filipino

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Religion: Roman Catholic

Place of Birth: Sampaloc, Manila

Date of Birth: September 3, 1966

Address: #42 Pag-asa Orion, Bataan

Occupation prior to admission: Police in Bureau of Custom

Education: Vocational Graduate

Date and time of admission: November 20, 2007 / 2:00 pm

Previous admissions: November 2, 1989- December 18, 1991 December 15, 1992 – December 18, 1992 December 11, 1195- August 31, 1996 August 23, 1997- June 21, 1998 January, 1999- February 25, 2000 February 28, 2000- January 12, 2004 May 29, 2004- September 19, 2007

Admitting Diagnosis: Paranoid Schizophrenia

Attending Physician: Dr. Cortez

Place where he spent the last 15 years of his life:

(1990’s)Manila, Lubao, Bataan; (2005-Aug2010)America; (August 2010-present)MMH

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Informant: JM’s cousin

IV. CHIEF COMPLAINTS

Mang JM admitted on November 20, 2007 due to ff:

• “Maraming J.M, patay na yung galing dito.”- Mang J.M • Positive delusions

• Refused to medications • Neglected hygiene • Talking aloud

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May 29, 2004

• Refused to medications “Lason daw ang gamot” • Refused check- ups

• Threatening his mother • Escape

• Alcohol intake

February 28, 2000

• Talkative pressure speech • Denial, auditory hallucination • Evasive and manipulative • Refused to medication • Smoked and drinks alcohol • Started fights and walking

January 19, 1999

• Denied presenting complaints • Oriented to place

• Had positive persecutory as he said “ Hinampas ako ng tubo kahit nagbibigay ako ng pera sa kanila”

• Impaired sleep

• Nagmumura, mainitin ang ulo • Nagbabanta

August 23, 1997

• Morbid ideas “ Gusto ko na sanang mamatay kahit sinong pumatay walang kasalanan”

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December 11, 1995

• Refused to oral medications

• Suspicious and jealous to his wife and relative • Impaired sleep

• Violent tendency when in influenced of marijuana

December 15, 1992

• Impaired sleep

• “Namumulot ng basura”

• Denies auditory hallucination and tangentiality • Homicidal and suicidal

• “Kung saan-saan humihiga”

November 2, 1989

• Nagwawala ( kung ano maisapan gawin gagawin, nambabato, hindi nakakakilala at seloso)

• Impaired sleep • Talking to self

• 20 months ago J.M claimed “Hindi na ko magmamaneho, magpapahinga muna ko” • Agitated

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HEALTH HISTORY

II. Health History

a. Past Health History (From the chart and JM)

According to Mang J.M’s chart he was first admitted in Mariveles Mental Hospital on November 2, 1989, when his cousin who lived in Orion, Bataan took him in the MMH for checked –up because as he noticed, Mang J.M seemed agitated, nervous and afraid of something for approximately 20 months after the incidence of hitting an old man in the highway while he was a jeepney driver. Upon arriving at home Mang J.M said that “Hindi na ko magmamaneho, magpapahinga muna ako.”After his consultation, he was advised for the confinement. The manifestations

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became persisted. He had chief complaints of having impaired sleep, talking to self, became aggressive and violent (nagwawala, kung ano maisipan gagawin, nambabato, hindi nakakakilala, at seloso). Mang J.M consumed 1 pack of cigarette per day and drinks 2 bottles of red horse and san Mig light. Based on the reported cues of his cousin, Mang J.M was then diagnosed of having bipolar manic and alcohol abuse by his attending psychiatrist, Dr. Rivera.

During his confinements, he took medications such as Haloperidol 5mg, Chlorpromazine 500mg, Risperdal ½ tablet, Roziman 50 mg, Diperidem HCL, Valporic acid 500mg, Levomeprazine 100 mg, Tusperidone1/2 tab, Bepeoden 1tab 20mg. These various type of drugs are psychotropic medications which being used in the treatment of mental illness.

After his first discharged on December 18, 1991, Mang J.M did not have a follow up consultation in MMH because he refused to. His relatives brought him at NCMH to have his first check-up on April 1992 and noted that there was no follow up due to Mang J.M refusal.

Mang J.M was brought in MMH on December 15, 1992. He had complaints of impaired sleep, “namumulot ng basura at kung saan- saan nahihiga”, denies auditory hallucination and tangentiality, having escape, homicidal and suicidal. After 3 days observation at ACIS he was discharge on December 18, 1992.

On March 4, 1993, Mang J.M applied as a trainee messenger at Binondo, Manila. He smoke heavily and suspected use of marijuana with unspecified amount and frequency.

On December 11, 1995, according to his chart, he was admitted in MMH again because he had impaired sleep and became jealous and made suspicion on his

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wife-- he thought that his uncle was having affair with his wife at the point that he saw the two having sex in their home, and started refusal in taking oral medications. Mang J.M did not comply with his drug regimen. He appeared that he was having violent tendency when he was influenced of marijuana as recorded on his chart, but he continues to deny. He claimed that he never used marijuana because it causes skin diseases. On, January 1, 1996 Mang J.M was placed on isolation by 15 days because he became violent and aggressive, according to his chart. And he attempted escape on May 28, 1996. Like on his previous admission, he recovered and was discharged on Aug 31, 1996.

Mang J.M had a morbid ideas about his death, where he claimed that “gusto ko na sana ng mamatay, kahit sinong pumatay walang kasalanan.” This was the complaint on his admission on August 23, 1997.

On June 21, 1998, Mang J.M had his home visit and went back in MMH afterwards.

January 19, 1999 when he returned in MMH, Mang J.M denied presenting complaints, oriented to place, had positive persecutory delusions as he said “hinampas ako ng tubo, kahit nag bibigay ako ng pera sa kanila.” But there were no evidence of physical injury upon assessment. Also, he had complaints of having impaired sleep, “nagbabanta”, “mainitin ang ulo”, at “nagmumura.”

After a year, on February 25, 2000 he was discharged. At home, Mang J.M started to become talkative and having pressured speech. He used to deny when he was asked. He had auditory hallucination, become manipulative and evasive. Mang J.M regains his vices and did not take his medications. He smoked and drinks alcohol heavily. Also, he walks endlessly and started fights. Due to reported behaviors of Mang J.M, he was placed back in MMH on February 28, 2000; he claimed that his

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mother did not provide his medications upon interview. Mang J.M was admitted thereafter. He was forced to take his medications to treat the displayed manifestations.

Mang J.M escaped in the hospital on December 25, 2000, but after several days on January 2, 2001 he returned by his relatives. He was discharged on January 12, 2004.

After four months, Mang J.M was readmitted on May 29, 2004 because he refused to take medications and claimed “lason ang gamot”, he done physical abuse to his mother and threatened her. Mang J.M refused for check-ups, continues to drink alcohol and escapes. These are the following complaints why he returned in MMH. But on September 7, 2007 he was allowed for home conduction and discharged on September 19, 2007.

He had conversation last October of the same year and according to his chart Mang J.M used to smoke and suddenly punch a neighbor. Later, Mang J.M refused to medications and had an impaired sleep.

In contrary, Mang J.M said that he was just admitted last year and will be discharged on the 3rd_{of February 2011.In fact he was 4 yrs at MMH since his recent} admission on November 20, 2007. According to him he was admitted in MMH not because he was a mentally ill, but because his mother wants to keep him away from the persons who wanted to steal his wealth and killed him after.

b. Present Health History

Mang J.M was been in MMH since his latest admission on November 20, 2007, around 2:00 pm with the diagnosis of paranoid schizophrenia by his attending psychiatrist, Dr. Cortez. He was placed at male ward B. According to his chart, Mang J.M’s chief complaints was having delusions and saying “Maraming J.M, patay na

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yung galing dito”, refused to medications, neglected hygiene, irritable and talking aloud. He was given Haloperidol 5mg 1amp, and Chlorpromazine 500mg tablet take at bedtime. These are psychotherapeutic drugs used by Mang J.M for the treatment of the disorder.

In addition, Mang J.M had alterations in thought process, thinking and communication, in perceiving and interpreting, in behaving and interpreting Mang J.M manifested illusions, delusions, grandiosity, hyperactive and withdrawal.

During the orientation, Mang J.M showed good cooperation with the SNs he was very eager to talk then suddenly jumped into another topic and discuss unrelated matters. He said that he was single and a very rich man and owned not only houses, but mansions. Mang J.M is always oriented to person, date, time and place.

Mang J.M refused on the grooming sessions in the first two weeks and done grooming on the last week but only brushing of his teeth. Mang J.M wears a wrinkled white shirt paired with abstract designed short until the last week, during Grand socialization he puts on the uniform of MMH as his topped.

On the therapies, he was cooperative and active participant. He used to talk a lot and listen attentively. Mang J.M’s laughed when his fellows provided wrong answers and made his judgments afterwards. During the nurse- client interaction he said that the persons around would kill him, and he added that he was just kidding. In addition, Mang J.M told that they are making a big swimming pool on the side of ACIS (MMH), he was a very rich man and owned the international corporation of san

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Miguel,he denied used of illegal drugs but admitted that he drinks alcohol and until now he used to smoke.

Moreover, according to Mang J.M, he had his own planet where exactly looked like earth. He described that there are living things such as cow, carabao, plants and people. He added that there is a big TV screen where he saw individuals like his two student nurses together with their loved ones and also our clinical instructor. Mang J.M named a thing which is “aparachi”. This thing was a peanut shape like, covered with gold and brings out everything that people need, as he explained. He also said that he had a conversation with the former president of USA, George Washington.

Lastly, Mang J.M appeared always hyperactive and talked about different killings. In contrast he claimed that he was good and did not bring any harm to others. He used to be keen listener and observer, Mang J.M knew when the questions are being change but with the same thoughts. He also used various defense mechanisms such as denial, projection and others. Moreover, Mang J.M manifested grandiosity, illusions, and delusions.

c. Family history

According to Mang J.M., they were four and he was 2nd_{to the eldest in his family. His} father died when he was 6 years old due to heart attack while her mother was still alive. They were raised and sent in good school by his mother, who was a dress maker. His three siblings have their own family and lived separately while Mang J.M remained single, which is contrary to the chart because his marital status is married and became separated to unnamed woman and they have no child.

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Also, he said that he had no known history of having mental illness in the family. Same in the chart, there were no reports that somebody in their family suffered from the same condition.

d. Social History

i. Childhood

Mang J. M told that he was born on September 3, 1966, in Sampaloc, Manila. He grew together with his family, but his father was died when he 6 years old. His mother raised them and sent to school. Mang J.M during his childhood, he once been like the other children, he played all day and love vacations. He was sent in Lubao, Pampanga every school break with his siblings and lived with his grandmother.

His mother decided to bring him in schooling at Lubao Elementary School when he was 8 years old. Mang J.M was then separated from his mother and siblings as well, though he told that it was sad at first. But he was used to it because this was not usual to him. By this time, he lived in Lubao in longer time. He joined his grandmother at home, helped her in chores and taking good care of the cows in their farm, as he added. During his free time according to Mang J.M, he played with their neighbors. Those routines ended when he came back in Manila to continue his study for high school.

ii. Adolescence

He entered high school at St. Jude College. According to him he was an active student. He joined competitions and different events whereas dancing and singing was his forte. He was been an officer in CAT during his time. Mang J.M also had peers, and he joined fraternity when he was 2nd_{year high school. He said that those persons were good. They had} bonding all the time and accompanied him through his ups and downs.

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During his high school life, Mang J.M learned to smoke and drinks alcohol together with his friends. He added that he consumed at least two bottles of each San Mig Light and Red Horse and 1 pack of cigarettes per day.

In addition, he also met his first girl friend which is CD during intramurals in their school, as he claimed that they last for almost six years. They were enjoying each others’ company, when there was a time that he experienced his first heartache because his girl friend went with other man. Mang J.M felt loneliness and depression. But he added that he easily coped up because he found a new love with EI. Like the first relationship it has to end.It last for one year and they totally separated because of the reason that he moved in Bataan to talk with his godfather about abroad and EI went to Pangasinan.

Moreover, he experienced those heartaches during his college years and according to Mang J.M he easily coped to those matters. In contrary, he said that he and CD were cool off and still in touch with each other.He claimed again that he entered MAPUA for his course police authority which is contrasting to his chart which showed that he finished vocational course.He admitted that he continued smoking and drinking alcohol, and denied use of illegal drugs.

iii. Adulthood

Mang J.M claimed that he went in US after his graduation in college from the year 2000 up to 2005. He became a Navy in US as he claimed. His habits were smoking, drinking alcohol, bar hopping but denied having sexual intercourse neither got married. Mang J.M said that he could drink two bottles of each San Mig Light and Red Horse because it was less expensive, consumed 1 packed of cigarettes per day, but consistently denies used of illegal drugs like marijuana.

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After Mang J.M came back from US, he became a driver in Orion, Bataan and worked in Bureau of Customs where he was a police authority as he said.

He spent his life in Manila, and Orion where he went fishing; making his vices and lived there for several years. According to Mang J.M, he also spends his life inside MMH as his record showed he was started to admit since1989. But he claimed that this was his first admission yet he claimed that he returned to work after his previous discharged.

a. Sexual History

Based on his chart he was separated which he continues to deny. He always says that he was single for the longest time and he claimed that giving roses to someone was a burden.

Also, he admitted that he had previous relationships. He added that they were happy having each other’s company, he admitted that he did kissing and touching private parts of his previous girlfriend’s body as their mutual willingness. But not involved in sexual intercourse as he added.

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UNIT II

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MENTAL STATUS ASSESSMENT

Name : Mang JM

Age : 44 years old

Ward : Male Ward A

ORIENTATION Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Person O RI E N T A TI O N S E L F-A W A R E N E S S        Place        Date        Time        Situation       

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Legend:  - manifested by Mang JM  - not manifested by Mang JM Analysis and Interpretation:

Day 1: Orientation Day 2: Self awareness

Day 3

No unusual finding was noted on Mang JM’s orientation. He was oriented and we knew it by his right response when we asked the above noted.

SN: “Ano pong pangalan niyo?”

C: “JM.”

SN: “Alam niyo po ba kung nasaan po tayo ngayon?”

C: “Oo, nasa mental nagpapagaling.”

SN: “Ano pong petsa ngayon Mang JM?”

C: “Ngayon ay Friday January 14, 2011.”

According to Nightingale, changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.

Day 4

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C: “JM.”

C: “Oo sa mental nagpapagaling.”

SN: “Ano pong petse ngayon Mang JM?”

C: “Ngayon ay Miyerkules January 19, 2011, umaga.”

According to Sigmund Freud there is a part of the mind called preconscious, thought and emotions are not currently in the person’s awareness, but he can recall them with some effort

Day 5

SN: “Ano po pangalan niyo?”

C: “JM.”

C: “Oo sa mental”

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As mentioned on Helson’s Theory, adaptation is a process of responding positively to environmental changes. Mang JM adapts effectively as he was able to identify the changes in her environment and positively responds to it.

Day 6

C: “JM.”

C: “Oo dito Mariveles sa mental.”

C: “Ngayon ay Biyernes ng umaga January 21, 2011.”

Day 7

C: “JM.”

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C: “Oo sa mental nagpapagaling.”

C: “Ngayon ay Miyerkules ng tanghali February 2, 2011.

According to Roy, awareness of self and environment is rooted in thinking and feeling. Mang JM was aware of his environment.

Day 8

C: “JM.”

SN: “Nasaan po ba tayo ngayon Mang JM?”

C: “Dito sa mariveles.”

SN: “Eh! Anu po bang araw ngayon?”

C: “Huwebes, Thursday February 3, 2011.”

SN: “Alam niyo po ba ang gagawin natin ngayon?”

C: “Sasayaw tayo ngayon.”

Day 9

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C: “JM.”

SN: “Nasaan po ba tayo ngayon?”

C: “Dito sa pantry, sa mariveles.”

SN: “Alam niyo po ba ang gagawin natin ngayon?”

C: “Grand Socialization.”

SN: “Anu po bang araw ngayon?”

C: “Friday, February 4, 2011.”

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DEFENSE MECHANISMS: Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 a. Repression O R I E N T A T I O N S E L F -A W A R E N E S S        b. Suppression        c. Regression        d. Fixation        e. Denial        f. Displacement        g. Conversion        h. Identification        i. Intellectual        j. Introjections        k. Projection        l. Rationalization        m. Sublimation        n. Substitution        o. Symbolism    _    p. Undoing       

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q. Reaction Formation       

r. Fantasy  _  _   

Legend:  - manifested by Mang JM  - not manifested by Mang JM Analysis and Interpretation:

Day 1: Orientation

Day 2: Self awareness

Day 3

Mang JM manifest one of the defense mechanism; Rationalization we noticed that he always justify his answer. He also manifest Denial as he said “Hindi man ako malakas uminom paminsan minsan lang.” and Projection during our conversation when we asked him “Malakas po ba kayo iinum ng alak Mang JM?” he said “Hindi ah!mahina ako iinum eh, siguro ikaw malaks kang iinom noh?”

According to Roger, the human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts.

Day 4

Mang JM manifest one of the defense mechanism; Fantasy we noticed that he always says he was close to George Washington because he once went to United States of America and met together and became friends. Maybe he wants us to be amazed of him.

SN: “Umano po kayo sa America Mang JM?”

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According to Johnson, Each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual.

Day 5

We don’t recognize any defense mechanism.

Day 6

Mang JM manifest one of the defense mechanism; Denial and Reaction Formation, we noticed that he’s angry but he denies it obviously he is because of the tone of his voice and through his gestures my slapping his legs. He smiled unnaturally.

SN: “Nagagalit po ba kayo Mang JM.”

C: “Hindi ako galit.”

SN: “Oh, ngiti nap o kayo.”

C: (Smiled but looks uncomfortable)

Day 7

Mang JM manifest one of the defense mechanism; Projection he often projects situations to us.

SN: “Mang JM, ngayon pong malapit na ang valentines may plano po ba kayong pagbigyan ng flowers?

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C: “Wala pa nga eh, hirap kasi baka may boyfriend na o may asawa na ang babae eh.” SN: “Anu pong dahilan at nasabi niyong mahirap?

C: “wala naman, ikaw marami ka ng napagbigyan ng rosas noh?”

In erik erikson’s psychosocial theory, in infant stage, the infant must learn to develop basic trust that she will be fed and taken care of, mistrust, the negative outcome of this stage will impair the person’s development throughout her life.

Day 8

Mang JM manifest one of the defense mechanism; Denial and Reaction Formation, he denies that he’s not ever try a drugs/ marijuana, reaction formation because he said that he’s a good boy.

SN: “Mang JM nakapagtry nap o ba kayo ng Drugs?”

C: “Hindi hindi ako gumagamit ng ganon.”

SN: “Ano pong dahilan?”

C: “Hindi, bawal yun samin mabait ako, hindi ako nangaaway, hindi ako nagdaDrugs, mabait ako.”

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Mang JM manifest one of the defense mechanism; Denial and Reaction Formation, Mang JM denies use of drugs/ marijuana, reaction formation because he said that its not good for our body.

SN: “Anu po ba ang feeling kapag naka-drugs?”

C: “Ay hindi, hindi ako gumagamit ng ganon.”

SN: “Anu pong dahilan?”

C: “Eh! Bawal kasi samin yun, tsaka nakita mu ba yung iba may mga galis galis dahil sa drugs yun.”

SN: “Talaga po Mang JM?”

C: “Oo, maniwala kayo masama sa katawan yun, mabait ako.”

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EXTRAPYRAMIDAL SYMPTOMS: Day 1 Day 2 Day

3 Day ₄ Day ₅ Day ₆ Day ₇ Day ₈ Day ₉

Pseudoparkinsonism O RI E N T A TI O N S E L F-A W A R E N E SS 1. Masklike face        2. No swinging of arms        3. Hesitancy of speech        4. Decreased muscle strength        5. Shuffling gait        6. Drooling       

7. Fine intention tremors       

Acute Dystonic Reaction 1. Muscle, spasm of jaw,

tongue, neck, eyes       

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Akathisia

1. Restlessness       

2. Tenseness       

3. Inability to sit still       

4. Rocking back and forth

of feet       

5. Crossing leg frequently       

6. Inability to relax       

Tardive Dyskinesia 1. Involuntary

movements of mouth, face, may extend to fingers, arms and trunk

      

Legend:  - manifested by Mang JM  - not manifested by Mang JM

Analysis and Interpretation:

Day 2: Self awareness Day 3

Our client displayed EPS under akathisia, during conversation we observed that Mang JM crossing leg frequently and inability to relax by rocking back and forth on feet and

appears restlessness.

In Orem’s self care model, the nurse should help the client by doing pharmacotherapy to manage their movement because according to Orem, the nurse provides assistance to those who are unable to meet self care needs. The

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nurse is required therapeutic care to the client with self care deficits until the person can care for herself.

Day 4

Our client displayed EPS under akathisia, during our therapy we noticed that Mang JM crossing leg frequently that manifest all through our conversation.

According to Henderson, unique function of the nurse is to assist the

individual, sick or well, in the performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strength, will, or knowledge.

Day 5

According to Ida Jean Orlando’s nursing process theory, she assumes that freedom from mental or physical discomfort and feeling of adequacy and well being contribute to health.

Day 6

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its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge.

Day 7

According to Orem’s self care deficit theory, it describes why a person needs self care but in the presence of illness, there was a deviation.

Day 8

Our client displayed EPS under akathisia, during our conversation we noticed that Mang JM crossing leg frequently.

individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the

necessary strength, will, or knowledge.

Day 9

Our client displayed EPS under akathisia, during our grand socialization we noticed that Mang JM crossing leg frequently that manifest all through our conversation.

individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the

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THINKING AND COMMUNICATION: Day

1 Day 2 Day 3 Day 4 5Day Day 6 Day 7 Day 8 Day 9 Looseness of Association ORI ENT ATI ON SEL F-AW ARE NES S Neologism        Word salad        Echolalia        Echopraxia        Clang Association        Illogical thinking        Alogia        Concrete thinking        Lack of insight        Aphasia        Apraxia        Agnosia        Flight of ideas       

Legend:  - manifested by Mang JM  - not manifested by Mang JM

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Day 3

Our client displayed looseness of association, these are neologism and echolalia. He mentioned the word “wisboro” which do not have meaning and repeating the questions we asked.

According to King, Each individual brings a different set of values, ideas, attitudes, perceptions to exchange.

Day 4

Our client displayed looseness of association, these are neologism and echolalia. He mentioned the word “aparachi” which do not have meaning and echolalia such as the shoemaker, the shoemaker which he unconsciously saying. Our client also manifested concrete thinking of flight of ideas.

Day 5

During the interview our client displayed lack of insight because sometimes he’s saying something which has no sense or even relation on the topic and flight of ideas.

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C: “Nagtatrabaho, Nagbabantay ng bagahe, tapos may nahuhuli din akong isda noon.”

According to jean piaget’s stage of preoperational thought (2-7 yrs.). In this stage, thinking and reasoning are intuitive, children learn without the use of reasoning.

Day 6

During the interview our client displayed looseness of association, these is neologism. He mentioned the word “aparachi” which do not have meaning.

SN: “Anu po bang ginagawa niyo doon?”

C: “Nagbabantay ako dun, tas dun yung aparachi.”

SN: “Anu po yung aparachi?”

C: “ gold yun, kung saan may lualabas na kalabaw, truck at kung anu ano pa.”

Day 7

There were no alteration of Mang JM’s thinking and communication.

Day 8

During the interview our client displayed flight of ideas because Mang JM introduces new topic without completing the topic.

SN: “ Ano pa po ba yung gingawa niyo doon?”

C: “wala naman nagbabantay, tignan mo yun oh mangga.”

Piaget viewed intelligence as an extension of biological adaptation that has a logical structure. Every stage occurs at a certain age, and children show a

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higher level of thought organization during each successive stage of development.

Day 9

There were no alteration of Mang JM’s thinking and communication.

PERCEIVING AND INTERPRETING: Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Delusion O RI E N T A TI O N S E L F-A W A R E N E SS 1. Reference        2. Persecution        3. External influence        4. Somatic        5. Grandiose        Hallucination        Illusion        Depersonalization        Attending to relevant stimuli       

Poor reality testing       

Attending to irrelevant

stimuli       

Poor reality testing       

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Day 2: Self- awareness

Day 3

There was no alteration noted on Mang JM’s perceiving and interpretation.

Day 4

There is an alteration on perceiving and thinking; Persecution Delusion by saying “if you want to kill me just tell me” and Grandiose Delusions by saying he is very rich. He also manifests illusion by saying that the clouds near on the mountain are smoke cause by burn.

According to Neuman, maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli.

Day 5

There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by saying “madami diyan sa paligid mamamatay tao” and Grandiose Delusion by saying

“marami kaming pera, nung minsan nagpunta dito yung mga truck namin ng pera”. He also manifests illusion by saying “doon sa ACIS may swimming pool kaming pinagawa diyan.”

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According to psychodynamic theory of Sigmund freud , this perceptual motor syndrome is developing from a person with psychic alterations. In addition, these alterations are contingent on the poor caregiving that is provided within the environment.

Day 6

There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by saying “dito lang tayo ah, wag kayo lalabas may mga mamamatay tao doon.” And Grandiose Delusion by saying “Oo maniwala ka sakinkami nagpagawa ng mga building na yun.” He also manifests illusion by saying “nakita mo na aba yung swiiming pool sa may ACIS?”

Day 7

There is no alteration on perceiving and thinking, manifest Grandiose Delusion by saying “Oo, meron kaming mansion dito sa Mariveles.”

Day 8

There is no alteration on perceiving and thinking, manifest Grandiose Delusion by saying “Marami nga kaming mga sasakyan eh! Tsaka Pajero.”

According to King, human beings are open systems in constant interaction with the environment.

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There is an alteration on Mang JM’s perceiving and thinking; Persecution Delusion by saying “tinago ako ni mommyko kasi maraming pumapatay diyan eh!” he also manifest Grandiose Delusion by saying “marami ako pera, totoo yun.”

FEELING AND AFFECT:

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Flat O RI EN TA TI O N SE LF -A W A RE NE SS        Blunted        Inappropriate        Lability       

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Day 3

No unusual finding because client displays appropriate feeling and affect now.

Day 4

Our client manifest labile mood during our therapy he suddenly laughing for no reason then suddenly back to serious mode.

According to Lazarrus (1982) he consider affect to be post-cognitive that is, affect is thought to be elicited only after a certain amount of cognitive processing of information has been accomplished

Day 5

Our client manifest blunted affect during our conversation, there is delay on our communication.

According to Parses human becoming theory, the client determines whether to show own affect/ feelings or not.

Day 6

Our client manifest blunted affect during our conversation, there is delay on our communication and labile mood during our conversation he got irritable C: “ayaw mo naming maniwala sakin eh!” (Slapped on his legs). He also manifests inappropriate affect. SN: “nagagalit po ba kayo?” C: “hindi ako galit” (Smiled unnaturally) but his voice seems angry.

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According to Johnson, Each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual.

Day 7

No unusual findings because client displays appropriate feeling and affect now.

Day 8

Our client manifest blunted affect during our conversation, there is delay on our communication. He also manifest labile mood because during the therapy Mang JM suddenly keeps quiet and then he smiled again.

Based on Watson’s curative factors , we must promote and accept expression of the client either it is positive or negative feelings and emotions.

Day 9

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BEHAVING AND INTERACTING: Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Withdrawal O RI E N T A TI O N SE LF -A W A R E N ES S        Motor hyperactivity        Motor hypoactivity        Ambivalence        Anhedonia        Avolition       

Poor personal hygiene       

Impulsive       

Paranoia       

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Day 3

The behavior pattern of our client is predictable but we noticed that he has poor personal hygiene and he had dark teeth that lead to bad breath and his nails were dirty.

According to Abdellah, she identified 21 problems and one of this is to maintain personal hygiene.

Day 4

Our client manifests motor hyperactivity because of his mood, overexcitement to express his feelings. We also noticed that he has poor personal hygiene and he had dark teeth that leads to bad breath and his clothes smelled.

According to Freud, conscious mind is where we are paying attention at the moment. Our way of thinking affects our attitude on how we are going to react in a certain situation.

Day 5

The behavior pattern of our client is predictable. But we noticed that he has poor personal hygiene and he had dark teeth that lead to bad breath his clothes smelled and his nails were dirty.

According to Orem’s self care deficit, the client can’t able to perform self care because of the presence of mental pathology.

Day 6

The behavior pattern of our client is predictable, but we noticed that he has poor personal hygiene and he had dark teeth that lead to bad breath and his clothes smelled.

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Day 7

Day 8

According to Orem’s self care deficit, the client can’t able to perform self care because of the presence of mental pathology

Day 9

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NEGATIVE COGNITION: Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Overgeneralization O RI E N T A TI O N SE LF -A W A RE NE SS        All-or-nothing thinking        Should statement        Labeling        Middle reading        Fortune telling       

Day 3

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As mentioned by Abdellah, a nurse should continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting her behavior in order to identify the client’s problem.

Day 4

No alteration noted on Mang JM’s negative cognition.

Day 5

Day 6

Day 7

Day 8

Day 9

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OTHERS: Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Amnesia O RI E N T A TI O N S E L F-A W A R E N E SS        Fugue        Depersonalization        Phobias        Memory

1. Remote (long term)       

2. Recent (early am)       

3. Recent part (current events)

      

4. Immediate memory (short

term)       

5. Immediate recall       

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During our conversation with our client he had a remote memory because he was able to determine his last 15 years of his life. He also remembered the food he eaten in the

morning and knows who the president of the Philippines is. He had also recalled us during our conversation.

According to Parse, Man’s reality is given meaning through lived experiences

Day 4

Our client had remote memory because he remembered he went to America last 2005, he also remembered his breakfast and knows who the president of the Philippines by saying the name of Pres. Benigno Aquino. He also recognizes our name.

According from psychoanalytic theory of Freud, the mind can be divided into main parts; the conscious mind includes everything that we are aware. A part of this includes our memory which is not always part of consciousness but can be retrieved easily at any time and brought into our awareness.

Day 5

Our client had remote memory because he remembered the things he did in the last 15 years of his life.

SN: “anu pong ginagawa niyo sa huling 15 taon ng buhay niyo?”.

C: “ mangingisda.”

He also recalled the food he was eaten in the morning.

SN: “ano po bang kinain niyo kanina?”.

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He also knows the President of the Philippines by saying the name of Pres. Benigno Aquino. He also recalled us during our conversation.

According to Parse, Man’s reality is given meaning through lived experiences

Day 6

Our client had remote memory because he remembered the things he did in the last 15 years of his life y saying “nangingisda ako noon.” He also remembered we did yesterday by saying “nagbingo tayo at nanalo akong 2 beses.” He also knows who the president of the Philippines by saying the name of Pres. Benigno Aquino. He also recalls us during our conversation.

According to Freud, preconscious thoughts and emotions are not currently in the person’s awareness, but she can recall them with some effort.

Day 7

Our client had remote memory because he remembered the things he did in the last 15 years of his life y saying “yung nanay ko nagtatahi ng magagandang damit.” He also

remembered we did last last week by saying “nagbingo, nanalo ng 2 beses at nagpakita ng mga pictures tulad ng doctor, urse etc. He also knows who the president of the Philippines by saying the name of Pres. Benigno Aquino. He also recalled we did before they go back in their ward.

SN: “anu- ano nga po pala uli ginawa natin kanina?”

C: “food festival”.

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Day 8

Our client had remote memory because he remembered the things he did in the last 15 years of his life, he also remembered things we’ve done yesterday and ingredients of our food by saying “food festival, yung mga sangkap ay gulaman, buko at cream.”, he also know president of the Philippines by saying the name of Pres. Benigno Aquino. He also recalls activity we did before they go back in their ward by saying “Oo sumayaw tayo kanina na gagawin natin bukas.”

According to Freud, the preconscious system is composed of those mental events, processes and contents capable of being brought into conscious awareness by the act of focusing attention.

Day 9

Our client had remote memory because he remembered the reason why he is admitted here in MMH in the year 1989 by saying “Sinave ako ni mama dun sa mga taong mangunguha, tsaka hindi ako magkatulog.” He also remembered the steps we practice yesterday. He also recalls us.

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UNIT III

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PSYCHOPATHOPHYSIOLOGY

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(Marijuana, 2 bottles of alcohol. 1 pack cigarette per day)

Affect the normal function of the brain system

Neurologic disturbances

Altered thought process

Looseness of ability in thinking and perceiving responses

Illusions Delusion Grandiose Maladaptation Violent behavior Persecutory

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Mang J.M took prohibited drugs as his record showed. But the amount and frequency were not determined. Being a drug abuser, Mang J.M therefore became a drug addict. This is the reason why he had looseness of ability in thinking and perceiving responses because of the effect of the drug in the brain. He had been aggressive to do things whatever he wants; he developed persecutory delusions and grandiosity.

Related Theory

Substance abuse would be describes according to Psychodynamic (Freudian) Theory from a developmental perspectives. Freud believes that vulnerable to substance abuse have powerful dependency needs that can be traced to their early years. They claim that when parents fail to satisfy a young child’s need for nurturance, the child is likely to grow up depending excessively on others for help and comfort, trying to find nurturance that was lacking during their early years. If this search for outside support includes experimentation with a drug, the person may well develop a dependent relationship with the drug which leads to substance abuse.

Maslow said that human beings are motivated by unsatisfied needs and that certain lower need to be satisfied before higher needs can be satisfied. Maslow ties the pre-occupation use of drugs and the negative effects which result from alcohol/drug addiction. He says that since addiction is a progressive illness, it destroys a person’s ability to achieve self-actualization, eventually destroying the person’s ability to meet their other needs including self-esteem, physiological need and safety.

Inadequate parental guidance

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Lack of moral advices and support from the parents

Inability to facilitate moral vs. immoral behavior

Seek help with trusting persons

Dependency

Influenced with immoral behaviors

Learned to use prohibited drugs, smoking, and drinking of alcohol

Substance dependency and intolerance (increase amount of substances)

Irrational thinking developed

Violent behavior

(hurting his mother, nagwawala, kung ano maisipan gagawin, nambabato )

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Due to early death of Mang J.M’s father, his mother needed to work hard to raise them well. This resulting Mang J.M to become dependent and able to seek company of others to fill the lacks of his parents’ assistance during growing years. And he did things that he acquired from such people without thinking if it is good or bad.

Related Theory

According to Duldt-Battey, Bonnie Weaver - Humanistic Nursing Communication Theory, The environment is a “booming, buzzing” world of strange sensations that must be sorted out to determine which are the most important; this sorting is achieved through communication with other people. The need to communicate is an innate imperative for human beings. The purpose of nursing is to intervene to support, to maintain, and to augment the client’s state of health.

Maslow's hierarchy explains human behavior in terms of basic requirements for survival and growth. According to theory, when the individual's physiological and safety needs are met, needs for love and belongingness emerge. These needs include longings for an intimate relationship with another person as well as the need to belong to a group and to feel accepted. Maslow emphasized that these needs involve both giving and receiving love.

Peer pressure (Fraternity)

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Bad influences caused by peers

Learned to use prohibited substance such as Marijuana, alcohol, cigarette

Dependency

Intolerance

( increase amount and dosage)

Irrational thinking

Violent behavior

(nagwawala, kung ano maisipan gagawin, nambabato)

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Mang J.M was a member of TAU GAMMA fraternity. Within this fraternity, we can conclude that he learned to use prohibited drugs, possible experienced hazing and involved in different troubles though he claimed that he was good and not participated in fights. These may cause him to become a drug abuser and later develop dependency resulting him to become violent.

Related Theory

There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system mode there are 4 assumptions of system: First assumption states that there is “organization, interaction, interdependency and integration of the parts and elements of behaviors that go to make up The system ” A system “tends to achieve a balance among the various forces operating within and upon it', and that man strive continually to maintain a behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces impinging upon him.”A behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to man that is to say, it is functionally significant in that it serves a useful purpose, both in social life and for the individual. The final assumption states “system balance reflects adjustments and adaptations that are successful in some way and to some degree.” The integration of these assumptions provides the behavioral system with the pattern of action to form “an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relation of the person to the objects, events and situations in his environment.

According to Sullivan, individual self identity is built up over the years through his perceptions of how significant people in his environment regard him. According also to Sullivan, people are influenced mostly by their relationship with others.

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Occupational stress

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Frustration in life

Inability to cope up with life situation

Hopelessness occur

Stress

Disruption in behavior

Depression

Restlessness Agitation

Analysis and interpretation

Mang J.M had a history of hitting a man during he was a jeepney driver. Due to the incidence he became agitated, always afraid of something and nervous for 20 months that

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leads to his first confinement. This situation caused him to be always under stress and become restless and agitated

Related Theory

Maslow's hierarchy explains human behavior in terms of basic requirements for survival and growth. According to theory, once the individual's basic physical needs are met, his or her needs for safety emerge. These include needs for a sense of security and predictability in the world. The person tries to maintain the conditions that allow him or her to feel safe and avoid danger. Maslow thought that inadequate fulfillment of these needs might explain neurotic behavior and other emotional problems in some people.

According to Roy, the person is a bio-psycho-social being. The person is in constant interaction with a changing environment. To cope with a changing world, person uses both innate and acquired mechanisms which are biological, psychological and social in origin. To respond positively to environmental changes, the person must adapt. The person’s adaptation is a function of the stimulus he is exposed to and his adaptation level.

Poor coping mechanism (Separation from loved ones)

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Inability to cope- up with the situation

Use of illegal Stress

Substance, drinks alcohol

And smoked cigarettes change in mood and affect

Substance dependency

Anxiety develops Intolerance (increased amount & dose)

Irrational thinking depression

Violent tendency and suicidal

Thoughts Self pity restlessness sleeplessness

Isolate self from others

Analysis and interpretation

Mang J.M has been separated from his wife. This situation may be a leading cause why he was under stress that leads in development of anxiety to depression resulting to self pity, restlessness and sleeplessness. On the other hand, it may also, causes Mang J.M to use

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illegal substances and became dependent that brought him in having violence and suicidal ideation.

Related Literate

According to Travelbee human conditions and life experiences encountered by all men as sufferings, hope, pain and illness. Illness is being unhealthy, but rather explored the human experience of illness. Suffering is a feeling of displeasure which ranges from simple transitory mental, physical or spiritual discomfort to extreme anguish and to those phases beyond anguishes the malignant phase of dispairful “not caring” and apathetic indifference. Pain is not observable. A unique experience. Pain is a lonely experience that is difficult to communicate fully to another individual. Hope is the desire to gain an end or accomplish a goal combined with some degree of expectation that what is desired or sought is attainable. Hopelessness is being devoid of hope. Nursing is an interpersonal process whereby the professional nurse practitioner assists an individual, family or community to prevent or cope with experience or illness and suffering, and if necessary to find meaning in these experiences.

According to Henderson individual compose of biological, psychological, sociological, and spiritual components. All external conditions and influences that affect life and development. Nursing assists and supports the individual in life activities and the attainment of independence. Nurse serves to make patient “complete” “whole", or "independent." The nurse is expected to carry out physician’s therapeutic plan Individualized care is the result of the nurse’s creativity in planning for care.

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LITERATURES

Paranoia Agent, Symptom, Cause, Treatment and Medication of Paranoia

Cause of Paranoia

1) Homosexual fixation: According to Freud, the patient suffering from the disease has repressed his tendency to homosexual love to such an extent that he develops a fixation concerning it. Freud's view has been found correct in many cases, but it does not explain each and every case of the disease.

2) Feelings of inferiority: Here the psychologists have found that the main cause of paranoia is a sense of inferiority that may be caused by a variety of condition such as failure, disgust, sense of guilt.

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3) Emotional complex: Certain psychologist points out emotional complexes, and also believe that they are seen to be present in other mental diseases as also in normal individuals. 4) Personality type: Cameron believes a certain type to be more susceptible to this disease, a personality that has sentimentally, jealousy, suspicion, ambition, selfishness and shyness etc. Patients of paranoia do exhibit these peculiarities of personality but on this basis they cannot be said to belong to definite personality.

5) Heredity: In the opinion of Fisher the main responsibility of paranoia lies fairly and squarely upon heredity, although he does not deny the importance of repression and emotional complexes. The causes of paranoia are not physical because no patient exhibits any signs of physical deformity and among the causes there are many important" ones, such as defects of personality, sense of inferiority, repression etc.

AREA OF THE ARTICLE THAT WE AGREE

We agree that people who have feeling of inferiority can significantly affect an individual. These circumstances stressful to an individual and can be cause of schizophrenia.

AREA OF THE ARTICLE THAT WE DISAGREE

No disagreement in the article.

SIGNIFICANCE TO US AS A NURSE

The literature stated that feelings of inferiority are a cause of paranoid schizophrenia. It means that a individual with poor coping mechanism are prone to schizophrenia. The nurse must can assist the client and help the client to verbalize feelings to overcome such problems.

Paranoid Schizophrenia - Case Study

Paranoid

Schizophrenia

UNIT I

(Dedication, Acknowledgement, Introduction, Personal Data,

Chief Complaints and Health History)

HEALTH HISTORY

UNIT II

UNIT III

PSYCHOPATHOPHYSIOLOGY

RELATED

LITERATURES