Diagnosis:

Acute polymorphic psychotic disorder with symptoms

Of schizophrenia- This is a very variable condition with hallucinations, delusions,
emotional turmoil, intense transient feelings such as ecstasy or anxiety but the
criteria for the major psychotic illnesses are not fulfilled. Also, there are symptoms
of schizophrenia that are present such as thought broadcasting, delusions of
control, passivity, and auditory hallucinations giving a running commentary on the
patient and catatonic behavior. They may or may not be associated with a marked
precipitating stressor and are defined as such, “with associated stress” or
“without associated acute stress”. There may be pro-dormal symptoms before the
florid onset or it may be observed as abrupt (i.e. within 48 hours) or over a longer
period of up to two weeks, the symptoms remitting completely usually within 3
months. If this period is much prolonged then the diagnosis should be
reconsidered. Disorders included in this group are the formerly named “bouffee
delirante” and cycloid psychoses.

Patient’s profile:
Name: Christine Alano Magdaraog
Age: 17 y/o
Gender: F Birthday: Jan. 9, 1993
Address: Gawad Kalinga Sison Magdaong Drive Muntinlupa City
Educational Attainment; High school Graduate
Father’s name: Carlos Dacer Magdaraog
Mother’s name: Zenaida Tibal Alano
First admission; May 11, 2010

Family history: no family history/ N/A

Psychodynamics of acute polymorphic psychoses is unknown; however it is clear

that some may be precipitated by stressful events and remit after the stress has
passed. Psychotic reactions to alcohol and drugs may occur which are
indistinguishable from these disorders and if they are prolonged may be very
difficult to distinguish from schizophrenia. However they usually remit when the
substance is no longer abused. Psychotic conditions due to substance abuse are
coded separately.

History of mental illness

Not fully known, but according to the sister “nagpapagala-gala, naRAPE,
lagging tulala, at iba iba sinasabi”.
Admission History:
Patient is the second of 5 siblings, high school graduate. She is going to
Manila March 26, 2010 to be a housekeeper while her family is leaving in
province. But the patient was being raped. According to medico-legal she has a
clear evidence of blunt penetrating trauma to the hymen. She was referred to the
psychiatric unit for the possible post traumatic stress syndrome. She’s also brought
to the hospital due to the swelling of her left index finger. She was disoriented with
tangential response to questions. Speech is none presumed but with looseness of
association. She’s always saying that she’s KIM CHUI and sometimes
CHHRISTINE HERMOSA.

Psychiatric test/ Lab test

(None)
 Management

Drug Study

Name of drug Indications contraindicatio Side effects

n
(brand and generic name)
haloperidol Haloperidol is an not for use in *headache, dizziness,
antipsychotic psychotic spinning sensation,
Generic Name: haloperidol medication. It works conditions drowsiness;
(HAL oh PER i dol) by changing the related to
Brand names: Haldol, actions of chemicals dementia *sleep problems
Haldol Decanoate in your brain. (insomnia);

Haloperidol is used to *feeling restless or

treat schizophrenia. It anxious;
is also used to control
motor and speech tics *mild skin rash or
in people with itching;
Tourette's syndrome.
*breast enlargement,
irregular menstrual
periods

*dry mouth, blurred

vision, urinating less
than usual.
Biperiden Hydrochloride Biperiden is a Narrow-angle Blurred vision, central
medicine licensed to glaucoma, nervous system effects,
treat Parkinson's asthma, urinary retention,
disease and certain obstruction of postural hypotension,
movement problems the genitourinary tachycardia, dry mouth,
or GI tract, or decreased sweating,
known and hypersensitivity
hypersensitivity reactions.
to this drug
prohibits its use.
 to help protect against Diabetics, Transient mild soreness
Ascorbic Acid infection, and patients prone to may occur at the site of
assisting with clearing recurrent renal intramuscular or
up infections and is calculi, those subcutaneous injection.
thought to enhance the undergoing stool Too-rapid intravenous
immune system. occult blood administration of the
tests, and those solution may cause
on sodium- temporary faintness or
restricted diets dizziness.
or anticoagulant
therapy should
not take
excessive doses
of vitamin C
over an extended
period of time.

Observed signs and symptoms: hallucinations, delusions or perceptual

disturbances are obvious but markedly variable, changing from day to day or even
from hour to hour. Emotional turmoil with intense transient feelings of happiness
or ecstasy, or anxiety and irritability, is also frequently present.

NURSING INTERVENTIONS:

Strengthening differentiation

 Provide patient with honest and consistent feedback in a non

threatening manner.
 Avoid challenging the content of patient’s behavior
 Focus interactions on patient’s behavior.
 Administer drugs as prescribed while monitoring and documenting
patient’s response to drug regimen.
 Use simple and clear language when speaking with the patient.
 Explain all procedures, test and activities to patient before starting
them

Promoting socialization

 Encourage patient to talk about feelings in the context of a trusting,

supportive relationship.
 Allow patient to reveal delusions to you without engaging in power
struggle over the content or the entire reality of the delusions.
 Use supportive, emphatic approach to focus on patient’s feelings
about troubling events or conflicts.
 Provide opportunities for socialization and encourage participation in
group activities.
 Be aware of personal space and use touch judiciously.
 Help patient to identify behaviors that alienate significant others and
family members.

Ensuring safety:
 Monitor patient for behaviors that indicate increased anxiety and
agitation.
 Collaborate patient to identify anxious behaviors as well as causes.
 Establish consistent limits on patients behavior and clearly
communicate these limits to patients, family member, and health care
providers.
 Secure all potential weapons and articles from patients room and the
unit environment that could be used to inflict injury.
 Determine the need for external control, including seclusion or
restraints. Communicate the decision to patient and put plan into
action.
 Frequently monitor the patient within guidelines of facility’s policy on
restrictive devices and assess the patients level of agitation.
 When patient’s level of agitation begins to decrease and self control
regained, establish a behavioral agreement that identifies specific
behaviors that indicate self control against are escalation agitation.