SCHIZOPHRENIA

OBJECTIVES
GENERAL OBJECTIVE:

After the end of the case presentation, the students will

be able to acquire the knowledge, enhance their skills
and develop attitude towards dealing of psychiatric
patients with Schizophrenia:
Specifically, this aims to:
KNOWLEDGE:
1. To be able to obtain the psychiatric history of the patient
such as:
 General data
 Chief complaint
 History of present illness
 Past personal history
 Family history
 Current social situation and home environment
 Pre-morbid personality
2. To be able to obtain information about the
mental status of the patient and to determine
the different psychiatric signs and symptoms
the patient is exhibiting by observing his:
General appearance and behaviour
Characteristics of speech
3. Note the client’s problems and identify his
coping skills.

4. Understand how this illness/process has

affected the client’s life.
SKILLS:
1. Demonstrate the appropriate approach used in
dealing with psychiatric patients with schizophrenia.
2. Perform therapeutic verbal and non-verbal
communication skills.
3. Perform nursing care and interventions with
competence and confidence in rendering care to
psychiatric patients with schizophrenia.
ATTITUDE:
1. Establish rapport to patient and folks.
2. Encourage folks to cooperate in the
interventions that are being performed to the
patient.
3. Collaborate with all the health team to
promote efficient care to the patient.
 PSYCHIATRIC HISTORY
I.  General Data
Name: S. I.
Age: 24
Sex: Male
Educational Attainment: High School Graduate; Vocational
Course – TESDA (Food and Beverage Services)
Civil Status: Single
Nationality: Filipino
Address: Nabitasan, Leganes Iloilo
Religion: Roman Catholic
II. Chief Complaint
Patient was admitted with a chief complaint of
restlessness and talking irrelevantly. Two weeks prior to
admission, he became restless and violent. For the reason
that his mother did not give him money to attend the
burial of his godchild in Kalibo. Because of that he started
to wander around naked and talking irrelevantly. Then he
was brought to Pototan Mental Health Unit by his mother
to be admitted.
III. History of Present Illness
At the age of 9, patient S.I. was scolded and pinched by their
principal in front of his classmates for being suspected in
doing such things he never did. He was ashamed and
humiliated. He never told his parents at first, because he was
afraid of how they would react.
When he was 13 years old, he often witnessed how his father
would abuse his mother physically during arguments. He also
saw how his neighbour, a policeman, assaulted his elder
brother and how the same person aimed a gun to his father.
After a week, he also witnessed the same neighbour brought
a grenade to their house and how his mother and family
panicked because of this incident.
Also, in his high school years, his mother decided to go to
Manila to work and earn money. S.I. was depressed. They
were left with their grandmother who is a gambler.
Because their grandmother isn’t always there, S.I. dropped
out from high school but continues to sell any
commodities in their community. He would not eat until
he could sell all of his items.
Last 2006, he was staying at Kalibo when he was
imprisoned for a day because of being violent while under
the influence of alcohol. Also from that year, he
manifested auditory hallucinations. He went home to
Iloilo and was brought to the hospital by his mother for a
check-up, as he also started to wander aimlessly, wanting
to be left alone. He was diagnosed with disorganized
Schizophrenia and was given medications by his doctor.
Last October 2010, he and his mother opted to go downtown (Iloilo City) to
get remittance from his sister working abroad. While waiting for his mother,
he decided to go ahead without any money. He ended up at SM City Iloilo
and ordered Halo-Halo from Dulcinea Restaurant. Because he has no money
to pay his bill, the security officers brought him to Bolilao Police Outpost.
He was then transferred to Mandurriao Police Station. His mother came
looking for him and found him with bruises on some parts of his body. He
appeared to be frail and seems to be in shock.

Two weeks prior to admission, his godchild from Kalibo died. He wanted to
attend the burial so he asked his mother for money. When his mother cannot
give him any, he became restless, violent, talking irrelevantly. He began to
take off his clothes and walked around their barangay naked, convincing his
mother to give him money. He was brought to Pototan Mental Health Unit
for treatment and was diagnosed of schizophrenia, disorganized type.
IV. PAST HISTORY
 Patient S.I. has no severe illness except for having fever and common colds.
When he was 2 years old, he had an allergic reaction to Birch Tree Milk. He
was never admitted but was only given Antihistamine drugs. When he
reached 5 years of age, a lump was found in his testicles. They consulted a
doctor but he told them that he was too young to be operated. His mother
then brought him to a quack doctor; they were given a herbal medicine to
drink. His lump, eventually, burst oozing with pus. One year later, another
lump grew in his left axilla, approximately 3 cm in diameter. His mother
did not attempt to consult the doctor because of financial constraints.
 Patient S.I. is an active smoker. He started smoking when he was 15 years
old. He can consumed 1 pack of cigarettes per day. He also drinks alcoholic
beverages (tanduay, beers etc.) occasionally, 2-3 bottles every 2 weeks.
V. FAMILY HISTORY
(+) Hypertension – paternal side

They have a history of mental illness on his maternal side; his

uncle has been diagnosed with a mental illness and was also
admitted at PMHU for two years.
His father has no stable job and his mother is a food vendor in
their barangay and a nearby school. Aside from food, his mother
also sells other commodities such as vegetables and fish. He has
also a sister who works abroad as a domestic helper and a brother
who is a carpenter. He has a harmonious relationship with his
siblings and family, except in times when his father tends to
physically abuse his mother when he is drunk.
VII. MARITAL HISTORY
Patient is single, never married although he had
experience having girlfriends in the past. He could not
recount on how many relationships he had. Lately he has
been courting a girl he knew at Pototan Mental Health
Unit when he was having his check-up. He would visit the
girl and bring orchids, which he would pick from his
uncle’s garden.
VIII. CURRENT SOCIAL SITUATION AND
HOME ENVIRONMENT
Patient is residing at Nabitasan, Leganes together with his parents
and siblings. The family lives in a clustered kind of
neighbourhood wherein the houses are within close proximity
with each other. Their neighbourhood is somewhat peaceful, with
the occasional altercations and conflicts brought about by
arguments amongst neighbours and sometimes from drunkards.
People from their place are well-acquainted with each other since
they live closely and most of them are relatives. Patient has a good
relationship with his parents and siblings. Both his parents consult
one another in deciding for their major and minor decisions in the
household, but oftentimes the wife is the decision maker.
The family is not that financially stable since their
expenses are sometimes greater than their income. The
mother tends to mismanage their money since she
occasionally lends money to some of their neighbours
even though they have barely enough. Sometimes they
ask for money from their relatives especially with regards
to the medications. Their source of income ranges from
the selling of food at the nearby school to casual jobs like
selling assorted goods and products.
IX. PRE-MORBID PERSONALITY
Patient is a quiet type of person, even as a child he
was silent and well-behaved. His elementary and high
school teachers are fond of him. He is sociable and
enjoys the company of a small group of friends but he
tends to keep his problems to himself, he doesn’t like
to open up and talk about his feelings even to his
family.
MENTAL STATUS EXAMINATION
General Appearance and Behavior:
S.I. is a 24 years old male of average height of 5’2 and average
weight of 62 kgs. At the time of examination, he was kempt,
well groomed with short hair neatly combed. He is clad in
clean clothes and dressed appropriately. He attends to his
hygiene by taking a bath everyday. No signs of abnormal
body movements or any mannerism. He is behaved,
manageable, helpful and mingled with co-patients inside
the ward. He is also able to manage activities of daily living
with minimum assistance. During interaction, Steve was
cooperative and maintained eye contact, except during the
times when recounting the incident between Rommel and
his family. Then, he appeared angry.
Characteristics of Speech:
S.I. articulated himself clearly. He answered questions
relevantly and spontaneously, on a normal rate and speed.
He talks in a normal audible voice with coherence.
Mood or Affect:
S.I.’s mood is appropriate to his thought content. His
affect was sad with normal range of mood. He was sad for
he already wanted to go home. He also appeared to be
angry at the sight of patient R.J.
Content of Thought:
S.I. did not exhibit any formal thought disorders. He was
able to answers question spontaneously and directly. He
did not use any new or created words. S.I. has no other
positive symptoms, such as delusions, phobias or
compulsions. Suicidal ideation was not detected. He
exhibits normal perception. Symptoms, such as illusions,
hallucinations and misinterpretations, were not elicited.
However, he was sad, wanting to go home and angry,
seeing patient R.J., blaming him for the circumstance that
happened to him and his family.
Sensorium Functions:
S.I. was alert and oriented to time, place and person. He
was able to answer questions with good immediate,
remote and recent memory. He recalls his past without
difficulties. His attention is easily aroused and sustained.
Insight and Judgment:
S.I. has the ability to size up a situation, when asked about
what he would do if he was able to go home, he would
answer that he will put up a business or any means of
income. When questioned about her condition, S.I.
accepted the fact that he is ill and requires treatment. He is
cooperative with the doctors and nurses and is compliant
with management.
HOSPITAL COURSE AND
OBSERVATION
On the tenth day of December 2010, S.I. was admitted to
open ward with restraints on both arms and extremities.
By 6:25 PM, Haloperidol 5mg/amp + diphenhydramine
50mg/amp was given IM.
Two days after admission, patient was responsive to
queries but with limited verbal response.
Around 6:00 PM, he kicked his mother without any
apparent reason
He usually roams around with his backpack with
incongruent affect verbalizing that he wants to go home.
Then he started attending activities and by the 16 th day of
December, he was already participative and manageable.
DIAGNOSTIC FORMULATION
OF IMPRESSION
Disorganized schizophrenia, also known
as foldermenia is a subtype of schizophrenia as defined in
the Diagnostic and Statistical Manual of Mental Disorders
, DSM-IV code 295.10.

Disorganized schizophrenia is marked by thoughts,

speech and behavior that are inappropriate and don't make
sense.

A person with disorganized schizophrenia may also

experience behavioral disorganization which may impair
his/her ability to carry out activities of daily living such as
showering or eating.
 Diagnostic criteria for disorganized schizophrenia include:
Disorganized speech
Disorganized behavior
Lack of emotion
Emotion inappropriate for the situation

It can sometimes be difficult to diagnose disorganized

schizophrenia, especially because different conditions can
have similar symptoms.
PSYCHOPATHOLOGY
 Incident when he was:
24 years old
•9 y.o.
uncle who has a
•His brother was assaulted.
mental illness •His father was aimed with a gun.
low socio economic
•Grenade
status. •His mother went to Manila

PRE MORBID PHASE

PRODROMAL PHASE
He was imprisoned in
Kalibo (2006)
ONSET OF SCHIZOPHRENIA

s/sx: s/sx:
• Disorganized speech • Auditory hallucinations
• Lack of attention to • Disorganized behavior
personal hygiene • Social isolation occur
 DISORGANIZED SCHIZ

s/sx: s/sx:
• Disorganized speech • Disorganized behavior
• Incongruent affect

PROGRESSIVE PHASE
Client recovered from the first episode and can experience relapse

Dulcinea event
His Godchild died, mother
cant give money
RELAPSE of Schiz
MEDICATIONS
NURSING CARE PLAN