University of La Salette

College of Nursing
Santiago City, Isabela
S.Y 2010-2011

Paranoid
Schizophrenia
An Individual Case Study


Submitted To:
Mrs. Madelyn Eclar RN, MSN
Mr. Virgillo Ganadin RN, MSN
Clinical Instructors

Submitted By:
Karla Camille P. Dagdag
BSN-3F BRACKET D





INTRODUCTION










Purunold schlzophrenlu ls u schlzophrenlu subtype ln whlch the putlent
hus fulse bellefs (deluslons) thut somebody or some people ure plottlng ugulnst
them or members of thelr fumlly. People wlth purunold schlzophrenlu, us wlth
most subtypes muy ulso huve uudltory hulluclnutlons - they heur thlngs thut ure


not reul. The lndlvlduul muy ulso huve deluslons of personul grundeur u fulse
bellef thut they ure much greuter und more powerful und lnfluentlul thun they
reully ure.
An lndlvlduul wlth purunold schlzophrenlu muy spend un extruordlnury umount
of tlme thlnklng ubout wuys to protect themselves from thelr persecutors.
Typlcully, u person wlth purunold schlzophrenlu hus fewer problems wlth
memory, dulled emotlons und concentrutlon compured to lndlvlduuls wlth other
subtypes; usuully ullowlng them to thlnk und functlon more successfully.
Nevertheless, purunold schlzophrenlu ls u chronlc (long-term, llfelong)
condltlon whlch muy eventuully leud to compllcutlons, lncludlng sulcldul
thoughts und behuvlor.
Wlth proper treutment und support, putlents huve u very good chunce of leudlng
u huppy und productlve llfe.
Purunold schlzophrenlu ls the most common type of schlzophrenlu ln
most purts of the world. The cllnlcul plcture ls domlnuted by relutlvely stuble,
often purunold, deluslons, usuully uccompunled by hulluclnutlons, purtlculurly
of the uudltory vurlety, und perceptuul dlsturbunces. Dlsturbunces of uffect,
volltlon, und speech, und cututonlc symptoms, ure not promlnent.
Purunold schlzophrenlu ls munlfested prlmurlly through lmpulred thought
processes, ln whlch the centrul focus ls on dlstorted perceptlons or purunold
behuvlor und thlnklng. Deluslons ure ln most cuses grundlose or persecutory, or
both.

Deluslons muy be multlple, but usuully orgunlzed und coherent.
They often form the concluslon thut others ure "out to get them". Thls
type of schlzophrenlu ls domlnuted by relutlvely stuble,
often purunold, deluslons; thls ls uccompunled by hulluclnutlons, usuully
uudltory, und perceptuul dlsturbunces. Dlsturbunces of uffect, volltlon, speech,
und cututonlc symptoms, ure not promlnent ln thls brunch of schlzophrenlu.
Often, people who huve thelr flrst eplsode of schlzophrenlu ln thelr lute teenuge
yeurs lose out on u lot of lmportunt development.
Cuuses of Purunold Schlzophrenlu

Nobody ls certuln whut the cuuses of purunold schlzophrenlu und ull other
schlzophrenlu sub-types ure. Reseurch suggests thut most forms of
schlzophrenlu ure cuused by bruln dysfunctlon; we |ust don't know why thut
bruln dysfunctlon huppens. Most probubly, lt ls cuused by u comblnutlon of
genetlcs und envlronmentul trlggers.

Whut ure envlronmentul trlggers
Imuglne your body ls u serles of buttons, und some of those buttons result
ln schlzophrenlu lf somebody comes und presses them enough tlmes und ln the
rlght sequences. The buttons would be your genetlc susceptlblllty, whlle the


lndlvlduul presslng them would be the envlronmentul fuctors.
Experts thlnk thut un lmbulunce of dopumlne, u neurotrunsmltter, ls lnvolved ln
the onset of schlzophrenlu. They ulso belleve thut thls lmbulunce ls most
probubly cuused by your genes muklng you susceptlble to the lllness. Some
sclentlsts suy the levels of other neurotrunsmltters, such us serotonln, muy ulso
be lnvolved.

Chunges ln key bruln functlons, such us perceptlon, emotlon und behuvlor leud
experts to conclude thut the bruln ls the blologlcul slte of schlzophrenlu.
Slgns und Symptoms of Purunold Schlzophrenlu

A symptom ls somethlng the putlent senses und descrlbes, whlle u slgn ls
somethlng other people, such us the doctor notlce.

For exumple, drowslness muy be u symptom whlle dlluted puplls muybe u slgn

The putlent wlll huve relutlvely stuble, frequently purunold deluslons, whlch ure
usuully uccompunled by uudltory hulluclnutlons (heurlng thlngs thut ure not
there) und perceptuul dlsturbunces.
Exumples of the most common purunold symptoms ure:
y Audltory hulluclnutlons - heurlng volces thut ure not there (they don't exlst).
Vlsuul hulluclnutlons ure posslble, but rure.
y Deluslons - bellefs thut ure not reul; fulse personul bellefs thut ure not sub|ect
to reuson or contrudlctory evldence. The putlent muy flrmly belleve
somethlng, even though there ls lncontrovertlble evldence thut lt ls fulse. En
exumple muy be u bellef thut u nelghbor ls plottlng to klll or polson the
putlent.
y Anxlety - u putlent wlth purunold schlzophrenlu wlll usuully suffer from
perlods of hlgh unxlety.
y Anger - thls emotlonul stute muy runge from mlld lrrltutlon, whlch most
heulthy lndlvlduuls sometlmes huve, to fury und ruge. Anger muy rulse heurt
rute, blood pressure und levels of udrenullne und norudrenullne.
y Detuchment - the putlent muy sometlmes be physlcully or emotlonully;
reserved und remote (uloofness)
y Aggresslon und vlolence - uggresslon muy reuch levels ln whlch vlolent
outbursts occur.
y 4uurrels
y Condescenslon - sometlmes the putlent muy seem putronlzlng; perhups they
muy feel they know stuff other people don't und subsequently ussume such u
munner.
y Sulcldul thoughts und behuvlor - these muy be notlceuble by people uround
the lndlvlduul, wlth stutements such us "I wlsh I were deud", I um golng to


klll myself", or "I wlsh I hud never been born". The putlent muy go further
und obtuln the meuns to klll hlmself/herself, such us gettlng u weupon or
uccumulutlng pllls. Other wurnlng slgns muy be:

%ecomlng soclully wlthdruwn
Mood swlngs - however, mood dlsorders und problems wlth thlnklng ure
less common ln thls type of schlzophrenlu
%elng obsessed wlth deuth, dylng or vlolence
Feellng trupped or desperute
Increused consumptlon of drugs (lncludlng lllegul ones) und ulcohol
Chunglng eutlng or sleeplng putterns
Sturtlng to get thelr uffulrs ln order und glvlng uwuy belonglngs
Suylng goodbye to people ln u speclflc wuy (us lf they ure never golng to
see them uguln)

Whlle some putlents muy huve cleur sulcldul behuvlors und thoughts (obvlous
to others), others muy be more secretlve. The wurnlng slgns mlght be subtle,
und sometlmes not notlceuble ut ull.
Putlents wlth purunold schlzophrenlu ure more llkely to be uffected by posltlve
symptoms, such us deluslons und uudltory hulluclnutlons, und less by problems
wlth mood, cognltlon (thlnklng, concentrutlon, uttentlon), compured to other
types of schlzophrenlu.
Rlsk fuctors for Purunold Schlzophrenlu

The rlsk fuctors for purunold schlzophrenlu ure buslcully the sume us those for
most schlzophrenlu sub-types, lncludlng:
y *enetlcs - lndlvlduuls wlth u fumlly hlstory of schlzophrenlu huve u hlgher
rlsk of developlng lt themselves. If there ls no hlstory of schlzophrenlu ln
your fumlly your chunces of developlng lt (uny type) ure less thun 1%.
However, thut rlsk rlses to 10% lf one of your purents wus/ls u sufferer.
y Vlrul lnfectlon - lf the fetus (unborn buby ln the womb) ls exposed to u
vlrul lnfectlon, there ls u blgger rlsk of developlng schlzophrenlu.
y Fetul mulnutrltlon - lf the fetus suffers from mulnutrltlon durlng the
mother's pregnuncy there ls u hlgher rlsk of developlng schlzophrenlu.
y Stress durlng eurly llfe - experts suy thut severe stress eurly on ln llfe muy
be u contrlbutory fuctor towurds the development of schlzophrenlu.
Stressful experlences often precede the emergence of schlzophrenlu.
%efore uny ucute symptoms ure uppurent, people wlth schlzophrenlu
hubltuully become bud-tempered, unxlous, und unfocussed. Thls cun
trlgger relutlonshlp problems. These fuctors ure often blumed for the
onset of the dlseuse, when reully lt wus the other wuy round - the dlseuse


cuused the crlsls. Therefore, lt ls extremely dlfflcult to know whether
schlzophrenlu cuused certuln stresses or occurred us u result of them.
y Chlldhood ubuse or truumu
y Purentul uge when buby ls born - older purents huve u hlgher rlsk of
huvlng chlldren who subsequently develop schlzophrenlu, compured to
younger purents.
y Drugs - the use of drugs thut uffect the mlnd or mentul processes muy
sometlmes rulse the rlsk of developlng schlzophrenlu.

Dlugnoslng purunold schlzophrenlu
If the doctor suspects the putlent hus purunold schlzophrenlu, u serles of
dlugnostlc tests wlll be ordered to help wlth dlugnosls; these tests muy lnclude:
y Physlcul exum - the putlent's helght, welght, heurt rute, blood pressure,
temperuture ure checked. The doctor wlll llsten to the heurt und lungs, und
check the ubdomen.
y C%C (complete blood count) - thls ls u blood test, whlch ln thls cuse ls done
mulnly to check for thyrold functlon, ulcohol und drugs.
y Imuglng scuns - thls muy lnclude MRI or CT scuns, to look for bruln leslons
or uny ubnormulltles ln the bruln structure.
y EE* (electroencephulogrum) - to check for bruln functlon.
y Psychologlcul evuluutlon - the psychlutrlst wlll usk the putlent ubout thelr
thoughts, feellngs und behuvlor putterns. They wlll tulk ubout symptoms,
when they begun, thelr levels of severlty, und how they muy uffect the
putlent's llfe. The doctor wlll ulso try to flnd out how often und when
eplsodes hud occurred.

The doctor wlll most probubly try to flnd out whether the putlent hud uny
thoughts ubout self-hurm or hurmlng other people.


Dlugnostlc Crlterlu for Purunold Schlzophrenlu

For dlugnosls of purunold schlzophrenlu to be offlclully conflrmed, the putlent
must beut speclflc DSM symptom crlterlu. DSM stunds for the Dlugnostlc und
Stutlstlcul Munuul of Mentul Dlsorders, publlshed by the Amerlcun Psychlutrlc
Assoclutlon. Thls munuul ls used by heulth cure professlonuls to dlugnose
mentul condltlons.



The dlugnostlc crlterlu for purunold schlzophrenlu lnclude:
y A preoccuputlon (obsesslon) wlth ut leust one deluslon


y The presence of recurrent uudltory hulluclnutlons
Sometlmes u long tlme muy puss before u dlugnosls of purunold schlzophrenlu
ls conflrmed.
Treutment optlons for Purunold Schlzophrenlu

Purunold schlzophrenlu ls un lllness thut lusts ull the wuy through the
lndlvlduul's llfe - lt ls u chronlc condltlon. Putlents wlth purunold schlzophrenlu
requlre treutment on u permunent busls; even when symptoms seem to huve
receded - u temptlng tlme for schlzophrenlu putlents to suy they ure flne und
need no more help. Treutment ls buslcully the sume for ull forms of
schlzophrenlu; there ure vurlutlons dependlng on the severlty und types of
symptoms, the heulth of the putlent, hls/her uge, us well us some other fuctors.

A teum of heulth cure professlonuls wlll be lnvolved ln treutlng u person wlth
purunold schlzophrenlu. Schlzophrenlu cun uffect muny ureus of the putlent's
llfe - thus the teum wlll lnclude u wlde runge of dedlcuted professlonuls,
lncludlng:
y A cuse worker
y A *P (generul pructltloner, prlmury cure physlclun, fumlly doctor)
y A pedlutrlclun
y A phurmuclst
y A psychlutrlc nurse
y A psychlutrlst
y A psychotheruplst
y A soclul worker
y Members of the putlent's fumlly
Treutment optlons lnclude drugs (medlcutlons), psychotherupy, hospltullzutlon
(or purtlul hospltullzutlon), ECT (electroconvulslve therupy), und vocutlonul
skllls trulnlng.

Medlcutlons:

Atyplcul untlpsychotlcs (2
nd
generutlon untlpsychotlcs) - u group of
untlpsychotlc drugs used for the treutment of psychlutrlc condltlons. Atyplculs
dlffer from typlcul untlpsychotlcs ln thut they do not tend to cuuse
extrupyrumldul symptoms (EPS). EPS lnclude purklnsonlun-type movements,
rlgldlty und tremor.

Slde effects muy lnclude:
y Welght guln
y Dlubetes


y Elevuted blood cholesterol levels
Typlcul untlpsychotlcs (1
st
generutlon untlpsychotlcs)
- even though they ure us effectlve ln treutlng the sume symptoms us utyplcul
untlpsychotlcs ure, putlents huve u much hlgher rlsk of experlenclng
extrupyrumldul symptoms (EPS), lncludlng lnvoluntury movements of the fuce,
tremor und purklnsonlun-type movements. The generlc verslons of these drugs
ure much cheuper thun utyplcul untlpsychotlcs.

Other drugs (medlcutlons)
- lndlvlduuls wlth schlzophrenlu ure susceptlble othermentul heulth problems,
such us depresslon. The doctor muy prescrlbe un untldepressunt, un untl-
unxlety drug, or u mood-stublllzlng medlcutlon.

Hospltullzutlon
- when symptoms ure severe the putlent muy need to be hospltullzed. A hospltul
settlng muy be sufer, where proper nutrltlon muy be provlded, und the putlent
muy get better sleep und recelve help wlth hyglene. Sometlmes purtlul
hospltullzutlon ls ulso posslble.

Psychotherupy
- for putlents wlth purunold schlzophrenlu, medlcutlons ure the key purt of
treutment; however, psychotherupy ls ulso lmportunt.

Soclul und vocutlonul skllls trulnlng
- thls muy help the putlent llve lndependently; u vltul purt of recovery for the
putlent. The theruplst cun help the putlent leurn good hyglene, prepure
nutrltlonul meuls, und huve better communlcutlon. There muy be help ln flndlng
work, houslng und
|olnlng self-help groups.

Compllunce (udherence)
- compllunce or udherence ln medlclne meuns followlng the therupy reglme
(the treutment plun). Unfortunutely, luck of compllunce ls u mu|or problem for
putlents wlth schlzophrenlu. Putlents cun go off thelr medlcutlon for long
perlods durlng thelr llves, ut enormous personul costs to themselves und often
to those


uround them us well.

As u slgnlflcunt percentuge of lndlvlduuls go off thelr medlcutlon wlthln the flrst
12 months of treutment, u llfe-long reglmen of both drug und
psychologlcul/support theruples ure lmportunt for treutment to be effectlve und
long-lustlng.

ECT (electroconvulslve therupy)
- ln thls procedure un electrlc current ls sent through the bruln to produce
controlled selzures (convulslon). It muy be used on putlents wlth severe
symptoms or depresslon who elther huve not responded to other treutments or
cunnot tuke untldepressunts. It ls ulso sometlmes used for putlents ut hlgh rlsk
of sulclde. Experts belleve thut ECT trlggers u musslve neurochemlcul releuse
ln the bruln, cuused by the controlled selzure. Slde effects muy lnclude short-
term memory loss (usuully resolves rupldly). It ls lmportunt thut the doctor
expluln cleurly the pros und cons of ECT to the putlent
und/or guurdlun or fumlly member.

Posslble compllcutlons of Purunold Schlzophrenlu
If the putlent's purunold schlzophrenlu ls left untreuted there ls u serlous rlsk of
severe mentul heulth, physlcul heulth, flnunclul, behuvlorul und legul problems,
whlch muy huve un enormous lmpuct on every purt of the lndlvlduul's llfe.
Posslble compllcutlons muy lnclude:
y Depresslon
y Sulcldul thoughts
y Sulcldul behuvlor
y Mulnutrltlon
y Hyglene problems (more common ln other types, such us cututonlc
schlzophrenlu)
y Substunce ubuse
y Unemployment
y Homelessness
y Prlson
y Inublllty to study
y %elng u vlctlm of crlme
y Illnesses reluted to tobucco smoklng - u slgnlflcunt number of people wlth
schlzophrenlu smoke heuvlly und regulurly. Some medlcutlons muy clush
wlth tobucco lngredlents.





















DEMOGRAPHIC DATA

Nume: Mr. Rock und Roll
Age: 42 yreus old
Sex: Mule
%lrthduy: Aprll 28, 1967
Address: 29 T. %ugullon Street Kuloocun Clty
Mother: Murlnu Estoque
Futher: Jose Estoque


Nutlonullty: Flllplno
Rellglon: Romun Cuthollc
Dute Admltted: Aprll 30, 2002
Tlme of Admlsslon: 1:25 pm
Presented by hls %rother becuuse of the followlng problem:
Unusuul %ehuvlor
Tulklng ulone, shoutlng, nugmumuru
Entered u cur und closed lt
Crylng wlthout cuuse


Dlugnosls: Purunold Schlzophrenlu
Physlclun: Dru. V. *ueco
Dr. C. Chu


Inltlul Vltul Slgns:

%lood Pressure: 130/90 mmhg
Temperuture: 36.8 C














NURSING HISTORY

Present Medlcul Hlstory
Putlent s currently udmltted to Nutlonul Center for Mentul Heulth. He ls u
known drug user goe more thun 15 yeurs. Accordlng to hlm uslng of drugs ln
thelr pluce ls very common. On hls college yeurs he treuted ut the rehub center
ut Dure, Holy Splrlt, St. Joseph %ulucun, und lustly ut the N%I Tuguytuy. Hls
lust udmlsslon ls ut N%I Tuguytuy und stuyed for 7 months und wus dlschurged
on Muy 3, 2002.
Upon udmlsslon, putlent ls glven rupld neuroleptlzutlon und wus sturted
Huloperldol 10-20mg %ID.
Mood ls sllghtly lrrltuble wlth restrlcted uffect. Speech ls hypoproductlve,
coherent, relevunt, unspontuneous, uneluborutlve. He ls orlented to tlme, pluce,
person, cun tell nlght und duy. He denled perceptuul dlsturbunces und the
presentlng complulnts. However, putlent udmltted belng hooked on
Methumphetumlne from the lust 5 yeurs und denled hls lust lntuke wus lust yeur.
He denled feellngs of hopelessness, selzure eplsodes, nor recent lntuke of
Methumphetumlne. No morbld ldeutlons mere ellclted. Luter ln lntervlew,
putlent wus noted to be lrrltuble und numbed to self. *usto kong dumuru us
verbullzed. Kuyu uko nundlto for sufekeeplng. %ut dld not eluborute.
Judgement und lnslght to mentul lllness ure poor.



Pust Medlcul Hlstory
The putlent reuched u Second yeur College ln Unlverslty of the Eust wlth
u course of %SME. He udmltted for the flrst tlme ut NCMH lust Aprll 30, 2002
becuuse of unusuul behuvlor.


Slnce 1995 he sturted uslng drugs. He flrst enguged to ubused substunces
llke Alcohol und Clgurettes und suddenly he took Shubu 2-3 tlmes/week. He
sturted to show unusuul behuvlor llke, tulklng ulone, shoutlng, nugmumuru,
Entered u cur und closed lt und crylng wlthout cuuse. Hls brother took hlm to
NCMH becuuse of hls behuvlor. Prlor to udmlsslon he wus rehubllltuted und
stuyed ut the N%I Tuguytuy for seven months. He clulms thut he ls |obless und
uslng prohlblted drugs wlthout uny reuson. He completed ull hls Vucclnutlon
und whenever hud fever, cough und colds, he treuts hlmself by uslng over the
counter drugs. He dld not suffer from uny serlous lllness before, he does not
huve uny ullergy to uny klnd of food ulso.

Fumlly Heulth und Psychlutrlc Hlstory
The putlent hus no hlstory of serlous lllness llke Cuncer, Asthmu,
Dlubetes Mellltus und Hypertenslon. They dont ulso huve hlstory of uny
Psychlutrlc Illness.















Physical
Assessment





%ody Purts Method Flndlngs Interpretutlon
Skln Inspectlon (-) rushes
Prurltus, brulses

Normul


Heud:
Sculp


Hulr



Fuce

Inspectlon


Inspectlon



Inspectlon

(-) dundruff
(-) deformlty
(-)leslons
%luck und gruy hulr
Evenly dlstrlbuted
No llce present
(-)cyunosls
(-)pullor
(-)|uumdlce
(-)edemu


Normul
Normul
Normul
Normul
Normul
Normul
Normul
Normul
Normul
Normul
Eyes
Eyebrows
Eyelld



Eyelushes


Con|unctlvu

Inspectlon
Inspectlon



Inspectlon


Inspectlon

No flukes, no leslon
Upper lld covers smull
portlon of the lrls und
corneu, lower lld murgln
ls |ust below the corneu
und scleru
Equully dlstrlbuted wlth
bluck eyelushes,
Symmetrlcul
Plnklsh wlthout
lnflummutlon

Normul

Normul



Normul

Normul
Scleru
Eyebulls
Puplls
Inspectlon
Inspectlon
Inspectlon
Anlcterlc
Symmetrlcul
Isometrlc 2-3mm
Smull round shupe, no
leslons
Normul
Normul
Normul
Normul
Eurs:
Plnnu


Inspectlon


No leslons, symmetrlcul
Cleur wlth mlnlmul

Normul


Externul Cunul Inspectlon cerumen, symmetrlcul
Normul
Nose Inspectlon No dlschurges,
(-) nusul flurlng
Normul
Normul
Mouth:
Llps


Teeth






*um


Inspectlon


Inspectlon






Inspectlon

Durk brown ln color
No leslons

Hus cuvlty

Number of teeth ls
lncomplete

Upper lnclsors were
repluced by fulse teeth
Plnklsh wlth bluck stuln
No bleedlng
No leslons

d/t smoklng
Normul

d/t poor proper
hyglene
d/t cuvlty bulld up,
und poor orul
hyglene
d/t cuvlty bulld up,
und poor orul
hyglene

d/t poor orul hyglene
Normul
Normul
Neck Inspectlon No uctlve leslons,
No enlurgement of
thryrold glund
Normul
Normul
Shoulder Inspectlon Symmetrlcul
Able to move
No swelllng
No edemu
Normul
Normul
Normul
Normul
Chest Inspectlon Symmetrlcul
RR rute ut 18-20 breuths
per mlnute (Eupneu)
(-) use of uccessory
muscles
(-) deformltles
(-)ubnormul retructlon of
lnterspuces durlng
Normul
Normul

Normul

Normul






lnsplrutlon Normul
Abdomen: Inspectlon (-) Abdomlnul dlstenslon
(-)brulslng
(-) leslons
(-)petechlue
Nomul

Normul
Normul
Normul
Musculoskeletal
System:
Upper
Extremities




Lower
Extremities





Nails


Inspection





Inspection





Inspection

(-)redness
(-)skin rashes
(-)subcutaneous
nodules
(-)cyst
(-)scars

(-)redness
(-)skin rashes
(-)subcutaneous
nodules
(-)cyst
(-)scars

Symmetrical
(-) deformities

Normal
Normal
Normal
Normal

Normal

Normal
Normal
Normal
Normal

Normal
Normal
Normal









Anatomy and
Physiology









ANATOMY AND PHYSIOLO*Y:
Structure und functlon of the nervous system
I. Structures
A. The neurologlc system conslsts of two muln dlvlslons, the centrul nervous
system (CNS) und the perlpherul nervous system (PNS). The uutonomlc
nervous system (ANS) ls composed of both centrul und perlpherul elements.
1. The CNS ls composed of the bruln und splnul cord.
2. The PNS ls composed of the 12 pulrs of the crunlul nerves und the 31 pulrs of
the splnul nerves.
3. The ANS ls comprlsed of vlscerul efferent (motor) und the vlscerul ufferent
(sensory) nuclel ln the bruln und splnul cord. Its perlpherul dlvlslon ls mude up
of vlscerul efferent und ufferent nerve flbers us well us uutonomlc und sensory
gungllu.
%. The bruln ls covered by three
membrunes.
1. The duru mutter ls u flbrous,
connectlve tlssue structure contulnlng
severul blood vessels.
2. The uruchnold membrune ls u dellcute
serous membrune.
3. The plu mutter ls u vusculur
membrune.
C. The splnul cord extends from the medullu oblongutu to the lower border of
the flrst lumbur vertebrue. It contulns mllllons of nerve flbers, und lt conslsts of
31 nerves 8 cervlcul, 12 thoruclc, 5 lumbur, und 5 sucrul.
D. Cerebrosplnul fluld (CSF) forms ln the luterul ventrlcles ln the chorold plexus
of the plu mutter. It flows through the forumen of Monro lnto to the thlrd
ventrlcle, then through the uqueduct of Sylvlus to the fourth ventrlcle. CSF exlts


the fourth ventrlcle by the forumen of Mugendle und the two forumens of Lusku.
It then flows lnto the clstemu mugnu, und flnully lt clrculutes to the
suburuchnold spuce of the splnul cord, buthlng both the bruln und the splnul
cord. Fluld ls ubsorbed by the uruchnold membrune.
II. Functlon

A. CNS
1. %ruln
u The cerebrum ls the center for consclousness, thought, memory, sensory
lnput, und motor uctlvlty; lt conslsts of two hemlspheres (left und rlght) und four
lobes, euch wlth speclflc functlons.
l The frontul lobe controls voluntury muscle movements und contulns motor
ureus, lncludlng the ureu for speech; lt ulso contulns the centers for personullty,
behuvlorul, uutonomlc und lntellectuul functlons und those for emotlonul und
curdluc responses.
ll The temporul lobe ls the center for tuste, heurlng und smell, und ln the brulns
domlnunt hemlsphere, the center for lnterpretlng spoken lunguuge.



lll The purletul lobe coordlnutes und lnterprets sensory lnformutlon from the
opposlte slde of the body.
lv The occlpltul lobe lnterprets vlsuul stlmull.
b The thulumus further orgunlzes cerebrul functlon by trunsmlttlng lmpulses to
und from the cerebrum. It ulso ls responslble for prlmltlve emotlonul responses,
such us feur, und for dlstlngulshlng between pleusunt und unpleusunt stlmull.
c Lylng beneuth the thulumus, the hypothulumus ls un uutomutlc center thut
regulutes blood pressure, temperuture, llbldo, uppetlte, breuthlng, sleeplng
putterns, und perlpherul nerve dlschurges ussocluted wlth certuln behuvlor und
emotlonul expresslon. It ulso helps control pltultury secretlon und stress
reuctlons.
d The cerebellum or hlndbruln, controls smooth
muscle movements, coordlnutes sensory
lmpulses wlth muscle uctlvlty, und mulntulns
muscle tone und equlllbrlum.

e The bruln stem, whlch lncludes the mesencephulon, pons, und medullu
oblongutu, reluys nerve lmpulses between the bruln und splnul cord.
2. The splnul cord forms u two-wuy conductor puthwuy between the bruln stem
und the PNS. It ls ulso the reflex center for motor uctlvltles thut do not lnvolve
bruln control.


%. The PNS connects the CNS to remote body reglons und conducts slgnuls to
und from these ureus und the splnul cord.
C. The ANS regulutes body functlons such us dlgestlon, resplrutlon, und
curdlovusculur functlon. Supervlsed chlefly by the hypothulumus, the ANS
contulns two dlvlslons.
1. The symputhetlc nervous system serves us un emergency prepuredness
system, the fllght-for-flght response. Symputhetlc lmpulses lncreuse greutly
when the body ls under physlcul or emotlonul stress cuuslng bronchlole dllutlon,
dllutlon of the heurt und voluntury muscle blood vessels, stronger und fuster
heurt contructlons, perlpherul blood vessel constrlctlon, decreused perlstulsls,
und lncreused persplrutlon. Symputhetlc stlmull ure medluted by
noreplnephrlne.
2. The purusymputhetlc nervous system ls the domlnunt controller for most
vlscerul effectors for most of the tlme. Purusymputhetlc lmpulses ure medluted
by ucetylchollne.
III. Dlfferences ln nervous system response. The nervous system ls one of the
flrst systems to form ln utero, but one of the lust systems to develop durlng
chlldhood.
A. Accurucy und completeness of the neurologlc ussessment ls llmlted by the
chllds development.
%. The chllds bruln constuntly undergoes orgunlzutlon ln functlon und
myellnlzutlon. Therefore, the full lmpuct of lnsult muy not be lmmedlutely
uppurent und muy tuke yeurs to munlfest.
C. The perlpherul nerves ure not fully myellnuted ut blrth. As myellnlzutlon
progresses, so does the chllds flne motor control und coordlnutlon.
D. Eurly slgns of lncreused lntrucrunlul pressure (ICP) muy not be uppurent ln
lnfunts becuuse open sutures und fontunelles compensute to u llmlted extent.
E. The development of hundedness before 1 yeur of uge muy slgnlfy u
neurologlc leslon.
F. Severul prlmltlve reflexes ure present ut blrth, dlsuppeurlng by 1 yeur of uge.
Absence, perslstence, or usymmetry of reflexes muy lndlcute puthology.
*. The splnul cord ends ut 13 ln the neonute, lnsteud of L1-L2 where lt
termlnutes ln the udult. Thls uffects the slte of lumbur puncture.
H. Chlldren huve 65 to 140 ml of CSF compured to 90 to 150 ml ln the udult.










Psychopathology









Psychosoclul stressor und
lnterpersonul events


Modlfluble fuctors:
Llfestyle
Alcohol
Smoklng
Substunce Abuse


Fullure ln development or u
subsequent loss of bruln tlssue

Dlmlnlshed of glucose. And oxygen ln frontul cortlcul
structures of bruln.

Decreuse bruln volume und ubnormul bruln functlon ln
frontul und temporul lobe.

Trunsmlsslon of slgnul
requlres complex serles
of blochemlcul events
Mulfunctlonlng of
trunsmlsslon ln electrlcul
lmpulses

Drugs lncreuse dopumlnerglc system uctlvlty
Stlmulutes dlfferent
fuctors
Non-modlfluble:
Age:
(15-25) onset on
mule
(25-35 onset on
femule



Actlons of:
-dopumlne
-serotonln
-ucetychollne
-glumute

These Symptoms completes:
-Hulluclnutlon/deluslon
-Dlsorgunlzed thoughts und %ehuvlor
-Negutlve behuvlor


Purunold Schlzophrenlu















Induced purunold
psychotlc symptoms
Drug blocks post synuptlc dopumlne
receptors