Tarlac State University COLLEGE OF NURSING Lucinda Campus Tarlac City

A CASE STUDY On

ARANOID SC!I"O !RENIA

resented #y$ Espin%sa& Rac'ael Ann () Granad%*in& C'enee L) Tapni%& Reselda

April ++& +,,-

TABLE OF CONTENTS Chapter 1 Chapter 2 Chapter ( . Introduction Theoretical Framework Personal Data History of present Illness Past Personal History Family History eneral appearance !otor "eha#ior $ensorium and Co%nities Perception &ttitude and 'eha#ior Defense !echanism &ffecti#e $tate $peech Thou%ht Process and Content . Psychopatholo%y )elated *iterature and $tudies Dru% $tudy Chapter + . Process )ecordin%s Prioriti,ed Psychiatric -ursin% Dia%noses Chapter . Psychotherapies Implemented

C!A TER . Intr%ducti%n Paranoid schi,ophrenia is the most common type of schi,ophrenia in most parts of the world. The clinical picture is dominated "y relati#ely sta"le/ often paranoid/ delusions/ usually accompanied "y hallucinations/ particularly of the auditory #ariety/ and perceptual distur"ances. Distur"ances of affect/ #olition/ and speech/ and catatonic symptoms/ are not prominent. 0ith paranoid schi,ophrenia/ your a"ility to think and function in daily life may "e "etter than with other types of schi,ophrenia. 1ou may not ha#e as many pro"lems with memory/ concentration or dulled emotions. $till/ paranoid schi,ophrenia is a serious/ lifelon% condition that can lead to many complications/ includin% suicidal "eha#ior. 2http344www.mayoclinic.com4health4paranoid5schi,ophrenia4D$667829 Patients who ha#e paranoid schi,ophrenia that has thou%ht disorder may "e o"#ious in acute states/ "ut if so it does not pre#ent the typical delusions or hallucinations from "ein% descri"ed clearly. &ffect is usually less "lunted than in other #arieties of schi,ophrenia/ "ut a minor de%ree of incon%ruity is common/ as are mood distur"ances such as irrita"ility/ sudden an%er/ fearfulness/ and suspicion. :-e%ati#e: symptoms such as "luntin% of affect and impaired #olition are often present "ut do not dominate the clinical picture. The course of paranoid schi,ophrenia may "e episodic/ with partial or complete remissions/ or chronic. In chronic cases/ the florid symptoms persist o#er years and it is difficult to distin%uish discrete episodes. The onset tends to "e later than in the he"ephrenic and catatonic forms. 2http344www.schi,ophrenia.com4s,paranoid.htm9 &ccordin% to the 0orld Health ;r%ani,ation/ It descri"es statistics a"out mental disorders of year 226679. $chi,ophrenia is a se#ere form of mental illness affectin% a"out < per thousand of the adult population/ mostly in the a%e %roup 1.5(. years. Thou%h the

incidence is low 2(516/6669/ the pre#alence is hi%h due to chronicity. &ccordin% to the facts it re#eals $chi,ophrenia affects a"out 2+ million people worldwide. $chi,ophrenia is a treata"le disorder/ treatment "ein% more effecti#e in its initial sta%es. !ore than .6= of persons with schi,ophrenia are not recei#in% appropriate care.>6= of people with untreated schi,ophrenia are in de#elopin% countries. Care of persons with schi,ophrenia can "e pro#ided at community le#el/ with acti#e family and community in#ol#ement. $chi,ophrenia affects men and women with e?ual fre?uency. $chi,ophrenia often first appears in men in their late teens or early twenties. In contrast/ women are %enerally affected in their twenties or early thirties. In the @.$./ mental disorders are dia%nosed "ased on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) . 2http344www.howstuffworks.com4framed.htmA parentBschi,ophrenia.htmCurlBhttp344www.nimh.nih.%o#4health4pu"lications4the5 num"ers5count5mental5disorders5in5america.shtml9 In the Philippine settin%/ the disa"ility sur#ey done in 2666 "y the -ational $tatistics ;ffice 2-$;9 found out that mental illness was the (rd most common form of disa"ility in the country. The pre#alence rate of mental disorders was 77 cases per 166/666 population and was hi%hest amon% the elderly %roup. This findin% was supported "y a more recent data from the $ocial 0eather $tation $ur#ey commissioned "y D;H in 266+. It re#eals that 6.< percent of the total households ha#e a family mem"er afflicted with mental disa"ility. The 'aseline $ur#ey for the -ational ;"Decti#es for Health in 2666 stated that the more fre?uently reported symptoms of an underlyin% mental health pro"lem were sadness/ confusion/ for%etfulness/ no control o#er the use of ci%arettes and alcohol/ and delusions. The most recent study on the pre#alence of mental health pro"lems was conducted "y the -ational Epidemi%l%/y Center 2D;H5-EC9 in 2668 which showed re#ealin% results thou%h the tar%et population was limited only to %o#ernment employees

from the 26 national a%encies in !etro !anila. &mon% (2< respondents/ (2 percent were found to ha#e eFperienced a mental health pro"lem at least once in their lifetime. The three most pre#alent dia%noses were3 specific pho"ias 21. =9/ alcohol a"use 216=9/ depression and schi,ophrenia 28=9. !ental health pro"lems were si%nificantly associated with the followin% respondent characteristics3 a%es 2652> years/ those who ha#e "i% families/ and those who had low educational attainment. The pre#alence rate %enerated from the sur#ey was much hi%her than those that were pre#iously reported "y 1< percent. 2http344<2.1+.2(..1(24searchA?Bcache3s h5-e&GHc@I3home.doh.%o#.ph4ao4ao266<5 666>.pdfJepidemiolo%yJofJschi,ophreniaJinJtheJphilippinesCcdB8ChlBtlCctBclnkC% lBph9 Currently/ there is no method for pre#entin% schi,ophrenia and there is no cure. !inimi,in% the impact of disease depends mainly on early dia%nosis and/ appropriate pharmacolo%ical and psycho5social treatments. Hospitali,ation may "e re?uired to sta"ili,e ill persons durin% an acute episode. The need for hospitali,ation will depend on the se#erity of the episode. !ild or moderate episodes may "e appropriately addressed "y intense outpatient treatment. & person with schi,ophrenia should lea#e the hospital or outpatient facility with a treatment plan that will minimi,e symptoms and maFimi,e ?uality of life. This introduced psychiatric case was chosen primarily "ecause it is the most interestin% amon%st the cases that were encountered "y the %roup mem"ers. It posts rele#ant manifestations that are psychiatric in nature and the entire case is hi%hly possi"le to "e studied comprehensi#ely within the limited time a#aila"le. T'e%retical Frame0%r1 !aslowKs hierarchy of needs is predetermined in order of importance. It is often depicted as a pyramid consistin% of fi#e le#els3 the first lower le#el is "ein% associated with physiolo%ical needs/ while the top le#els are termed %rowth needs associated with psycholo%ical needs. Deficiency needs must "e met first. ;nce these are met/ seekin% to satisfy %rowth needs dri#es personal %rowth. The hi%her needs in this hierarchy only come into focus when the lower needs in the pyramid are met. ;nce an indi#idual has

mo#ed upwards to the neFt le#el/ needs in the lower le#el will no lon%er "e prioriti,ed. If a lower set of needs is no lon%er "ein% met/ the indi#idual will temporarily re5prioriti,e those needs "y focusin% attention on the unfulfilled needs/ "ut will not permanently re%ress to the lower le#el. For instance/ a "usinessman at the esteem le#el who is dia%nosed with cancer will spend a %reat deal of time concentratin% on his health 2physiolo%ical needs9/ "ut will continue to #alue his work performance 2esteem needs9 and will likely return to work durin% periods of remission. The lower four layers of the pyramid are what !aslow called :deficiency needs: or :D5needs:3 physiolo%ical/ safety and security/ lo#e and "elon%in%/ and esteem. 0ith the eFception of the lowest 2physiolo%ical9 needs/ if these :deficiency needs: are not met/ the "ody %i#es no physical indication "ut the indi#idual feels anFious and tense.
(http://en.wikipedia.org/wiki/Maslow !"s#hierarch$#of#needs)

Personal Data Name %2 t'e atient$ A/e$ Gender$ Address$ Civil Status$ Nati%nality$ Reli/i%n$ (irt'day$ Date admitted$ Admittin/ Dia/n%sis$ 3anuary 4.& +,,5 6+$47 pm8 Paranoid $chi,ophrenia !r. L +6 years old !ale -ue#a EciDa Sin/le Filipino )oman Catholic

!ist%ry %2 resent Illness Patient has pre#ious admission at !ari#eles !ental Hospital. He was dischar%ed from male ward on Decem"er/ 266<. He had 152 consultations with Dra. !edina. His parents cannot afford to "rin% him in Ca"anatuan. @pon dischar%e he resumed smokin% and after few months he resumed alcohol intake and he "ecame suspicious and #er"ally assaulti#e when not %i#in% ci%arettes. &fter few hours upon admission/ he heard his female cousin and a nei%h"or talkin% to each other and felt reDu#enated. He went down the house and with carryin% an ice pick. He sta""ed at his cousin who sustained se#eral a"rasions in the forearm and she %ot a scar on the head and on her ri%ht lower ?uadrant of a"domen. The nei%h"or placed him in restraints and informed his father who was out in the farm. !ist%ry %2 revi%us Illness The patient was first admitted on ;cto"er +/ 266 at !ari#eles !ental Hospital with chief complaints of poor appetite/ cannot a"le to sleep and hears a female #oice on his ear. & year prior to admission/ the patient used ille%al dru% such as sha"u. &fter usin%

sha"u/ few months prior to admission he was en%a%ed to a"used su"stances like alcohol and ci%arettes. He started to "ecome #iolent and shouts to his parents. Few hours upon admission/ he was saw lau%hin% "y him only/ "ecomes a%%ressi#e and always shoutin%. His father took him to !!H hence the reason for his admission. His condition "ecomes "etter and he was dischar%ed on &u%ust 1>/ 2661. 'ut he was then readmitted on -o#em"er 1./ 2662 for the reason of he took thin%s from the stores and insisted that it was his property. ;n the nest se#en succeedin% years/ he was in and out of !!H with an admittin% dia%nosis of @ndifferentiated $chi,ophrenia. 'ut early this year/ Ianuary >/ 266>/ he was a%ain readmitted with a new dia%nosis of Paranoid $chi,ophrenia. Family !ealt' and syc'iatric !ist%ry

C'apter + 9ENTAL STATUS ASSESS9ENT A) General Appearance Criteria ood %roomin% &ppropriate facial eFpression &ppropriate posture !aintains eye contact Day 1 M M Day 2 M M Day ( M M M Day + M M M M

Durin% nurse5patient interaction/ the patientNs %roomin% was not %ood prior to mornin% care "ut on the later part he impro#es and shows %ood %roomin%. !ost of the time/ he eFhi"ited appropriate facial eFpressions and posture durin% interactions. &t first/ he cannot display eye contact which may show lack of focused and interest on the topic. &s days passes "y student nurse esta"lished trust on the patient and he maintains %ood eye contact. () 9%t%r (e'avi%r Criteria &utomatism Hyperkinesthesia 0aFy FleFi"ility CatapleFy Catalepsy $tereotype Compulsion Psychomotor )etardation EchopraFia Catatonic $tupor Catatonic eFcitement Tics and spasms Impulsi#eness Choreiform mo#ements Day 1 M Day 2 M Day ( M Day + M

&utomatism is defined as repeated purposeless "eha#iors often indicati#e of anFiety/ such as drummin% of fin%ers/ twistin% of locks of hair or tappin% of foot. &ll

throu%h out the + day nurse5patient interaction/ the patient presented automatism. -o other motor "eha#iors were noted. C. $ensorium and Co%niti#e Criteria ;rientation Time Place Person Concentration !emory )emote )ecent Immediate retention Day 1 M M M M M M M M M Day 2 M M M M M M M M M Day ( M M M M M M M M M Day + M M M M M M M M M

$ensorium and co%nities consist of the assessment of orientation/ concentration/ and memory. ;rientation refers to the clientNs reco%nition of person/ place and time. That is/ knowin% who and where he or she is and the correct day/ date and year. 2Oide"eck/ Psychiatric !ental Health -ursin%9. !em%ry is an or%anismKs mental a"ility to store/ retain and recall information which is di#ided into recent and remote memory. $hort5term memory allows recall for a period of se#eral seconds to a minute without rehearsal. *on%5term memory can store much lar%er ?uantities of information for potentially unlimited duration 2sometimes a whole life span9. Durin% the + day nurse5patient interaction/ patientNs orientation and memory are sta"le. He can recall memories from the past and aware of the place/ who is he/ time/ day/ and year. 'ased from the a"o#e definition of memory/ he has an intact recollection of the past e#ents in his life. D) ercepti%n Criteria Hallucination Oisual ;lfactory &uditory Tactile ustatory *iliputian Day 1 Day 2 Day ( Day +

Illusions Delusions

In the most recent Dia%nostic and $tatistical !anual of !ental Disorders/ a delusion is defined as a false "elief "ased on incorrect inference a"out eFternal reality that is firmly sustained despite what almost e#ery"ody else "elie#es and despite what constitutes incontro#erti"le and o"#ious proof or e#idence to the contrary. The "elief is not one ordinarily accepted "y other mem"ers of the personKs culture or su"culture. From the 1st up to +th day of nurse5patient interaction/ the patient manifest presence of delusions wherein he always claims that he was the hus"and of $heryl Cosim. ;ther perceptions were not noted. E) Attitudes and (e'avi%r Criteria Cooperation ;ut%oin% 0ithdrawn E#asi#e $arcastic &%%ressi#e PerpleFed &pprehensi#e &rro%ant Dramatic $u"missi#e Fearful $educti#e @ncooperati#e Impatient )esistant Impulsi#e Day 1 M M Day 2 M M Day ( M M Day + M M

Attitude is a position of the "ody or manner of carryin% oneself. It is a position or posture of the "ody appropriate to or eFpressi#e of an action/ emotion The patient eFhi"ited cooperation in the whole duration of duty and a"le to answers all ?uestions asked to him and participates in all acti#ities. It was also o"ser#ed

that he was out%oin% with other patient and student nurse. He also shows apprehensi#eness throu%hout the interaction.

F) De2ense 9ec'anism Criteria Denial )epression $uppression )ationali,ation )eaction Formation $u"limation Compensation ProDection Displacement Identification InterDection Con#ersion $ym"oli,ation Dissociation @ndoin% )e%ression $u"stitution Fantasy Day 1 Day 2 Day ( M M Day + M M

De2ense mec'anisms are psycholo%ical strate%ies "rou%ht into play "y #arious entities to cope with reality and to maintain self5ima%e. Healthy persons normally use different defenses throu%hout life. &n e%o defense mechanism "ecomes patholo%ical only when its persistent use leads to maladapti#e "eha#ior such that the physical and4or mental health of the indi#idual is ad#ersely affected. The purpose of the E%o Defense !echanisms is to protect the mind4self4e%o from anFiety/ social sanctions or to pro#ide a refu%e from a situation with which one cannot currently cope. The patient manifests fantasy from day 1 to day + and shows also denial and reaction formation on the later days of interaction. G) A22ective State Criteria Euphoria Day 1 Day 2 Day ( Day +

Flat affect 'luntin% Elation EFultation Ecstasy &nFiety Fear &m"i#alence Depersonali,ation Irrita"ility )a%e *a"ility Depression

&ffect is a %roupin% of physic phenomena manifestin% under the form of emotions/ feelin%s or passions/ always followed "y impressions of pleasure or pain/ satisfaction or discontentment / likin% or dislikin%/ Doy or sorrow. 24www.cere"romente.or%9. Flat a22ect$ & se#ere reduction in emotional eFpressi#eness. People with depression and schi,ophrenia often show flat affect. & person with schi,ophrenia may not show the si%ns of normal emotion/ perhaps may speak in a monotonous #oice/ ha#e diminished facial eFpressions/ and appear eFtremely apathetic. 2www.medterms.com9 The patient sometimes shows flat affect durin% the whole interaction. !) Speec' Criteria Oer"i%eration )hymin% Punnin% !utism &phasia @nusual rates of speech @nusual Oolume of speech @nusual Intonation @nusual !odulation Speec' refers to the processes associated with the production and perception of sounds used in spoken lan%ua%e. Day 1 Day 2 Day ( Day +

Durin% the interaction/ the patient does not show any alteration in his speech pattern. He did not eFperience #er"i%eration/ aphasia/ other speech pro"lems.

I) T'%u/'t r%cess and C%ntent Criteria 'lockin% Fli%ht of Ideas 0ord $alad Perser#eration -eolo%ism Circumstantiality Echolalia Condensation Delusion Pho"ia ;"session Hypochondriac Day 1 Day 2 Day ( Day +

M M

M M

M M M

Durin% the first part of our nurse5patient interaction/ the patient shows delusion. He also manifested o"session wherein he keeps on insistin% that his wife is $heryl Cosim who is a famous news anchor.

C'apter 4 syc'%pat'%l%/y (%%1:(ased

Client:(ased

Related Literature and Studies

0hat is $chi,ophreniaA It is a mental illness which affects one person in e#ery hundred. $chi,ophrenia interferes with the mental functionin% of a person and/ in the lon% term/ may cause chan%es to a personKs personality. First onset is usually in adolescence or early adulthood. It can de#elop in older people/ "ut this is not nearly as common. $ome people may eFperience only one or more "rief episodes in their li#es. For others/ it may remain a recurrent or life5lon% condition. The onset of illness may "e rapid/ with acute symptoms de#elopin% o#er se#eral weeks/ or it may "e slow/ de#elopin% o#er months or e#en years. Durin% onset/ the person often withdraws from others/ %ets depressed and anFious and de#elops eFtreme fears or o"sessions. &lthou%h an eFact definition of schi,ophrenia still e#ades medical researchers/ the e#idence indicates more and more stron%ly that schi,ophrenia is a se#ere distur"ance of the "rainKs functionin%. In The 'roken 'rain3 The 'iolo%ical )e#olution in Psychiatry/ Dr. -ancy &ndreasen states :The current e#idence concernin% the causes of schi,ophrenia is a mosaic. It is ?uite clear that multiple factors are in#ol#ed. These include chan%es in the chemistry of the "rain/ chan%es in the structure of the "rain/ and %enetic factors. Oiral infections and head inDuries may also play a role....finally/ schi,ophrenia is pro"a"ly a %roup of related diseases/ some of which are caused "y one factor and some "y another.: 2p. 2229. There are "illions of ner#e cells in the "rain. Each ner#e cell has "ranches that transmit and recei#e messa%es from other ner#e cells. The "ranches release chemicals/ called neurotransmitters/ which carry the messa%es from the end of one ner#e "ranch to the cell "ody of another. In the "rain afflicted with schi,ophrenia/ somethin% %oes wron% in this communication system. $ometimes schi,ophrenia has a rapid or sudden onset. Oery dramatic chan%es in "eha#iour occur o#er a few weeks or e#en a few days. $udden onset usually leads fairly

?uickly to an acute episode. $ome people ha#e #ery few such attacks in a lifetimeP others ha#e more. $ome people lead relati#ely normal li#es "etween episodes. ;thers find that they are #ery listless. depressed/ and una"le to function well. In some/ the illness may de#elop into what is known as chronic schi,ophrenia. This is a se#ere/ lon%5lastin% disa"ility characteri,ed "y social withdrawal/ lack of moti#ation/ depression/ and "lunted feelin%s. In addition/ moderate #ersions of acute symptoms such as delusions and thou%ht disorder may "e present in the chronic disorder. ;'at are t'e sympt%ms %2 sc'i*%p'renia< !aDor symptoms of schi,ophrenia include3

Delusions 5 false "eliefs of persecution/ %uilt or %randeur or "ein% under outside control. People with schi,ophrenia may descri"e plots a%ainst them or of think they ha#e special powers and %ifts. $ometimes they withdraw from people or hide to a#oid ima%ined persecution.

Hallucinations 5 most commonly in#ol#in% hearin% #oices. ;ther less common eFperiences can include seein%/ feelin%/ tastin% or smellin% thin%s which to the person are real "ut which are not actually there.

Thou%ht disorder 5 where the speech may "e difficult to followP for eFample/ Dumpin% from one su"Dect to another with no lo%ical connection. Thou%hts and speech may "e Dum"led and disDointed. The person may think someone is interferin% with their mind.

;ther symptoms of schi,ophrenia include3

*oss of dri#e 5 where often the a"ility to en%a%e in e#eryday acti#ities such as washin% and cookin% is lost. This lack of dri#e/ initiati#e or moti#ation is part of the illness and is not la,iness.

'lunted eFpression of emotions 5where the a"ility to eFpress emotion is %reatly reduced and is often accompanied "y a lack of response or an inappropriate response to eFternal e#ents such as happy or sad occasions.

$ocial withdrawal 5 this may "e caused "y a num"er of factors includin% the fear that someone is %oin% to harm them/ or a fear of interactin% with others "ecause of a loss of social skills.

*ack of insi%ht or awareness of other conditions 5 "ecause some eFperiences such as delusions and hallucinations are so real/ it is common for people with schi,ophrenia to "e unaware they are ill. For this and other reasons/ such as medication side5effects/ they may refuse to accept treatment which could "e essential for their well5"ein%.

Thinkin% difficulties 5 a personKs concentration/ memory/ and a"ility to plan and or%anise may "e affected/ makin% it more difficult to reason/ communicate/ and complete daily tasks.

;'at causes sc'i*%p'renia< -o sin%le cause has "een identified/ "ut se#eral factors are "elie#ed to contri"ute to the onset of schi,ophrenia in some people3 Genetic 2act%rs & predisposition to schi,ophrenia can run in families. In the %eneral population/ only 1 per cent of people de#elop it o#er their lifetime. If one parent suffers from schi,ophrenia/ the children ha#e a 16 per cent chance of de#elopin% the condition 5 and a >6 per cent chance of not de#elopin% it. (i%c'emical 2act%rs Certain "iochemical su"stances in the "rain are "elie#ed to "e in#ol#ed in this condition/ especially a neurotransmitter called dopamine. ;ne likely cause of this chemical im"alance is the personKs %enetic predisposition to the illness. Family relati%ns'ips

-o e#idence has "een found to support the su%%estion that family relationships cause the illness. Howe#er/ some people with schi,ophrenia are sensiti#e to any family tension which/ for them/ may "e associated with relapses. Envir%nment It is well reco%nised that stressful incidents often precede the onset of schi,ophrenia. They often act as precipitatin% e#ents in #ulnera"le people. People with schi,ophrenia often "ecome anFious/ irrita"le and una"le to concentrate "efore any acute symptoms are e#ident. This can cause relationships to deteriorate/ possi"ly leadin% to di#orce or unemployment. ;ften these factors are then "lamed for the onset of the illness when/ in fact/ the illness itself has caused the crisis. It is not/ therefore/ always clear whether stress is a cause or a result of illness. Dru/ use The use of some dru%s/ especially canna"is and *$D/ is likely to cause a relapse in schi,ophrenia. $ource3 www.mental5health5matters.com aran%id Sc'i*%p'renia People with paranoid schi,ophrenia/ the most common form of the disorder/ mainly eFperience hallucinations. They tend to "elie#e that others are poisonin%/ harassin%/ or plottin% a%ainst them. They may also hear #oices/ which order them to do thin%s. Contrary to popular "elief/ people sufferin% from this type of schi,ophrenia are actually not prone to #iolenceP in fact/ they %enerally prefer to "e left alone. C%mm%n Sympt%ms %2 aran%id Sc'i*%p'renia For people with paranoid schi,ophrenia/ the primary symptoms are delusions or auditory hallucinations. People with paranoid schi,ophrenia usually do not ha#e thou%ht disorder/ disor%ani,ed "eha#ior/ or affecti#e flattenin%.

People with paranoid schi,ophrenia ha#e %randiose delusions. For eFample/ they may "elie#e that others are deli"erately3

Cheatin% them Harassin% them Poisonin% them $pyin% on them Plottin% a%ainst them or the people they care a"out.

&uditory hallucinations can include hearin% :#oices: that may3

Comment on the personKs "eha#ior ;rder him or her to do thin%s 0arn of impendin% dan%er Talk to each other 2usually a"out the affected person9.

aran%id Sc'i*%p'renia and =i%lence People with paranoid schi,ophrenia are not especially prone to #iolence and often prefer to "e left alone. $tudies show that if people ha#e no record of criminal #iolence "efore they de#elop schi,ophrenia and are not su"stance a"users/ they are unlikely to commit crimes after they "ecome ill. !ost #iolent crimes are not committed "y people with paranoid schi,ophrenia/ and most people with schi,ophrenia do not commit #iolent crimes. $u"stance a"use almost always increases #iolent "eha#ior/ whether or not the person has schi,ophrenia. If someone with paranoid schi,ophrenia "ecomes #iolent/ their #iolence is most often directed at family mem"ers and takes place at home. Source: http://schi%ophrenia.e&edt'.co&

Dru/ Study

Name %2 dru/

Date %rdered> Date started> Date c'an/ed

R%ute> D%sa/e> Fre?uency %2 administrati%n

General acti%n>mec'anism %2 acti%n

Indicati%n > urp%se

Client@s resp%nse t% medicine 0it' actual s>e

Generic Name$

Date Ordered$ Ianuary (1 266> Date Started$ Clona,epam Ianuary (1 266> Date Ended$ 555555555555555555555 5

R%ute %2 C'emical E22ect$ Administrati%n3 !ay act "y Per ;rem facilitatin% effects of D%sa/e and inhi"itory Fre?uency$ neurotransmitter 2m% H$ &'&. T'erapeutic E22ect$ Pre#ents or stops sei,ure acti#ity.

For patients with acute manic episodes/ panic disorders/ or sei,ures.

&dministration of the dru% was not actually o"ser#ed

NURSING RES ONSI(ILITIES$ (EFORE$ EFplain the importance and action of the dru%s. Tell the possi"le reaction or side effects of the dru%s. !onitor patient for any ad#erse reaction.

DURING$ The client may sip small amount of water $tay with the client for at least 1.5(6 minutes after %i#in% the dru% 'e alert for ad#erse reaction and dru% interaction

Name %2

Date %rdered>

R%ute>

General

Indicati%n>

Client@s

dru/ Generic Name$ Haloperido l

Date started> Date c'an/ed Date Ordered$ Ianuary (1/ 266> Date Started$ Ianuary (1/ 266> Date Ended$ 55555555555555555555 5

D%sa/e> Fre?uency %2 administrati%n R%ute %2 Administrati%n$ Per ;rem D%sa/e and Fre?uency$ .m% ta" tid

acti%n>mec'anism %2 acti%n C'emical E22ect$ !ay "lock postsynaptic dopamine receptors in "rain. T'erapeutic E22ect$ Decreases psychotic "eha#iors.

urp%se This is %i#en to the patient with chronically psychotic disorder who needs prolon%ed therapy.

resp%nse t% medicine 0it' actual s>e &dministration of the dru% was not actually o"ser#ed

NURSING RES ONSI(ILITIES$ (EFORE$ EFplain the importance and action of the dru%s. Tell the possi"le reaction or side effects of the dru%s. !onitor patient for any ad#erse reaction.

DURING$ $tay with the client for at least 1.5(6 minutes after %i#in% the dru% !onitor patient for tardi#e dyskinesia/ which may not appear until months or years later and may disappear spontaneously or persists for life despite stoppin% use of dru%.

C!A TER 7 SYC!OT!ERA IES I9 LE9ENTED syc'%t'erapy: treatment of mental disorders and "eha#ioral distur"ances usin% #er"al and non#er"al communication/ as opposed to a%ents such as dru%s or electric shock/ to alter maladapti#e patterns of copin%/ relie#e emotional distur"ance/ and encoura%e personality %rowth. &lso called ps$chotherapeutics. Individual syc'%t'erapy: Throu%h one5on5one con#ersations/ this approach focuses on the patientKs current life and relationships within the family/ social/ and work. Gr%up syc'%t'erapy: roup psychotherapy is a special form of therapy in which a roup therapy helps people learn a"out

small num"er of people meet to%ether under the %uidance of a professionally trained therapist to help themsel#es and one another. themsel#es and impro#e their interpersonal relationships. It addresses feelin%s of isolation/ depression or anFiety. &nd it helps people make si%nificant chan%es so they feel "etter a"out the ?uality of their li#es. RE9OTI=ATION T!ERA Y De2initi%n$ & simple %roup therapy which aims to "rid%e the fantasy5 world of the Psychotics to the real world. Is a techni?ue of simple %roup therapy/ o"Decti#e in nature/ used with a %roup of patients in an effort to reach the QunwoundedR areas of each patientNs personality C to %et them "ack into reality. Title %2 t'e p%em$ An/ (ula1la1 The short poem descri"es the importance of flower in our nature. G%als$ To stimulate patients to "e fellow eFplore the real world.

 To de#elop their a"ility to communicated and share ideas and eFperiences with the other people. To de#elop feelin%s of acceptance. To promote %roup harmony and identification. R%le %2 t'e nurse$ To "e a facilitator in the acti#ity To encoura%e clients feelin% a"out the topic To present the reality to the client a"out the poem. NE;S A ER T!ERA Y De2initi%n$ -ewspaper therapy is %i#in% information to the clients a"out e#ents and what is happenin% outside -ewspaper therapy is cuttin% clippin%s from newspaper and sharin% this information to the clients and knowin% their feelin%s and ideas a"out the information %i#en. Pro#idin% "asic information a"out places4e#ents may moti#ate the clients to follow the medical re%imen to "e well. The facilitator let the clients to read the topic/ then ask them ?uestions. Title %2 t'e cut ne0s$ (%Ain/ The news was all a"out "oFin% competition held in &raneta Coliseum C who won for that competition. G%als$ To %i#e information to the clients on what is happenin% outside and to %i#e latest news today. To encoura%ed emotions and reactions a"out the news

R%le %2 t'e Nurse$ To introduce topics that will encoura%e clients participation4cooperation To assess le#el of intelli%ence of the clients To encoura%e the clients to eFpress4#er"ali,e feelin%s4ideas re%ardin% to the topic LAY T!ERA Y De2initi%n$ & form of psychotherapy used to help them eFpress or act out their eFperiences/ feelin%s/ and pro"lems "y playin% with dolls/ toys/ and other play material. Name %2 t'e lay$ (all catc'in/ r%cedure$ The clients are instructed to catch the "all with their respecti#e partners. G%als$ To esta"lish rapport since it is the first recreational acti#ity of the client To encoura%e release4 eFpress clients emotions To let the client learn on how to cooperate To let the client play freely and acti#ely R%le %2 t'e Nurse$ To "e the facilitator of the %ame To let and encoura%e the clients to participate on the play DANCE T!ERA Y

De2initi%n Dance is the most fundamental of the arts/ in#ol#in% direct eFpression throu%h the "ody. Dance 4mo#ement therapy effects chan%es in feelin%s/ co%nition/ physical functionin%/ and "eha#ior. Title %2 t'e dance s%n/$ C'a:C'a:C'a Facilitators are in the front/ dancin% different steps/ in a"le for the client to follow easily the facilitators) G%als$ To encoura%e release4 eFpress clients emotions To let the client learn on how to dance in simple steps To let the client dance freely and acti#ely R%le %2 t'e Nurse$ To "e the facilitator of the %ame To let and encoura%e the clients to participate on the dance SONG T!ERA Y De2initi%n$ & kind of recreational therapy under the music cate%ory/ which connects us with our creati#ity/ innate wisdom and our #ast inner resources for %rowth and well5 "ein%. It has a soothin% and pleasin% effect and pro#ides for emotion and release. Title %2 t'e s%n/$ Ta/:ulan r%cedure$ @sin% the #isual aids that has the written lyrics/ the patients read it first. The nurse sin%s the son% with the use of %uitars.

 -urses/ to%ether with the patients/ sin% the son%. *astly/ let the patients sin% to the tune of %uitars.

G%als$ De#elop patientNs a"ility to read and reflect. De#elop patientNs listenin% skill. To encoura%e them to participate and cooperate. Patients will learn to eFpress emotions and feelin%s. R%le %2 t'e Nurse$ EFplain the procedure to the patients. To "e a %ood facilitator. To "e an acti#e participant too. To promote trust. ART T!ERA Y De2initi%n$ is the use of art materials for self5eFpression and reflection. Name$ !%use:Tree: ers%n r%cedure$ Patients are pro#ided with crayons and ( pieces of paper as drawin% materials. They are then asked to draw a house/ afterwards a tree/ and lastly/ a person on each of the papers with the use of crayons. $eries of ?uestions constitute the post drawin% interro%ations. Durin% post drawin% phase/ paients are %i#en opportunity to define/ descri"e/ and interpret the o"Dects drawn.

G%als$ To o"tain data concernin% patientNs pro%ress. To aid in the esta"lishment of rapport "etween the nurse and the patient. Help the patients %ain insi%ht throu%h interpretations. !easure patientNs self perception and attitudes. R%le %2 Nurses$ EFplain the procedure of the acti#ity. Pro#ide the means of the therapy 2crayons/ papers9. Interro%ate patients durin% post drawin% phase. &ssessin% and interpretin% answers "ased on 'uckNs HTP interpretation. De#elop a deeper nurse5patient relationship throu%h "uildin% of trust. OCCU ATIONAL T!ERA Y De2initi%n$ &ny acti#ity/ mental or physical/ prescri"ed and %uided to aid an indi#idualNs reco#ery from diseases or inDury. This acti#ity eFcludes competition and pressure. There is opportunity for creati#eness and produce somethin% tan%i"le out of patientNs own thinkin% and ima%ination. $elf confidence and personal achie#ements are also eFperienced. Title$ Desi/nin/ icture Frame r%cedure$ Desi/nin/ icture Frame -urses play a %reat role in makin% this therapy successful. -urses %i#e picture frame. Different shapes of cut cartolina C different styles of stickers are also %i#en alon% with the %lue. Patients are asked to desi%n their picture frame where#er they like.

G%als$ EFpose patientsN hidden a"ilities in desi%nin% and pastin%. Increase patientsN self confidence. &ssess patientsN motor and intellectual functionin%. R%le %2 Nurses$ To select the most useful acti#ity. To facilitate the acti#ity successfully. To assist the patients. To promote positi#e personality %rowth

BIBLIOGRAPHY Oide"eck/ Psychiatric !ental Health -ursin%/ Third Edition $hi#es/ Isaacs/ 'asic Concepts of Psychiatric5!ental Health -ursin% )e"raca et. al./ Psychiatric !ental Health -ursin%/ .th Edition -urses Dictionary/ $econd Edition <th Edition -ursin% Dia%nosis Hand"ook3 & uide to Plannin% Care "y 'etty I &uckley and ail '. *adwi% http344www.answers.com4topic4psychosis http344www.emedicine.com4med4"yname4"rief5psychotic5disorder.htm http344www.hawaii.edu4hi#andaids4PhilippinesG!entalGHealthGCountryGProfile.pdf http344en.wikipedia.or%4wiki4PsychoticGdisorder