A Case of Bipolar Affective Disorder r/o Paranoid Schizophrenia

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A Psychiatric Case Study Presented to the Faculty of the College of Nursing Colegio San Agustin – Bacolod

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In Partial Fulfillment of the Requirements for the course Nursing Care Management 203

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By: Chiara Francesca L. Miranda BSN3-B/Group 7

June 2010

COLEGIO SAN AGUSTIN-BACOLOD College of Nursing
PSYCHIATRIC NURSING CASE ANALYSIS RECORD (PNCAR)-INITIAL INTRODUCTION (Narrative overview of patient’s diagnosis based on book view) Bipolar disorders are those in which individuals experience the extremes of mood polarity. Individuals might feel very euphoric or very depressed. Although the term bipolar disorder is accepted diagnostic terminology, many professionals and much professional literature still use the terms manic-depressive or bipolar affective disorder (Keltner, Psychiatric Nursing 5th Edition, p. 393). Predisposing and precipitating factors of Bipolar Affective Disorder includes genetic wherein First-degree relatives of people with BPI are approximately 7 times more likely to develop BPI than the general population. Remarkably, offspring of a parent with bipolar disorder have a 50% chance of having another major psychiatric disorder (Soreff & McInnes, 2006). Moreover, according to Soreff (2006), Multiple biochemical pathways likely contribute to bipolar disorder, which is why detecting one particular abnormality is difficult. A number of neurotransmitters have been linked to this disorder, largely based on patients' responses to psychoactive agents. Environmentally, Because of the nature of their work, certain individuals have periods of high demands followed by periods of few requirements. For example, one person was a landscaper and gardener. In the spring, summer, and fall, he was busy. During the winter, he was relatively inactive except for plowing snow. Thus, he appeared manic for a good part of the year, and then he would crash and hibernate for the cold months. Schizophrenia, on the other hand, is a diagnostic term used to describe a major psychotic disorder characterized by disturbances in perception, thought process, reality testing, feeling, behaviour, attention, motivation. Contributing to the overall deterioration is a decline in psychosocial functioning (Keltner, Psychiatric Nursing 5th Edition, p. 339). The most common type of schizophrenia is Paranoid Schizophrenia. The clinical picture is dominated by relatively stable, often paranoid, delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition, and speech, and catatonic symptoms, are not prominent. Examples of the most common paranoid symptoms are delusions of persecution, reference, exalted birth, special mission, bodily change, or jealousy; hallucinatory voices that threaten the patient or give commands, or auditory hallucinations without verbal form, such as whistling, humming, or laughing; hallucinations of smell or taste, or of sexual or other bodily sensations; visual hallucinations may occur but are rarely predominant. The course of paranoid schizophrenia may be episodic, with partial or complete remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is difficult to distinguish discrete episodes. The onset tends to be later than in the hebephrenic and catatonic forms (WHO, ICD-10, 1992).

OBJECTIVES Within 50 hours of duty in National Center for Mental Health, I will be able to:

KNOWLEDGE: 1. Identify the predisposing and precipitating factors that contributed to the illness of the client. 2. Explain the relationship of the client to her family and how it added to her illness. 3. Retrieve important information such as client’s diagnosis, chief complaints, etc., for the psychiatric case study. 4. Define terms used in the case study such as Bipolar Affective Disorder and Schizophrenia. 5. Formulate a complete and detailed psychiatric case study using the data gathered from the client’s chart and from the client herself.

SKILLS: 1. Produce a factual psychiatric case study by utilizing the data gathered during chart-reading and interview of the client. 2. Create a comprehensive psychopathology in relation to the illness of the client. 3. Discuss client’s illness thoroughly and clearly. 4. Interpret the different conscious/unconscious movements or behaviours made by the client. 5. Minimize the use of non-therapeutic techniques when communicating with the client.

ATTITUDE: 1. Promote confidentiality while working the case study. 2. Relate ideas or terms that is vague to the clinical instructor and group mates. 3. Establish a professional working relationship with the client effectively. 4. Respect the client’s attitude and answer when communicating with her. 5. Encourage a positive outlook when doing the case study.

CASE ANALYSIS PROPER I. ADMISSION INFORMATION

General Admission Information Client’s initials___AP___ Age _13_ Gender _Female Marital status ____Single______ Name of significant other _Elena Pedrosa_______ Contact number _____N/A________ Residential address _Brgy. Tacuranga, Palo, Leyte_____________________________ Pavilion/Unit/Room number and name _Pavilion 10_____________________________ Date & time of admission _February 20, 2009 / 3:35 PM_________________________ Name of Attending Physician _Dr. MCA______________________________________ Conditions of Admission Check one (1) only: Voluntary ( ) Involuntary ( ) Accompanied by (family, friend, police, other) _Elena Pedrosa-sister_ ______________ Route of admission (ambulatory, wheelchair, trolley) _ambulatory__________________ Admitted from (home, other facility, street, OPD section) _OPD section ___________ Other Significant Information upon Admission Vital signs: Pulse 100 bpm BP 120/80 mmhg Respiration 16 cpm Temperature 37 C°__ Height __5”1’_ Weight ____ Race _Filipino_ Dominant Language ___Tagalog ______ Orientation (person, place, time, situation) _Oriented to person, place, time and_______ situation_______________________________________________________________ Discharge to: (home, facility, other) ___________ Estimated length of stay __________ Diagnosis: Upon admission Paranoid schizophrenia_____________________________ Current _Bipolar Affective Disorder, improved r/o Paranoid Schizophrenia__ Chief Complaint/s (as verbalized by patients or significant others/informant) Sinampal ang kapatid, nambabato (duration: 2002)_____________________________ ______________________________________________________________________ II. BIOPSYCHOSOCIAL HISTORY ASSESSMENT

Predisposing Factors Genetic/biologic influences (related to mental and other illnesses) Structural assessment of the family: Use a genogram as applicable: Family of origin/culture extended and present family/significant persons. (Refer to prescribed format of genogram.) Family of origin:

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