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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:

TP A

F A T Ac A E Patient La Lb E A