Schizophrenia(F20)

Crisis Paper Presentation

Provider 3
 Group B3

Hadeel Naji 219008550 Wadha Nasser 219013997

Eman Habib 219039445 Dhuha Ahmed 219025521

Hanin Altharman 219026413 Abrar Yousef 219014095

Eman Ali 219020781 Hind Nahar 219013509

Presentation Outline
INTRODUCTION

CLIENT'S DATA

NURSING RECORD

NURSIG CARE PLANS

MEDICATIONS

HEALTH EDUCATION

TREATMENT MODALITIES

REFERENCES

 Mental Health
Mental health is essential to our overall well-being and as important as
physical health. When we feel mentally well, we can work productively, enjoy
our free time, and contribute actively to our communities (Who, 2019).

In recent years, there has been increasing acknowledgement of the important

role mental health plays in achieving global development goals, as illustrated
by the inclusion of mental health in the Sustainable Development Goals.
Depression is one of the leading causes of disability. Suicide is the fourth
leading cause of death among 15-29-year-olds (Who, 2019).
 What is

Schizophrenia?
Schizophrenia is a brain disease that disrupts normal brain function. It causes
affected people to behave strangely, often irrationally or disorganizedly.
Schizophrenia causes psychosis and is associated with significant disability,
affecting all aspects of life such as personal, family, social, educational, and
occupational functioning. People with schizophrenia are frequently subjected to
stigma, discrimination, and violations of their human rights. There are a variety
of effective care options for people with schizophrenia, and at least one in three
will be able to fully recover (Who, 2022.)
 Magnitude
Schizophrenia affects approximately 24
million people or 1 in 300 people (0.32%)
worldwide. This rate is 1 in 222 people
(0.45%) among adults. It is not as
widespread as many other mental illnesses.
Onset occurs most frequently in late
adolescence and the twenties, and it occurs
earlier in men than in women (Who, 2022.)
Approximately 70% of people with schizophrenia will have hallucinations.
Hearing voices—sometimes multiple voices—or other sounds like
whispering or murmuring are common in people with schizophrenia. Voices
may appear angry or urgent, and they frequently make demands on the
hallucinating individual (Smith. K, 2021.)
Our patient B.A, 57 years old and divorced. She is Saudi
born in Kuwait but living in Al-Ahsa. She was brought to
the hospital by her ex-husband on 26/02/2005. From the
patient's point of view, the reason she is in the hospital
is her inability to get pregnant, but the actual reason is
that she was hyperactive, irritable, and her speech was
irrelevant, incoherent, and verbally aggressive as her ex-
husband stated. She was diagnosed with schizophrenia
accompanying with auditory hallucination, and she got
the symptoms gradually. Her mother, sister, and brother
are all suffering from the same disease.
Nursing Record
I. GENERAL APPEARANCE

a. Facial Expression:
Depressed facial expression (blunted affect, does not express
emotions.) She did not smile during our conversation about the
disease and family, but when we thanked her and told her that she
helped us in our case she smiled. Also, when she was talking about
her hobbies (making handmade bracelets, drawing, and putting nail
polish on), she was smiling and happy.
Patient did not make eye contact during the entire conversation.
Cont..
b. Posture Body Deformities:
Normal posture, hips are in good alignment with shoulders
and with knees. No body deformities.

c. Personal Hygiene:
She had a good personal hygiene. Her dress was clean, and
she said that she takes a shower every day.
Cont..
d. Dress Appearance:
She wears proper clothes, appropriate for the season.
e. Mannerism:
Toes were crossed most of the time. She was moving her hand over her hair while
talking.

II. EATING HABITS

She has good appetite. consumes all her meal plate. She eats by hand and
sometimes by using a spoon. The dietitian planed for her to get a diabetic diet (focuses
mainly on fruits, vegetables, and whole grains.) She said that her breakfast was egg
“Shakshuka”, and she likes to eat white rice with fish or chicken for lunch.
Cont..

III. ELIMINATION
a. Urination:
Regular, 5 times a day as she said.

b. Defecation:
Regular, once daily.
Cont..
IV. INTERPERSONAL

She is unable to interact with staff although the staff find her
easy to take care of. She collaborated with us as students
even though she was afraid at the beginning of our interview.
She was talking and suddenly stopped in the middle of the
conversation and then refused to talk.

She does not like to join other patients’ activities, even in the
television room, she was setting in alone. She said, “other
patients said to me we don’t want to talk with you, and we
don’t want you.”
Cont..
V. ACTIVITY

The patient showed interest in joining group activity

with the students. In the activity, she told us that she
loves to apply nail polish and to draw, so we applied her
favourite nail polish color (light red) and henna. She
was showing happy facial expressions and we enjoyed
the activity.
She is nonassertive and indecisive she said,
“whenever the nurses tell me to do
something, I would do what I am told to”
Cont..
VI. MOOD
The patient said that she is lonely and afraid. Patient’s mood
was blunt when talking about her ex-husband’s violence
against her and the hysterectomy. Also, she was scared and
panic when discussing about “life”.
VII. AFFECT
She has a flat affect as she did not express
emotions when she talked about her ex-husband and
her hysterectomy, but when she was talking about
her hobby, she was smiling.
Cont..
VIII. THOUGHT & TALK
a. Content:
At the first contact with the patient, we observed that she did not experienced any type
of delusion (false fixed belief), obsessions, or suicidal ideation.
b. Stream:
Circumstantiality is present. Patient was saying a lot of details and by doing so she
delays reaching the point of our communication. When we asked her “are you
married?” she answered "because I could not get pregnant, I had previously
experienced bleeding, I was scared and nervous, which led to the removal
of my uterus in Dammam, my husband brought me to the psychiatric
hospital. After that he divorced me”
The patient did not have neither word salad nor neologism. However,
the patient stated “my ex-husband said that I don't know how to
communicate like other people. I'm always confused and saying random and
meaningless words”
Cont..
IX. PERCEPTION
She is experiencing auditory hallucination. As evidenced
by her verbalization, "One time I said I'm hearing sounds
and they did not discharge me, so I do not want to say if I
hear voices or not. There will be no benefit if I said I’m
hearing voices or not." She also stated, "I cannot sleep
well because I frequently wake up and talk with “ life””.
As what we observed, she was afraid and uncomfortable
when talking about her hallucination. She always said
that “life” told her to be sacred from people and the
world, as she stated, “ ” life ” is telling me that I have to
be afraid of life when I am talking, we have to be afraid of
everything in life, you have to be scared too.”
Cont..

X. ORIENTATION (TIME, PLACE, PERSON)

The patient is oriented to the person, place, and time. As

evidenced by the patient's identification, “you are
students from the college, and we are at the psychiatric
hospital in the morning.”
Cont..
XI. CONCENTRATION

When we met her, she was focusing well on the

questions asked. She showed lack of knowledge
regarding her family members. For instance, when we
were discussing about her age and the age of her
siblings, she told us they were young and then grew up
without telling us their age or their order in the family.
She also knew nothing about her younger brothers.
The last thing she remembers is her mother taking her
brother to the hospital and not knowing what
happened to him after that. In addition, she
occasionally changes the subject or refuses to
answer, especially when it comes to the voices she
hears.
Cont..
XII. MEMORY (IMMEDIATE, RECENT, REMOTE)

a. Immediate:
Good memory, we introduced ourselves. Later, we asked her,
"Do you remember who we are?" She replied, “you are students
from the college.”
b. Recent:
When we asked her "What did you eat for lunch yesterday?" she
said, "I ate white rice with fish" as was validated by the nurse.

c. Remote:
When we asked her “Do you know when your birthdate is?” she
said, “they said my birthday was in the last month.”
Cont..
XIII. JUDGMENT

B.A is having a good judgment, we asked her what she

would do if she was putting in effort to make a
handmade bracelet with very beautiful beads and
someone came along and ripped it off. She replied, "I
will ask why because I don’t want to be in a trouble
with the other patients”. She also stated that she had
made a bracelet and that one of the patients had
ripped it off. Then we asked her, "What did you do?"
She stated, "I did nothing; I just made another one."
Cont..
XIV. INSIGHT

Good insight. The patient knows that she is in the

psychiatric hospital, but she did not admit that it is
because of mental illness. When we asked her about
her plan if she is discharged, she said “anything I’m not
interested in what will happen at that time because I
was rejected from my family.”
Definition of

Complete

Diagnosis

B.A. was diagnosed with schizophrenia. Schizophrenia is a chronic, severe

mental disorder that affects the way a person thinks, acts, expresses emotions,
perceives reality, and relates to others. Though schizophrenia isn’t as common as other major mental

illnesses, it can be the most chronic and disabling. People with schizophrenia often have problems

doing well in society, at work, at school, and in relationships. They might feel frightened and withdrawn

and could appear to have lost touch with reality. This lifelong disease can’t be cured but can be

controlled with proper treatment.

Contrary to popular belief, schizophrenia is not a split or multiple personality. Schizophrenia involves a

psychosis, a type of mental illness in which a person can’t tell what’s real from what’s imagined.
At times, people with psychotic disorders lose touch with

reality. The world may seem like a jumble of confusing

thoughts, images, and sounds. Their behavior may be very

strange and even shocking. A sudden change in personality

and behavior, which happens when people who have it lose

touch with reality, is called a psychotic episode.

Predisposing Factors:
1- Physiological
a. Genetics. b. Histological Changes:
Sadock and colleagues (2015) report

that epidemiological data indicate a high

incidence of schizophrenia after prenatal

exposure to influenza.

c. Biochemical: d. Anatomical Abnormalities:

This theory suggests that
With the use of neuroimaging

schizophrenia may be caused by an

technologies, structural brain

excess of dopamine-dependent
abnormalities have been observed in

neuronal activity in the brain. individuals with schizophrenia.

Cont..
2- Environmental
a. Sociocultural:
Epidemiological statistics have shown that greater numbers of

individuals from the lower socioeconomic classes experience

symptoms associated with schizophrenia than do those from the

higher socioeconomic groups (Puri & Treasaden, 2011). This may

occur as a result of the conditions associated with living in poverty,

such as congested housing accommodations, inadequate nutrition,

absence of prenatal care

b. Stressful Life Events

 Stressful Event
B. A’s family are suffering from mental illness. The mother and sister are
schizophrenic. Her sister is in the psychiatric hospital and one of patient’s
younger brothers is also receiving treatment in the psychiatric hospital. Our
patient used to come to the hospital with her ex-husband for her medications as
she said. The patient’s life was not easy given her family members’ mental
illnesses also she is coming from a poor family.

She got uterine cancer, and she undergone hysterectomy in King Faisal
specialist
hospital in Dammam, according to the patient, her ex-husband and her family
were upset that she will not have children which led her to feel devastated. She
could not sleep most of the days because of overthinking.
 Stressful Event Cont..
Her thoughts were mainly concentrated on if her husband will still be married to
her after the surgery. She said, “my husband was violent, but after the surgery
his violence against me increased”. Also, she said, "he was hitting my hand with a
stick, but after a while, I could not feel the pain in my hand." Two weeks before
the admission, she was hyperactive, irritable, and her speech was irrelevant,
incoherent, and verbally aggressive as her husband stated.

Her relationship with her family was poor, and that showed when she wanted the
family to visit her or go out with them, she said, "When I went home, they told me
why you came, we do not want you here.” Her sister is in the psychiatric hospital
with her, but our patient is afraid of her as she said, “I do not like to go outside
the room when my sister is there because she will hit me, she always says that I
am worthless and stupid.”
Nursing Care

Plans
NURSING

DIAGNOSIS
1. Disturbed sensory perception related to altered sensory reception as evidenced by auditory

hallucinations.
2. Fear related to phobic stimulus as evidenced by the patient’s reaction when discussing about

“life” (scared and panic).

3. Social isolation related to feeling rejected from others as evidenced by no eye contact and

staying alone in the television room.

4. Low self-esteem related to feelings of abandonment as evidenced by the client’s verbalization
“My sister always says that I am worthless and stupid.”
Other Treatment

Modalities

Applicable to The

Patient
Individual psychotherapy:
Schizophrenia patients involve regularly scheduled talks between the patient
and a mental health professional such as a psychiatrist, psychologist, psychiatric social
worker, or nurse. The sessions (most effective if held on a regular basis) may focus on
current or past problems, experiences, thoughts, feelings, or relationships by sharing
experiences.
Support groups:
Support groups help people with schizophrenia and their families feel less alone. Members
of the group offer each other emotional support, acceptance, and advice.
Psychosocial therapy:
Psychosocial therapy helps an individual feel comfortable being in a community. This
method of therapy can include social skills training, rehabilitation, family education, and self-
help groups.
Social skills training (SST):
SST uses the principles of behaviour therapy to teach communication skills, assertiveness
skills, and other skills related to disease management and independent living.
Psychopharmacology:
Anitpsychotic medications, they are effective in the treatment of acute and chronic
manifestations of schizophrenia and in maintenance therapy to prevent exacerbation of
schizophrenic symptoms.
Occupational therapy:
Is focused on the acquisition and the recovery of daily activities and/or occupation. Thus,
through an occupational therapy-based intervention, the patient with schizophrenia should
be able to independently manage daily function, constructive engagement, positive
participation, and adaptive responding should be improved.
Recommendations
 - Family
Although most families want to be constructively involved in their patient's
treatment, often they do not have the necessary knowledge or skills to
undertake this role. Many also experience the continuing impacts of their
patient's mental illness and therefore need treatment and support in their
own right (Harvey & O'Hanlon, 2013). Families of people with psychotic
illnesses experience higher rates of depression and anxiety, greater social
isolation and decreased quality of life compared with the rest of the
community (Hayes, 2015).
Unfortunately, family caregivers frequently report a lack of engagement from
mental health professionals, as well as insufficient information and support,
resulting in distress and frustration.
 -Community
Community education can help to reduce stigma surrounding mental
health conditions and promote a positive mental health environment.
For example, in US and Canada there is Assertive Community
Treatment (ACT) is a program that provides services to individuals in
the community who have severe and persistent mental illness. This
program has shown success in reducing the rate of hospital
admissions by managing symptoms and medications, assisting clients
with social, recreational, vocational needs, and providing support to
clients and their families.
 -Community
People with schizophrenia are frequently misunderstood to be more
dangerous, aggressive, and violent people ( Ylmaz et al., 2015). The
illness has a significant impact on those who are affected, such as
high unemployment rates and a life expectancy of roughly 10–20
years (Owen et al., 2016). Psychiatric diseases and treatment,
particularly schizophrenia, are complicated by stigma and
discrimination.
The current antistigma program "Open the Doors" of the World
Psychiatric Association, currently being implemented in 26 countries
is aimed at reducing the stigma attached to, and discrimination
against, schizophrenia. Since 1999 the program has been running in 7
project centers in Germany. Information programs for the public, and
measures aimed at specific target groups will, it is hoped, improve
knowledge about the causes, nature and therapeutic options in
schizophrenic disorders, and break down prejudices and negative
attitudes, thus facilitating the social rehabilitation of those affected.
 - Client (diet and sport)
Medications to treat schizophrenia can cause weight gain, which can
increase the risk of obesity-related health conditions.so we encourage
her to eat nutritious diet it is the best way to maintain a healthy weight.
Also, she can do Regular exercise is another way to promote weight
maintenance and general well-being. Engaging in aerobic exercises like
walking or other activities like stretching or yoga can be beneficial for
weight management among people with schizophrenia. And while not a
replacement for appropriate psychiatric care, exercise is a noninvasive
and low-cost approach to improving both mental and physical health.
 - Client (medication)
She needs to stay on the medication as prescribed, even if she starts to
feel better. Continuous medicine can help prevent relapses. Also, she
needs to get education about the medications that she is taking and any
side effects.
Nursing Care

Plans
Medication
Genogram