BY JANE KINYA MURIUNGI

REG NO : BSN -1-1211-2/2019

SUPERVISOR : MADAM MILKER SIMBA

DATE : 11/2/2022
CASE STUDY ON DRUG INDUCED PSYCHOSIS

BIODEMOGRAPHIC DATA

PATIENTS NAME : MARTIN MUGAMBI

IP NO : 2022-10886

Age : 23 years

Sex : Male

Religion : Christian

Occupation : Business Man

Next of Kin : Joel Matheta ( Father)

PHYSICAL ADDRESS

County : Meru County

Sub county : Igembe South

Location : Makiri

Village : Mbee (Luluma)

Chief : Kagwiria

Ward : Akachiu

Admitting diagnosis – Drug induced psychosis

Date of admission : 26/2/2022

Mode of admission : Involuntary admission

Allegations
Taking bhang
Destructive and aggressiveness

Being violent

REACTION TO THE ALLEGATIONS:

The patient denied the allegations stating that he was brought to the facility due to conflict with
father and other family members. He said he hates his father so much for bringing him to the
facility.

HISTORY OF PRESENTING ILLNESS

The allegations made were of gradual onset over three months characterized by aggressiveness
and violent behavior and destroying property. The allegations were aggravated by smoking
bhang.

PAST MEDICAL HISTORY

The patient is a known psychiatric patient who has been on follow up for drug induced psychosis
at Dr. Muikamba Mental clinic.

He was admitted last year 2021 may with drug overdose at Meru teaching and referral hospital.

He has been in Kaaga rehabilitation Centre for behavior change.

PERSONAL HISTORY

He was born in hospital through caesarian section cried immediately after birth with no physical
injuries or abnormalities. The mother had no post-partum complication.

He was fully immunized according to KEPI schedule and had normal developmental milestones.

Early childhood experience

Grew up as a normal child raised by both parents. No history of trauma or stressful events.

Education history

Started school at the age of 4 years and completed class 8 and was an average student. Went to
secondary school and completed form 4 after which he ventured into business.

Marital status.
He is not married. He says he is young and when time comes, he will get married. No known
sexual disorders or sexually transmitted diseases but he says he experiences sexual feeling.

Employment history

After completion of form four he starred his own business. He sells cloths and he has opened a
car wash, and he says he has a lot of money, and he can’t stick to one business for more than 2
years

SOCIAL HISTORY.

He relates well with family and friends but he hates his dad for bringing him to the facility and
not visiting him frequently.

Social responsibilities at his work place. He is social and has many friends that they drink with,
chew Miraa and smoke bhang. He reports that he started smoking in primary school and
continued in high school with his friends.

hobbies: he says he enjoys reading the bible as he was holding one during the interview and he
had written down other books he want to read like 48 rules of life. He is also a rugby player

Habits: he likes smoking, taking alcohol especially gilbeys (GIN) and chewing Khat/Miraa and
smoking bhang.

FAMILY HISTORY

His father is married to two wives and he is the lastborn in the family of three, one brother and
sister of the second wife.

The 1st wife of his father also has three children two girls and one son. Both parents are alive.
The two families live separately.

TABLE SHOWING THE ORDER OF FAMILY SIBLINGS

NAME SE OCCUPATION MARITAL STATUS LIFE STATUS

X
C.K F Secretary at County Single Alive
Office
P.M M Tour guide Single Alive

M. M the M Business man Single Alive

client

He declined to give history of the other siblings of the first wife of his father.
FORENSIC HISTORY

He has never been arrested by the police

PREMORBID HISTORY

Before the illness he was a talkative and sociable. He has many friends and he relates well with
them.

PHYSICAL EXAMINATION

Head – The hair looked tiny and well distributed black in color

No swelling or oedema on palpation.

Eyes – The eyes are well aligned with no abnormality noted.

No pallor or jaundice noted.

Nose- Normal in size and shape. No abnormality noted.

No abnormal discharge noted and there is continuity of the septum.

Mouth – Dark lips, pink tongue, No tooth missing

Ears – Both ears have no abnormal discharge and they are

Normal in size and shape. The patient responds to sound well.

Neck – No distended jugular veins and the thyroid gland

Not distended. Tonsils palpable not enlarged/inflamed

No scars observed.

Chest – Normal in size and shape and regular breathing

Patterns. No scars on the chest. 20 breaths per

Minutes and pulse rate 84 beats per minute. S1 S2 heart sound heard.

Back – No scars and there is continuity of the spinal cord.

No pain on palpation

Upper limbs – Both arms are present, equal in size and no scars

Noted capillary refill is <3 seconds.

Abdomen – Has no distention of abdomen, no scars noted. Bone

Sounds present on auscultation. No tenderness on palpation

No mass felt on palpation.

Genitalia – Normal morphology. No inguinal swelling and lymph nodes not enlarged.

Lower limbs – Both present and equal in size. No edema.

General appearance-well built body and he looks healthy

Vital signs and observations

Blood pressure 118/76 mmhg

Pulse rate 84

Respiration rate 20 breaths per minute

MENTAL STATUS ASSESSMENT

(i) General appearance

Mode of dressing. The patient was well dressed with a t shirt, Jacket and a pair of Jeans. He
looked good and was appropriately dressed.

personal hygiene

His hair was short and clean- he appeared well kempt.

Facial expression – masked

Eye contact – Not maintained

Behavior – restless and abusive

level of consciousness - alert.

Attitude towards the nurse – Uncooperative

Psychomotor behavior.

Gait – steady
 Posture – upright

Ticks and mannerism absent

Speech– Tone – High

Speed – Normal
Volume – pressured

Affect – Appropriate

Mood – Euthymic

Thinking Had linear organized thought content. No thought insertions no phobias and no
suicidal ideas.

The patient had no flight of ideas, No thought blocks, No poverty of ideas.

perceptions

I asked him whether he was hearing some voices he said No and had none even on admission.

The patient had no hallucinations or illusions.

orientation

He was oriented to time, person and place

concentration

He had good concentration and as the time of interview he was playing a game with another
patient.

memory

Recent memory, immediate and remote memory were intact.

judgment

Had good judgment.

I gave the patient a scenario of a burning house and a little kid inside and also a bag full of
money inside. I asked him what he will save first and he said he would save the kid first.

ABSTRACT REASONING.

Had a good abstract reasoning.

He was able to interpret a proverb. Asiyefunzwa na mama ufunzwa na ulimwengu.

INSIGHT.

He was not aware of his mental sickness and he believed he was not sick on admission but
during the interview he says he knows he is sick and will take his medication.

PLAN

Admit psychiatry unit for management

MANAGEMENT – PHARMACO THERAPY.

The patient was put on midazolam 10mg intravenous stat.

Midazolam is a benzodiazepine that acts on glycine receptors and produce a muscle relaxing
effects Acts on the central nervous system at many levels to produce generalized central nervous
systems depression. It sedates and give anxiolytic effects.

benzhexol – trihexyphenidyl

Is a anticholinergic agent

Its an antispasmodic drug used to treat stiffness, tremors, spasms and poor muscle control. Used
to treat and prevent Parkinson’s – like symptoms that are caused by using certain antipsychotic
medication.

clopixol 200mg stat- monthly

Clopixol belongs to a group of medicines called thioxanthene neuroleptics. It helps correct

chemical imbalances in the brain. It acts by antagonizing of D1 and D2 dopamine receptors.

aripiprazole

Aripiprazole is a partial agonist at D2 receptors. It acts as an antipsychotic by lowering

dopaminergic neurotransmission in the mesolimbic pathway and enhancing dopaminergic
activity in the mesocorticolimbic pathway.

carbamazepine.

Acts by enhancement of Sodium channel inactivation by reducing high frequency repetitive

firing of action potential and action on synaptic transmission. It’s used as an anticonvulsant and
a mood stabilizer.
NUTRITION

The patient had good appetite; he had no difficulties in feeding. He was served with porridge
every day in the morning at 6.30 am and at 10 am served with tea. The patient remained active
most of the day, moving around, talking a lot, and singing with fellow patients. The patient
remained energetic throughout the day. Lunch time he was given lunch and a lot of safe drinking
water and at 6 pm every day he was provided with Ugali and cabbage. The food however lacked
greens and fruit which is also essential for the patient.

HYGIENE

I encouraged the patient to take a both at least once a day, in the morning when he wakes up as
they are provided with hot water and to change in a clean hospital uniform.

PSYCHOTHERAPY.

INDIVIDUAL THERAPY.

During the management of my client, I frequently offered individual psychotherapy where we

discussed various issues which were disturbing him. Among the issues we discussed, helping
him understand why he was admitted and to gain insight of his illness, because on admission he
lacked insight and did not agree that he was mentally sick. And needed medical assistance.

We discussed drug compliance with my patient. Initially he did not understand why he was
being injected with drugs and he had declined taking oral drugs because he felt he was not sick.
After several sessions on importance of medication he agreed to comply.
NURSING CARE PLAN OF MY CLIENT.

Date/T ASSESSME NURSING GOALS/EXPEC NURSIN RATIONAL IMPLEMENT Name

ime NT DATA DIAGNOSIS TED G E ATION EVALUAT and sign
OUTCOME INTERVE ION
NTION

On Risk for Goal Offer Individua Individual Goal

assessme individ l partially
violence To protect psychothera
nt, ual psychoth met
patient related to patient from psychot erapy py offered
verbalize range causing any herapy permits to the
s to the the
increased reactions. harm to patient patient to patient at
hatred others and and ventilate 10:30 am.
towards encoura his
his father, self during ge him feelings Patient
looks to and accepted to
hospital stay.
very forgive arrive at forgive his
E/Outcome father
angry his a solution
when Patient will father of
talking verbalize problems
about the relief from Teach without
incidence hating his patient much
, and has mother and on guidance.
muscle will appear proper
tensions. relaxed conflict Forgiving
when talking resoluti his father
about the on will bring
conflicts. skills about
Patient will psycholo
demonstrate gical
proper relief and
conflict relaxatio
solving skills n.
On Disturbed Goal Encour Warm At 4pm Goal on
assessme going
sleep Patient to age the bath Patient
nt,
patient pattern sleep at least patient promotes encouraged
verbalize related to for 6 hours to take relaxatio to be taking
s sleeping
late and perceptual per night in a warm n to bath before
waking and 48 hours bath encourag going to
up early,
sleeping cognitive E/Outcome. before e sleep. bed
less than impairment Patient will bedtime Low At 4pm
six hours stimulati Patient
as verbalize .
per night ons will encouraged
and evidenced getting Let the allow to sleep in a
making patient patient to quiet corner
by patient adequate
noise at sleep in relax and of the room
night verbalizatio sleep at the area get to avoid
n of night. of the adequate disturbance.
room sleep at
sleeping Patient will with night. At 3pm
not make low discouraged
late and
noise at stimulat Naps patient
waking up night. ion during from taking
early. daytime unnecessar
Discour will y naps
age make during
patient patient daytime
from lack
taking enough
naps sleep at
during night
the day
On Knowledge Goal Discuss Always At 10AM Goal
partially
assessme deficit Patient to the patient discussed
met
nt, related to gain relation has with the
patient lack of knowledge ship of misperce patient the
verbalize information and insight substan ption or relationship
s and of his own ce use denial of of
statement information condition to real substance
s of misinterpret during current reason use and
concern, ations hospitalizati situatio for mental
questions evidenced on n. admissio illness at
and by patient E/Outcome. Review n to the 11am.
the
developm verbalizatio Patient will psychiatri At 10 AM
conditi
verbalize we
ent of n of on and c unit.
understandin discussed
preventab statements prognos
g of own the
is and Provides condition
le of concern, condition
future knowledg and
and
complicat questions expecta e base
participate in prognosis at
 ions. and treatment tions from the same
program togethe which time.
developmen
including the r with patient
t of plan for the can make AT 9AM
preventable long-term patient informed involved
care. choice. patient in
complicatio Involve the drug
ns. patient Involving administrati
in his patient in on
care care will
such as enable
drugs the
used for patient to
treatme master
nt and
understan
d the
drugs
used.

DISCHARGE PLAN FOR THE CLIENT.

My client has hot fully recovered and was still in the ward. I talked to him about abstinence
from substance abuse so that after discharge he will not relapse and get admitted again. I
explored various ways of avoiding substance abuse, problem solving skills and stress coping
mechanism in order to avoid going back to substance abuse.

I discussed with him advantages of taking drug as advised and effects of poor drug adherence.
He was ready to continue taking medication as advised after discharge.

He also agreed to continue attending outpatient clinic as per the appointments after discharge.

We discussed about avoiding friends who encourage him to take drug substances as they mean
no good in his life.
I discussed with his family members (father) about accepting him back after discharge and
supporting him to avoid relapses.