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Tarlac State UniversityCOLLEGE OF NURSING
Lucinda CampusTarlac City
A CASE STUDY
On
ARANOIDSC!I"O !RENIA
resented #y$
Espin%sa& Rac'ael Ann ()Granad%*in& C'enee L)
Tapni%& Reselda
April ++& +,,-
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TABLE OF CONTENTS
Chapter 1 .
IntroductionTheoretical Framework Personal DataHistory of present IllnessPast Personal HistoryFamily History
Chapter 2
eneral appearance!otor "eha#ior $ensorium and Co%nitiesPerception&ttitude and 'eha#ior Defense !echanism&ffecti#e $tate$peechThou%ht Process and Content
Chapter ( .
Psychopatholo%y)elated *iterature and $tudiesDru% $tudy
Chapter + .
Process )ecordin%sPrioriti,ed Psychiatric -ursin% Dia%noses
Chapter
Psychotherapies Implemented
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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. ou may not ha#e as many pro"lemswith memory/ concentration or dulled emotions. $till/ paranoid schi,ophrenia is a serious/
lifelon% condition that can lead to many complications/ includin% suicidal "eha#ior.
http344www.mayoclinic.com4health4paranoid5schi,ophrenia4D$66782 9
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"ancessuch 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. http344www.schi,ophrenia.com4s,paranoid.htm 9
&ccordin% to the 0orld Health ;r%ani,ation/ It descri"es statistics a"out mental
disorders of year 26679. $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
http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862http://www.schizophrenia.com/szparanoid.htmhttp://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862http://www.schizophrenia.com/szparanoid.htm -
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incidence is low (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) .
http344www.howstuffworks.com4framed.htmA
parentBschi,ophrenia.htm urlBhttp344www.nimh.nih.%o#4health4pu"lications4the5
num"ers5count5mental5disorders5in5america.shtml9
In the Philippine settin%/ the disa"ility sur#ey done in 2666 "y the -ational
$tatistics ;ffice -$;9 found out that mental illness was the (rd most common form ofdisa"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 ;" ecti#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 D;H5-EC9 in 2668 which showed
re#ealin% results thou%h the tar%et population was limited only to %o#ernment employees
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from the 26 national a%encies in !etro !anila. &mon% (2< respondents/ (2 percent were
found to ha#e e perienced a mental health pro"lem at least once in their lifetime. The
three most pre#alent dia%noses were3 specific pho"ias 1 =9/ alcohol a"use 16=9/
depression and schi,ophrenia 8=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.
http344
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mo#ed upwards to the ne t 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
physiolo%ical needs9/ "ut will continue to #alue his work performance esteem 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 e ception of the lowest physiolo%ical9 needs/ if these :deficiency needs: are not met/
the "ody %i#es no physical indication "ut the indi#idual feels an ious and tense.
(http://en.wikipedia.org/wiki/Maslow !"s#hierarch$#of#needs)
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Personal Data
Name %2 t'e atient$ !r. LA/e$ +6 years old
Gender$ !ale
Address$ -ue#a Eci a
Civil Status$ Sin/le
Nati%nality$ Filipino
Reli/i%n$ )oman Catholic
(irt'day$
Date admitted$ 3anuary 4.& +,,5 6+$47 pm8
Admittin/ Dia/n%sis$ Paranoid $chi,ophrenia
!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
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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/ anuary >/ 266>/ he was a%ain readmitted with a new dia%nosis of
Paranoid $chi,ophrenia.
Family !ealt' and syc'iatric !ist%ry
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C'apter +
9ENTAL STATUS ASSESS9ENT
A) General Appearance
Criteria Day 1 Day 2 Day ( Day +ood %roomin% M
&ppropriate facial e pression M M M M
&ppropriate posture M M M M!aintains eye contact M M
Durin% nurse5patient interaction/ the patientNs %roomin% was not %ood prior to
mornin% care "ut on the later part he impro#es and shows %ood %roomin%. !ost of the
time/ he e hi"ited appropriate facial e pressions and posture durin% interactions. &t first/
he cannot display eye contact which may show lack of focused and interest on the topic.
&s days passes "y student nurse esta"lished trust on the patient and he maintains %ood
eye contact.
() 9%t%r (e'avi%r
Criteria Day 1 Day 2 Day ( Day +&utomatism M M M MHyperkinesthesia0a y Fle i"ilityCataple yCatalepsy$tereotypeCompulsionPsychomotor )etardationEchopra iaCatatonic $tupor Catatonic e citementTics and spasmsImpulsi#enessChoreiform mo#ements
&utomatism is defined as repeated purposeless "eha#iors often indicati#e of
an iety/ such as drummin% of fin%ers/ twistin% of locks of hair or tappin% of foot. &ll
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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 Day 1 Day 2 Day ( Day +;rientation M M M M Time M M M M Place M M M M Person M M M MConcentration M M M M!emory M M M M )emote M M M M )ecent M M M M Immediate retention 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. Oide"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 sometimes 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 Day 1 Day 2 Day ( Day +Hallucination Oisual ;lfactory &uditory Tactile
ustatory *iliputian
http://en.wikipedia.org/wiki/Mentalhttp://en.wikipedia.org/wiki/Mental -
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IllusionsDelusions M M M M
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 e ternal 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 1 st up to + th day of nurse5patient interaction/ the patient manifest
presence of delusions wherein he always claims that he was the hus"and of $heryl
Cosim. ;ther perceptions were not noted.
E) Attitudes and (e'avi%r
Criteria Day 1 Day 2 Day ( Day +Cooperation M M M M;ut%oin% M M M M0ithdrawnE#asi#e$arcastic&%%ressi#ePerple ed
&pprehensi#e M M M M&rro%antDramatic$u"missi#eFearful$educti#e@ncooperati#eImpatient)esistantImpulsi#e
Attitude is a position of the "ody or manner of carryin% oneself. It is a position or
posture of the "ody appropriate to or e pressi#e of an action/ emotion
The patient e hi"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
http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disordershttp://en.wikipedia.org/wiki/Culturehttp://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disordershttp://en.wikipedia.org/wiki/Culture -
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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 Day 1 Day 2 Day ( Day +Denial M M)epression$uppression)ationali,ation M M)eaction Formation$u"limationCompensationPro ection
DisplacementIdentificationInter ectionCon#ersion$ym"oli,ationDissociation@ndoin%)e%ression$u"stitutionFantasy M M 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 an iety/ 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 andreaction formation on the later days of interaction.
G) A22ective State
Criteria Day 1 Day 2 Day ( Day +Euphoria
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Flat affect M M'luntin%ElationE ultationEcstasy
&n ietyFear &m"i#alenceDepersonali,ationIrrita"ility)a%e*a"ilityDepression
&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%/ oy or sorrow.
4www.cere"romente.or%9.
Flat a22ect$ & se#ere reduction in emotional e pressi#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 e pressions/ and appear e tremely apathetic. www.medterms.com9
The patient sometimes shows flat affect durin% the whole interaction.
!) Speec'
Criteria Day 1 Day 2 Day ( Day +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.
http://www.medterms.com/script/main/art.asp?articlekey=342http://www.medterms.com/script/main/art.asp?articlekey=470http://www.medterms.com/script/main/art.asp?articlekey=470http://en.wikipedia.org/wiki/Speech_productionhttp://en.wikipedia.org/wiki/Speech_perceptionhttp://en.wikipedia.org/wiki/Soundshttp://en.wikipedia.org/wiki/Spoken_languagehttp://www.medterms.com/script/main/art.asp?articlekey=342http://www.medterms.com/script/main/art.asp?articlekey=470http://www.medterms.com/script/main/art.asp?articlekey=470http://en.wikipedia.org/wiki/Speech_productionhttp://en.wikipedia.org/wiki/Speech_perceptionhttp://en.wikipedia.org/wiki/Soundshttp://en.wikipedia.org/wiki/Spoken_language -
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Durin% the interaction/ the patient does not show any alteration in his speech
pattern. He did not e perience #er"i%eration/ aphasia/ other speech pro"lems.
I) T'%u/'t r%cess and C%ntent
Criteria Day 1 Day 2 Day ( Day +'lockin%Fli%ht of Ideas0ord $aladPerser#eration
-eolo%ismCircumstantialityEcholalia
CondensationDelusion M M MPho"ia;"session M M M MHypochondriac
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 Cosimwho is a famous news anchor.
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C'apter 4
syc'%pat'%l%/y(%%1:(ased
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Client:(ased
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Related Literature and Studies
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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 e perience 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 an ious and de#elops e tremefears or o"sessions.
<hou%h an e act 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 in uries 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.: p. 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 tothe 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
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?uickly to an acute episode. $ome people ha#e #ery few such attacks in a lifetime 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