INTORDUCTION Paranoid schizophrenia This subtype of schizophrenia is the combination of false beliefs (delusions) and hearing voices (auditory

hallucinations), with more nearly normal emotions and cognitive functioning (cognitive functions include reasoning, judgment, and memory). The delusions of paranoid schizophrenics usually involve thoughts of being persecuted or harmed by others or exaggerated opinions of their own importance, but may also reflect feelings of jealousy or excessive religiosity. The delusions are typically organized into a coherent framework. Paranoid schizophrenics function at a higher level than other subtypes, but are at risk for suicidal or violent behavior under the influence of their delusions.

Theoretical Framework
Sigmund Freud's Psychosexual Development Theory Born on May 6, 1856 in Moravia, Sigmund Freud was an Austrian neurologist who, in the late 19 th and early 20thcenturies, developed the field of psychoanalysis. Freud developed many theories including those that focus on the unconscious, the interpretation of dreams, Id, ego, and super ego, and what is referred to as the psychosexual development theory. Psychosexual development is a theory that Freud based upon the Greek tragedy by Sophocles Oedipus Rex and is often referred to as the Oedipus Complex. The Oedipus Complex teaches that the unconscious holds repressed thoughts that boys have a desire to have sexual intercourse with their mothers, while wanting to murder their father. The theory isn't limited solely to males, as Freud believed that girls had a sexual attraction to their fathers; this was later referred to as the Electra Complex. Freud taught that these unconscious thinking patterns form during several stages of development until they are eradicated by normal, healthy sexual development. Freuds theory of psychosexual development is divided into five stages. These are oral, anal, phallic, latency, and genital. Freuds theory was an important factor to his teachings based upon the development of the human personality. Oral Stage The oral stage occurs in an infants life from birth to 18 months. During this time, an infant is focused with receiving oral pleasure. This occurs through breast or bottle feeding, or sucking on a pacifier. It is believed that if an infant receives too much or too little oral stimulation, they may develop a fixation or a personality trait that is fixated on oral gratification. It is believed that these people may focus on activities that involve the mouth such as over eating, biting the fingernails, smoking, or drinking. The theory states that these people may develop personality traits such as becoming extremely gullible or naive, always following others and never taking the lead, and becoming extremely dependent upon others. Anal Stage The anal stage is directly related to a childs awareness of bowel control and gaining pleasure through the act of eliminating or retaining feces. Freuds theory puts the anal stage between 18 months and three years. It is believed that when a child becomes fixated on receiving pleasure through controlling and eliminating feces, a child can become obsessed with control, perfection, and cleanliness. This is often referred to as anal retentive, while anal expulsive is the opposite. Those who are anal expulsive may be extremely disorganized, live in chaos, and are known for making messes.

Phallic Stage Freud believes the phallic stage or the Oedipus or Electra complexes occurs during a child is three to six years of age. The belief is that male children harbor unconscious, sexual attraction to their mothers, while female children develop a sexual attraction to their father. Freud taught that young boys also deal with feelings of rivalry with their father. These feelings naturally resolve once the child begins to identify with their same sex parent. By identifying with the same sex parent, the child continues with normal, healthy sexual development. If a child becomes fixated during this phase, the result could be sexual deviance or a confused sexual identity. Latency Stage The latency stage is named so because Freud believed there weren't many overt forms of sexual gratification displayed. This stage is said to last from the age of six until a child enters puberty. Most children throughout this age form same sex friendships and play in a manner that is nonsexual. Unconscious sexual desires and thoughts remain repressed. Genital Stage Freud believed that after the unconscious, sexual desires are repressed and remain dormant during the latency stage, they are awakened due to puberty. This stage begins at puberty and develops with the physiology changes brought on through hormones. The prior stages of development result in a focus on the genitals as a source for pleasure and teens develop and explore attractions to the opposite sex. The genital stage is the last stage of the psychosexual development theory.

PERSONAL DATA PATIENTS NAME : AGE : GENDER ADDRESS CIVIL STATUS NATIONALITY RELIGION BIRTHDAY : : : : : : Mr. S 46 yrs/o Male Mandaluyong, City Married Filipino Roman Catholic

DATE ADMITTED :

ADMITING DIAGNOSIS: Paranoid Schizophrenia

PRESENT HISTORY Mr. S is currently admitting at NCMH, for about 7yrs with the diagnosis of paranoid schizophrenia, Mr. S is manageable but he is still in suppression, because he avoid thinking disturbing problems, wishes, feeling or experiences.

Past History Mr. S is a victim of rape, he was raped by his gay uncle when he was a child, so he had an identity crisis, and his vices during teenage years triggered it, which turns him to be hallucinated and be violent, so his family decided to send him to the mental hospital.

Family history Mr. S is married w/ 4 children.

MENTAL STATUS ASSESSMENT A. General Appearance Criteria Good grooming Appropriate facial expression Appropriate posture Maintains eye contact Day 1 Day 2 Day 3 Day 4

B. Motor Behavior Criteria Hyperkinesthesia Waxy flexibility Cataplexy Catalepsy Stereotype Compulsion Dystonia Day 1 Day 2 Day 3 Day 4

C. Sensorium and Cognitive

D. Attitude and Behavior Criteria Cooperation Responsive Outgoing withdrawn Dramatic Day 1 Day 2 Day 3 Day4

E. Defense Mechanism Criteria Denial Suppression Regression Acting out dissociation Projection Reaction formation F. Affective State Criteria Blunted affect Broad affect Flat affect Inappropriate affect Restricted affect labile G. speech Criteria Slurred Rhyming Aphasia Day 1 Day 2 Day 3 Day 4 Day 1 Day 2 Day 3 Day 4 Day 1 Day 2 Day 3 Day 4

PSYCHOPATHOLOGY Psychosexual Development

Modifiable: Lifestyle -alcohol -smoking -substance abuse

Non-modifiable variable:

-age -gender -family/relatives

-Traumatic experiences (raped by his same sex relatives) -substance abuse can trigger

-Disorganized thought confusions -identity crisis

hallucinations

Systemic persecution delusion

Delusion of anger

violence

Marked social isolation by putting him on the hospital

Paranoid schizophrenia

NURSING CARE PLAN Assessment s-namimiss ko na yung asawa ko o-suppression hallucinations regression extrapyramidal syndrome Diagnosis Disturbed thought process related to ineffective coping mechanism Planning -The client will be able to trust the nurse and verbalizing his feeling of suppression -to lessen his suppression concentrating to a single point Interventions -Give the client a broad opening Rationale -may stimulate him to take iniative -it signify that you are paying attention to what the patient is saying -may prevent a multitude of factors or problems from overwhelming the client Giving advice implies that only the nurse knows what is best for the client. Evaluations The client was entrusted the nurse and verbalized his feelings.

-Be an active listener to the client

-the client was lessen his suppression.

-advising

DRUG STUDY GENERIC NAME: clozapine BRAND NAME: Clozaril, Fazacio ODT

DRUG CLASS AND MECHANISM: Clozapine is an anti-psychotic medication that works by blocking receptors in the brain for several neurotransmitters (chemicals that nerves use to communicate with each other) including dopamine type 4 receptors, serotonin type 2 receptors, norepinephrine receptors, acetylcholine receptors, and histamine receptors. Unlike traditional anti-psychotic agents, such as chlorpromazine (Thorazine) and haloperidol (Haldol) as well as the newer anti-psychotics, risperidone(Risperdal) and olanzapine (Zyprexa), clozapine only weakly blocks dopamine type 2 receptors.

PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Tablets (orally disintegrating): 12.5, 25, 100, 150, and 200 mg STORAGE: Tablets should be kept below 30 C (86 F). PRESCRIBED FOR: Clozapine is use in the management of psychotic disorders including schizophrenia. Because of concern for the side effect of agranulocytosis (see side effects), clozapine should be reserved for patients who have failed to respond to other standard medications or who are at risk for recurring suicidal behavior. DOSING: Clozapine is given once, twice, or three times daily. The dose often is increased slowly until the optimal dose is found. The full effects of clozapine may not be seen until several weeks after treatment is begun. DRUG INTERACTIONS: Risperidone (Risperdal) may cause an increase in the amount of clozapine in the blood. This could lead to an increased risk of side effects from clozapine.

SIDE EFFECT The most common side effect of clozapine is drowsiness. Other side effects include increased heart rate, increased salivation, headache, tremor, low blood pressure, and fever. Clozapine has anticholinergic effects that interfere with the function of smooth muscles. This can lead to blurred visionand difficulty urinating (when there is enlargement of the prostate) due to effects on the muscles of the eye and bladder. Clozapine slows the intestine and leads to constipation in approximately 14% of patients. Paralysis of the intestinal muscles can lead to paralytic ileus, a condition in which the intestine stops working.

PARANOID SCHIZOPHRENIA

Razona, Jenzeil D BSN III-I (RLE) NCMH,7-1pm Mrs. Julliet, daos