General Objectives

This case study aims to identify and determine the general health problems and needs
of the patient with an admitting diagnosis of Undifferentiated Schizophrenia. This study
also intends to help us promote health and medical understanding of such condition
through the application of the nursing skills.

Specific Objectives
After the completion of this case study, the students will be able to:

Introduction

Define Schizophrenia (Undifferentiated)

Trace the Psychopathology
Enumerate the different signs and symptoms
Identify and understand different types of medical treatment
Formulate and apply nursing care plan utilizing nursing process

Schizophrenia
The word "schizophrenia" comes from the Greek roots schizo (split) and phrene
(mind) to describe the fragmented thinking of people with the disorder.
It is a psychotic disorder (or a group of disorder) marked by severely impaired

Thinking
Perception
Emotions or feelings
Behavior

Schizophrenic patients are typically unable to filter sensory stimuli and may have
enhanced perception of sounds, colors, and other features of their environment. Most
schizophrenics, if untreated, gradually withdraw from interactions with other people, and
lose their ability to take care of personal needs.
The course of schizophrenia in adults can be divided into three phases or
stages. In the acute phase, the patient has an overt loss of contact with reality (psychotic
episode) that requires intervention and treatment. In the second or stabilization phase, the
initial psychotic symptoms have been brought under control but the patient is at risk for
relapse if treatment is interrupted. In the third or maintenance phase, the patient is
relatively stable and can be kept indefinitely on anti-psychotic medications. Even in the
maintenance phase, however relapses are not unusual and patients do not always return
to full functioning
Types of schizophrenia
1.Disorganized schizophrenia- characterized by:

Impaired ADL

Disorganized speech, thinking and behavior

Somatic delusions
Flat or inappropriate affect

2. Paranoid schizophrenia characterized by:

Extreme suspiciousness
Delusion of persecution
Unpredictable violence
Ideas of reference
Auditory hallucination

3. Catatonic schizophrenia characterized by:

Catatonic stupor:

Stupor or rigidity
Bizarre mannerism
Automatism
Sudden onset of mutism
Waxy flexibility

Catatonic excitement:

Have dangerous periods of agitation

Impulsive and explosive behavior

4. Undifferentiated schizophrenia characterized by symptoms of more than one type

of schizophrenia but does not meet the criteria for paranoid, disorganized or catatonic
type.
5. Residual schizophrenia history of at least one psychotic episode but curently
without or limited overt psychotic behavior.

Theories of Etiology

1. Biological factors

Genetic Predispositon
Neurochemical factor
Neuroanatomic or structural dysfunctions

2. Social factors

Decrease financial status

Family and caregiver stress
Homelessness
Stigma and community isolation

3. Psychological factors

Difficulties in relating
Difficulties with decision making
Decreased stress response and coping
Affective blunting
Self concept changes
Loss of family relationships

Epidemiology

Affects 1% of the total population.

8% in siblings of affected subjects.
12% in offsprings of one affected parents
40% in offsprings of two affected parents
47% in subjects of affected monozygotic twins

Treatment

Institutional care
Antipsychotic drugs
Psychotherapy
The community approach

Nursing History

Patients Profile

Patients name:

Ms. X

Informant: Patient herself and neighbor

Gender:

Female

Reliability: 80%

Birth date:

September 16, 1964

Admitting diagnosis: F20.3

Civil status:

single

undifferentiated schizophrenia type

Age:

50 y/o

Occupation: housekeeper

Hospital #:

8363

educational attainment: Grade VI

Religion:

Catholic

Address: #508 Paete St. Mandaluyong

Citizenship:

Filipino

City

Place of Birth:

Pangasinan

Height:

52

Weight:

170 lbs

Date of admission: December 13, 2014

5:06 pm

Chief Complaint:
According to the informant:nangugulat, sumisigaw, nananakot.
According to the patient:

parang susumpungin ako, gusto ko mag-pa admit.

History of present illness:

The HPI started when the patient was 16 y/o, she was diagnosed to have mental
illness and was admitted at NCMH, she is compliant to unrecalled medication which she
took every night. She was then discharged.
She was apparently well, compliant to her medications until 2005 wen she had
recurrence of mental illness, hence she was admitted.
She was apparently well, functional at home, compliant to chlorpromazine 200mg 2
tablets every night until 1 month prior to admission when the patient had a feeling of
despair and suicidal ideation. She channeled her thoughts in doing household chores.
Few hours prior to admission, she was noted to have shouting episodes, nanggugulat,
naninigaw, nananakot nanaman sya. as verbalized by the informant. Patient also
verbalized parang susumpungin ako, gusto ko mag-pa admit. she was then
accompanied by her neighbor to NCMH ER and was subsequently admitted.

Past medical history:

(-) HPN
(-) DM

no check-up

(-) PTB
(+) measles, mumps, unknown immunization
(-) surgery, accidents, trauma

Physical Examination

General Apperance: Patient is coherent, conscious, ambulatory, non-febrile and with VS BP:
150/100 HR: 91bpm RR: 19cpm Temp: 36.7 degree Celsius
HEENT: Anicteric sclerae, pink palpabral conjunctiva, no naso-aural discharged, no
tonsillopharingeal congestion, no cervical lymphadenopathy with mole right upper lip
Lungs: Symmetrical chest expansions, no lagging, no retractions, vesicular breath sounds with
scar at the upper right back
Heart: Adynamic precordium with normal heart rate and regular rhythm, no murmurs
Abdomen: Flabby abdomen, hormoactive bowel sounds, non-tender upon light and deep
palpation
Extremeties: Grossly normal extremeties with 2x2 cm skin tags at the left lateral thigh, no
edema, no cyanosis, pull and equal pulses on extremeties with scar just below the skin tags

Neurological Exam

Cerebrum: conscious, alert, coherent, oriented to time, place and person. Able to follow simple
commands.
Cerebellar: not assessed (patient is restrained)
Cranial Nerves
CN I- can smell
CN II- 2mm pupils equally reactive to light and accommodation
CN III, IV, VI- intact EOM
CN V- able to feel pain prick at forehead, able to clench teeth
CN VII- no facial asymmetry, able to raise eyebrows
CN VIII- able to hear
CN IX, X- intact gag reflex, uvula at the midline
CN XI- able to shrug shoulder against resistance
CN XII- tongue is at the midline

Motor strength:

Sensory strength:

5555
5555

100% 100%
100%

100%

(-) nuchal rigidity

(-) kernigs
(-) Brudzinski

Mental Status Examination

General appearance:
Patient is female, old looking, looking appropriate at her age, with average height, black hair
with some white hair, wearing floral house dress, brown in complexion, groomed with good eye
contact, good posture, no, mannerism, no signs of agitation, no unusual gestures, cooperative

Speech:
Patient answers cues spontaneously in moderate tone in normal pace, no neologism, no
resistance and talks appropriately
Mood and Affect:
Euthymic mood with appropriate affect
Thought Process:
Patient is coherent, comprehensive and goal oriented
Thought Content:
Patient has no delusions, she is not preoccupied, she denies suicidal idea, no intention to hurt
others and no phobias
Perception:
Patient has no aunditory and visual hallucination. She denies illusions and depersonalization

Cognition and Sensorium:

Patient is alert, conscious and coherent. She is attentive, oriented to time, and person. She can
do simple calculation with intact immediate, recent and remembering memory. She is able to
differentiate banana and apple by differentiating the two
Insight:
Patient understands and has true emotional insight of her illness
Judgment:
Patient has good judgment when asked what shell do id she found a wallet with full of money,
she answered that if the wallet has an addressed on it she will return it to the owner.

Emergency Room
General Survey:
Conscious, coherent, disoriented to time and place. Oriented to person, not in distress,
restrained to bed
VS:
BP: 120/180

RR: 18

HR: 80

TEMP: 37.2 degree Celsius

Skin: brown, soft, good skin turgor, capillary refill less than 2 seconds
HEENT: no neck vein distension (no corvicolynphedenopathy)
(no cervical lymphadenopathy)
Chest and Lungs: symmetric chest, well expansion, vesicular smooth sounds, no lagging, no
retraction
Heart: adynamic pericardium, no heaves, no thrills, normal note, regular rhythm, no murmur
Abdomen: flabby, soft, non-tender with normal active bowel sounds
Extremeties: grossly normal extremities, no cyanosis, no edema

Neurological Exam
Cerebrum: conscious, coherent, hypoproductive speech, disoriented to time and place, oriented
to person, able to do simple commands
Cerebellum: restrained to bed, unable to perform other cerebellar test
Cranial Nerves
CN I- unable to assess
CN II- pupils equally round and reactive to light
CN III, IV, VI- intact EOM
CN V- can clench teeth
CN VII- no facial asymmetry
CN VIII- not assessed
CN IX, X- uvula at the midline
CN XI- shrugs shoulders
CN XII- tongue is midline, no atrophy

Motor strength: Cannot assess motor function

Sensory strength:
100% 100%
100%

100%

Daily Activities
Day 2
Dance Aerobic Activity
Definition- Dance is the most fundamental of the arts, involving direct expression
through the body. Dance movement therapy effects changes in feelings, cognition,
physical functioning, and behavior.
Title of the dance song: Break Free
Facilitators are in the front, dancing different steps, enabling the patients to follow the
dance steps.
Goals:

To encourage the patients to release or express their emotions

To let the client learn on how to dance in simple steps
To increase the physical activity of the patients
To enhance the memory of the patients
To communicate/receive a satisfying sense of social engagement

Role of Nurse:
Lead and explain the different dance aerobic steps.
Participate and cooperate in dance activity.
Facilitate the whole activity.

Day 3
Dance Aerobic Activity
Definition- Dance is the most fundamental of the arts, involving direct expression
through the body. Dance movement therapy effects changes in feelings, cognition,
physical functioning, and behavior.
Title of the dance song: Break Free
Facilitators are in the front, dancing different steps, in able for the client to follow easily
the facilitators.

Goals:

To encourage release or express clients emotions

To let the client learn on how to dance in simple steps
To increase the physical activity of the patients
To enhance the memory of the patients
To communicate/receive a satisfying sense of social engagement

Role of Nurse:
Lead and explain the different dance aerobic steps.
Participate and cooperate in dance activity.
Facilitate the whole activity.

Recreational Activity
Definition- A form of psychotherapy used to help them express or act out their
experiences, feelings, and problems by playing group games. The purpose of
recreational therapy in the field of mental health is to provide clients with opportunities
to explore health leisure choices that enable the development of a variety of skills they
can transfer into their day-to-day lives.
Goals:
Enhance memory.
Encourage participation and cooperation.
Enhance positive personal growth.
Role of Nurse:
Facilitator in the activity.
Provide the needed materials.
Leader in positive personal independency of the patients

Name of the Game 1: Pantomime

Procedure: Participants stand in a circle, arms distance apart. Ask each person to think
of a verb and action which starts with same letter as the persons first name e.g.
jumping James.

The person does the action and yells out their action-name. Everyone then repeats the
action and the action-name.
This requires high level of energy from the instructor. People are shy to start with, you
must encourage everyone to join in and say the name and action of everyone else.
For participants who verbalize I cant think of anything, just respond keep thinking,
well come back to you. If they still do not come up with anything. I ask the group to
help.

Name of Game 2: Human Chain

Materials: Yarn
Procedure: Form a group of two with equal amount of players. Form a line facing left
side with arm sideward and hold the hand of the member to your left and right. A yarn
that is tied at the ends will be given to the first player. The yarn should pass the body of
all the players up to the last without the use of their hands.

Name of Game 3: Banana Relay

Materials: Banana
Procedure: Form a group of two with equal amount of players. A banana will be given to
the first player, she will put it to her body with the exception of the hands and runs
through the designated point and goes back. She then will pass it to the next player.
Note you cannot repeat the same body parts that had been used.

Music and Art Therapy

Description- The use of art materials for self-expression and reflection.
Materials: Crayons, Bond Paper, and relaxing instrumental music
Procedure: Patients are provided with crayons and one piece of bond paper each.
They are then asked to draw an interpretation of what they are feeling at that moment;
while the instrumental music is playing. After each patient is done drawing, they are
asked one by one to explain their individual drawings.

Goals:
To encourage patients ability to think and reflect regarding their experiences.
To encourage patients participation and cooperation.
To let and encourage the patient to express their emotions and feelings.
Role of Nurse:

Explain the procedure.

Provide needed materials to be use.
Facilitate on the activity
Leader of positivity

Day 4
Dance Aerobic Activity
Definition- Dance is the most fundamental of the arts, involving direct expression
through the body. Dance movement therapy effects changes in feelings, cognition,
physical functioning, and behavior.
Title of the dance song: Break Free
Facilitators are in the front, dancing different steps, in able for the client to follow easily
the facilitators.
Goals:
To encourage release or express clients emotions
To let the client learn on how to dance in simple steps
To enhance memory to follow simple steps given.
Role of Nurse:
Lead and explain the different dance aerobic steps.
Participate and cooperate in dance activity.
Facilitate the whole activity.

Recreational Therapy
Goals:
Enhance memory.
Encourage participation and cooperation.
Enhance positive personal growth.
Role of Nurse:

Explain the procedure.

Provide needed materials to be use.
Facilitate on the activity.
Leader of Positive personal growth.

Name of Game: Musical Instruments

Procedure: Get a partner and will be assigned of a group number. The game starts with
a song sumisikat na ang araw sagisag ng bagong buhay, Gawain ay naghihintay
halinat ating simulant. Nasaan and group a group will be dcalled and say narito
ang grouptumutugtog ng will say a musical instrument and mimic its sound and
how to play it. The song ends to the last group to perform its musical instrument.
Name of Game: Fruit Salad
Procedure: Let the patient form a line , then when the student nurse says banana
they must lean their hips forward, when the student nurse says apple they must lean
their hips backwards, when the student nurse says mango they must move their hips
to the left, when the student nurse says orange they must move their hips to the right,
lastly when the student nurse says fruit salad they must rotate their hips.

Occupational Therapy:
Name of Activity: Making of Graham Balls
Definition: Any activity, mental or physical, prescribed and guided to aid an individuals
recovery from diseases or injury. This activity excludes competition and pressure. There
is opportunity for creativeness and produce something tangible out of patients own
thinking and imagination. Self-confidence and personal achievements are also
experienced.

Materials:
Crushed Grahams, Marshmallows, Condensed Milk, Disposable Plastic Gloves, Paper
Plates.
Procedure:
Each of patients were given the materials and instructed on how to incorporate the
marshmallows with the condensed milk. They were then instructed to place crushed
grahams on the marshmallows that were covered in condensed milk.
Goals:
To promote positive personal growth.
To give patient extra income when they are to be discharge.
To encourage cooperation and participation.
Role of the Nurse:
Explain the procedure of the activity.
Facilitate the activity successfully.
Assist the patient in doing the activity.

ANATOMY AND PHYSIOLOGY

Structure and function of the nervous system
I. Structures
A. The neurologic system consists of two main divisions, the
central nervous system (CNS) and the peripheral nervous system
(PNS). The autonomic nervous system (ANS) is composed of both
central and peripheral elements.
1. The CNS is composed of the brain and spinal cord.
2. The PNS is composed of the 12 pairs of the cranial nerves and
the 31 pairs of the spinal nerves.
3. The ANS is comprised of visceral efferent (motor) and the
visceral afferent (sensory) nuclei in the brain and spinal cord. Its
peripheral division is made up of visceral efferent and afferent
nerve fibers as well as autonomic and sensory ganglia.
B. The brain is covered by three
membranes.
1. The dura matter is a fibrous,
connective
tissue
structure
containing several blood vessels.
2. The arachnoid membrane is
a delicate serous membrane.
3. The pia matter is a vascular
membrane.
C. The spinal cord extends from the medulla oblongata to the
lower border of the first lumbar vertebrae. It contains millions of
nerve fibers, and it consists of 31 nerves 8 cervical, 12 thoracic,
5 lumbar, and 5 sacral.
D. Cerebrospinal fluid (CSF) forms in the lateral ventricles in
the choroid plexus of the pia matter. It flows through the foramen

of Monro into to the third ventricle, then through the aqueduct of

Sylvius to the fourth ventricle. CSF exits the fourth ventricle by
the foramen of Magendie and the two foramens of Luska. It then
flows into the cistema magna, and finally it circulates to the
subarachnoid space of the spinal cord, bathing both the brain and
the spinal cord. Fluid is absorbed by the arachnoid membrane.
II. Function

A. CNS
1. Brain
a The cerebrum is the center for consciousness, thought,
memory, sensory input, and motor activity; it consists of two
hemispheres (left and right) and four lobes, each with specific
functions.
i The frontal lobe controls voluntary muscle movements and
contains motor areas, including the area for speech; it also

contains the centers for personality, behavioral, autonomic and

intellectual functions and those for emotional and cardiac
responses.
ii The temporal lobe is the center for taste, hearing and smell,
and in the brains dominant hemisphere, the center for
interpreting spoken language.

iii The parietal lobe coordinates and interprets

information from the opposite side of the body.

sensory

iv The occipital lobe interprets visual stimuli.

b The thalamus further organizes cerebral function by
transmitting impulses to and from the cerebrum. It also is
responsible for primitive emotional responses, such as fear, and
for distinguishing between pleasant and unpleasant stimuli.
c Lying beneath the thalamus, the hypothalamus is an
automatic center that regulates blood pressure, temperature,
libido, appetite, breathing, sleeping patterns, and peripheral
nerve discharges associated with certain behavior and emotional
expression. It also helps control pituitary secretion and stress
reactions.

d The cerebellum or hindbrain, controls smooth muscle

movements, coordinates sensory impulses with muscle activity,
and
maintains
muscle
tone
and
equilibrium.

e The brain stem, which includes the mesencephalon, pons, and

medulla oblongata, relays nerve impulses between the brain and
spinal cord.
2. The spinal cord forms a two-way conductor pathway between
the brain stem and the PNS. It is also the reflex center for motor
activities that do not involve brain control.
B. The PNS connects the CNS to remote body regions and
conducts signals to and from these areas and the spinal cord.
C. The ANS regulates body functions such as digestion,
respiration, and cardiovascular function. Supervised chiefly by the
hypothalamus, the ANS contains two divisions.
1. The sympathetic nervous system serves as an emergency
preparedness system, the flight-for-fight response. Sympathetic
impulses increase greatly when the body is under physical or
emotional stress causing bronchiole dilation, dilation of the heart
and voluntary muscle blood vessels, stronger and faster heart
contractions, peripheral blood vessel constriction, decreased
peristalsis, and increased perspiration. Sympathetic stimuli are
mediated by norepinephrine.

2. The parasympathetic nervous system is the dominant

controller for most visceral effectors for most of the time.
Parasympathetic impulses are mediated by acetylcholine.

Pathophysiology

Psychosocial stressor and

interpersonal events
Stimulates different factors

Modifiable factors:

Lifestyle
Alcohol
Smoking
Substance Abuse

Non-modifiable:
Age:

Failure in development
or a subsequent loss of
brain tissue

(15-25) onset on
male
(25-35 onset on
female

Diminished of glucose. And oxygen in frontal

cortical structures of brain.

Decrease brain volume and abnormal brain

function in frontal and temporal lobe.

Transmission of
signal requires
complex series of
biochemical events

Malfunctioning of
transmission in
electrical impulses

Drugs increase dopaminergic system

Induced
paranoid psychotic symptoms
activity
Actions of:
-dopamine
-serotonin
Drug blocks post synaptic dopamine
acetycholine
receptors
-glumate

These Symptoms
completes:
-Hallucination/delusion
-Disorganized thoughts and Behavior
-Negative behavior

Assessment

Diagnosis

Planning

Schizophre
nia
Intervention

Rationale

Evaluation

S: Nakakahiya
naman, mabaho
na yata kili kili
ko, wala kasing
deodorant eh.
Tapos wala ring
shampoo ang
kati tuloy ng ulo
ko. As
verbalized by the
patient.
O:
-sad facial
expression
-armpits
guarding
-head scratching
-(+) dandruff
flakes
-self conscious

Disturbed body
image related
to unrealistic
perception of
appearance as
evidenced by
verbalization of
perception and
feeling towards
ones own
appearance.

Within 8 hours,
the client will
be able to
have a clean
and good
appearance.

Determine
whether
condition is
permanent
with no
suspection for
resolution.
Recognize
behaviour
indicative of
overconcern
with body and
its process.
Have a client
describe self,
noting what is
negative. Be
aware of how
client believes
others see self.
Health
teaching.

Nursing Care Plan

After 8
hours, the
client was
able to
perform
good
hygiene and
will
cooperate to
the
procedure of
proper
grooming.

Assessment

Diagnosis

Planning

Intervention

Rationale

Evaluation

Disturbed thought
process related
to increased
dopaminergic as
manifested by
disorganized
thoughts.

Within 2-3
weeks of
nursing
intervention
the client will
have maintain
reality
orientation
and identify
intervention to
deal effectively
with the
situation.

Tested ability to
receive, send and
appropriately
interpret
communications.

Determine
ability to
participate
in planning
and
executing
care.

After 2-3
weeks of
nursing
interventio
, the clien
identifies
and
understan
interventio
to improve
behaviors
and
maintains
reality
orientation

S:

Maintain reality
oriented relationship
and environment.

Present reality
concisely and briefly
and do not challenge
logical thinking.
Encouraged
participation in
resocialization
activities.

Client may
respond
with
anxious or
aggressive
behaviours
if started or
over
stimulated
Client may
feel
threatened
and may
withdraw or
rebel.
To maintain
gains and
continue
progress if
tables

Assessment
S: As per by
informant patient is
restlessness,
continuous on
shouting, talking to
herself.

Diagnosis

Impaired social
interaction
related to
mental health
condition as
manifested by
poor
O:
interpersonal
-not continuous eye action.
contact
-social isolation
-disorientation
-inactivity

Planning
Within 4-6
ours of
nursing
intervention
patient will
regain her
social
functioning.

Intervention
Assess the
patients ability
to carry out
activities of
daily living.

Provide a safe,
relaxing
environment.

Engage the
patient in reality
oriented
activities that
involve human
contact with her
co-client.
Avoid
promoting
dependence.

Giving rewards
or recognition.

Rationale
To know how
patient
response to
the plan of
care

Evaluatio

After 4-6
hours of
nursing
intervent
patient
increase
social
To minimize
functionin
stimuli that will and
trigger
interactio
symptoms of
disease of
anxiety.

To gain
confidence of
the patient in
interacting
with other
people.

To meet the
patients
needs but
only do for the
patient what
she cant do.

This will help

to improve his
level of
functioning.

ASSESSMENT
S:
" Minolestya ako
ng
stepfather ng
stepmother
ko pero wala
akong
ginawa.
Sinarili ko lang
lahat."
O:
-Decrease use of
social support
-Sleep
disturbance
-Crossing of
arms
-use of forms of
coping that
impede adaptive
behaviour

DIAGNOSIS

PLANNING

Ineffective
coping related
to
dysfunctional
family
system as
evidence by
inappropriate
use of
defense
mechanism.

Within 2
weeks of
nursing
intervention,
the client will
be able to:

INTERVENTION

-encourage same
staff to work with
client as much as
possible
-avoid laughing,
whispering, or
talking quietly
short term
where client can
goal:
see but not hear
-will develop what is being said.
trust in at
-be honest and
least one staff keep all promises
member
-determine previous
within 2
methods of dealing
weeks.
with life problems
-encourage client to
Long term
verbalize true
goal:
feelings. The nurse
-will
should avoid
demonstrate becoming
use of more defensive when
adaptive
angry feelings are
coping skills directed at him or
her.-confront client
when behavior is
inappropriate,

RATIONALE

EVALUATION

- it reinforce the
paranoid
feelings.
-honesty and
dependability
promote a
trusting
relationship.
-to identify
successful
techniques that
can be used in
current
situation.
-verbalization of
feelings in a
non-threatening
environment
may help client
come to terms
with long
unresolved
issues.
-provides
external locus of
control,
enhancing

After 2 weeks of
nursing intervention,
the client was able
to:
-assess the current
situation accurately
-verbalize awareness
of own coping
abilities.
-verbalize feelings
congruent with
behaviour.

pointing out
difference between
words and actions
-converse at client's
level, providing
meaningful
conversation while in order to promote
development of
trusting relationship
performing care.
-provide for gradual
implementation and
continuation of
necessary
behsvior/
Lifestyle
changes

safety.
-enhances
therapeutic
relationship
-enhances
commitment to
plan.

NAME

CLASSIFICATION

Generic Name:
Biperiden

Anticholinergic drug

Brand Name:
Akineton
Dosage &Frequency:
2 mg tab OD
Route
of Administration:
Oral

Drug Study

INDICATION

Parkinsonian
syndrome
Action:
especially to
Synthetic
counter act
anticholinergic drug, muscular
blocks cholinergic
rigidity and
responses in the CNS tremor;
extrapyramidal
symptoms

ADVERSE
EFFECTS

CONTRAINDICA
ION

Fatigue

Untreated
narrow angle
glaucoma,
intestinal
stenosis or
obstruction,
mega colon,
prostatic
hypertrophy.

NAME

CLASSIFICATION

INDICATION

ADVERSE
EFFECTS

CONTRAINDICATI
ON

Generic name:
risperidone

Antipschotic

Treatment of
schizophrenia

Insomnia

Contraindicated
with
hypersensitivity to
risperidone.

Brand Name:
Risperdal
Dosage&Frequency
: 2mg tab OD
Route of
Administration: Oral

Action: Blocks
dopamine and
serotonin
receptors in
the brain,

Delaying relapse
in long-term
treatment of
schizophrenia
Unlabeled uses:
Bipolar disorder;
treatment of
patients with
dementia-related
psychotic
symptoms

Use cautiously
with
cardiovascular
disease,
pregnancy, renal
or hepatic
impairment,
hypotension

NAME

CLASSIFICATION

Generic Name:
Diphenhydramine
hydrochloride

Antihistamine

Brand Name:
Benadryl
Frequency&Dosag
e
50mg cap OD
Route of
administration: Oral

INDICATION

Diphenhydramine
is used for its
Action: Blocks the antimiscarinic
effect of
properties in the
histamine at the
H1 receptor sites, control
and is used for a of parkinsonism
and drug-induced
wide range of
effects, ranging
extrapyramidal
from allergy and
disorders
itching relief, to
sleep aids, to
nausea relief.

ADVERSE
EFFECTS

CONTRAINDICATI
ON

Insomnia

Increased
Pressure in the
Eye, Closed
Angle Glaucoma,
Chronic Difficulty
having a Bowel
Movement, High
Blood Pressure,
Stenosing Peptic
Ulcer, Blockage of
Urinary Bladder,
Enlarged
Prostate, Cannot
Empty Bladder,
Overactive
Thyroid Gland

Discharge Planning

AFTER YOU LEAVE:

Medicines:
Antipsychotics
Antianxiety
Mood stabilizers
Tranquilizers
Antidepressants

ENVIRONMENT
Provide a safe and secure environment.

Treatment Settings
Crisis residential program: This is a program where you live in a home-care facility. Caregivers
work in these homes just like in hospitals. This program is helpful especially when you are having a
relapse (your symptoms return).
Day treatment program: This program provides a chance to learn and practice skills. This also
provides long-term support so you may have an improved quality of life.
Partial care program: A partial care program is also called day hospitalization or partial
hospitalization. This is group therapy and lasts 4 to 6 hours a day, 3 to 5 days a week. It may help
you avoid going into the hospital or help you get out of the hospital sooner. It may also help you get
symptoms under control and avoid a relapse.

Health Teaching:
Do not stop taking your medicines: Tell your primary healthcare provider or psychiatrist if you
have any problems with or questions about your medicines.
Do not stop your therapies: It is normal to have doubts about or feel discomfort with your therapy.
Tell your primary healthcare provider or psychiatrist if you are not comfortable or have questions
about your therapies.
Get regular sleep: Try to get 6 to 8 hours of sleep each night. Tell your primary healthcare provider
or psychiatrist if you are not able to sleep, or if you are sleeping too much.
Do not drink alcohol: Alcohol interacts with medicine used to treat schizophrenia.

Contact your primary healthcare provider or psychiatrist

if:
You feel that you are having symptoms of schizophrenia.
You are not able to sleep well, or are sleeping more than usual.
You cannot eat or are eating more than usual.
You have questions or concerns about your condition or care.

Seek care immediately

You think about killing yourself or someone else.
You have a rash, swelling, or trouble breathing after you take your medicine.

Outpatient
An outpatient program is when you meet regularly with your therapist. You may meet one-to-one
with your therapist, or you might meet with your therapist in a group.

DIET AND NUTRITION

Balance your blood sugar and avoid stimulants

Your intake of sugar, refined carbohydrates, caffeine, alcohol and cigarettes, as well as
stimulant drugs, all affect the ability to keep ones blood sugar level balanced. On top of this
common antipsychotic medication may also further disturb blood sugar control. Stimulant
drugs, from amphetamines to cocaine, can induce schizophrenia. The incidence of blood
sugar problems and diabetes is also much higher in those with schizophrenia.
Therefore it is strongly advisable to reduce, as much as possible, your intake of sugar,
refined carbohydrates, caffeine and stimulant drugs and eat a low glycemic load diet.