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Running Head: SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 1

Michael Guterwill

Schizophrenia Mental Health Case Study

Youngstown State University

October 10, 2018


SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 2

Abstract

Schizophrenia is a disease that affects a person's ability to speak, feel, and act appropriate. Often

times this disease runs in the family. Many families struggle to cope with this disease whether

they are dealing with a loved one who has it or they themselves do. A person who is diagnosed

with this disease often has auditory or visual hallucinations which is a really hard thing to deal

with. Stay on medications when someone has schizophrenia is key and often times people with

schizophrenia feel like they should stop taking their current medications. This case study is about

D.M., a patient I had the opportunity to speak with and to learn about. This case study will cover

his background, nursing interventions, and potential nursing diagnoses for this particular patient.
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Objective Data

D.M. is a 48 year old Caucasian male admitted on September 29, 2018. The date of care

was on October 2, 2018. Based on DSM IV-TR, this patients current diagnosis is in Axis 1,

which is schizophrenia. Axis I, schizophrenia, is his acute reason for seeking care. He has

Schizotypal personality disorder from Axis II as he believes a higher power is constantly talking

to him and giving him information about people so he could help them in "miraculous ways".

Axis III is for medical conditions that could impact the patients mental disorder and make them

worse. In D.M.'s case he has insomnia, which he mentions he generally struggles with sleeping.

Axis IV is used to describe psychosocial and environmental factors affecting a person and in

D.M.'s case he has problems with a primary support group as he feels he is all alone and no one

understands him. He also has problems relating to the social environment. In addition he has

housing and economic problems. Axis V is a rating scale called the Global Assessment of

Functioning, which consists of a rating from 0 to 100. It is supposed to summarize how well a

person is functioning. D.M. came in with a score of 10. This meaning that he was in severe

danger of hurting himself or others. He was having auditory hallucinations with clear

expectations of death. He voluntarily arrived to the emergency room stating that he is hearing

voices and they were telling him to not eat anything. He stated that he decided to call 911 after

he cut his right arm in attempt to severely hurt himself. He said it has been a few days since he

had something to eat and he had lost a lot of weight. In addition, the voices he was hearing also

told him to hurt himself so he took a knife and made an incision down his right arm. He stated

that he stopped taking his medications for his schizophrenia, but cannot recall when he stopped

taking them. He believes that shortly after he stopped taking them he began having auditory

hallucinations. He reported that the voices were giving him suicidal thoughts was thinking about
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"ending it all" and was still currently having those thoughts on admission. He was placed in

suicidal precautions in the Emergency room. On the date of care he was no longer on suicidal

precautions. Jus the regular 15 minute checks they do for everyone on the mental health floor.

On the floor the he originally was given an injection of 5mg of haloperidol. Then he was

prescribed Aripiprazole 20mg PO daily to help with his psychotic features. He was prescribed

Trazodone 50mg PO daily at night to help with his insomnia. He was prescribed Hydroxyzine

which is an antihistamine. Finally they prescribed him Oxcarbazepine 300mg PO every 12 hour

to hopefully help stabilize in mood out.

Summarize

Schizophrenia is a chronic disease that affects a person's ability to think, feel, and behave

clearly. They often have auditory and visual hallucinations and delusions. Many times they feel

like there is someone always there telling them to do things that isn't considered socially

acceptable. Schizophrenia is often seen in individuals who have had traumatizing events while

growing up. It is also generally seen to run in families so it may get passed down from

generation to generation. The article Risk factors for Suicide in Schizophrenia: Systematic

Review and Clinical Recommendations" perfectly describes schizophrenia. The article states

"The characteristic symptoms of schizophrenia involve a wide range of cognitive, behavioural

and emotional dysfunctions. The diagnosis involves a constellation of signs and symptoms

associated with impaired occupational or social functioning" (2014, Popovic, pg. 419). This

helps summarize the disease by showing that they struggle with normal functions. They

sometimes act out and tend to isolate themselves. People with schizophrenia need to adhere to

their medications and if they don't they will behind to have more problems. An article I found

called " Problems with the Administration of Antipsychotic Drugs in Depot Formulations in the
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Treatment of Schizophrenia" states " Patients’ non-adherence to oral medication treatments is a

potential problem that may lead to higher relapse rates which in turn worsen long-term outcomes

and lead to poor prognosis" (2018, Rankovic, pg. 66) This helps to show that those with

schizophrenia live much better lives if they are able to stay on their medications. There is also

seen an increase in suicide with people with schizophrenia. The same article that was mentioned

before also stated "Approximately 2-12% of all suicides are attributable to schizophrenia" (2014,

Popovic, pg. 419). This is showing that those who are diagnosed with schizophrenia are

automatically at a higher risk for suicide attempt.

Discuss

D.M. was diagnosed with schizophrenia at 17 years old. He said he started hearing voices

around this time. According to him he had a very abusive childhood. His father would tell him

regularly that he would "amount to nothing" and there his life was worthless. He states that both

of his parents would beat him and there was no love for him in that household. Both of his

parents were addicted to drugs and alcohol. He mentioned that he spent a lot of time in foster

care, but he couldn't find a family for him and always went back to his parents even though they

abused him. An interesting article I read which may suggest an explaination to this is called

"Relationship between Disability and Psychopathology Severity in Subjects having Acute

Exacerbation of Schizophrenia on Treatment over three Month’s Duration" and it states "One of

the most known aspects of this is the social amotivation. This is a classical deficit symptom in

which the individual appears to have no interest to have interaction with others and tries to avoid

social contact as much as possible" (2018, Arathil, Sharama, pg. 12). I think this shows why he

struggled to find a good fit in foster home. People with schizophrenia tend to try and isolate

themselves. He used to abuse drugs such as marijuana, cocaine, methamphetamine, and "acid".
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D.M. said that he used drugs whenever he felt isolated, as a way to self medicate. He states that

he is no longer addicted to drugs and hasn't used in months. There is no proof of any mental

illness in parents. They both died a few years ago. He said his father was killed by his mother

and his mother was never charged because she died from cancer before the trial was held. He

said that the death of his parents do not bother him, but states that he has forgiven his father. At

this point, it is hard to tell if he is making up his childhood based on what he thought had

happened due to having schizophrenia, or his childhood was an onset to cause his schizophrenia.

Identify

Prior to his hospitalization D.M. was living in a form of a group home. However, he said

he was basically homeless and was never there. He was spending most of his time with religious

activities. He had many stories of God telling him things that he shouldn't know about people

and then going up to them and helping them emotionally. During this time the voices in his head

were telling him not to eat. For many days he wasn't hardly eating anything due to these voices.

He states that he began noticing how much weight he was losing and that he felt very unhealthy.

However, he just continued on. Eventually the voices in his head started telling him to hurt

himself and to kill himself. This resulted with him cutting his right arm. This lead to him calling

911 and getting admitted to the mental health unit.

Describe

When D.M. arrived to the hospital he was evaluated and then placed under suicidal

precautions. This is because of the state of mind he was in and when a patient feels like this they

need to be observed at all times. Suicide precautions means having a 1 on 1 sit there and watch

the patient to make sure they do not attempt to hurt their self. They also get a safety tray for

meals which just means that there are no cans or metal silverware that they could hurt themselves
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with. The staff will also remove any cords or unnecessary items from the room. The goal of this

nursing intervention is to keep the patient safe and prevent any sort of self harm from occurring.

The nurses also use milieu therapy on the floor to help him recover. The floor is a very calm

place with structured activities for him. There are many different groups to participate in and

these are all to help promote a healthy state of mind. They also have visiting hours and certain

times to make phone calls. This way they could still have contact with loved ones.

During the date of care D.M. participated in both groups. The first one was a spiritual

group and he showed up late. He was very outgoing in this group and told everyone his story. He

showed that he felt very close to God and that was how he was still alive today. He mentioned

that he is dedicating his life to God and they God speaks to him every day. He feels that he is still

here to change other people's lives. He was also comfortable enough to tell everyone about his

abuse past. After this group he participated in the social group where he was much more quiet.

He mostly kept to himself and barely participated. However, I feel these groups helped him

express himself and it showed that these groups are helping him with his mental health.

Analyze

D.M. is a very religious man. He claims religion is what keeps him here on this earth.

D.M. believes that he is one with God and is here to change the lives of others around him. He

told a story about him in a Denny's restaurant talking to a waitress. He said she was acting

cheerful on the outside, but then God told him that she is really broken on the inside. He

approached the waitress and told her what God had told him and she broke down crying asking

him for advice. He told her to give herself to God and everything will be fine. He was very proud

of this story and told me that he saw himself as a disciple whose job is to bring people closer to

God. Aside from his religious views, D.M. mostly group up in a foster home. This makes me
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believe it had a poor influence on his ability to function while growing up. He struggles in

appropriate socialization and I believe this is part of the explanation as to why.

Evaluate

D.M. stated that he is no longer having auditory hallucinations. He stated that he is

feeling much better than when he originally arrived. The groups had helped him express himself

and he feels like the medications he had been receiving have been helping him feel better. He

said jokingly that once he is released he wants to become a pastor to a church.

Summarize

The plans for discharge start with getting D.M. back on his medications and to keep it

that way. It would be good to get him into an outpatient setting where he could get steady help to

keep him from ending up back on the mental health floor. He will have a 14 day follow up to see

how his medications have been working on him and that he is still taking them daily. D.M. will

hopefully find a positive coping strategy for when he begins acting out or when he feels like he

no longer needs his medications. It is very important for his health that he stays on this

medication regimen.

Prioritized Nursing Diagnosis

1. Risk for suicide or self-harm related to auditory hallucination commands as evidence by

cut his right arm.

2. Disturbed Sensory Perception: Auditory/ Visual related to biochemical alterations in the

brain of certain neurotransmitters as evidence by disturbances in cognitive associations.

3. Disturbed thought process related to altered perceptions as evidence by auditory

hallucinations.
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Potential Nursing Diagnosis

1. Ineffective coping related to abruptly stopping medications when stressed as evidence by

recurring hallucinations.

2. Interrupted family process related to being in foster care as evidence by stating he could

never find love from his family.

3. Impaired social interaction related to psychological barriers as evidence by stating he

always feels alone.

Conclusion

In conclusion, schizophrenia is a disease that affects a person's ability to think,

feel, and behave clearly. D.M. is a man suffering from this disease and is struggling with

staying on his medications. When he becomes stressed or feels isolated he feels the need

to stop taking those medications. An important part of daily living with schizophrenia is

adhering to your medications which he has hopefully learned while being on the mental

health floor. D.M. also needs to find better coping methods to deal with future stress and

feelings of loneliness.
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References

D. P. (2014, August 14). Risk Factors for Suicide in Schizophrenia: Systematic Review and Clinical

Recommendations. Retrieved October 10, 2018, from

https://eps.cc.ysu.edu:3287/pg_99?100248614475101::NO:99:P99_ENTITY_TYPE,P99_ENTIT

Y_ID:MAIN_FILE,22455476&cs=3wNuGxHOku0F-6b-

AqUFFAxg0xooBsdMWz6ky1cNGimK4w3f_Freh6AYDZmPwmHTijaljiMDmN28zNCeaFhyP

yg

Praveen, A., & Sharma, P. (2018, August). Relationship between Disability and Psychopathology

Severity in Subjects having Acute Exacerbation of Schizophrenia on Treatment over three

Month’s Duration. Retrieved October 10, 2018, from

https://eps.cc.ysu.edu:3253/ehost/pdfviewer/pdfviewer?vid=2&sid=091d089a-15ad-4fec-8a29-

f22536e85cc0@sessionmgr120

Rankovic, A., & Jankovic, S. (2018). Problems with the Administration of Antipsychotic Drugs in

Depot Formulations in the Treatment of Schizophrenia. Retrieved October 10, 2018, from

https://eps.cc.ysu.edu:3253/ehost/pdfviewer/pdfviewer?vid=2&sid=8c22e3a1-fa21-4053-ad27-

c69d688dddc4@pdc-v-sessmgr05