INTRODUCTION

Schizophrenia (from the Greek word σχιζοφρένεια, or schizophreneia, meaning

"split mind") is a psychiatric diagnosis that describes a mental illness characterized by
impairments in the perception or expression of reality, most commonly manifesting as
auditory hallucinations, paranoid or bizarre delusions or disorganized speech and
thinking in the context of significant social or occupational dysfunction. Onset of
symptoms typically occurs in young adulthood,[1] with approximately 0.4–0.6%[2][3] of the
population affected. Diagnosis is based on the patient's self-reported experiences and
observed behavior. No laboratory test for schizophrenia exists.
Studies suggest that genetics, early environment, neurobiology and psychological
and social processes are important contributory factors. Current psychiatric research is
focused on the role of neurobiology, but a clear organic cause has not been found. Due to
the many possible combinations of symptoms, there is debate about whether the
diagnosis represents a single disorder or a number of discrete syndromes. For this reason,
Eugen Bleuler termed the disease the schizophrenias (plural) when he coined the name.
Despite its etymology, schizophrenia is not synonymous with dissociative identity
disorder, previously known as multiple personality disorder or split personality; in
popular culture the two are often confused.
Increased dopaminergic activity in the mesolimbic pathway of the brain is a
consistent finding. The mainstay of treatment is pharmacotherapy with antipsychotic
medications; these primarily work by suppressing dopamine activity. Dosages of
antipsychotics are generally lower than in the early decades of their use. Psychotherapy,
vocational and social rehabilitation are also important. In more serious cases—where
there is risk to self and others—involuntary hospitalization may be necessary, though
hospital stays are less frequent and for shorter periods than they were in previous years.

Signs and symptoms

A person experiencing schizophrenia may demonstrate symptoms such as
disorganized thinking, auditory hallucinations, and delusions. In severe cases, the person
may be largely mute, remain motionless in bizarre postures, or exhibit purposeless
agitation; these are signs of catatonia. The current classification of psychoses holds that
symptoms need to have been present for at least one month in a period of at least six
months of disturbed functioning. A schizophrenia-like psychosis of shorter duration is
termed a schizophreniform disorder.[16] No one sign is diagnostic of schizophrenia, and all
can occur in other medical and psychiatric conditions.[16]
Social isolation commonly occurs and may be due to a number of factors.
Impairment in social cognition is associated with schizophrenia, as are the active
symptoms of paranoia from delusions and hallucinations, and the negative symptoms of
apathy and avolition. Many people diagnosed with schizophrenia avoid potentially
stressful social situations that may exacerbate mental distress.[17]
Late adolescence and early adulthood are peak years for the onset of
schizophrenia. These are critical periods in a young adult's social and vocational
development, and they can be severely disrupted by disease onset. To minimize the
impact of schizophrenia, much work has recently been done to identify and treat the
prodromal (pre-onset) phase of the illness, which has been detected up to 30 months
before the onset of symptoms, but may be present longer.[18] Those who go on to develop
schizophrenia may experience the non-specific symptoms of social withdrawal,
irritability and dysphoria in the prodromal period,[19] and transient or self-limiting
psychotic symptoms in the prodromal phase before psychosis becomes apparent.[20]

Positive and negative symptoms

Schizophrenia is often described in terms of positive (or productive) and negative
(or deficit) symptoms.[23] Positive symptoms include delusions, auditory hallucinations,
and thought disorder, and are typically regarded as manifestations of psychosis. Negative
symptoms are so-named because they are considered to be the loss or absence of normal
traits or abilities, and include features such as flat or blunted affect and emotion, poverty
of speech (alogia), anhedonia, and lack of motivation (avolition). Despite the appearance
of blunted affect, recent studies indicate that there is often a normal or even heightened
level of emotionality in Schizophrenia especially in response to stressful or negative
events.[24] A third symptom grouping, the disorganization syndrome, is commonly
described, and includes chaotic speech, thought, and behaviour. There is evidence for a
number of other symptom classifications.[25]

Epidemiology
Schizophrenia occurs equally in males and females although typically appears
earlier in men with the peak ages of onset being 20–28 years for males and 26–32 years
for females.[1] Much rarer are instances of childhood-onset[45] and late- (middle age) or
very-late-onset (old age) schizophrenia.[46] The lifetime prevalence of schizophrenia, that
is, the proportion of individuals expected to experience the disease at any time in their
lives, is commonly given at 1%. A 2002 systematic review of many studies, however,
found a lifetime prevalence of 0.55%.[3] Despite the received wisdom that schizophrenia
occurs at similar rates throughout the world, its prevalence varies across the world,[47]
within countries,[48] and at the local and neighbourhood level.[49] One particularly stable
and replicable finding has been the association between living in an urban environment
and schizophrenia diagnosis, even after factors such as drug use, ethnic group and size of
social group have been controlled for.[50] Schizophrenia is known to be a major cause of
disability. In a 1999 study of 14 countries, active psychosis was ranked the third-most-
disabling condition, after quadriplegia and dementia and before paraplegia and blindness.
[51]

Treatment and services

Medication
The mainstay of psychiatric treatment for schizophrenia is an antipsychotic
medication.[101] These can reduce the "positive" symptoms of psychosis. Most
antipsychotics take around 7–14 days to have their main effect.
Though expensive, the newer atypical antipsychotic drugs are usually preferred
for initial treatment over the older typical antipsychotics; they are thought to be generally
better tolerated and associated with lower rates of tardive dyskinesia, although they are
more likely to induce weight gain and obesity-related diseases.[102] It remains unclear
whether the newer antipsychotics reduce the chances of developing neuroleptic malignant
syndrome, a rare but serious and potentially fatal neurological disorder most often caused
by an adverse reaction to neuroleptic or antipsychotic drugs.[103]
The two classes of antipsychotics are generally thought equally effective for the
treatment of the positive symptoms. Some researchers have suggested that the atypicals
offer additional benefit for the negative symptoms and cognitive deficits associated with
schizophrenia, although the clinical significance of these effects has yet to be established.
Recent reviews have refuted the claim that atypical antipsychotics have fewer
extrapyramidal side effects than typical antipsychotics, especially when the latter are used
in low doses or when low potency antipsychotics are chosen.[104]
A substantial number of individuals with schizophrenia do not benefit
satisfactorily from antipsychotics. "Treatment-resistant schizophrenia" is a term used in
psychiatric services for the failure of symptoms to respond satisfactorily to at least two
different antipsychotics;[105] patients in this category may be prescribed clozapine,[106] a
medication of potentially superior effectiveness but several potentially lethal side effects
including agranulocytosis and myocarditis.[107] For other patients who are unwilling or
unable to take medication regularly, long-acting depot preparations of antipsychotics may
be given every two weeks to achieve control. America and Australia are two countries
with laws allowing the forced administration of this type of medication on those who
refuse but are otherwise stable and living in the community. Nevertheless, some findings
indicate that in the longer-term many individuals do better without taking antipsychotics.
[108]

Psychological and social interventions

Psychotherapy is also widely recommended and used in the treatment of
schizophrenia, although services may often be confined to pharmacotherapy because of
reimbursement problems or lack of training.[109]
Cognitive behavioral therapy (CBT) is used to reduce symptoms and improve
related issues such as self-esteem, social functioning, and insight. Although the results of
early trials were inconclusive,[110] more recent reviews suggest that CBT can be an
effective treatment for the psychotic symptoms of schizophrenia.[111] Another approach is
cognitive remediation therapy, a technique aimed at remediating the neurocognitive
deficits sometimes present in schizophrenia. Based on techniques of neuropsychological
rehabilitation, early evidence has shown it to be cognitively effective, with some
improvements related to measurable changes in brain activation as measured by fMRI.[112]
A similar approach known as cognitive enhancement therapy, which focuses on social
cognition as well as neurocognition, has shown efficacy.[113]
Family Therapy or Education, which addresses the whole family system of an
individual with a diagnosis of schizophrenia, has been consistently found to be beneficial,
at least if the duration of intervention is longer-term.[114][115][116] Aside from therapy, the
impact of schizophrenia on families and the burden on carers has been recognized, with
the increasing availability of self-help books on the subject.[117][118] There is also some
evidence for benefits from social skills training, although there have also been significant
negative findings.[119][120] Some studies have explored the possible benefits of music
therapy and other creative therapies.[121][122][123]
Other
Electroconvulsive therapy is not considered a first line treatment but may be
prescribed in cases where other treatments have failed. It is more effective where
symptoms of catatonia are present,[124] and is recommended for use under NICE
guidelines in the UK for catatonia if previously effective, though there is no
recommendation for use for schizophrenia otherwise.[125] Psychosurgery has now become
a rare procedure and is not a recommended treatment for schizophrenia.[126]
An unconventional approach is the use of omega-3 fatty acids, with one study
finding some benefits from their use as a dietary supplement.[127]
Service-user led movements have become integral to the recovery process in
Europe and America; groups such as the Hearing Voices Network and the Paranoia
Network have developed a self-help approach that aims to provide support and assistance
outside the traditional medical model adopted by mainstream psychiatry. By avoiding
framing personal experience in terms of criteria for mental illness or mental health, they
aim to destigmatize the experience and encourage individual responsibility and a positive
self-image. Partnerships between hospitals and consumer-run groups are becoming more
common, with services working toward remediating social withdrawal, building social
skills and reducing rehospitalization.
 ANATOMY AND PHYSIOLOGY OF THE NERVOUS SYSTEM

Structure and Function

1. Supportive connective tissue cells

a. Neuroglia support and protect neurons in the CNS. Specific glial cells are
phagocytes; others myelinate neuron processes in the CNS or line cavities.
b. Schwann cells myelinate neuron processes in the PNS.
2. Neurons
a. Anatomy: All neurons have a cell body containing the nucleus and
processes (fibers) of two types; (1) axons (one per cell) typically generate
and conduct impulses away from the cell body and release a
neurotransmilter, and (2) dendrites (one to many per cell) typically carry
electrical currents toward the cell body. Most large fibers are myelinated;
myelin increases the rate of nerve impulse transmission.
b. Classification
1. On the basis of function (direction of impulse transmission) there
are sensory (afferent) and motor (efferent) neurons and association
neurons (interneurons). Dendritic endings of sensory neurons are
bare (pain receptors), or are associated with sensory receptors.
2. On the basis of structure, there are unipolar, bipolar, and
multipolar neurons; the terminology reveals the number of
processes extending from the cell body. Motor and association
neurons are multipolar; most sensory neurons are unipolar. The
exceptions are sensory neurons in certain special sense organs (ear,
eye), which are bipolar.
c. Physiology
1. A nerve impulse is an electrochemical event (initiated by various
stimuli) that causes a change in neuron plasma membrane
permeability, allowing sodium ions (Na+) to enter the cell
(depolarization). Once begun, the action potential, or nerve
impulse, continues over the entire surface of the cell. Electrical
conditions of the resting state are restored by the diffusion of
potassium ions (K+) out of the cell (repolarization). Ion
concentrations of the resting state are restored by the sodium-
potassium pump.
2. A neuron influences other neurons or effector cells by releasing
neurotransmitters, chemicals that diffuse across the synaptic cleft
and attach to membrane receptors on the postsynaptic cell. The
result is opening of specific ion channels and activation or
inhibition, depending on the neurotransmitter released and the
target cell.
3. A reflex is a rapid, predictable response to a stimulus. There are
two typesÛautonomic and somatic. The minimum number of
components of a reflex arc is four: receptor, effector, and sensory
and motor neurons (most, however, have one or more
 interneurons). Normal reflexes indicate normal nervous system
function.

Central Nervous System

1. The brain is located within the cranial cavity of the skull and consists of the
cerebral hemispheres, diencephalon, brain stem structures, and cerebellum.
a. The two cerebral hemispheres form the largest part of the brain. Their
surface, or cortex, is gray matter and their interior is white matter. The
cortex is convoluted and has gyri, suici, and fissures. The cerebral
hemispheres are involved in logical reasoning, moral conduct, emotional
responses, sensory interpretation, and the initiation of voluntary muscle
activity. Several functional areas of the cerebral lobes have been
identified. The basal nuclei, regions of gray matter deep within the white
matter of the cerebral hemispheres, modify voluntary motor activity.
Parkinson's disease and Huntington's chorea are disorders of the basal
nuclei.
b. The diencephalon is superior to the brain stem and is enclosed by the
cerebral hemispheres. The major structures include the following:
1. The thalamus encloses the third ventricle and is the relay station
for sensory impulses passing to the sensory cortex for
interpretation.
2. The hypothalamus makes up the "floor" of the third ventricle and
is the most important regulatory center of the autonomic nervous
system (regulates water balance, metabolism, thirst, temperature,
and the like).
3. The epithalamus includes the pineal body (an endocrine gland) and
the choroid plexus of the third ventricle.
c. The brain stem is the short region inferior to the hypothalamus that merges
with the spinal cord.
1. The midbrain is most superior and is primarily fiber tracts.
2. The pons is inferior to the midbrain and has fiber tracts and nuclei
involved in respiration.
3. The medulla oblongata is the most inferior part of the brain stem.
In addition to fiber tracts, it contains autonomic nuclei involved in
the regulation of vital life activities (breathing, heart rate, blood
pressure, etc.).
4. The cerebellum is a large, cauliflower-like part of the brain
posterior to the fourth ventricle. It coordinates muscle activity and
body balance.
2. Protection of the CNS
a. Bones of the skull and vertebral column are the most external protective
structures.
b. Meninges are three connective tissue membranesÛdura mater (tough
outermost), arachnoid mater (middle weblike), and pia mater (innermost
delicate). The meninges extend beyond the end of the spinal cord.
 c. Cerebrospinal fluid (CSF) provides a watery cushion around the brain and
cord. CSF is formed by the choroid plexuses of the brain. It is found in the
subarachnoid space, ventricles, and central canal. CSF is continually
formed and drained.
d. The blood-brain barrier is composed of relatively impermeable capillaries.
3. Brain dysfunctions
a. Head trauma may cause concussions (reversible damage) or contusions
(nonreversible damage). When the brain stem is affected, unconsciousness
(temporary or permanent) occurs. Trauma-induced brain injuries may be
aggravated by intracranial hemorrhage or cerebral edema, both of which
compress brain tissue-
b. Cerebrovascular accidents (CVAs, or strokes) result when blood
circulation to brain neurons is blocked and brain tissue dies. The result
may be visual impairment, paralysis, and aphasias.
c. Alzheimer's disease is a degenerative brain disease in which abnormal
protein deposits and other structural changes appear. It results in slow,
progressive loss of memory and motor control plus increasing dementia.
d. Techniques used to diagnose brain dysfunctions include the EEG, simple
reflex tests, pneumo-encephalography, angiography, and CT, PET, and
MRI scans.
4. The spinal cord is a reflex center and conduction pathway. Found within the
vertebral canal, the cord extends from the foramen magnum to L1 or L2. The cord
has a central bat-shaped area of gray matter surrounded by columns of white
matter, which carry motor and sensory tracts from and to the brain.

Peripheral Nervous System

1. A nerve is a bundle of neuron processes wrapped in connective tissue coverings

(endoneurium, perineurium, epineurium).
2. Cranial nerves: Twelve pairs of nerves that extend from the brain to serve the
head and neck region. The exception is the vagus nerves, which extend into the
thorax and abdomen.
3. Spinal nerves: Thirty-one pairs of nerves are formed by the union of the dorsal
and ventral roots of the spinal cord on each side. The spinal nerve proper is very
short and splits into dorsal and ventral rami. Dorsal rami serve the posterior body
trunk; ventral rami (except T1 through T12) form plexuses (cervical, brachial,
lumbar, sacral) that serve the limbs.
4. Autonomic nervous system: Part of the PNS, composed of neurons that regulate
the activity of smooth and cardiac muscle and glands. This system differs from
the somatic nervous system in that there is a chain of two motor neurons from the
CNS to the effector. Two subdivisions serve the same organs with different
effects.
a. The sympathetic division is the "fight-or-flight" subdivision, which
prepares the body to cope with some threat. Its activation results in
increased heart rate and blood pressure. The pre-ganglionic neurons are in
the gray matter of the cord. The postganglionic neurons are in sympathetic
 chains or in collateral ganglia. Postganglionic axons secrete
norepinephrine.
b. The parasympathetic division is the "housekeeping" system and is in
control most of the time. This division maintains homeostasis by seeing
that normal digestion and elimination occur, and that energy is conserved.
The first motor neurons are in the brain or the sacral region of the cord.
The second motor neurons are in the terminal ganglia close to the organ
served. Postganglionic axons secrete acetylcholine.

Developmental Aspects of the Nervous System

1. Maternal and environmental factors may impair embryonic brain development.

Oxygen deprivation destroys brain cells. Severe congenital brain diseases include
cerebral palsy, anencephaly, hydrocephalus, and spina bifida.
2. Premature babies have trouble regulating body temperature because the
hypothalamus is one of the last brain areas to mature prenatally.
3. Development of motor control indicates the progressive myelination and
maturation of a child's nervous system. Brain growth ends in young adulthood.
Neurons die throughout life and are not replaced; thus, brain mass declines with
age.
4. Healthy aged people maintain nearly optimal intellectual function.
DiseaseÛparticularly cardiovascular diseases the major cause of declining mental
function with age.
 PATIENT’S PROFILE

NAME: C.U.

ADDRESS: Aparri, Cagayan

AGE: 37

BIRTHDAY: February 8, 1970

NATIONALITY: Filipino

CIVIL STATUS: Single

RELIGION: Roman Catholic

OCCUPATION: None

DATE AND TIME OF ADMISSION: February 2004; 3:06 PM

DIAGNOSIS: Schizophrenia, undifferentiated type, chronic and relapse

 MENTAL HEALTH AND PSYCHIATRIC
NURSING ASSESSMENT
A. GENERAL INFORMATION

NAME: C.U..
AGE: 37 years old
SEX: Female
MARITAL STATUS: Single
ADDRESS: Aparri, Cagayan
Chief complaints:
“ Haan makaturturug nu rabii”
“ Agubur ti balay”
“ Agpukhaw- pukhaw”
DIAGNOSIS: Schizophrenia, undifferentiated , Chronic in relapse.

B. PSYCHIATRIC NURSING HISTORY

1. MEDICAL / PSYCHIATRIC HISTORY
During the interview, the mother stated that C.O often suffers from
stomach pain, and was brought to the nearby hospital at Tabbuk, Cagayan for
the said complaints. In addition the client also suffered from fever and
headache during her childhood years, when she was 6 years old.
According to the client’s mother, when C.O was at her age of 17, she was
pushed by a man who was under the influence of alcohol that night and
accidentally bumped her daughter’s forehead on the wall that is located near
their sari-sari store.
. The client’s mother stated that right after the said incident they brought
her daughter to the nearest hospital in Tabbuk for check up. Her mother stated
that a few weeks after the said incident her daughter, manifested some
behaviors and attitudes which are inappropriate for a normal person with a
capable thinking capacity.
For instance, a few months after the incidence, while they are selling fruits
in the market her daughter suddenly throws the fruits and some vegetables that
they are selling and without any reason at all and when her mother ask her for
the reason why she threw the fruits, her daughter could not give any
reasonable answer.
Another instance is when her daughter could not sleep for a consecutive
days and cooks her food during midnight. These said behavior of her daughter
did last for almost a week.
 During the said interview with her mother, she articulated that during her
daughter’s teenage years, she had a boyfriend and according to her. Her
daughter’s break –up with her boyfriend prompted her to engage in habits like
drinking alcohol, cigarette smoking and using marijuana at the same time.
In relation with her daughter’s behavior her mother stated that there are
times when her daughter tends to become anti-social because she only wants
to have friends whom are girls and tends to isolate herself from her friends
whom are boys, due to what her boyfriend did to her.
On the latter months of the year 1987, the client and her mother met
Surrina, they then became neighbors. According to the client’s mother Surrina
and her daughter became good friends, there are times when her daughter is
the one whom is taking good care with Surrina’s children. According to the
client she and Surrina had an intimate relationship and they engaged in sexual
activities. And her mother assumed that her daughter and Surrina did had an
intimate relationship.
After one year Surrina died because of vehicular accident. And according
to C. U’s mother, her daughter could not accept the situation that happened to
Surrina. According to the client’s mother C.U then again engaged to her habits
like drinking alcohol, cigarette smoking and using marijuana but this time she
was overdose of the said marijuana use.
The death of Surrina triggered the client to manifest again the said
symptoms when she was pushed to the wall by a man who was drunk. Which
prompted her mother to bring C.O to psychiatric ward.
In the year 1988 when the client was already 18 years old, she was first
brought by her mother to the Psychiatric Ward of CVMC, for consultation,
Prior to admission the client manifested complaints such as, difficulty
sleeping, “Agubur ti balay”, and “Agpukaw-pukhaw”

2. SOCIAL FUNCTIONING
According to the client she is a shy type of person, because she does not
participate in school activities and do not have many friends.
According to the clients mother C.U. is very picky in choosing her friends
and do not trust person easily. During her daughter’s elementary days, her
mother stated that C.U was often bullied in school and when she comes home,
she would tell her mother that there are students who create a quarrels with
her daughter.
She also stated that her daughter during school age had a best friend whom
was a girl and when the mother is asked for the best friends name she could
not remember the name anymore.
. She had her boyfriend when she was 16 y/o and broke up with him when
she was 17 y/o, from then on she started smoking and drinking alcohol. In
1987 she became close with her neighbor Surina, whom, according to client
Surrina and her, had an intimate relationship and Surrina became her
girlfriend.
 During the peak of her illness, she exhibited inappropriate behaviors such
as stoning houses and shouting at people. The client further said that she had a
girlfriend before she was admitted to the Psychiatric ward named Surrina.
Her mother described her daughter’s life during childhood that her
daughter did not enjoy her childhood because at a young age C.U. started to
earn a living for them through selling fruits and vegetables..

3. HISTORY OF PRESENT ILLNESS

The client was first brought to the mental ward for consultation in the year
1988, when C.O. manifested symptoms such as, difficulty sleeping because
she had nightmares about Surrina, Throwing stones and shouting at people
passing by their house..

4. DEVELOPMENTAL HISTORY
a. Prenatal history
According to the client she is the youngest among three siblings. And
according to the clients mother she was born through Normal Spontaneous
Delivery. She was born planned and wanted by her parents without any
birth defects noted. According to the client’s mother C.U. was breastfed
and after a few years shifted to bottle-fed..

b. Toddler or early childhood

According to her mother as a toddler, she did not experience
maternal/fraternal deprivation. Because she was blessed with a loving,
caring and supportive parents. With regards to her eating ability her
mother stated that she did not experience or develop eating problems.
When being asked about her early growth and development, she cannot
recall anymore if when was the first time she was able to talk, walk and
had her first tooth. But according to her mother when she was 1 year old,
the client could already state simple words like “Ma and Dada”. But could
not remember anymore when was her daughters first walk and had her
tooth.
According to the clients mother she did not experience having
temper tantrums, head bumping, night terrors but articulated that her
daughter experienced bedwetting. And according to the client she
experienced thumb sucking during her childhood, but overcome it.
According to the client she is a shy type of person,

c. Middle childhood
According to the clients mother, at age 7 C.U was was sent to one of
the elementary school in their barrio at Tabbuk, Cagayan but only
finished Grade 4 because she was often bullied in school. According to the
client her favorite subject is mathematics which was true according to her
mother. During this period the client stated that she was not aware of her
gender, According to the client’s mother C.U. did not experience being
punished by her parents. When it comes to phobias her mother stated that
 she does not have phobias. Likewise her mother stated that the client had a
limited number of friend and mentioned that she had a best-friend whom
is a Kalinga.

d. Later adulthood ( Puberty to adolescence)

During his later adulthood period, her mother mentioned that she had a
good and harmonious relationship with her parents but her attitude
changed when she had her break-up with her boyfriend She did not went
to high school according to her mother. Regarding her social life,
according to her mother this is the time when her daughter tends to isolate
herself from her male friends. .

School History

The client did not finish her primary education in a public school in the barrio of
(Tabbuk, Cagayan). In addition client only finished fourth grade at Tabbuk elementary
school.. Likewise with her secondary education wherein she did not enroll as a first year
student, because according to her mother she had loss her interest in going to school
because of some schoolmates who tries to bully her everyday, instead client prefers to
accompany her mother in selling foods and fruits around their barrio.
During an interview with the clients mother, she articulated that during the clients
four years as an elementary student, the client excels in Mathematics and National
Language as her favorite subject. The client does not show interest for sports or any
outgoing activities around their school. When she was still at an age of eight years old
she loves to show her mother the scores that she gets after their examination or
quizzes. .Her mother stated that the client is fund of getting a “star” on her paper as her
score after the said examination.

Psychosexual Examination
The client had knowledge toward sex and masturbation The client stated that she
experienced having sex with the same sex, because for her males could not be trusted and
in general they are “manloloko”.
 MENTAL STATUS EXAMINATION

A. HISTORY
According to her mother, she was brought to the hospital in 1988 for consultation.
due to C.U’s sleeplessness, “ agucbor ti balay”, “ Agpukh-pukhaw.. She was
released in 2004 and stayed with her mother in Don Domingo. In the same year, she
was brought back to the psychiatric ward by the Tanod because she was again
caught shouting and throwing stones in their neighborhood.
According to the chart, C.U was brought by the Brgy. Tanod because she was
shouting and throwing stones in their neighborhood.

B. GENERAL APPEARANCE AND MOTOR BEHAVIOR

During the orientation phase of NP, the client was not appropriately groomed,
C.U. does not appear to be her stated age. She has many gray hairs, and does not
looked 37 y/o but 50 y/o. She was dressed with torn clothes and did not changed for
3 days (while the SN handled her). She looked like, dressed, and act like a man. She
has a hunchback posture, and walks limply. C.U. manifested automatism (tapping
of foot).

C. SPEECH
The patient does not talk non-stop. She talks in a moderate rate but audible. She
whispers answers to questions about sensitive topics. She often stutters. She
answers questions directly and elaborate answers when needed.

D. MOOD AND AFFECT

C.U displays inappropriate affect. She smiles when she says that she misses
Sorina. She also feels sad when talking about her mother, she is happy when the
topic is about socialization.

E. THOUGHT PROCESS AND CONTENT

The client manifest somatic delusion; she no longer menstruate, instead, she
experiences ejaculation; that she is not a woman, but a man.

F. ASSESSMENT OF SUICIDE OR HARM TOWARD OTHERS

C.U has a history of harming others when she was caught by the Barangay Tanod
throwing stones to her neighbors, she has no history of suicide attempts. At present,
the patient, has not manifested symptoms or behaviors relating to suicide and harm
toward others.

G. SENSORIUM AND INTELLECTUAL PROCESSES

1. MEMORY
C.U. remembers what she did the other day, the name of her mother, and so with
her birthday (except for the year).
 2. ABILITY TO CONCENTRATE
The client can not spell the word D-O-G backwards, but she can count from 1-100
and knows the days of the week.

3. ABSTRACT AND INTELLECTUAL ABILITIES

The client used concrete thinking when asked about the meaning of the proverb
“Kapag may naitago, may madudukot”. The patient answers “Kapag may
makikita ka, may makukuha ka” (literal translation).

4. SENSORY – PERCEPTUAL ALTERATIONS

The client experiences auditory and visual hallucination; she sees Angelina and
she said that Angelina is blaming her for the break off.

5. JUDGEMENT AND INSIGHT

The patient has poor judgement; When asked about what she’ll do when she
found money on the ground, she answers “Edi pulutin mo!”
The patient blames Sorina for her condition. And she also states that, “Hindi na
ako sinusumpong dahil tuloy-tuloy ang gamut ko dito.”

6. SELF CONCEPT
She said that she is not a woman but a man. She doesn’t like to be partnered to
another man. She said that she is already well because of the maintenance
medication that she takes. She thinks that she was not loved by her mother. She
eats 3 times a day and complies with the medicines ordered.

7. ROLES AND RELATIONSHIPS

The patient felt unloved by her mother because her mother doesn’t want to get her
even when she thinks that she is already well. She often thinks of Sorina and
misses her. She further states that she meets her sexual needs by masturbation, she
also stated that she has a relationship with other 2 patients in the ward.

8. PHYSIOLOGIC AND SELF CARE

The patient can eat well, but if she dislike the food, she just throws it. She can
sleep well when not bothered by dreams about Sorina or Angelina. She takes her
medications with compliance. She only takes a bath when she has soap, but do not
change her clothing.

General Comments: