Mental Health Case Study: Schizoaffective Disorder 1

Kaitlyn Kalicatzaros

Youngstown State University

March 22nd 2018

Teresa Peck

NURS 4842L CRN 22271

Mental Health Case Study: Schizoaffective Disorder 2

Abstract

This case study is focused on a thirty-four year old, female patient diagnosed with

schizoaffective disorder. On March 9th, 2018 the patient was admitted to Trumbull

Memorial Hospital after being pink slipped by Warren Police. The date of care of this

patient was March 9th and March 20th of 2018. The information provided was

observed throughout two six-hour shifts at Trumbull Memorial Hospital. Data was

collected via the patient’s chart; information was taken from the health history,

admission notes, MAR, labs, and notes written by both the physicians and nurses.

Data was also collected by assessment, interview, and observation of the patient in-

group and around the floor.

Mental Health Case Study: Schizoaffective Disorder 3

Objective Data

The patient is a thirty four year old woman who was admitted to Trumbull

Memorial Hospital on March 9th 2018. Police brought the patient to the Emergency

Room after they were called to the patient’s house. The patient lives at home with

her mother, they began fighting when the patient threatened to “shoot and kill” her.

She also stated to police that, “my mother is putting blood in my milk and someone

is raping me in the middle of the night.” Homicidal Ideation caused her to be pink

slipped by police and brought in by ambulance. She was cleared medically in the

Emergency Room. Upon evaluation, the patient was unable to sit still, very

tangential, grandiose, and having looseness of thoughts. She stated, “My mom has

Alzheimer’s and is making false accusations,” to the nurses on admission. She denied

any of this happened. In the past, the patient has had multiple hospitalizations at

Trumbull Memorial Hospital, Mercy Health, North Coast Behavior and Health, and

Behavioral Health, including a pink slip by police in 2015. The patient is allergic to

grass. She has a history of seizures and asthma. She is on suicide and seizure

precautions on the unit. The patient’s DSM IV-TR would be Axis 1 with her diagnosis

of Schizoaffective Disorder –Bipolar Type. This admission she is also being treated

for anxiety and depression. She is noncompliant with her medications, but says she

is taking them. The patient’s Valproic Acid level was only a 6.1 on admission. She is

currently prescribed Abilify, 20 milligrams daily and Aristada 662 milligrams,

intramuscular injection every thirty days for schizophrenia. Depakote extended

release 750 milligrams twice a day for bipolar and as a mood stabilizer. She is also

taking hydroxyzine, 25 milligrams daily for anxiety and sleep. The goal of this
Mental Health Case Study: Schizoaffective Disorder 4

hospitalization is to increase her Valproic Acid and administer the patient’s long-

acting Aristada injection that was due on March 11th. The patient is expected to stay

on the unit for seven to ten days.

Summarize

The term “schizoaffective' was first used by Jacob Kasanin in 1933 to

describe a group of patients with acute psychosis that contained both schizophrenic

and affective features (Sangeeta, 1999). The term itself sounds like a subtype or

category of schizophrenia. 'Schizoaffective disorder" implies that clinically the

disease manifests with features of both schizophrenia and affective or mood

disorder. Without this classification these patients wouldn’t have a clear diagnosis

(Sangeeta, 1999). They wouldn’t exactly fit the classification of having schizophrenia

or a mood disorder because their symptoms are a combination of the two.

Schizoaffective was first introduced in the DSM-III in 1980 but it listed no criteria

for a diagnosis (Malaspina, 2013). It was used in cases when the physician could not

make the distinction between schizophrenia and a mood disorder, basically

encompassing those patients who didn’t quite fit into either disorder. Although all

editions of the DSM have included the term ‘schizoaffective,” it was not until 1987

that it outlines the diagnostic criteria for the disease, (Malaspina, 2013). The client

with schizoaffective may appear depressed, with psychomotor retardation and

suicidal ideation or symptoms may include euphoria, grandiosity, and hyperactivity.

The DSM-IV lists four criteria for the diagnosis of schizoaffective disorder, (A) at

least one period of psychosis with affective symptoms; (B) at least one period of

psychosis, for at least two weeks, WITHOUT affective symptoms; (C) the total
Mental Health Case Study: Schizoaffective Disorder 5

duration of Mood Episodes is “not brief” and (D) there is no “organic cause”

(Malaspina, 2013). This statement from the DSM-III-R is still true today: “The term

schizoaffective disorder has been used in many different ways since it was first

introduced as a subtype of schizophrenia, and represents one of the most confusing

and controversial concepts in psychiatric nosology” (Heckers, 2012).

Identify

This current hospitalization was caused by a fight between the patient and

her mother. The patient lives with her mother and refers to her as her “step

mother.” The patient was having a fight a fight with her mother when the patient

threatened to “shoot and kill,” her. Her mother called the police. When they arrived

the patient told police that her mother had Alzheimer’s and denied any of this had

taken place. The patient had also told police that her mother was putting blood in

her milk and that a man was coming in and raping her in the middle of the night. On

the day of care the patient did not mention many of this but stated the reasoning for

the hospitalization was caused by her psychic feelings that something bad was going

to happen. She said that two days later her uncle died and now she just found out

her cousin died as well. The patient was having delusions of grandeur. She also

stated that the reason she was there was because her step mom was after her

money and royalties from being a childhood actress and a singer/songwriter for

Sony. The patient could not clearly identify the cause of her hospitalization because

of her delusions.
Mental Health Case Study: Schizoaffective Disorder 6

Discuss

The patient has had multiple psychiatric episodes such as this one in the past.

She has had multiple hospitalizations at Trumbull Memorial Hospital. She has also

been admitted to Mercy Health, Northcoast Behavior and Health, and Behavioral

Health. There is no history of mental illness on in her mother and father. However

the patient states she was adopted and that information was not provided in the

chart. The patient is noncompliant with her medications and continues to end up

hospitalized. She was kicked out of her group home and now her mother is threating

to kick her out as well. She has three daughters that are currently in the custody of

her sister.

Describe

During my time on the unit with patient we did a lot of talking. This patient

was not supposed to be mine originally. However she approached us stating, “I’d

really like to talk to one of you.” I was able to utilize communication techniques such

as, offering self, asking direct questions, making observations, exploring, restating,

and using silence throughout our conversation. The milieu at Trumbull Memorial is

very open. There is a large room with tables, televisions, coloring and drawing

supplies, and other activities. There are two phones that can be used in the

designated times, and never to be used during group. There are windows around the

unit to allow sun to get in and patients to see the outside rather than just hospital

walls. The nurse’s station is in a location where the patients are able to approach it

and the nurses can observe everything on the unit. The rooms are in a square, so the

patients are able to walk around the unit when they are feeling restless or cannot sit
Mental Health Case Study: Schizoaffective Disorder 7

still. The floor has a schedule that is posted on the wall; this helps the patient and

ensures they have a steady routing. They have two group sessions during our care.

One is usually nursing and the other is usually social work. The patient attended

both groups and participated occasionally. We were able to discus coping skills in

which she said she likes to listen to music and sing and is also very religious so she

also enjoys praying to cope when she is stressed.

Analyze

The patient was so delusional it was hard to understand what her ethnic and

cultural influences would be exactly. She stated that she was adopted from the

Vatican when she was five months old. Her adoptive father put her in movies. She

was in the movie, Mary Poppins. She said that she had lived in California while she

was acting and also lived in Africa and Europe for some time. She said that she also

had another set of adoptive parents named Michelle and Barak Obama and she lived

with them in Chicago for a while. Although, this is all the product of grandeur

delusions, this made the real information hard to decipher. As stated above, the

patient did explain that she uses religion as a coping skill. The patient did not specify

what religion she was. She just explained that she believed that God could help us

cope when we are stressed, so she uses prayer to cope. She explained that listening

to gospel music also helped her cope.

Evaluate

The patients nursing diagnosis’ had to do a lot with her delusions and how

they were effecting the patient’s reality The outcome to “use effective
Mental Health Case Study: Schizoaffective Disorder 8

communication techniques,” was partially met because the patient was

communicating and using appropriate speech and conversation cues, however the

information she was conveying was mostly delusions. The patient outcome to,

"participate in activities of daily living (ADL’S),” was met. The patient was able to

complete all activities of daily living on her own and completed them appropriately.

The outcome to “state accurate information about the situation,” was not met. The

patient was unable to stat factual information about her life and the events that lead

up her current hospitalization.

Summarize

On March 9th, 2018, the patient’s only discharge plan was that she would be

on the unit for at least seven to ten days after being pink slipped by Warren Police.

The goals were to increase her Valproic Acid level because it was so low on

admission. The next week when we arrived, the patient seemed extremely less

delusional. Her mood was better however she did seem quite paranoid. She stated

that she didn’t understand why she was still there and she felt like the nurses were

keeping her there because she helps the other patients a lot. She was unclear on her

plans for where she would live after discharge stating that her friend “Tony,” was

going to let her live with him. Then later stated that she was going to move into her

own apartment but was waiting for it to get furnished. The patient received and

Aristada intramuscular injection on March 11th, 2018. This injection only has to be

given every thirty days so it helps with patients who are not compliant with their

medications. Her Valproic acid level was back into normal range, so with the

physician’s orders the patient would be “ready” for discharge.

Mental Health Case Study: Schizoaffective Disorder 9

Potential Nursing Diagnosis

1. Impaired verbal communication related to delusional thinking evidenced by

grandeur delusions throughout care

2. Adult failure to thrive related to delusional state evidenced by inability to live

on own or maintain a job

3. Fear related to content of intrusive thoughts evidenced by telling police her

mother was putting blood in her milk and a man was raping her in the middle

of the night.

List

Anxiety

Impaired Verbal Communication

Ineffective Coping

Interrupted Family Process

Fear

Ineffective Health Maintenance

Hopelessness

Disturbed Personal Identity

Impaired Memory

Self Neglect
Mental Health Case Study: Schizoaffective Disorder 10

Self care deficit

Impaired Social Interaction

Social Isolation

Risk for Self and other directed Violence

Conclusion

In conclusion this patient was perfect for doing the case study. Before having

this patient I was nervous because I felt like my patients weren’t really talkative or

having any extreme psych symptoms. This patient was so interesting because the

schizophrenia symptoms were so easy to point out ad observe. Listening to the

patient talk was honestly very shocking because it was crazy how quickly she was

able to recall her delusions and how true all of them were to her. She was very

friendly and appropriate in conversation. It was very strange to me because if I

didn’t know all of it was a lie, she would have been very believable.
Mental Health Case Study: Schizoaffective Disorder 11

References

Malaspina, Dolores & J Owen, Michael & Heckers, Stephan & Tandon, Rajiv &

Bustillo, Juan & Schultz, Susan & Barch, Deanna & Gaebel, Wolfgang & Gur,

Ruben & Tsuang, Ming & van Os, Jim & Carpenter, William. (2013). Retrieved

March 22, 2018. Schizoaffective Disorder in the DSM-5. Schizophrenia

research. 150. 10.1016/j.schres.2013.04.026.

Heckers, Stephan. (2012). Retrieved March 22, 2018. Diagnostic criteria for

schizoaffective disorder. Expert review of neurotherapeutics. 12. 1-3.

10.1586/ern.11.179.

Shrivastava, Amresh & Rao, Sangeeta. (1999). Retrieved March 22, 2018.

Schizoaffective disorder: Consistency of diagnosis. Indian Journal of

Psychiatry. 41.