Manuel S.

Enverga University Foundation

Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

I. INTRODUCTION

OVERVIEW
Schizophrenia is a chronic, severe, debilitating mental illness characterized by disordered
thoughts, abnormal behaviors, and anti-social behaviors. It is a psychotic disorder, meaning the
person with schizophrenia does not identify with reality at times.

Who Is Affected?
 Schizophrenia affects about 1.1% of the world's population
 3.5 million Americans have schizophrenia
 Schizophrenia is most commonly diagnosed between the ages of 16 to 25
 Schizophrenia can be hereditary (runs in families)
 It affects men 1.5 times more commonly than women
 Schizophrenia and its treatment has an enormous effect on the economy, costing between
$32.5-$65 billion each year

Schizophrenia in young children is rare. The National Institute of Mental Health (NIMH)
estimates only 1 in 40,000 children experience the onset of schizophrenia symptoms before the
age of 13.

Phases of Schizophrenia

Schizophrenia usually progresses through three distinct phases:

 Prodromal Phase

 Occurs before hospitalization or within the year.

 Characterized by clear decline from his previous level of functioning.
 May withdraw from friends and families and hobbies and interests, exhibit peculiar
behavior, and deterioration in work and school performance.
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

 Active Phase

 Commonly triggered by a stressful event

 Characterized by presence of acute psychotic symptoms (e.g. hallucinations,
delusions, incoherence, and catatonic behaviors).
 Prognosis worsens with each acute episode.

 Residual Phase

 This is at this point in which illness pattern is established, disability level may be
stabilized, and late improvements may occur.

Types of Schizophrenia

There are five types of schizophrenia (discussed in the following slides). They are categorized by
the types of symptoms the person exhibits when they are assessed:

 Paranoid schizophrenia- Paranoid-type schizophrenia is distinguished by paranoid

behavior, including delusions and auditory hallucinations. Paranoid behavior is exhibited by
feelings of persecution, of being watched, or sometimes this behavior is associated with a
famous or noteworthy person a celebrity or politician, or an entity such as a corporation.
People with paranoid-type schizophrenia may display anger, anxiety, and hostility. The
person usually has relatively normal intellectual functioning and expression of affect.
 Disorganized schizophrenia- A person with disorganized-type schizophrenia will exhibit
behaviors that are disorganized or speech that may be bizarre or difficult to understand. They
may display inappropriate emotions or reactions that do not relate to the situation at-hand.
Daily activities such as hygiene, eating, and working may be disrupted or neglected by their
disorganized thought patterns.
 Catatonic schizophrenia- Disturbances of movement mark catatonic-type schizophrenia.
People with this type of schizophrenia may vary between extremes: they may remain
immobile or may move all over the place. They may say nothing for hours, or they may
repeat everything you say or do. These behaviors put these people with catatonic-type
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

schizophrenia at high risk because they are often unable to take care of themselves or
complete daily activities.
 Undifferentiated schizophrenia- Undifferentiated-type schizophrenia is a classification
used when a person exhibits behaviors which fit into two or more of the other types of
schizophrenia, including symptoms such as delusions, hallucinations, disorganized speech or
behavior, catatonic behavior.
 Residual schizophrenia- When a person has a past history of at least one episode of
schizophrenia, but the currently has no symptoms (delusions, hallucinations, disorganized
speech or behavior) they are considered to have residual-type schizophrenia. The person may
be in complete remission, or may at some point resume symptoms.

What Are Causes of Schizophrenia?

Schizophrenia has multiple, intermingled causes which may differ from person to person,
including:

 Genetics (runs in families)

 Environment
 Brain chemistry
 History of abuse or neglect

Is Schizophrenia Hereditary?
Schizophrenia has a genetic component. While schizophrenia occurs in only 1% of the
general population, it occurs in 10% of people with a first-degree relative (parent, sibling) with
the disorder. The risk is highest if an identical twin has schizophrenia. It is also more common in
people with a second-degree relative (aunts, uncles, cousins, grandparents) with the disorder.

Schizophrenia Symptoms
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

Many people with schizophrenia do not appear ill. However, many behavioral changes will
cause the person to seem 'off' as the disease progresses. Symptoms include:

 Social withdrawal
 Anxiety
 Delusions
 Hallucinations
 Paranoid feelings or feelings of persecution
 Loss of appetite or neglecting to eat
 Loss of hygiene

Positive (More Overtly Psychotic) Symptoms

The "positive," or overtly psychotic, symptoms are symptoms not seen in healthy people,
include:

 Delusions
 Hallucinations
 Disorganized speech or behavior
 Dysfunctional thinking
 Catatonia or other movement disorders

Negative (Deficit) Symptoms

"Negative" symptoms disrupt normal emotions and behaviors and include:

 Social withdrawal
 "Flat affect," dull or monotonous speech, and lack of facial expression
 Difficulty expressing emotions
 Lack of self-care
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

 Inability to feel pleasure (anhedonia)

Cognitive Symptoms

Cognitive symptoms may be most difficult to detect and these include:

 Inability to process information and make decisions

 Difficulty focusing or paying attention
 Problems with memory or learning new tasks

Affective (or Mood) Symptoms

Affective symptoms refer to those which affect mood. Patients with schizophrenia often
have overlapping depression and may have suicidal thoughts or behaviors.

Types of Undifferentiated Schizophrenia

 Chronic - six months and more

 Acute - less than six months, usually three months

How Is Schizophrenia Diagnosed?

The diagnosis of schizophrenia is made both by ruling out other medical disorders that can
cause the behavioral symptoms (exclusion), and by observation of the presence of characteristic
symptoms of the disorder. The doctor will look for the presence of delusions, hallucinations,
disorganized speech or behavior, and/or negative symptoms, along with social withdrawal and/or
dysfunction at work or in daily activities for at least six months.
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

The doctor may use physical examination, psychological evaluation, laboratory testing of blood,
and imaging scans to produce a complete picture of the patient's condition.

Mental health screening and evaluation is an important part of the diagnosis process for
schizophrenia. Many other mental illnesses such as bipolar disorder, schizoaffective disorder,
anxiety disorders, severe depression, and substance abuse may mimic symptoms of
schizophrenia. A doctor will perform an assessment to rule out these other conditions.

Schizophrenia Treatment - Medications

Antipsychotic medications are the first-line treatment for many patients with schizophrenia.
Medications are often used in combination with other types of drugs to decrease or control the
symptoms associated with schizophrenia. Some antipsychotic medications include:

 olanzapine (Zyprexa)
 risperidone (Risperdal)
 quetiapine (Seroquel)
 ziprasidone (Geodon)
 aripiprazole (Abilify)
 paliperidone (Invega)

Mood swings and depression are common in patients with schizophrenia. In addition to
antipsychotics, other types of medications are used.

Mood stabilizers include:

 lithium (Lithobid)
 divalproex (Depakote)
 carbamazepine (Tegretol)
 lamotrigine (Lamictal)
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

Antidepressants include:

 fluoxetine (Prozac)
 sertraline (Zoloft)
 paroxetine (Paxil)
 citalopram (Celexa)
 escitalopram (Lexapro)
 venlafaxine (Effexor)
 desvenlafaxine (Pristiq)
 duloxetine (Cymbalta)
 bupropion (Wellbutrin)

Schizophrenia Treatment - Psychosocial Interventions

o Family psycho-education: It is important to include psychosocial interventions in the

treatment of schizophrenia. Including family members to support patients decreases the
relapse rate of psychotic episodes and improves the person's outcomes. Family
relationships are improved when everyone knows how to support their loved one dealing

with schizophrenia.
o Assertive community treatment (ACT): Another form of psychosocial intervention
includes use of out-patient support groups. Support teams including psychiatrists, nurses,
case managers, and other counselors, meet regularly with the schizophrenic patient to

help reduce the need for hospitalization or a decline in their mental status.
o Substance abuse treatment: Many people with schizophrenia (up to 50%) also have
substance abuse issues. These substance abuse issues worsen the behavioral symptoms of
schizophrenia and need to be addressed for better outcomes.
o Social skills training: Patients with schizophrenia may need to re-learn how to
appropriately interact in social situations. This kind of psychosocial intervention involves
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

rehearsing or role-playing real-life situations so the person is prepared when they occur.

This type of training can reduce drug use, and improve relationships.
o Supported employment: Many people with schizophrenia have difficulty entering or re-
entering the work force due to their condition. This type of psychosocial intervention
helps people with schizophrenia to construct resumes, interview for jobs, and even

connects them with employers willing to hire people with mental illness.
o Cognitive behavioral therapy (CBT): This type of intervention can help patients with
schizophrenia change disruptive or destructive thought patterns, and enable them to
function more optimally. It can help patients "test" the reality of their thoughts to identify
hallucinations or "voices" and ignore them. This type of therapy may not work in actively
psychotic patients, but it can help others who may have residual symptoms that

medication does not alleviate.

o Weight management: Many anti-psychotic and psychiatric drugs cause weight gain as a
side effect. Maintaining a healthy weight, eating a well-balanced diet, and exercising
regularly helps prevent or alleviate other medical issues.

What Is the Prognosis for Schizophrenia?

The prognosis for people with schizophrenia can vary depending on the amount of support
and treatment the patients receives. Many people with schizophrenia are able to function well
and lead normal lives. However, people with schizophrenia have a higher death rate and higher
incidence of substance abuse. When medications are taken regularly and the family is supportive,
patients can have better outcomes.

NURSING MANAGEMENT

 Recognize schizophrenia. Note characteristic signs and symptoms of schizophrenia

 Establish trust and rapport. Don’t tease or joke with patients. Expect that patient is going
to put you through rigorous testing periods.
 Introduce yourself and explain your purpose.
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

 Maximize level of functioning. Assess patient’s ability to carry out activities of daily
living.
 Assess positive symptoms. Assess for command hallucinations; explore answers. Assess
if the client has fragmented, poorly organized, well-organized, systematized, or extensive
system of beliefs that are not supported by reality.
 Assess negative symptoms. Assess for the negative symptoms of schizophrenia.
 Assess medical history.
 Assess support system. Determine whether the family is well informed about the disease.

COMMON MANIFESTATIONS

II. CLINICAL SUMMARY

A. GENERAL DATA PROFILE

NAME: Patient RRG

ADDRESS: C/O Paco Police Community Precint P.Gil
Cor
AGE: 39 years old
GENDER: Male
BIRTHDAY: October 22, 1979
BIRTH PLACE: Manila
SPOUSE NAME: Antonette
INFORMANT: Rogelio Q. Donghit
FATHER: Tonio Gomez
MOTHER: Elsa Rodrigora Gomez
NATIONALITY: Filipino
RELIGION: Roman Catholic
OCCUPATION/S: Multiple short-term careers (Piggery, Call
Center, etc.) No permanent occupation.
DATE OF ADMISSION: June 29, 2015
FINAL DIAGNOSIS: F20.3 Undifferentiated Schizophrenia
ADMITTING PHYSICIAN: Mariane Romano, M.D
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

COMPONENTS OF PSYCHIATRIC HISTORY

A. PHYSICAL ASSESMENT

a) Physical Assessment upon Admission

Prior to admission the patient was conscious and coherent and not in cardiorespiratory
distress:

Complaints: “nambabato ng kotse”

Vital signs as follow:

TEMP- 37.4 c

BP 130/80 mmHg

RR- 19

PR- 89

Head and neck – pinkish conjunctiva

Heart- normal heart rhythm

Lungs- clear breath sounds

Abdomen- flat abdomen soft and non-tender

Skeletal systems: negative nodules, positive abscess right leg

Other systems: essentially normal

b) Physical Assessment Presently

 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

Latest V/S:

BP: 110/80 mmHg HR: 89 bpm

RR: 24 bpm Temperature: 36.1 C

PHYSICAL NORMAL ACTUAL FINDINGS INTERPRETATION

ASSESMENT FINDINGS
GENERAL -clean in appearance -clean in appearance; -normal findings
APPEARANCE and well groomed well groomed
-cooperative
-cooperative
SKIN -with good skin -good skin turgor -normal findings
turgor
HAIR -evenly distributed - evenly distributed - normal findings
hair - thin hair
-thick hair
NAILS -with good capillary -with capillary refill of - long nails related to poor
refill of 1-2 seconds 2-3 seconds hygiene and grooming
-with pinkish nail -with pale nail bed
beds -with clean and long
-with clean and short nails
nails
SKULL AND FACE -mouth uniform -mouth uniform - normal findings
consistency absence consistency absence of
of nodules and nodules and masses;
masses prominent cheek bones
-rounded and smooth -emaciated/bony facial
skull contour appearance
-symmetrical facial -rounded and smooth
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

movement skull contour

-symmetrical facial
movement
EYES -no eye discharges -no eye discharges - normal findings
-with pinkish -with pinkish
conjunctiva and white conjunctiva and whitish
sclera sclera
-eyebrows hair evenly -eyebrows with intact
distributed with intact skin
skin

EARS -Auricle color same -Auricle color same as Normal findings.

as facial skin facial skin
-Auricle are mobile -Auricle are mobile
firm and not tender firm and not tender
-no edema and -no edema and
discharges discharges
MOUTH -pinkish lips -dark lips -bad oral hygiene
-without missing -with missing teeth - unable to meet basic
teeth -yellow teeth needs
-with dark gums
-with pink gums -breath with foul odor
-no foul odor -with symmetrical
-with symmetrical contour
contour -with gingivitis
-with cavity
MUSCULOSKETAL -symmetrical - symmetrical - normal findings
(UPPER AND -with full range of -with full range of
LOWER motion motion
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

EXTREMETIES)
ABDOMEN -No abdominal -no abdominal -normal findings
distension distension
-Flat rounded -flat rounded abdomen
abdomen -no surgical incision
-No surgical incision

A. PSYCHIATRIC HISTORY

A. Pertinent personal history

Adult male with long hair, He was filthy, smell of body odor. He was
attentive with good eye contact fairly behaved. Mood anxious with restricted
affect. Speech was normoproductive with circumstantial thought. He was
consistent with his name and place of origin which is aklan and other pertinent
information. Claimed to have auditory hallucination and delusions “and delusions
“yung paty kong nanay sumasapi sa akin at naririnig ko”

B. Previous mental health hospitalization

The patient has been living at National Center For Mental Health for about 4 years,
they occasionally perform consultation and continuous treatment such as intervention
and evaluation.

C. Chief Complaint
Patient was apprehended along Aguinaldo St. Paco Manila when he was reported to
throw stones at parked cars. When apprehended he tried to escape but was cought and
was brought to our institution for consult and was subsequently admitted.
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

D. Personality Profile
a. The client was able to participate in activities

E. MENTAL STATUS EXAMINATION

The patient was seen and examined as a male; average height; medium built; short
browmt hair with brown complexion. He was behaved and cooperative. He had euthymic
mood and blunted affect. Speech was spontaneous. He claimed that “pumunta po ako
samin pero pagdating ko dun wala nang tao sa bahay namin”

F. General appearance & motor behaviour

The client shows;

 Poor personal hygiene and grooming- yellowish teeth and cavity

 Active motor responses and actions; often fidgets;
o Automatisms – repeated purposeless behaviors often indicative of anxiety
 frequent shaking/ tapping of leg and foot
 frequent ruffling of hair with fingers
 Eye contact: client maintained eye contact when focused or interested on
conversation
 Facial Expression: the client only smiles when giving recognition but mostly flat
affect

G. Communication
According to client’s records the client was previously talk spontaneously.
Presently, the client responded appropriately with congruent messages.

A. Perception, Thought Process and Content

 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

-Perceptual disturbances (Hallucinations)

According to clients records the client verbalized that he has
auditory hallucinations occurring whenever he got sober from drinking
alcohol and was triggered when his mother passed away.
The client was avoiding eye contact and always stares at something
else during conversation and paying attention only when he was noticed
and mentioned by the student nurse
B. Mood and Affect
o -has euthymic mood- the client display normal in mental state

-the client seems in normal state during activities with student nurses and
other client

o Restricted affect- displaying one type of expression, usually serious or somber.

-Client usually shows a serious, domineering facial expression.

o -blunted affect- Display little in emotional context

-the client recalling his mother’s death might simply recount the factual
details of the death.
o –anhedonia- inability to feel pleasure
-the client seems not able to gain pleasure during activity
o -flat affect- lacking of showing emotion
C. Sensorium and Intellectual Process
-The client was oriented to person and settings (time, date, place)
-The client has a good memories.( specifically, about his family)
D. Judgement and Insight
-the patient has fair judgment and insight
E. Self-Concept
-has average self-concept, the client always go with the flow and participate without
showing emotions
 Manuel S. Enverga University Foundation
Lucena City
Granted Autonomous Status
CHED CEB Res.076-2009
COLLEGE OF NURSING & ALLIED HEALTH SCIENCES

F. Roles and Relationship

a. Social Isolation
 Unconcerned towards well-being, thoughts and feelings of others
 Has difficulty forming satisfying social relationships due to
impaired thought process
b. Withdrawal
 When the client is not interested in topics he stares at something
else.

G. CLINICAL DISCUSSION OF THE DISEASE