Schizophrenia case #1 - case study PDF

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Description

A 26-year-old man who is a medical student with no prior psychiatry history is referred to your office by the dean of students. The student’s friends came to the Dean with concerns that he has not been going to classes for over a month. They reported that over the past 6 months, he hasn’t seemed himself, he’s been more withdrawn, and he doesn’t seem to be doing as well in his classes. After he stopped going to class, they went to his apartment to check on him. They became scared because his apartment was filthy, he had taped aluminum foil over all the windows, and he kept telling them they had to leave “before they become targets too.” The patient appears disheveled as though he hasn’t showered or brushed his hair in over a week. He clutches a notebook to his chest with all the “proof of the conspiracy” written inside. When you ask to see the notebook, he quickly opens it to a random page, which you see is covered with words scribbled in no organized fashion. He reports feeling depressed because “they will eventually catch me and torture me for the secrets…who wouldn’t be depressed?” He denies changes in sleep or appetite but admits he has run out of food at his apartment and has been too scared to leave to buy more groceries. He would love to play basketball—his favorite hobby—but states, “I don’t have time because I have to protect the secrets.” On mental status exam, he is unkempt. He has poor eye contact, and his eyes constantly dart around the room. His affect is blunted. He is suspicious, asking several times, “Are you in on it? How do I know you’re not in on it?” He denies hearing voices, but you notice him frequently turning to the side and mumbling under his breath. He denies using drugs because he states “I’ve got to stay sharp!” He states he can fly and has extra powers to do anything he wants to do. However, he denies suicidal or homicidal thoughts.

Complete the components of the mental status below:

What behaviors do you see? The patient exhibits symptoms of paranoia, has scattered thinking and auditory hallucinations.

Describe his appearance? The patient appears disheveled as though he hasn’t showered or brushed his hair in over a week. Describe his mood? Patient appears to be depressed because he is unable to do the things he wants because he has to “keep his secret” hidden.

Identify 2 nursing diagnoses for this patient. Place them in order of priority. 1. Defensive Coping related to perceived threat to self as evidence by patient stating “they will eventually catch me and torture me for the secrets” 2. Disturbed sensory perception related to auditory distortions as evidence by patients actions like turning to the side and mumbling under his breath.

What is Tardive Dyskinesia, NMS and EPS? - Tardive Dyskinesia: A neurological syndrome marked by slow, rhythmical, stereotyped movements, either generalized or in single muscle groups. These occur as an undesired effect of therapy with certain psychotropic drugs, esp. the phenothiazines. Treatments include withholding the responsible drug or drugs and giving vesicular monoamine transporter (VMAT) inhibitors. - NMS: A potentially fatal syndrome marked by hyperthermia, catatonic rigidity, altered mental status, profuse sweating, and, occasionally, rhabdomyolysis, renal failure, seizures, and death. It typically occurs

after exposure to drugs that alter levels of dopamine in the brain (such as antipsychotic agents) or after the withdrawal of agents that increase central nervous system dopamine levels (such as levodopa or carbidopa). The death rate may be as high as 30%. Antipyretics, curare-based paralytic drugs, bromocriptine, and dantrolene are used to treat the syndrome. - EPS: Any of several degenerative nervous system diseases that involve the extrapyramidal system and the basal ganglion of the brain. The symptoms include tremors, chorea, athetosis, and dystonia. Parkinsonism is an extrapyramidal syndrome. What is the presenting complaint? - Patient presents with change behavior, paranoia, scattered thinking and auditory hallucinations. Is he suicidal? - The patient does not show major signs of being suicidal but if he continues to have auditory hallucinations he might be at risk for hurting himself.

General Description (Appearance) Motor Activity (Describe) Speech Patterns (Describe) General Disposition (Describe) Emotions (Mood and Affect)

Thought Process (Form and content of thought) Perceptual Disturbances (Describe) Sensorium and Cognitive Ability (Orientation) Impulse Control (Agitation) Judgment and Insight (Awareness)...