8/6/2019 Paranoid Schizoprenia (Individual Case)

1/25

University of La Salette

College of Nursing

Santiago City, Isabela

S.Y 2010-2011

Paranoid

SchizophreniaAn Individual Case Study

Submitted To:

Mrs. Madelyn Eclar RN, MSN

Mr. Virgillo Ganadin RN, MSN

Clinical Instructors

Submitted By:

Karla Camille P. Dagdag

BSN-3F BRACKET D

8/6/2019 Paranoid Schizoprenia (Individual Case)

2/25

INTRODUCTION

3DUDQRLG VFKL]RSKUHQLDLV DVFKL]RSKUHQLDVXEW\SH LQ ZKLFK WKH SDWLHQWKDVIDOVHEHOLHIVGHOXVLRQVWKDWVRPHERG\RUVRPHSHRSOHDUHSORWWLQJDJDLQVWWKHPRUPHPEHUVRIWKHLUIDPLO\3HRSOHZLWKSDUDQRLGVFKL]RSKUHQLDDVZLWKPRVWVXEW\SHVPD\DOVRKDYHDXGLWRU\KDOOXFLQDWLRQVWKH\KHDUWKLQJVWKDWDUH

8/6/2019 Paranoid Schizoprenia (Individual Case)

3/25

8/6/2019 Paranoid Schizoprenia (Individual Case)

4/25

LQGLYLGXDO SUHVVLQJ WKHP ZRXOG EH WKH HQYLURQPHQWDO IDFWRUV

([SHUWVWKLQNWKDWDQLPEDODQFHRIGRSDPLQHDQHXURWUDQVPLWWHULVLQYROYHGLQ

WKH RQVHW RI VFKL]RSKUHQLD 7KH\ DOVR EHOLHYH WKDW WKLV LPEDODQFH LV PRVW

SUREDEO\ FDXVHG E\\RXU JHQHVPDNLQJ \RX VXVFHSWLEOH WR WKH LOOQHVV 6RPH

VFLHQWLVWVVD\WKHOHYHOVRIRWKHUQHXURWUDQVPLWWHUVVXFKDVVHURWRQLQPD\DOVREH LQYROYHG

&KDQJHVLQNH\EUDLQIXQFWLRQVVXFKDVSHUFHSWLRQHPRWLRQDQGEHKDYLRUOHDG

H[SHUWVWRFRQFOXGHWKDWWKHEUDLQLVWKHELRORJLFDOVLWHRIVFKL]RSKUHQLD

6LJQVDQG6\PSWRPVRI3DUDQRLG6FKL]RSKUHQLD

$ V\PSWRP LV VRPHWKLQJ WKH SDWLHQW VHQVHV DQG GHVFULEHV ZKLOH D VLJQ LV

VRPHWKLQJ RWKHU SHRSOH VXFK DV WKH GRFWRU QRWLFH

)RUH[DPSOHGURZVLQHVVPD\EHDV\PSWRPZKLOHGLODWHGSXSLOVPD\EHDVLJQ

7KHSDWLHQWZLOOKDYHUHODWLYHO\VWDEOHIUHTXHQWO\SDUDQRLGGHOXVLRQVZKLFKDUH

XVXDOO\ DFFRPSDQLHG E\ DXGLWRU\ KDOOXFLQDWLRQV KHDULQJ WKLQJV WKDW DUH QRW

WKHUHDQGSHUFHSWXDOGLVWXUEDQFHV

([DPSOHVRIWKHPRVWFRPPRQSDUDQRLGV\PSWRPVDUH

y $XGLWRU\KDOOXFLQDWLRQVKHDULQJYRLFHVWKDWDUHQRWWKHUHWKH\GRQWH[LVW9LVXDOKDOOXFLQDWLRQVDUHSRVVLEOHEXWUDUH

y 'HOXVLRQVEHOLHIVWKDWDUHQRWUHDOIDOVHSHUVRQDOEHOLHIVWKDWDUHQRWVXEMHFWWR UHDVRQ RU FRQWUDGLFWRU\ HYLGHQFH 7KH SDWLHQW PD\ ILUPO\ EHOLHYHVRPHWKLQJHYHQWKRXJKWKHUHLVLQFRQWURYHUWLEOHHYLGHQFHWKDWLWLVIDOVH(QH[DPSOH PD\ EH D EHOLHI WKDW D QHLJKERU LV SORWWLQJ WR NLOO RU SRLVRQ WKH

SDWLHQWy $Q[LHW\ D SDWLHQW ZLWK SDUDQRLG VFKL]RSKUHQLD ZLOO XVXDOO\ VXIIHU IURP

SHULRGVRIKLJKDQ[LHW\y $QJHU WKLV HPRWLRQDO VWDWH PD\ UDQJH IURP PLOG LUULWDWLRQ ZKLFK PRVW

KHDOWK\LQGLYLGXDOVVRPHWLPHVKDYHWRIXU\DQGUDJH$QJHUPD\UDLVHKHDUWUDWHEORRGSUHVVXUHDQGOHYHOVRIDGUHQDOLQHDQGQRUDGUHQDOLQH

y 'HWDFKPHQW WKH SDWLHQW PD\ VRPHWLPHV EH SK\VLFDOO\ RU HPRWLRQDOO\UHVHUYHGDQGUHPRWHDORRIQHVV

y $JJUHVVLRQ DQG YLROHQFH DJJUHVVLRQ PD\ UHDFK OHYHOV LQ ZKLFK YLROHQWRXWEXUVWVRFFXU

y 4XDUUHOVy &RQGHVFHQVLRQVRPHWLPHVWKHSDWLHQWPD\VHHPSDWURQL]LQJSHUKDSVWKH\

PD\IHHOWKH\NQRZVWXIIRWKHUSHRSOHGRQWDQGVXEVHTXHQWO\DVVXPHVXFKDPDQQHU

y 6XLFLGDOWKRXJKWVDQGEHKDYLRUWKHVHPD\EHQRWLFHDEOHE\SHRSOHDURXQGWKH LQGLYLGXDOZLWKVWDWHPHQWVVXFKDV,ZLVK ,ZHUHGHDG ,DPJRLQJ WR

8/6/2019 Paranoid Schizoprenia (Individual Case)

5/25

NLOOP\VHOIRU,ZLVK,KDGQHYHUEHHQERUQ7KHSDWLHQWPD\JRIXUWKHUDQG REWDLQ WKHPHDQV WR NLOO KLPVHOIKHUVHOI VXFK DV JHWWLQJ DZHDSRQ RUDFFXPXODWLQJSLOOV2WKHUZDUQLQJVLJQVPD\EH

%HFRPLQJVRFLDOO\ZLWKGUDZQ 0RRGVZLQJVKRZHYHUPRRGGLVRUGHUVDQGSUREOHPVZLWKWKLQNLQJDUH

OHVVFRPPRQLQWKLVW\SHRIVFKL]RSKUHQLD %HLQJREVHVVHGZLWKGHDWKG\LQJRUYLROHQFH )HHOLQJWUDSSHGRUGHVSHUDWH ,QFUHDVHGFRQVXPSWLRQRIGUXJVLQFOXGLQJLOOHJDORQHVDQGDOFRKRO &KDQJLQJHDWLQJRUVOHHSLQJSDWWHUQV 6WDUWLQJWRJHWWKHLUDIIDLUVLQRUGHUDQGJLYLQJDZD\EHORQJLQJV 6D\LQJJRRGE\HWRSHRSOHLQDVSHFLILFZD\DVLI WKH\DUHQHYHUJRLQJWR

VHHWKHPDJDLQ

:KLOHVRPHSDWLHQWVPD\KDYHFOHDUVXLFLGDOEHKDYLRUVDQGWKRXJKWVREYLRXVWRRWKHUVRWKHUVPD\ EHPRUHVHFUHWLYH7KHZDUQLQJVLJQVPLJKWEHVXEWOHDQGVRPHWLPHVQRWQRWLFHDEOHDWDOO

3DWLHQWVZLWKSDUDQRLGVFKL]RSKUHQLDDUHPRUHOLNHO\WREHDIIHFWHGE\SRVLWLYH

V\PSWRPVVXFKDVGHOXVLRQVDQGDXGLWRU\KDOOXFLQDWLRQVDQGOHVVE\SUREOHPV

ZLWK PRRG FRJQLWLRQ WKLQNLQJ FRQFHQWUDWLRQ DWWHQWLRQ FRPSDUHG WR RWKHU

W\SHVRIVFKL]RSKUHQLD

5LVNIDFWRUVIRU3DUDQRLG6FKL]RSKUHQLD7KHULVNIDFWRUVIRUSDUDQRLGVFKL]RSKUHQLDDUHEDVLFDOO\WKHVDPHDVWKRVHIRU

PRVWVFKL]RSKUHQLDVXEW\SHVLQFOXGLQJ

y *HQHWLFVLQGLYLGXDOVZLWKDIDPLO\KLVWRU\RIVFKL]RSKUHQLDKDYHDKLJKHUULVNRIGHYHORSLQJLWWKHPVHOYHV,IWKHUHLVQRKLVWRU\RIVFKL]RSKUHQLDLQ\RXU IDPLO\ \RXUFKDQFHVRIGHYHORSLQJ LWDQ\ W\SH DUH OHVV WKDQ+RZHYHUWKDWULVNULVHVWRLIRQHRI\RXUSDUHQWVZDVLVDVXIIHUHU

y 9LUDOLQIHFWLRQLIWKHIHWXVXQERUQEDE\LQWKHZRPELVH[SRVHGWRDYLUDOLQIHFWLRQWKHUHLVDELJJHUULVNRIGHYHORSLQJVFKL]RSKUHQLD

y )HWDO PDOQXWULWLRQ LI WKH IHWXV VXIIHUV IURPPDOQXWULWLRQGXULQJ WKHPRWKHUVSUHJQDQF\WKHUHLVDKLJKHUULVNRIGHYHORSLQJVFKL]RSKUHQLD

y 6WUHVVGXULQJHDUO\OLIHH[SHUWVVD\WKDWVHYHUHVWUHVVHDUO\RQLQOLIHPD\EH D FRQWULEXWRU\ IDFWRU WRZDUGV WKH GHYHORSPHQW RI VFKL]RSKUHQLD6WUHVVIXO H[SHULHQFHV RIWHQ SUHFHGH WKH HPHUJHQFH RI VFKL]RSKUHQLD%HIRUH DQ\ DFXWH V\PSWRPV DUH DSSDUHQW SHRSOH ZLWK VFKL]RSKUHQLDKDELWXDOO\ EHFRPH EDGWHPSHUHG DQ[LRXV DQG XQIRFXVVHG 7KLV FDQWULJJHU UHODWLRQVKLS SUREOHPV 7KHVH IDFWRUV DUH RIWHQ EODPHG IRU WKHRQVHWRIWKHGLVHDVHZKHQUHDOO\LWZDVWKHRWKHUZD\URXQGWKHGLVHDVH

8/6/2019 Paranoid Schizoprenia (Individual Case)

6/25

FDXVHG WKH FULVLV 7KHUHIRUH LW LV H[WUHPHO\ GLIILFXOW WR NQRZ ZKHWKHUVFKL]RSKUHQLDFDXVHGFHUWDLQVWUHVVHVRURFFXUUHGDVDUHVXOWRIWKHP

y &KLOGKRRGDEXVHRUWUDXPDy 3DUHQWDO DJH ZKHQ EDE\ LV ERUQ ROGHU SDUHQWV KDYH D KLJKHU ULVN RI

KDYLQJ FKLOGUHQ ZKR VXEVHTXHQWO\ GHYHORS VFKL]RSKUHQLD FRPSDUHG WR

\RXQJHUSDUHQWVy 'UXJV WKH XVH RIGUXJV WKDW DIIHFW WKHPLQG RUPHQWDO SURFHVVHVPD\

VRPHWLPHVUDLVHWKHULVNRIGHYHORSLQJVFKL]RSKUHQLD

'LDJQRVLQJSDUDQRLGVFKL]RSKUHQLD

,I WKH GRFWRU VXVSHFWV WKH SDWLHQW KDV SDUDQRLG VFKL]RSKUHQLD D VHULHV RI

GLDJQRVWLFWHVWVZLOOEHRUGHUHGWRKHOSZLWKGLDJQRVLVWKHVHWHVWVPD\LQFOXGH

y 3K\VLFDO H[DP WKH SDWLHQWV KHLJKW ZHLJKW KHDUW UDWH EORRG SUHVVXUHWHPSHUDWXUHDUHFKHFNHG7KHGRFWRUZLOO OLVWHQWR WKHKHDUWDQGOXQJVDQGFKHFNWKHDEGRPHQ

y &%&FRPSOHWHEORRGFRXQWWKLVLVDEORRGWHVWZKLFKLQWKLVFDVHLVGRQHPDLQO\WRFKHFNIRUWK\URLGIXQFWLRQDOFRKRODQGGUXJV

y ,PDJLQJVFDQVWKLVPD\LQFOXGH05,RU&7VFDQVWRORRNIRUEUDLQOHVLRQVRUDQ\DEQRUPDOLWLHVLQWKHEUDLQVWUXFWXUH

y ((*HOHFWURHQFHSKDORJUDPWRFKHFNIRUEUDLQIXQFWLRQy 3V\FKRORJLFDO HYDOXDWLRQ WKH SV\FKLDWULVWZLOO DVN WKH SDWLHQW DERXW WKHLU

WKRXJKWV IHHOLQJV DQG EHKDYLRU SDWWHUQV 7KH\ZLOO WDON DERXW V\PSWRPVZKHQ WKH\ EHJDQ WKHLU OHYHOV RI VHYHULW\ DQG KRZ WKH\ PD\ DIIHFW WKHSDWLHQWV OLIH 7KH GRFWRU ZLOO DOVR WU\ WR ILQG RXW KRZ RIWHQ DQG ZKHQHSLVRGHV KDG RFFXUUHG7KHGRFWRUZLOOPRVWSUREDEO\WU\WRILQGRXWZKHWKHUWKHSDWLHQWKDGDQ\WKRXJKWV DERXW VHOIKDUP RU KDUPLQJ RWKHU SHRSOH

'LDJQRVWLF&ULWHULDIRU3DUDQRLG6FKL]RSKUHQLD

)RUGLDJQRVLVRISDUDQRLGVFKL]RSKUHQLDWREHRIILFLDOO\FRQILUPHGWKHSDWLHQW

PXVWEHDWVSHFLILF'60V\PSWRPFULWHULD'60VWDQGVIRUWKH'LDJQRVWLFDQG

6WDWLVWLFDO0DQXDORI0HQWDO'LVRUGHUVSXEOLVKHGE\ WKH$PHULFDQ3V\FKLDWULF

$VVRFLDWLRQ 7KLV PDQXDO LV XVHG E\ KHDOWK FDUH SURIHVVLRQDOV WR GLDJQRVH

PHQWDO FRQGLWLRQV

7KHGLDJQRVWLFFULWHULDIRUSDUDQRLGVFKL]RSKUHQLDLQFOXGH

y $SUHRFFXSDWLRQREVHVVLRQZLWKDWOHDVWRQHGHOXVLRQ

8/6/2019 Paranoid Schizoprenia (Individual Case)

7/25

y 7KHSUHVHQFHRIUHFXUUHQWDXGLWRU\KDOOXFLQDWLRQV6RPHWLPHVDORQJWLPHPD\SDVVEHIRUHDGLDJQRVLVRISDUDQRLGVFKL]RSKUHQLD

LVFRQILUPHG

7UHDWPHQWRSWLRQVIRU3DUDQRLG6FKL]RSKUHQLD3DUDQRLG VFKL]RSKUHQLD LV DQ LOOQHVV WKDW ODVWV DOO WKH ZD\ WKURXJK WKH

LQGLYLGXDOVOLIHLW LVDFKURQLFFRQGLWLRQ3DWLHQWVZLWKSDUDQRLGVFKL]RSKUHQLD

UHTXLUH WUHDWPHQW RQDSHUPDQHQW EDVLV HYHQZKHQ V\PSWRPVVHHP WRKDYH

UHFHGHG D WHPSWLQJWLPH IRU VFKL]RSKUHQLDSDWLHQWVWRVD\ WKH\DUH ILQHDQG

QHHG QR PRUH KHOS 7UHDWPHQW LV EDVLFDOO\ WKH VDPH IRU DOO IRUPV RI

VFKL]RSKUHQLD WKHUH DUH YDULDWLRQV GHSHQGLQJ RQ WKH VHYHULW\ DQG W\SHV RIV\PSWRPVWKHKHDOWKRIWKHSDWLHQWKLVKHUDJHDVZHOODVVRPHRWKHUIDFWRUV

$WHDPRIKHDOWKFDUHSURIHVVLRQDOVZLOO EHLQYROYHG LQWUHDWLQJDSHUVRQZLWK

SDUDQRLG VFKL]RSKUHQLD 6FKL]RSKUHQLDFDQDIIHFWPDQ\ DUHDV RI WKHSDWLHQWV

OLIH WKXV WKH WHDP ZLOO LQFOXGH D ZLGH UDQJH RI GHGLFDWHG SURIHVVLRQDOV

LQFOXGLQJ

y $FDVHZRUNHUy $*3JHQHUDOSUDFWLWLRQHUSULPDU\FDUHSK\VLFLDQIDPLO\GRFWRUy $SHGLDWULFLDQy $SKDUPDFLVWy $SV\FKLDWULFQXUVHy $SV\FKLDWULVWy $SV\FKRWKHUDSLVWy $VRFLDOZRUNHUy 0HPEHUVRIWKHSDWLHQWVIDPLO\7UHDWPHQW RSWLRQV LQFOXGHGUXJV PHGLFDWLRQVSV\FKRWKHUDS\KRVSLWDOL]DWLRQ

RU SDUWLDO KRVSLWDOL]DWLRQ (&7 HOHFWURFRQYXOVLYH WKHUDS\ DQG YRFDWLRQDO

VNLOOVWUDLQLQJ

0HGLFDWLRQV$W\SLFDODQWLSV\FKRWLFV

QGJHQHUDWLRQDQWLSV\FKRWLFVDJURXSRI

DQWLSV\FKRWLFGUXJVXVHGIRUWKHWUHDWPHQWRISV\FKLDWULFFRQGLWLRQV$W\SLFDOVGLIIHUIURPW\SLFDODQWLSV\FKRWLFVLQWKDWWKH\GRQRWWHQGWRFDXVH

H[WUDS\UDPLGDOV\PSWRPV(36(36LQFOXGHSDUNLQVRQLDQW\SHPRYHPHQWVULJLGLW\DQGWUHPRU6LGHHIIHFWVPD\LQFOXGH

y :HLJKWJDLQy 'LDEHWHV

8/6/2019 Paranoid Schizoprenia (Individual Case)

8/25

y (OHYDWHGEORRGFKROHVWHUROOHYHOV7\SLFDODQWLSV\FKRWLFV

VWJHQHUDWLRQDQWLSV\FKRWLFV

HYHQWKRXJKWKH\DUHDVHIIHFWLYHLQWUHDWLQJWKHVDPHV\PSWRPVDVDW\SLFDO

DQWLSV\FKRWLFV DUH SDWLHQWV KDYH D PXFK KLJKHU ULVN RI H[SHULHQFLQJH[WUDS\UDPLGDOV\PSWRPV(36LQFOXGLQJLQYROXQWDU\PRYHPHQWVRIWKHIDFH

WUHPRUDQGSDUNLQVRQLDQW\SHPRYHPHQWV7KHJHQHULFYHUVLRQVRIWKHVHGUXJV

DUH PXFK FKHDSHU WKDQ DW\SLFDO DQWLSV\FKRWLFV

2WKHUGUXJVPHGLFDWLRQV

LQGLYLGXDOV ZLWK VFKL]RSKUHQLD DUH VXVFHSWLEOH RWKHUPHQWDO KHDOWKSUREOHPV

VXFK DVGHSUHVVLRQ 7KH GRFWRU PD\ SUHVFULEH DQ DQWLGHSUHVVDQW DQ DQWL

DQ[LHW\ GUXJ RU D PRRGVWDELOL]LQJ PHGLFDWLRQ

+RVSLWDOL]DWLRQ

ZKHQV\PSWRPVDUHVHYHUHWKHSDWLHQWPD\QHHGWREHKRVSLWDOL]HG$KRVSLWDO

VHWWLQJPD\EHVDIHUZKHUHSURSHUQXWULWLRQPD\EHSURYLGHG DQGWKHSDWLHQW

PD\ JHW EHWWHU VOHHS DQG UHFHLYH KHOS ZLWK K\JLHQH 6RPHWLPHV SDUWLDO

KRVSLWDOL]DWLRQ LV DOVR SRVVLEOH

3V\FKRWKHUDS\

IRU SDWLHQWV ZLWK SDUDQRLG VFKL]RSKUHQLD PHGLFDWLRQV DUH WKH NH\ SDUW RI

WUHDWPHQWKRZHYHUSV\FKRWKHUDS\LVDOVRLPSRUWDQW

6RFLDODQGYRFDWLRQDOVNLOOVWUDLQLQJ

WKLVPD\KHOS WKHSDWLHQW OLYH LQGHSHQGHQWO\ DYLWDOSDUWRIUHFRYHU\ IRU WKH

SDWLHQW 7KH WKHUDSLVW FDQ KHOS WKH SDWLHQW OHDUQ JRRG K\JLHQH SUHSDUHQXWULWLRQDOPHDOVDQGKDYHEHWWHUFRPPXQLFDWLRQ7KHUHPD\EHKHOSLQILQGLQJ

ZRUNKRXVLQJDQG

MRLQLQJVHOIKHOSJURXSV

&RPSOLDQFHDGKHUHQFH

FRPSOLDQFH RU DGKHUHQFH LQPHGLFLQH PHDQV IROORZLQJ WKH WKHUDS\ UHJLPH

WKHWUHDWPHQWSODQ8QIRUWXQDWHO\ODFNRIFRPSOLDQFHLVDPDMRUSUREOHPIRU

SDWLHQWV ZLWK VFKL]RSKUHQLD 3DWLHQWV FDQ JR RII WKHLU PHGLFDWLRQ IRU ORQJ

SHULRGVGXULQJWKHLUOLYHVDWHQRUPRXVSHUVRQDOFRVWVWRWKHPVHOYHVDQGRIWHQ

WRWKRVH

8/6/2019 Paranoid Schizoprenia (Individual Case)

9/25

DURXQGWKHPDVZHOO

$VDVLJQLILFDQWSHUFHQWDJHRILQGLYLGXDOVJRRIIWKHLUPHGLFDWLRQZLWKLQWKHILUVW

PRQWKVRIWUHDWPHQWDOLIHORQJUHJLPHQRIERWKGUXJDQG

SV\FKRORJLFDOVXSSRUWWKHUDSLHVDUHLPSRUWDQWIRUWUHDWPHQWWREHHIIHFWLYHDQG

ORQJODVWLQJ

(&7HOHFWURFRQYXOVLYHWKHUDS\

LQ WKLV SURFHGXUH DQ HOHFWULF FXUUHQW LV VHQW WKURXJK WKH EUDLQ WR SURGXFH

FRQWUROOHG VHL]XUHV FRQYXOVLRQ ,W PD\ EH XVHG RQ SDWLHQWV ZLWK VHYHUH

V\PSWRPVRUGHSUHVVLRQZKRHLWKHUKDYHQRWUHVSRQGHGWRRWKHUWUHDWPHQWVRU

FDQQRWWDNHDQWLGHSUHVVDQWV,WLVDOVRVRPHWLPHVXVHGIRUSDWLHQWVDWKLJKULVN

RIVXLFLGH([SHUWVEHOLHYHWKDW(&7WULJJHUVDPDVVLYHQHXURFKHPLFDOUHOHDVH

LQWKHEUDLQFDXVHGE\WKHFRQWUROOHGVHL]XUH6LGHHIIHFWVPD\LQFOXGHVKRUW

WHUP PHPRU\ ORVV XVXDOO\ UHVROYHV UDSLGO\ ,W LV LPSRUWDQW WKDW WKH GRFWRU

H[SODLQFOHDUO\WKHSURVDQGFRQVRI(&7WRWKHSDWLHQW

DQGRUJXDUGLDQRUIDPLO\PHPEHU

3RVVLEOHFRPSOLFDWLRQVRI3DUDQRLG6FKL]RSKUHQLD

,IWKHSDWLHQWVSDUDQRLGVFKL]RSKUHQLDLVOHIWXQWUHDWHGWKHUHLVDVHULRXVULVNRI

VHYHUHPHQWDOKHDOWKSK\VLFDOKHDOWKILQDQFLDOEHKDYLRUDODQGOHJDOSUREOHPV

ZKLFK PD\ KDYH DQ HQRUPRXV LPSDFW RQ HYHU\ SDUW RI WKH LQGLYLGXDOV OLIH

3RVVLEOHFRPSOLFDWLRQVPD\LQFOXGH

y 'HSUHVVLRQy 6XLFLGDOWKRXJKWVy 6XLFLGDOEHKDYLRUy 0DOQXWULWLRQy +\JLHQHSUREOHPVPRUHFRPPRQLQRWKHUW\SHVVXFKDVFDWDWRQLF

VFKL]RSKUHQLDy 6XEVWDQFHDEXVHy 8QHPSOR\PHQWy +RPHOHVVQHVVy 3ULVRQy ,QDELOLW\WRVWXG\y %HLQJDYLFWLPRIFULPHy ,OOQHVVHVUHODWHGWRWREDFFRVPRNLQJDVLJQLILFDQWQXPEHURISHRSOHZLWK

VFKL]RSKUHQLDVPRNHKHDYLO\DQGUHJXODUO\6RPHPHGLFDWLRQVPD\FODVK

ZLWKWREDFFRLQJUHGLHQWV

8/6/2019 Paranoid Schizoprenia (Individual Case)

10/25

DEMOGRAPHIC DATA

1DPH 0U5RFNDQG5ROO

$JH \UHDVROG

6H[ 0DOH

%LUWKGD\ $SULO

$GGUHVV 7%XJDOORQ6WUHHW.DORRFDQ&LW\

0RWKHU 0DULQD(VWRTXH

)DWKHU -RVH(VWRTXH

8/6/2019 Paranoid Schizoprenia (Individual Case)

11/25

1DWLRQDOLW\ )LOLSLQR

5HOLJLRQ 5RPDQ&DWKROLF

'DWH$GPLWWHG $SULO

7LPHRI$GPLVVLRQSP

3UHVHQWHGE\KLV%URWKHUEHFDXVHRIWKHIROORZLQJSUREOHP

8QXVXDO%HKDYLRU7DONLQJDORQHVKRXWLQJQDJPXPXUD(QWHUHGDFDUDQGFORVHGLW&U\LQJZLWKRXWFDXVH

'LDJQRVLV 3DUDQRLG6FKL]RSKUHQLD

3K\VLFLDQ 'UD9*XHFR

'U&&KX

,QLWLDO9LWDO6LJQV

%ORRG3UHVVXUH PPKJ

7HPSHUDWXUH C

8/6/2019 Paranoid Schizoprenia (Individual Case)

12/25

NURSING HISTORY

3UHVHQW0HGLFDO+LVWRU\

3DWLHQWVFXUUHQWO\DGPLWWHGWR1DWLRQDO&HQWHUIRU0HQWDO+HDOWK+HLVD

NQRZQGUXJXVHUJRHPRUHWKDQ\HDUV$FFRUGLQJWRKLPXVLQJRIGUXJVLQ

WKHLUSODFHLVYHU\FRPPRQ2QKLVFROOHJH\HDUVKHWUHDWHGDWWKHUHKDEFHQWHU

DW'DUH+RO\6SLULW 6W -RVHSK%XODFDQDQGODVWO\DWWKH1%,7DJD\WD\+LV

ODVWDGPLVVLRQLVDW1%,7DJD\WD\DQGVWD\HGIRUPRQWKVDQGZDVGLVFKDUJHG

RQ0D\

8SRQDGPLVVLRQSDWLHQW LVJLYHQ UDSLG QHXUROHSWL]DWLRQDQGZDVVWDUWHG

+DORSHULGROPJ%,'

0RRGLVVOLJKWO\LUULWDEOHZLWKUHVWULFWHGDIIHFW6SHHFKLVK\SRSURGXFWLYH

FRKHUHQWUHOHYDQWXQVSRQWDQHRXVXQHODERUDWLYH+HLVRULHQWHGWRWLPHSODFH

SHUVRQ FDQ WHOO QLJKW DQG GD\ +H GHQLHG SHUFHSWXDO GLVWXUEDQFHV DQG WKH

SUHVHQWLQJ FRPSODLQWV +RZHYHU SDWLHQW DGPLWWHG EHLQJ KRRNHG RQ

0HWKDPSKHWDPLQHIURPWKHODVW\HDUVDQGGHQLHGKLVODVWLQWDNHZDVODVW\HDU

+H GHQLHG IHHOLQJV RI KRSHOHVVQHVV VHL]XUH HSLVRGHV QRU UHFHQW LQWDNH RI

0HWKDPSKHWDPLQH 1R PRUELG LGHDWLRQV PHUH HOLFLWHG /DWHU LQ LQWHUYLHZ

SDWLHQWZDVQRWHGWREHLUULWDEOHDQGQXPEHGWRVHOI *XVWRNRQJGXPXUDDV

YHUEDOL]HG .D\D DNR QDQGLWR IRU VDIHNHHSLQJ %XW GLG QRW HODERUDWH

-XGJHPHQWDQGLQVLJKWWRPHQWDOLOOQHVVDUHSRRU

3DVW0HGLFDO+LVWRU\

7KHSDWLHQWUHDFKHGD6HFRQG\HDU&ROOHJHLQ8QLYHUVLW\RIWKH(DVWZLWK

DFRXUVHRI%60(+HDGPLWWHGIRUWKHILUVWWLPHDW1&0+ODVW$SULO

EHFDXVHRIXQXVXDOEHKDYLRU

8/6/2019 Paranoid Schizoprenia (Individual Case)

13/25

6LQFHKHVWDUWHGXVLQJGUXJV+HILUVWHQJDJHGWRDEXVHGVXEVWDQFHVOLNH$OFRKRO DQG&LJDUHWWHVDQG VXGGHQO\KH WRRN6KDEX WLPHVZHHN +HVWDUWHGWRVKRZXQXVXDOEHKDYLRUOLNHWDONLQJDORQHVKRXWLQJQDJPXPXUD(QWHUHGD FDUDQGFORVHG LWDQGFU\LQJZLWKRXWFDXVH+LVEURWKHUWRRNKLPWR1&0+EHFDXVH RIKLVEHKDYLRU 3ULRU WR DGPLVVLRQ KH ZDV UHKDELOLWDWHGDQG

VWD\HGDWWKH1%,7DJD\WD\IRUVHYHQPRQWKV+HFODLPVWKDWKHLVMREOHVVDQGXVLQJSURKLELWHGGUXJVZLWKRXW DQ\ UHDVRQ +H FRPSOHWHG DOO KLV9DFFLQDWLRQDQGZKHQHYHUKDGIHYHUFRXJKDQGFROGVKHWUHDWVKLPVHOIE\XVLQJRYHUWKHFRXQWHUGUXJV+HGLGQRWVXIIHUIURPDQ\VHULRXVLOOQHVVEHIRUHKHGRHVQRWKDYHDQ\DOOHUJ\WRDQ\NLQGRIIRRGDOVR

)DPLO\+HDOWKDQG3V\FKLDWULF+LVWRU\

7KH SDWLHQW KDV QR KLVWRU\ RI VHULRXV LOOQHVV OLNH &DQFHU $VWKPD'LDEHWHV 0HOOLWXV DQG +\SHUWHQVLRQ 7KH\ GRQW DOVR KDYH KLVWRU\ RI DQ\3V\FKLDWULF,OOQHVV

8/6/2019 Paranoid Schizoprenia (Individual Case)

14/25

Physical

Assessment

%RG\3DUWV 0HWKRG )LQGLQJV ,QWHUSUHWDWLRQ

6NLQ ,QVSHFWLRQ UDVKHV

3UXULWXVEUXLVHV

1RUPDO

8/6/2019 Paranoid Schizoprenia (Individual Case)

15/25

+HDG

6FDOS

+DLU

)DFH

,QVSHFWLRQ

,QVSHFWLRQ

,QVSHFWLRQ

GDQGUXII

GHIRUPLW\

OHVLRQV

%ODFNDQGJUD\KDLU

(YHQO\GLVWULEXWHG

1ROLFHSUHVHQW

F\DQRVLV

SDOORU

MDXPGLFH

HGHPD

1RUPDO

1RUPDO

1RUPDO

1RUPDO

1RUPDO

1RUPDO

1RUPDO

1RUPDO

1RUPDO

1RUPDO

(\HV

(\HEURZV

(\HOLG

(\HODVKHV

&RQMXQFWLYD

,QVSHFWLRQ

,QVSHFWLRQ

,QVSHFWLRQ

,QVSHFWLRQ

1RIODNHVQROHVLRQ

8SSHU OLG FRYHUV VPDOO

SRUWLRQ RI WKH LULV DQG

FRUQHD ORZHU OLG PDUJLQ

LV MXVW EHORZ WKH FRUQHD

DQGVFOHUD

(TXDOO\ GLVWULEXWHG ZLWK

EODFNH\HODVKHV

6\PPHWULFDO

3LQNLVK ZLWKRXW

LQIODPPDWLRQ

1RUPDO

1RUPDO

1RUPDO

1RUPDO

6FOHUD

(\HEDOOV

3XSLOV

,QVSHFWLRQ

,QVSHFWLRQ

,QVSHFWLRQ

$QLFWHULF

6\PPHWULFDO

,VRPHWULFPP

6PDOOURXQGVKDSHQR

OHVLRQV

1RUPDO

1RUPDO

1RUPDO

1RUPDO

(DUV

3LQQD

,QVSHFWLRQ

1ROHVLRQVV\PPHWULFDO

&OHDUZLWKPLQLPDO

1RUPDO

8/6/2019 Paranoid Schizoprenia (Individual Case)

16/25

([WHUQDO&DQDO ,QVSHFWLRQ FHUXPHQV\PPHWULFDO

1RUPDO

1RVH ,QVSHFWLRQ 1RGLVFKDUJHV

QDVDOIODULQJ

1RUPDO

1RUPDO

0RXWK

/LSV

7HHWK

*XP

,QVSHFWLRQ

,QVSHFWLRQ

,QVSHFWLRQ

'DUNEURZQLQFRORU

1ROHVLRQV

+DVFDYLW\

1XPEHURIWHHWKLV

LQFRPSOHWH

8SSHULQFLVRUVZHUH

UHSODFHGE\IDOVHWHHWK

3LQNLVKZLWKEODFNVWDLQ

1REOHHGLQJ

1ROHVLRQV

GWVPRNLQJ

1RUPDO

GWSRRUSURSHU

K\JLHQH

GWFDYLW\EXLOGXS

DQGSRRURUDO

K\JLHQH

GWFDYLW\EXLOGXS

DQGSRRURUDO

K\JLHQH

GWSRRURUDOK\JLHQH

1RUPDO

1RUPDO

1HFN ,QVSHFWLRQ 1RDFWLYHOHVLRQV

1RHQODUJHPHQWRI

WKU\URLGJODQG

1RUPDO

1RUPDO

6KRXOGHU ,QVSHFWLRQ 6\PPHWULFDO

$EOHWRPRYH

1RVZHOOLQJ

1RHGHPD

1RUPDO

1RUPDO

1RUPDO

1RUPDO

&KHVW ,QVSHFWLRQ 6\PPHWULFDO

55UDWHDWEUHDWKV

SHUPLQXWH(XSQHD

XVHRIDFFHVVRU\PXVFOHV

GHIRUPLWLHV

DEQRUPDOUHWUDFWLRQRI

LQWHUVSDFHVGXULQJ

1RUPDO

1RUPDO

1RUPDO

1RUPDO

8/6/2019 Paranoid Schizoprenia (Individual Case)

17/25

LQVSLUDWLRQ 1RUPDO

$EGRPHQ ,QVSHFWLRQ $EGRPLQDOGLVWHQVLRQ

EUXLVLQJ

OHVLRQV

SHWHFKLDH

1RPDO

1RUPDO

1RUPDO

1RUPDO

Musculoskeletal

System:

Upper

Extremities

Lower

Extremities

Nails

Inspection

Inspection

Inspection

(-)redness

(-)skin rashes

(-)subcutaneous

nodules

(-)cyst

(-)scars

(-)redness

(-)skin rashes

(-)subcutaneous

nodules

(-)cyst

(-)scars

Symmetrical

(-) deformities

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal

8/6/2019 Paranoid Schizoprenia (Individual Case)

18/25

Anatomy and

Physiology

8/6/2019 Paranoid Schizoprenia (Individual Case)

19/25

$1$720

8/6/2019 Paranoid Schizoprenia (Individual Case)

20/25

WKHIRXUWKYHQWULFOHE\WKHIRUDPHQRI0DJHQGLHDQGWKHWZRIRUDPHQVRI/XVND,W WKHQ IORZV LQWR WKH FLVWHPD PDJQD DQG ILQDOO\ LW FLUFXODWHV WR WKHVXEDUDFKQRLG VSDFH RI WKH VSLQDO FRUG EDWKLQJ ERWK WKH EUDLQ DQG WKH VSLQDOFRUG)OXLGLVDEVRUEHGE\WKHDUDFKQRLGPHPEUDQH

,,)XQFWLRQ

$&16

%UDLQ

D 7KH FHUHEUXP LV WKH FHQWHU IRU FRQVFLRXVQHVV WKRXJKW PHPRU\ VHQVRU\LQSXWDQGPRWRUDFWLYLW\LWFRQVLVWVRIWZRKHPLVSKHUHVOHIWDQGULJKWDQGIRXUOREHVHDFKZLWKVSHFLILFIXQFWLRQV

L 7KH IURQWDO OREH FRQWUROV YROXQWDU\ PXVFOH PRYHPHQWV DQG FRQWDLQV PRWRUDUHDVLQFOXGLQJWKHDUHDIRUVSHHFKLWDOVRFRQWDLQVWKHFHQWHUVIRUSHUVRQDOLW\EHKDYLRUDO DXWRQRPLF DQG LQWHOOHFWXDO IXQFWLRQV DQG WKRVH IRU HPRWLRQDO DQGFDUGLDFUHVSRQVHV

LL7KHWHPSRUDOOREHLVWKHFHQWHUIRUWDVWHKHDULQJDQGVPHOODQGLQWKHEUDLQVGRPLQDQWKHPLVSKHUHWKHFHQWHUIRULQWHUSUHWLQJVSRNHQODQJXDJH

8/6/2019 Paranoid Schizoprenia (Individual Case)

21/25

LLL 7KH SDULHWDO OREH FRRUGLQDWHV DQG LQWHUSUHWV VHQVRU\ LQIRUPDWLRQ IURP WKH

RSSRVLWHVLGHRIWKHERG\

LY7KHRFFLSLWDOOREHLQWHUSUHWVYLVXDOVWLPXOL

E7KHWKDODPXVIXUWKHURUJDQL]HVFHUHEUDOIXQFWLRQE\WUDQVPLWWLQJLPSXOVHVWRDQGIURPWKHFHUHEUXP,WDOVRLVUHVSRQVLEOHIRUSULPLWLYHHPRWLRQDOUHVSRQVHVVXFKDVIHDUDQGIRUGLVWLQJXLVKLQJEHWZHHQSOHDVDQWDQGXQSOHDVDQWVWLPXOL

F /\LQJ EHQHDWK WKH WKDODPXV WKH K\SRWKDODPXV LV DQ DXWRPDWLF FHQWHU WKDWUHJXODWHV EORRG SUHVVXUH WHPSHUDWXUH OLELGR DSSHWLWH EUHDWKLQJ VOHHSLQJ

SDWWHUQVDQGSHULSKHUDOQHUYHGLVFKDUJHVDVVRFLDWHGZLWKFHUWDLQEHKDYLRUDQGHPRWLRQDO H[SUHVVLRQ ,W DOVR KHOSV FRQWURO SLWXLWDU\ VHFUHWLRQ DQG VWUHVVUHDFWLRQV

G7KHFHUHEHOOXPRUKLQGEUDLQ FRQWUROVVPRRWKPXVFOH PRYHPHQWV FRRUGLQDWHV VHQVRU\LPSXOVHV ZLWK PXVFOH DFWLYLW\ DQG PDLQWDLQVPXVFOHWRQHDQGHTXLOLEULXP

H7KHEUDLQVWHPZKLFKLQFOXGHVWKHPHVHQFHSKDORQSRQVDQGPHGXOOD

REORQJDWDUHOD\VQHUYHLPSXOVHVEHWZHHQWKHEUDLQDQGVSLQDOFRUG

7KHVSLQDOFRUGIRUPVDWZRZD\FRQGXFWRUSDWKZD\EHWZHHQWKHEUDLQVWHPDQGWKH316,WLVDOVRWKHUHIOH[FHQWHUIRUPRWRUDFWLYLWLHVWKDWGRQRWLQYROYHEUDLQFRQWURO

8/6/2019 Paranoid Schizoprenia (Individual Case)

22/25

%7KH316FRQQHFWVWKH&16WRUHPRWHERG\UHJLRQVDQGFRQGXFWVVLJQDOVWRDQGIURPWKHVHDUHDVDQGWKHVSLQDOFRUG

& 7KH $16 UHJXODWHV ERG\ IXQFWLRQV VXFK DV GLJHVWLRQ UHVSLUDWLRQ DQGFDUGLRYDVFXODU IXQFWLRQ 6XSHUYLVHG FKLHIO\ E\ WKH K\SRWKDODPXV WKH $16

FRQWDLQVWZRGLYLVLRQV

7KH V\PSDWKHWLF QHUYRXV V\VWHP VHUYHV DV DQ HPHUJHQF\ SUHSDUHGQHVVV\VWHP WKH IOLJKWIRUILJKW UHVSRQVH 6\PSDWKHWLF LPSXOVHV LQFUHDVH JUHDWO\ZKHQWKHERG\LVXQGHUSK\VLFDORUHPRWLRQDOVWUHVVFDXVLQJEURQFKLROHGLODWLRQGLODWLRQ RI WKH KHDUW DQG YROXQWDU\PXVFOHEORRG YHVVHOV VWURQJHU DQG IDVWHUKHDUW FRQWUDFWLRQV SHULSKHUDO EORRGYHVVHO FRQVWULFWLRQ GHFUHDVHG SHULVWDOVLVDQG LQFUHDVHG SHUVSLUDWLRQ 6\PSDWKHWLF VWLPXOL DUH PHGLDWHG E\QRUHSLQHSKULQH

7KH SDUDV\PSDWKHWLF QHUYRXV V\VWHP LV WKH GRPLQDQW FRQWUROOHU IRU PRVWYLVFHUDOHIIHFWRUVIRUPRVWRI WKHWLPH3DUDV\PSDWKHWLFLPSXOVHVDUHPHGLDWHGE\DFHW\OFKROLQH

,,,'LIIHUHQFHVLQQHUYRXVV\VWHPUHVSRQVH7KHQHUYRXVV\VWHPLVRQHRIWKHILUVWV\VWHPVWRIRUPLQXWHUREXWRQHRIWKHODVWV\VWHPVWRGHYHORSGXULQJFKLOGKRRG

$$FFXUDF\DQGFRPSOHWHQHVVRIWKHQHXURORJLFDVVHVVPHQWLVOLPLWHGE\WKHFKLOGVGHYHORSPHQW

% 7KH FKLOGV EUDLQ FRQVWDQWO\ XQGHUJRHV RUJDQL]DWLRQ LQ IXQFWLRQ DQGP\HOLQL]DWLRQ 7KHUHIRUH WKH IXOO LPSDFW RI LQVXOW PD\ QRW EH LPPHGLDWHO\DSSDUHQWDQGPD\WDNH\HDUVWRPDQLIHVW

& 7KH SHULSKHUDO QHUYHV DUH QRW IXOO\ P\HOLQDWHG DW ELUWK $V P\HOLQL]DWLRQSURJUHVVHVVRGRHVWKHFKLOGVILQHPRWRUFRQWURODQGFRRUGLQDWLRQ

'(DUO\VLJQVRILQFUHDVHGLQWUDFUDQLDOSUHVVXUH,&3PD\QRWEHDSSDUHQWLQLQIDQWVEHFDXVHRSHQVXWXUHVDQGIRQWDQHOOHVFRPSHQVDWHWRDOLPLWHGH[WHQW

( 7KH GHYHORSPHQW RI KDQGHGQHVV EHIRUH \HDU RI DJH PD\ VLJQLI\ DQHXURORJLFOHVLRQ

)6HYHUDOSULPLWLYHUHIOH[HVDUHSUHVHQWDWELUWKGLVDSSHDULQJE\\HDURIDJH$EVHQFHSHUVLVWHQFHRUDV\PPHWU\RIUHIOH[HVPD\LQGLFDWHSDWKRORJ\

* 7KH VSLQDO FRUG HQGV DW LQ WKH QHRQDWH LQVWHDG RI // ZKHUH LWWHUPLQDWHVLQWKHDGXOW7KLVDIIHFWVWKHVLWHRIOXPEDUSXQFWXUH

+&KLOGUHQKDYHWRPORI&6)FRPSDUHGWRWRPOLQWKHDGXOW

8/6/2019 Paranoid Schizoprenia (Individual Case)

23/25

Psychopathology

8/6/2019 Paranoid Schizoprenia (Individual Case)

24/25

3V\FKRVRFLDOVWUHVVRUDQG

LQWHUSHUVRQDOHYHQWV

0RGLILDEOHIDFWRUV

/LIHVW\OH $OFRKRO 6PRNLQJ 6XEVWDQFH$EXVH

)DLOXUHLQGHYHORSPHQWRUDVXEVHTXHQWORVVRIEUDLQWLVVXH

'LPLQLVKHGRIJOXFRVH$QGR[\JHQLQIURQWDOFRUWLFDO

VWUXFWXUHVRIEUDLQ

'HFUHDVHEUDLQYROXPHDQGDEQRUPDOEUDLQIXQFWLRQLQ

IURQWDODQGWHPSRUDOOREH

7UDQVPLVVLRQRIVLJQDO

UHTXLUHVFRPSOH[VHULHV

RIELRFKHPLFDOHYHQWV

0DOIXQFWLRQLQJRI

WUDQVPLVVLRQLQHOHFWULFDO

LPSXOVHV

'UXJVLQFUHDVHGRSDPLQHUJLFV\VWHPDFWLYLW\

6WLPXODWHVGLIIHUHQW

IDFWRUV

1RQPRGLILDEOH

$JH

RQVHWRQPDOH

RQVHWRQIHPDOH

8/6/2019 Paranoid Schizoprenia (Individual Case)

25/25

$FWLRQVRI

GRSDPLQH

VHURWRQLQ

DFHW\FKROLQH

JOXPDWH

7KHVH6\PSWRPVFRPSOHWHV

+DOOXFLQDWLRQGHOXVLRQ

'LVRUJDQL]HGWKRXJKWVDQG%HKDYLRU

1HJDWLYHEHKDYLRU

3DUDQRLG6FKL]RSKUHQLD

,QGXFHGSDUDQRLG

SV\FKRWLFV\PSWRPV

'UXJEORFNVSRVWV\QDSWLFGRSDPLQH

UHFHSWRUV