Title: LOVE OVER LIMBS

I. Brief Summary Statement:

CF, a 30 year old female, single, Filipino, Roman Catholic, licensed nurse, third year

prosthetics student, from Baguio. She complaint about substance abuse while her father

complaint about her desire to die. She feels depressed due to amputation and after reading in the

magazine that patient with diabetes and connective tissue disease end up having both legs

amputed, became more depressed, and the lack of energy, being unable to enjoy the things she

used to do, difficulty sleeping, and feelings of hopelessness worsened.

II. Biopsychosocial causes

a. Biologic factors

1. Inherited tendency to develop the disease

(+) “Depression” / “Break down” (uncle, paternal side)

(+) ADHD (nephew)

2. Brain chemistry (abnormalities in the dopamine and glutamate system). The function

of too much dopamine in the mesolimbic and mesocortial pathways of the brain has

been given particular attention in research on the cause of schizophrenia. Serotonin,

GABA, Norepinehphrine, Glutamate, Acetylcholine may also have a role base on

recent studies.
3. Substance Abuse- BMC use of substances like alcohol, cigarettes and marijuana

contains dopamine agonists. Cannabis(marijuana) has been linked to schizophrenia

most frequently. According to National Institute of Mental Health (NIMH) Nicotine

is the most common drug abused by people with schizophrenia. As noted, BCM

Smoke, 1-6 sticks/day since 16 years old.

4. Irritability is one of the manifestation of high tendency to schizophrenia. It was

observed to BCM since childhood.

b. Psychological Factors-

1. Excessive Life Stress and Decompensating- Diathesis-Stress Model expressed

the tendency to be activated under condition of stress. Stress makes a person

with a predisposition for schizophrenia develop the disorder. The higher the

stress the higher the tendency to develop disorder. BCM had Precipitating events

that trigger her stress: First, she felt abandoned when her father left the family

because of other women. Second, her mother left abroad and they were just left

to her grandmother with her eldest sister as her surrogate mother. Third, her first

relationship broke up because of another woman. Fourth, she was left alone in her

house by her mother to move to her eldest sister’s house to take care of her

nephew. Living in a house with tension-filled due to conflicts which is beyond

her control intensify her depression. Learned helplessness is

2. Learned helplessness (Seligman and Maier). In the case of BCM, she has the

thought that she can never resolved their family issue, thus she became depress

because she thought that she can do nothing about the issue.
 3. Suppressing emotional response, such as fear or anger, increase sympathetic

nervous activity, which may contribute to psychopathology.

C. Family and other interpersonal factors

1. Early Psychic Trauma increased Vulnerability- deep hurts that the individuals

have suffered during his childhood or adolescence makes the individual tense and

bitter. He comes to realize the world as hostile, withdrawn from it and start

hallucinating.

2. Destructive Family Interaction – Suman (2016) stated in her study that

disintegrated family where couples lived in chronic discord where common

among families with schizophrenic offspring. In the case of BCM, her parents

separated due to other woman.

3. Faulty Learning- Conditioning – early psychic trauma and increased

vulnerability. BMC experienced a series of abandonment issues from her father,

mother, boyfriend and another from her mother when she was left alone in their

house. So, thinking that her mother’s house is the only thing she has, upon

knowing that it has been sold, it increased her depression.

D. Sociocultural and environmental factors

-predominantly lower social class. BCM, it was noted that due to financial difficulties,

her mother went abroad. Although, her family was categorized in middle-income

household.

-
 E. Strength and protective factors (strength of the patients)

-good family relationship and connectedness

-proper nurturing

-Increase self-worth

-Active social life

III. Diagnosis and Differential Diagnosis

Diagnosis- Schizophrenia

Based on the signs and symptoms presented by the patients, she is suffering from

schizophrenia. Schizophrenia is a psychotic problem which core feature is loss contact

with reality. In schizophrenia, psychotics symptoms are divided into positive and

negative and the patient presented both. She presented positive psychotic symptoms.

Positive symptoms are psychotic behaviors not generally seen in healthy people. For

BCM she experienced like hallucinations(hearing voices), paranoid delusions( thinking

that her neighbors were talking about her and that her family is conspiring against

her),and bizarre behaviors such as talking to rats and insects and avoid throwing trash due

to the belief that it had life in it.; BMC Showed negative psychotic symptoms as well

which associated with disruptions to normal emotions and behaviors. BCM stop taking a

bath that neglect her basic personal hygiene. This may make them seem lazy or

unwilling to help themselves. Subclinical symptoms were also observed like depression

and poor sleep. Suicidal thoughts are very common to schizophrenic and this happened to

BCM. According the DSM 5, the diagnostic criteria of schizophrenia must at least 2 of

the following: 1. delusion, 2. Hallucination, 3. Disorganized speech, 4. Grossly

 disorganized or catatonic behavior and 5. Negative symptoms which has the duration of

at least 1 month. At least one of these must 1, 2, or 3. For significant period of time

As the signs and symptoms presented by the patients, she was able to meet the necessary

criteria to qualify to the disorder.

IV. Problem List

- Schizophrenia

- Family unawareness to the issue

- Substance use

V. Management/Plan for Intervention

1. Medications-taking neuroleptic medications may help people with schizophrenia

to: -clarify thinking and perception of reality; -reduce hallucination and delusions

- Antipsychotics diminish psychotic symptom expression and reduce relapse

Rates

-Drug treatment must be consistent to be effective. Inconsistent dosage may

aggravate existing symptoms or create new ones.

2. Hospitalization

‣ Stabilization of medications

‣ Patients’ safety

3. Psychosocial interventions are also effective at preventing some of the side

effects of antipsychotic medications.

4. Psychosocial Treatment- Psychosocial treatments help individuals deal with the

everyday challenges of their illness, such as difficulty with communication, work,

and forming and keeping relationships. Learning and using coping skills to

address these problems helps people with schizophrenia to pursue their life goals.

Individuals who participate in regular psychosocial treatment are less likely to

have relapses or be hospitalized.

The engagement of family members and the wider community in providing support is

very important

5. Illness Management Skill

People with schizophrenia can take an active role in managing their own illness.

Once they learn basic facts about schizophrenia and its treatment, they can make

informed decisions about their care. If they know how to watch for the early warning

signs of relapse and make a plan to respond, patients can learn to prevent relapses.

Patients can also use coping skills to deal with persistent symptoms.

6. Family Education and Support

Family education and support teaches relatives or interested individuals about

schizophrenia and its treatment and strengthens their capacity to aid in their loved

one’s recovery.

7. Family Therapy- can help patient and family understand the disease and

symptoms triggers. This also provides resources for dealing with emotional and

practical challenges.

8. Cognitive Behavioral Therapy

 Cognitive behavioral therapy (CBT) is a type of psychotherapy that

focuses on changing unhelpful patterns of thinking and behavior. The CBT

therapist teaches people with schizophrenia how to test the reality of their

thoughts and perceptions, how to “not listen” to their voices, and how to manage

their symptoms overall. CBT can help reduce the severity of symptoms and

reduce the risk of relapse.

9. Social Skills Training- can occur in hospital or community settings. Teaches the

person with schizophrenia social, self-care, and vocational skills.

VI. Ethics (Discuss possible ethical issues applicable to the case

1. Informed Consent- schizophrenia is a severe mental illness that is frequently

accompanied by neuropsychological deficits. These impairments, as well as

psychotic symptoms and lack of insight, can affect patient’s abilities to make fully

informed decisions about her own care. Ensuring that consent for treatment is

informed, voluntary, and competent can thus become a more difficult endeavor.

2. Exclusion of suicidal patients from research on schizophrenia. Suicide and

attempted suicide occur at high rate in individual with schizophrenia. Yet most

basic biological and intervention research on schizophrenia excludes those at risk

for suicide.

3. Early intervention with prodromal patients

4. Medication withdrawal and medication-free protocols

5. Genetic research on schizophrenia

Reference:

Luhrmann, T. M., & Marrow, J. (2016). Our Most Troubling Madness : Case Studies in

Schizophrenia Across Cultures. Oakland, California: University of California Press.

Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1132450&site=ehos

t-live

World Mental Health Day (2014). Living with Schizophrenia. Retrieved from

https://www.who.int/mental_health/world-mental-health-day/paper_wfmh.pdf

World health Organization (2018). Schizophrenia. Retrieved from:

http://apps.who.int/mediacentre/factsheets/fs397/en/index.html

National Mental Health. Schizophrenia. Retrieved from

https://www.nimh.nih.gov/health/publications/schizophrenia/nih_15-3517_155600.pdf

Suman, S. (2016). Psychological and Interpersonal factors in Schizophrenia. Retrieved

from: http://www.mindauthor.com/psychology/psychological-interpersonal-factors-

schizophrenia/
Dunn LB.(2007). Ethical issues in schizophrenia: considerations for treatment and

research. Retrieved from: https://www.ncbi.nlm.nih.gov