UNIVERSITY OF CAGAYAN VALLEY

College of Health
College Avenue, Tuguegarao City 3500
Main Campus: Dr. Matias P. Perez Sr. Bldg
Telefax: (078) 844-8981

A CASE
PRESENTATION
ON
SCHIZOPHRENIA

Prepared By:

Belango, Jude

Buyugan, Jeli Anne

Daquioag, Joan

Gallego, Jilian Elaine C.

Guanzon, Francis Anne

Tactay, Romelyn
 Objectives

General Objectives:

At the end of this case presentation, we the presenter’s want to enhance the students’
knowledge with the regards to the patients general health and disease conditions ,mental
assessment, its psychopathology, nurse-patient interaction,treatment plan and medical regimen.
Furthermore, this case presentation intends to improve the student’s attitudes towards the nursing
intervention and management of the disease to become efficient nurses.

Specific Objectives:

 Give a brief introduction about Schizophrenia.

 Present the patient Demographic data and nursing health history
 Present the result of the mental assessment and process recording made on the client
 Trace the psychopathology of Schizophrenia
 Present the different laboratory result or examinations done to the client with its
interpretation
 Discuss the drug prescribed to the patient by a drug study
 Significance of the Study

SIGNIFICANCE OF THE STUDY

The study shall be beneficial to the following persons:

For the presenters:

This is significant for the presenters as they have the privilege to render care in the ward.
It will be serves as an avenue on enhancing thinking skills and applying their learned concept
and principles on Psychiatric Health Nursing.

For the audience:

The audience will be given the privilege to ask relevant questions and share their knowledge
about the said disorder not mentioned by the presenters for the purpose of enhancing this work.

For Clinical Instructors:

This presentation will provide a venue for the clinical instructors to assess the presenters
in terms of their knowledge, skills, and attitude and for them to give supplements regarding the
topic.
Introduction

Schizophrenia is a mental disorder characterized by disintegration of thought processes and of

emotional responsiveness.
 
It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or
disorganized speech and thinking, and it is accompanied by significant social or occupational
dysfunction. The onset of symptoms typically occurs in young adulthood, with a global lifetime
prevalence of about 0.3 – 0.7%. Diagnosis is based on observed behaviour and the patient's
reported experiences. Genetics, early environment, neurobiology, and psychological and social
processes appear to be important contributory factors; some recreational and prescription drugs
appear to cause or worsen symptoms. Current research is focused on the role of neurobiology,
although no single isolated organic cause has been found. The many possible combinations of
symptoms have triggered debate about whether the diagnosis represents a single disorder or a
number of discrete syndromes. Despite the etymology of the term from the Greek roots skhizein
(σχίζειν ,"to split") and phrēn, phren (φρήν, φρεν - ; "mind"), schizophrenia does not imply a
"split mind" and it is not the same as dissociative identity disorder — also known as "multiple
personality disorder" or "split personality" — a condition with which it is often confused in
public perception. The mainstay of treatment is antipsychotic medication, which primarily works
by suppressing dopamine activity. Psychotherapy and vocational and social rehabilitation are
also important. In more serious cases — where there is risk to self and others — involuntary
hospitalization may be necessary, although hospital stays are now shorter and less frequent than
they were. The disorder is thought mainly to affect cognition, but it also usually contributes to
chronic problems with behaviour and emotion. People with schizophrenia are likely to have
additional (co morbid)conditions, including major depression and anxiety disorders; the lifetime
occurrence of substance abuseis almost 50%. Social problems, such as long-termunemployment,
poverty and homelessness, are common. The average life expectancy of people with the disorder
is 12 to 15 years less than those without, the result of increased physical health problems and a
higher suicide rate (about 5%).B.
 
A combination of genetic and environmental factors plays an role in the development
of schizophrenia. People with a family history of schizophrenia who suffer a transient or self-
limiting psychosis have a 20 – 40% chance of being diagnosed one year later.

Genetic
Estimates of heritability vary because of the difficulty in separating the effects of genetics
and the environment. The greatest risk for developing schizophrenia is having a first-degree
relative with the disease (risk is 6.5%); more than 40% of monozygotic twins of those with
schizophrenia are also affected. It is likely that many genes are involved, each of small effect.
Many possible candidates have been proposed, including specific copy number variations,
NOTCH4and his tone protein loci. A number of genome-wide associations such as zinc finger
protein 804A have also been linked. There appears to be significant overlap in the genetics
of schizophrenia and bipolar disorder. Assuming a hereditary basis, one question from
evolutionary psychology is why genes that increase the likelihood of psychosis evolved,
assuming the condition would have been maladaptive from an evolutionary point of view. One
theory implicates genes involved in the evolution of language and human nature, but so far all
theories have been disproved or remain unsubstantiated.

Environment
Environmental factors associated with the development of schizophrenia include the
living environment, drug use and prenatal stressors. Parenting style seems to have no effect,
although people with supportive parents do better than those with critical parents. Living in an
urban environment during childhood or as an adult has consistently been found to increase the
risk of schizophrenia by a factor of two, even after taking into account drug use, ethnic group,
and size of social group. Other factors that play an important role include social isolation and
immigration related to social adversity, racial discrimination, family dysfunction,
unemployment, and poor housing conditions. Childhood experiences of abuse or trauma are risk
factors for a diagnosis of schizophrenia later in life.
 Substance abuse
A number of drugs have been associated with the development of schizophrenia
including cannabis, cocaine and amphetamines. About half of those with schizophrenia use drugs
and/or alcohol excessively. The role of cannabis could be causal, but other drugs may be used
only as coping mechanisms to deal with depression, anxiety, boredom, and loneliness. Cannabis
is associated with a dose-dependent increase in the risk of developing a psychotic disorder.
Frequent use has been found to double the risk of psychosis and
schizophrenia. Some research has however questioned the causality of this link. Amphetamine,
cocaine, and to a lesser extent alcohol, can result in psychosis that presents very similarly to
schizophrenia.

Prenatal
Factors such as hypoxia and infection, or stress and malnutrition in the mother during
fetal development, may result in a slight increase in the risk of schizophrenia later in life. People
diagnosed with schizophrenia are more likely to have been born in winter or spring (at least in
the northern hemisphere), which may be a result of increased rates of viral exposures in utero.
This difference is about 5 to 8%.C.

Incidence
Schizophrenia affects around 0.3 – 0.7% of people at some point in their life, or24 million
people worldwide as of 2011. It occurs 1.4 times more frequently in males than females and
typically appears earlier in men — the peak ages of onset are 20 – 28 years for males and 26 –
32 years for females. Onset in childhood is much rarer, as is onset in middle-or old age. Despite
the received wisdom that schizophrenia occurs at similar rates worldwide, its prevalence varies
across the world, within countries, and at the local and neighbourhood level. It causes
approximately 1% of worldwide disability adjusted life years. The rate of schizophrenia varies
up to threefold depending on how it is defined.
 
 PERSONAL DATA
PATIENT’S PROFILE

Name : Ms. MF
Age : 37 years old
Gender : Female
Date of Birth : July 14, 1980
Civil Status : Married
Address : Caliguian, Burgos ,Isabela
Nationality : Filipino
Religion : Roman Catholic
Educational Attainment :
Occupation : Housewife
Date of Admission : March 9, 2017
Time of Admission : 10:28 am
Mode of Arrival : via Police Patrol
Chief Complaint :
Ward : Psychiatric Ward
Admitting Diagnosis : Bipolar disorder
Final Diagnosis : Schizophrenia
Attending Physician : Dr. P.
Source of Information : Patient, chart
Mode of referral

The Provincial Warden of Isabela was directed to bring the patient at the Cagayan Valley
Medical Center for her psychiatric evaluation and or assessment.

Hence admitted in the Psychiatry Department exact 10:28 am escorted by his father and
the officials of BJMP.

History of Presenting Complaint

According to patient M.F record “hindi makatulog, nagmumura at kung ano gusto un
lang”. Patient M.F was apparently doing well as a housewife; she took care of her four children.
On March 3, 2017, her father and daughter receive a call from the private investigator in Burgos,
Isabela saying the patient M.F killed her three children aged, 3 and 2 years and a 4 months old
baby. She was initially brought and detained at Burgos Police Station. She was manifested to IRI
the following day. In jail, she was observed to be sleepy, restless and resistant to be brought
insist in the cell.

Current Neurology

Patient M.F verbalized that “parang may nagsasabi sa akin na totoo na parang hindi na
hindi ko sila nakikita. Katulad ng may nagsasabi sa akin na mahuhulog ang anak ko ay
pinupuntahan ko ang anak ko kaagad para maiwasan ang pangyayari na mahulog siya kung kaya
nasasalo ko ung anak ko.” and also she said “nahahandle ko pa ung mga naririnig ko at agkararag
nak tapos sabi ng anak ko; mama bakit ganun? natatakot na ako. It reflects profound fear and
anxiety along with the loss of the ability to tell what’s real and what’s not real. And she added
that before the incident “1 week before ung insidente ay may mga malalakas akong naririnig na
nagsasabi sa akin ng kung ano-ano, mga alas-tres hanggang ala-sais ng gabi nangyayari iyon.
Tinanong ko ang kasambahay ko na kung narinig niya iyon ay ang sabi ng kasambahay ko na
naririnig niya daw tapos nung araw na iyon ay umalis ang kasambahay ko kase natatakot na siya.
Nung araw na iyon ay mas lumalakas ang mga naririnig ko at nagkakasabay sabay lahat ng
naririnig ko. Nahihilo ako nung araw na iyo; basta hindi ko maipaliwanag. Ung time na
mangyari un ay maggagabi na.

Medical history
Patient MF has no history of hypertension, allergy of foods and has no trauma. Her OB score is
G5P4A1, her first child is aborted the second child(2010) is normal delivery and the third(2013),
fourth(2016) and fifth(2017) is caesarean.She has been under treatment from various psychiatrist
and has been taking different anti psychotic(Respiridon, haloperidol biperidine) and anti
histamine ( diphenhydramine). When she taking this medication she felt sleepy.

Social History

Patient MF is the eldest among the four (4) siblings. She described herself as the black
sheep of the family. She took Computer Secretarial at the age of 18 but she just finished one (1)
year and one (1) semester because she shifted to BS Nursing because it was the time Nursing is
in demand. During her forth (4) year, second (2) semester she stop from her study. Patient MF
worked for six (6) months as a branch manager in Makati. She was married to her first boyfriend
at the age of 30. Her husband is two (2) years older than her and he works as a seaman. They
have four (4) children and patient MF has a good relationship with the family of her husband and
also to their neighbours. Before giving birth to their fourth child, she has their nanny who
became their companion in the house. One (1) week before the incident the patient shared her
thoughts/feelings to her nanny and after that her nanny didn’t come back to report.

Pre morbid Personality

Patient MF has features (traits) of being true to herself. “Basta ako nagpapakatotoo ako sa
sarili ko at sakanila. Pag may ayaw ako, sinasabi ko agad ewan ko lang kung ganun din ba sila.
Syempre, di ko naman alam kung sila ba nagpapakatotoo sa akin. Pinapabayaan ko nalang sila.
Ako kasi yung taong nag oobserve lang ng mga attitude ng tao.” as verbalized by the patient.

PHYSICAL EXAMINATION

On Physical Examination patient MF is well good grooming and hygien. Her BP is 140/90,
temperature 36.6, PR 85bpm and RR is 23cpm.

MENTAL HEALTH ASSESSMENT

A. GENERAL APPEARANCE AND MOTOR BEHAVIOR

Appearance
During the nurse-patient interaction, the patient shows a good grooming and
hygiene and dressed-up appropriately. Most of the time, he exhibited appropriate facial
expressions but shows a blunted affect. He has a good eye contact and posture during
interactions.
Motor Activity
The patient doesn’t exhibit any tremors or any motor abnormalities.
Speech Patterns
The patient speaks spontaneously with moderate pacing and volume.
General Attitude
The patient is assertive and cooperative in the whole duration of the duty. She was
able to answer all questions asked and participative during the interaction. Upon
observation, the patient displays a paranoid behavior by verbalizing, “Ikaw, siya, kayong
lahat, sa akin, may ibig sabihin lahat ng galaw at sinasabi niyo.”
B. MOOD AND AFFECT
The patient’s mood during the nurse patient interaction is happy and she smiled
when asked how is she.
C. THOUGHT PROCESSES AND CONTENT
The patient speaks spontaneously with a normal pacing. The flow of ideas that the
patient verbalized are logical from one to next. She can easily catch up what the
interviewee mean and answers relevant to the questions.

D. SENSORIUM AND INTELLECTUAL PROCESSES

He is aware of himself, to where he is and to time, day, and year. She has an intact
memory of the past and event in her life such as, in which school did she attended her
college and how did she met her husband.

E. SENSORY-PERCEPTUAL ALTERATIONS
During the interview, she denies experiencing hallucination. According to the
patient, “ wala naman akong naririnig na iba ngayon pero may mga pumapasok
lang sa utak ko na si ganito ganyan. She also added that, before hospitalization,
“may pumapasok kasi sa utak ko, gaya ng tignan mo yung anak mo o puntahan
mo yung anak mo kasi baka mahulog.”
 F. JUDGEMENT AND INSIGHT
When given a scenario, she can make decisions on her own. According to her,
“lahat ng nasa paligid ko, konktado lahat.” She understand her case and why she was
admitted.

G. SELF-CONCEPT
According to the patient, she is fond of reading bible. When problems or crises
arise, she
prays and afterwards, she felt that her problem was solved. She described herself
as a simple and true person to herself and to her neighbors.

Diagnostic and Statistical Manual of Mental Disorders Text Revision

Axis I

 Schizophrenia

Axis II

 Paranoid

Axis III

 No current medical condition reported

Axis IV

 Problem with primary social support group

Conclusion:

Under the Axis I, the patient has been identified schizophrenia. In Axis II, the patient has a
+paranoia as charted last April 11, 2017. There was no current medical condition reported for
Axis III, in Axis IV, the psychosocial and environmental problem that the patient has is the
problem with primary social support group.

PSYCHOTHERAPIES IMPLEMENTED

Psychotherapy-treatment of mental disorders and behavioural disturbances using verbal and

nonverbal communication, as opposed to agents such as drugs or electric shock, to alter
maladaptive patterns of coping, relieve emotional disturbance, and encourage personality
growth. It is also called psychotherapeutics.

Individual Psychotherapy- Through one-on-one conversations, this approach focuses on the

patient’s current life and relationships within the family, social, and work.
 HEMATOLOGY RESULT

Name: MF Age: 37 Sex. Female Date of Birth: 07-14-1980

Diagnosis: Schizophrenia Physician: Dr. P. Ward: PSYCH

COMPLETE BLOOD RESULT REF. RANGE ANALYSIS

COUNT
Hemoglobin 126 g/L 120-160 NORMAL
Hematocrit 0.407 0.380-0.470 NORMAL
RBC Count 6.00 x10^ 12/L 4.50-6.00 NORMAL
Platelet Count 390 x 10^ 9/L 150-400 NORMAL
MCV 80.2 fL 80.0-100.0 NORMAL
MCH 26.8 pg 26.0-32.0 NORMAL
MCHC 329 g/L 320- 360 NORMAL
WBC Count 6.19 x 10^ 9/L 4.50-11.00 NORMAL

Differential Count RESULT REF. RANGE ANALYSIS

Nuetrophils 53.5 % 35.0-65.0 NORMAL
Lymphocytes 36.4% 20.0-40.0 NORMAL
Monocytes 6.4% 2.0- 8.0 NORMAL
Eosinophils 3.4% 0.0-5.0 NORMAL
Basophils 0.3% 0.0-1.0 NORMAL
 Urinalysis Result Form

Name: MF Hosp. No.:

Birthday: 07/14/80 Ward: PSYCHE WARD
Age: 36 y/o
Diagnosis: SCHIZOPHRENIA

PHYSICAL EXAMINATION
PARAMETERS RESULT REF. RANGE ANALYSIS
COLOR Straw NORMAL
TRANSPARENCY Clear NORMAL

CHEMICAL ANALYSIS
pH 6.5 NORMAL
Specific gravity 1.005 NORMAL
Protein Negative NORMAL
Glucose Negative NORMAL
Ketone Negative NORMAL
Blood Negative NORMAL
Bilirubin Negative NORMAL
Urobilinogen NORMAL NORMAL
Nitrite Negative NORMAL
Leukocytes Negative NORMAL

URINE FLOWCYTOMETRY
Wbc 1 /uL 0-17 NORMAL
Rbc 1 /uL 0-11 NORMAL
Epith. Cells 0 /uL 0-17 NORMAL
Hyaline cast 0 /uL 0-1 NORMAL
Bacteria 3 /uL 0-278 NORMAL
 SEROLOGY SECTION

Name: Mrs. M.F

Requesting Physician: Dr. P
Date: March 10, 2017
Diagnosis: Schizophrenia

TEST/S RESULT METHOD NORMAL RANGE ANALYSIS

TSH 1.3914 Uiu/Ml CHEMILUMINESCENCE 0.35-4.94 Uiu/ mL NORMAL
FT4 14.18 pmol/L CHEMILUMINESCENCE 9.00-19.00 pmol/ L NORMAL
FT3 3.99 pmol/L CHEMILUMINESCENCE 2.63-5.7 pmol/L NORMAL

Date and Time Reported: 3-10-2017

9:18AM
 CLINICAL CHEMISTRY

Name: Mrs. M.F

Requesting Physician: Dr. P
Date: March 10, 2017
Diagnosis: Schizophrenia
Specimen: Blood

TEST RESULT REFERENGE RANGE ANALYSIS

GLUCOSE 5.50 mmol/ L 3.90-6.10 mmol/ L NORMAL
BUN 5.4 mmol/ L 3.3-6.7 mmol/ L NORMAL
CREATININE 72 umol/ L 53-115 umol/ L NORMAL
TRIGLYCERIDES 1.41 mmol/ L 0.11-1.98 mmol/ L NORMAL
TOTAL CHOLESTEROL 5.9 mmol/ L UP TO 5.2 NORMAL
HIGH DENSITY 2.41 mmol/ L 0.85-1.9 mmol/ L NORMAL
LIPOPROTEIN
LOW DENSITY 2.84 mmol/ L <3.35 mmol/ L NORMAL
LIPOPROTEIN
ASPARATE 22 U/L 15-37 U/L NORMAL
AMINOTRANSFERASE
ALANINE 42 U/L 30-65 U/L NORMAL
AMINOTRANSFERASE

Date and Time Reported: 3-10-2017

6:30AM