Republic of the Philippines

Cebu Normal University Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254 4837
Email: cn@cnu.edu.ph
Website: www.cnu.edu.ph

PSYCHOGENESIS OF A CASE
Formulation Guide

• Psychogenesis of Chronic Paranoid Schizophrenia with Acute Exacerbation using the Biomedical Model

Contributing Factors

Biomedical Model Diathesis-Stress Model Vulnerability Stress Model Psychoanalytic Theory

• Neurobiological Factors • Psychological Factors:

(Neurotransmitter
Dysregulation)
: Excess of Dopamine
: Reduced Glutamate in the
Cerebrospinal Fluid
: Levels of Gamma Aminobutyric
Acid (GABA) expression in
prefrontal cortex
: Increased levels of serotonin
: Decreased levels
norepinephrine
: History of Drug Misuse (Teenage
Years): Cannabis, Cocaine,
Mescaline, and Nicotine
(Psychostimulants)
: Repetitive behaviors and interests
: Unusual obsessions • Genetic Factors • Psychosexual Factor
: Excessive need to keep things order and : Family history of Menta
organized Disorders, including
: Increased childhood stress and anxiety due to
: Primary Narcissism secondary to
Schizophrenia Ego Disintegration with regression
excessive thoughts of danger and fear when left
alone and fixation in the oral phase (early
: Inability to control basic drives • Environmental Factors: stage of psychosexual
: Stressful academic pressure
: Poor social skills and difficulty relating with others development)
: Having a weak and fragile ego
: Unhealthy eating habits due to low self-esteem, : Parental Denial of Early Signs
disturbed body image, and pressure to maintain with limited ability to contain the
and Symptoms of Schizophrenia
of weight during adolescence
id’s desires and can be broken
• Precipitating Psychological Factors: : Academic Pressure and Peer
apart by its attempt to contain the
: Psychological Trauma of Exacerbated Psychosis Pressure
id, leaving the id in overall control
pre- and post-diagnosis and Excessive Physical : Urbanicity: Living in an urban
Restraints and isolation during hospital admission of the psyche.
area and a fast-paced lifestyle
: History of non-compliance to medications

Positive Symptoms
Client-Specific Signs and Symptoms
: Hallucinations
: Delusions
: Disordered Thinking (Psychosis:
Losing Touch with Reality)
: Suspiciousness
: Disorganized Thoughts and Speech
: Unusual motor behavior: Agitation,
Rocking, and Pacing
: Anxiety
: Thought Disorders and Difficulty in
Concentrating
: Aggressiveness and Hostility
: Depersonalization and Derealization
Other signs and symptoms:
: Inappropriate affect
: Somatic Preoccupations
: Catatonic Behavior
Signs and Symptoms
Negative Symptoms Other symptoms:
Client-Specific Signs and Symptoms Psychosocial and Psychosexual
Symptoms
: Depressed Mood: Losing interest and
motivation : Loss of contact with reality with inability
: Trouble with Speech to distinguish between themselves and
: Lack of Pleasure others, their desires and fantasies and
: Diminished emotional expression and reality
affective flattening : Regression to primary narcissism with
: Social withdrawal and Isolation inability to organize own behavior and
: Attention deficit and lack of distinguish imaginations from reality
concentration
: Intellectual Impairment
: Struggling with the basics of daily life: Cognitive Symptoms
: Poor grooming and selfcare
: No follow-through with difficulty staying : Disorganized thinking and Poor
on schedule or finishing what they concentration
started : Attention Disturbances
: Difficulty initiating tasks
Other signs and symptoms: : Lack of planning and problem-solving
skills
: Motor Retardation : Impaired judgment and memory
: Apathy impairment
: Lack of thoughts : Illogical/ Concrete thinking
: Blunted affect : Difficulty expressing and integrating
: Alogia thoughts, feelings, and behavior
: Avolition : Disturbances in executive function
: Anhedonia : Indecisiveness
: Asociality : Anosognosia
Social and Occupational Symptoms
Client-specific signs and symptoms:
Disturbances in sense of identity and
 Social and Occupational Symptoms

Legend Client-specific signs and symptoms:

: Disturbances in sense of identity and
Contributing Factors self-image, work/activity, interpersonal
relationships, and self-care
Theory
: Social Withdrawal and Isolation
Signs and Symptoms : Diminished quality of life with social and
occupational limitations secondary to
Positive Symptoms acute exacerbations of positive
symptoms
Negative Symptoms : Comorbidities: Clinical Depression,
OCD, and Anxiety and Panic Disorder
Psychosocial and
Psychosexual Symptoms Others:
: Mortality
Cognitive Symptoms

Social and Occupational Mood Symptoms

Symptoms
Client-specific symptoms:
Mood Symptoms : Depression: Feeling empty, sad,
worthless, and hopeless
: Suicidality
: Manic Mood: characterized anger,
aggressiveness, and hostility
: Labile Mood

Other:
: Dysphoria
 REFERENCES

Americal Psychiatric Association. (2013). Diagnostic and Statistical Manual of Menta Disorders: DSM-5. 5th Edition. Washington, DC: Americal Psychiatric Publishing.

Frankenbur, F. R. (2021). Schizophrenia. Retrieved on March 22, 2023 from https://emedicine.medscape.com/article/288259-overview

Hany, M., Rehman, B., Azhar, Y., and Chapman, J. (2023, January 30. Schizophrenia. Retrieved on March 22, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK539864/

Jones, S. R., & Fernyhough, C. (2007). A new look at the neural diathesis--stress model of schizophrenia: the primacy of social-evaluative and uncontrollable situations.
Schizophrenia bulletin, 33(5), 1171–1177. https://doi.org/10.1093/schbul/sbl058

Legg, T.J. (2018, September 3). What is Paranoid Schizophrenia?. Retrieved on March 22, 2023 from https://www.healthline.com/health/schizophrenia/paranoid-
schizophrenia

Rupani, K. and De Sousa, A. (2017). Psychodynamic Theories of Schizophrenia - Revisited. Retrieved on March 22, 2023 from
https://indianmentalhealth.com/pdf/2017/vol4-issue1/Review_Article_1.pdf

Singh, N. (2020). Psychological Theories of Schizophrenia. Retrieved on March 22, 2023 from https://magadhmahilacollege.org/wp-content/uploads/2020/04/theories-of-
schizophrenia.pdf

Videbeck, S.L. (2011). Psychiatric-Mental Health Nursing. 5th Edition. Philadelphia, USA: Wolters Kluwer | Lippincott Williams & Wilkins.