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SCHIZOAFFECTIVE DISORDER: CASE STUDY

Schizoaffective Disorder: Case Study

Paris Bumgardner

November 9, 2022

Mrs. Mackenzie Kriss, MSN, APRN, PMHNP-BC

NURS 4842L Mental Health Nursing Laboratory

Youngstown State University

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SCHIZOAFFECTIVE DISORDER: CASE STUDY

Abstract

JP is a 33-year-old male patient who was admitted to the inpatient psychiatric due to being pink

slipped and having paranoid delusions. He has a mental health diagnosis of schizoaffective

disorder and is experiencing paranoid delusions and some visual hallucinations. JP is currently

taking medications for his psychiatric symptoms but it is tough to say how he is doing as far as

symptom improvement. He is able to hide his delusions very well and the main reason that it is

known that he is still having delusions is from collateral information. Nursing care for this

patient includes building trust and having JP verbalize recognition of his delusions.
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SCHIZOAFFECTIVE DISORDER: CASE STUDY

Objective Data

Patient identifier JP

Age 33

Sex Male

Date of admission November 03, 2022

Date of care November 08, 2022

Psychiatric diagnosis Schizoaffective disorder

Other diagnoses ADHD, OCD

Behaviors on admission JP was having persecutory delusions and had the belief that his

electronic devises were hacked and someone was trying to take control of him through his phone.

He took the devises out of his house and drove off with the intent to destroy them. He had stated

that while driving a truck was shooting flames at him. He turned his phone off, due to his

paranoia, and family became worried, so they called the police and that is when an ambulance

brought him into the emergency department and he was pink slipped. He stated to staff in the

emergency department that he is a member of the secret service. JP’s girlfriend stated that she

had found his Adderall prescription empty which was filled just seven days prior.

Behaviors on day of care JP was very calm and spoke clearly and logically. He appeared well

groomed and he had taken a shower on the day of care. He stated that it he is in the hospital

because it was all a big misunderstanding and was confused on how he even got pink slipped in

the first place. JP stated that a part of the reason that he was pink slipped was because of the

psychiatrist that he sees for his Adderall prescription, who he sees once every 3 months, stated

that he was not at his baseline mentally. When asked questions about the events leading to his
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SCHIZOAFFECTIVE DISORDER: CASE STUDY
admission he was able to provide a very logical and believable story as to what had really

happened, according to him. For example when the “truck shooting flames” was brought into

question he said that his check engine light came on and the vehicle had stated “engine

combustible” and he was scared that his own truck would catch fire. He also said that he turned

his phone off because of the hack which he explained was sending messages to people and he

didn’t want any of his friends or family‘s phones to get hacked as well. He denied ever thinking

that his phone would be able to control him. He displayed no frustration or anger for being in

there at just wanted to sort things out so that he could head back home. The interview was

shorter than typical because he denied having any psychological symptoms at all and he

described having good copping strategies.

Safety and security measures JP was kept on a locked psychiatric unit and was not permitted

off because he was seen as a threat to himself. The staff was present at all times and he was

monitored by them. The main goal for JP was to get his mood stabilized and to get him out of his

psychosis. Trying to manage his delusions and reorient him to reality was difficult due to him

denying any symptoms at all. Collateral information from JP’s mother showed that he was still

having paranoid delusions.

Laboratory results

Lab Value Result

N - normal
L – low
Potassium 3.8(N)

Sodium 137(N)

Glucose 94(N)

A1C 5.1(N)

BUN 17(N)
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SCHIZOAFFECTIVE DISORDER: CASE STUDY

Creatinine 1.17(N)
RBC 5.44(N)

Hemoglobin 16.2(N)

Hematocrit 46.5 (N)

WBC 8.1(N)

AST 18(N)

ALT 23(N)

Depakote 30.2(L)

TSH 0.98(N)

T4 0.96(N)

Drug +Amphetamines
Toxicology

UA Alcohol <3
Level

QTC 421(n)

JP’s depakote levels are low because. He just started taking this med while on the unit. He was

not perceived it at home. He was prescribed Adderall which explains his positive amphetamine

result.

Psychiatric medications

Generic Trade Name Class/Category Dose/Frequency Reasoning

Name

Divalproex Depakote Anticonvulsants  500mg BID, PO Mood stabilization

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SCHIZOAFFECTIVE DISORDER: CASE STUDY

Risperidone Risperdal Antipsychotic 1mg BID, PO Psychosis

Trazodone Molipaxin  Antidepressant 50 mg QHS PRN, Sleep

PO

Summary of psychiatric diagnosis

Schizoaffective disorder is a serious mental health diagnosis that has characteristics of

schizophrenia, like hallucinations and delusions, as well as mood disturbances such as depression

and mania. If left untreated patients may have issues maintaining a job, going to school, being in

social situations, and can cause them to be lonely.

According to the DSM-5, the diagnostic criteria of schizoaffective disorder requires the

following:

A. An uninterrupted period of illness during which there is a major mood episode (major

depressive or manic) concurrent with Criterion A of schizophrenia.

Note: The major depressive episode must include Criterion A1 : Depressed mood.

B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood

episode (depressive or manic) during the lifetime duration of the illness.

C. Symptoms that meet criteria for a major mood episode are present for the majority of

the total duration of the active and residual portions of the illness.
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SCHIZOAFFECTIVE DISORDER: CASE STUDY
D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a

medication) or another medical condition.

(American Psychiatric Association 2017).

Upon assessment of JP’s chart he was admitted and initially diagnosed with acute

psychosis. This can be defined as “the organic of symptoms is indicated by a rapidly fluctuating

course, the presence of visual hallucinations and absence of mood congruent delusions”

(Saldanha 2013). The possible organic cause that can this original diagnosis can be brought back

to is the fact that JP took his entire Adderall prescription within seven days. Although Adderall is

a stimulant it does have the paradoxical effect of focus and relaxation in an already hyper and

non-focused patient, but in high doses, the effects are no longer paradoxical. High doses of

stimulants, like amphetamines, can cause restlessness, anxiety, and possibly hallucinations. This

does explain the report from JP’s girlfriend that he was awake for days. This was the first

encounter where JP was found to have any psychotic symptoms and is psychiatrist stated that he

is being treated for OCD, ADHA, and anxiety, but nothing psychosis related. It is stated by a

peer-reviewed article on cureus.com that “subsequent excessive dopamine release from

amphetamine might make them prone to developing psychotic disorders”, and “Adderall, when

used above the therapeutic dosage, can lead to psychotic episodes that may persist” (Desai 2022).

With the seeming uncertainty of JP’s exact diagnosis it seems that schizoaffective disorder was

settled on because “SAD often has been used as a diagnosis for individuals having an admixture

of mood and psychotic symptoms whose diagnosis is uncertain” (Miller 2019).

Identify the stressors and behaviors that precipitated current hospitalization

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Prior to JP’s admission onto the unit he has having relationship troubles with his

girlfriend of ten years. He lives with her in a house they own, but with all of the stressors of the

relationship and his eventual psychosis, he had slept in his truck the night prior to his admission

to Trumbull Regional Medical Center. During the interview conducted on November 9, 2022 he

had stated that his family had recently become divided. JP said that social media and politics

drove the family apart. He described his relationship with mom as not very good and he does not

know his dad. Finances are another stressor for JP because he is on disability and cannot work

due to his cluster headaches. Lastly his relationship with his girlfriend has been struggling and

they have been in couples counciling trying to figure it all out.

Patient and family history of mental illness

JP has a history of mental illness, he has been diagnosed with OCD, ADHD, and anxiety.

As previously stated he takes Adderall for his ADHD, and he was on antidepressants for

treatment of his OCD and anxiety but he was unable to recall what it was that he was taking. He

stopped taking his antidepressants because he did not like they way they made him feel.

Although it can take four to six weeks for those types of meds to work, he may not have given it

enough time to become therapeutic. Prior to being pink slipped and being brought Trumbull

Regional Medical Center, JP has had no previous inpatient psychiatric hospitalizations. As for

his family he denies having any family members with mental illness and he also denied that any

family members had ever committed suicide.

Psychiatric evidence based nursing care provided

Upon admission to the psychiatric unit, JP started receiving nursing care from the unit

staff. Prior to interview conducted on November 9, 2022 JP attended a group therapy. The goal
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of this group therapy session was to educate the patients about bipolar disorder. JP did not seem

very interested in the group and he did not have anything to say when most of the other patients

chimed in and discussed their thoughts, he remained silent. Another form of care provided to JP

was cognitive based therapy(CBT). There are several strategies involved in CBT, one of which

would be very effective for JP is, “learning to recognize one’s distortions in thinking that are

creating problems, and then to reevaluate them in light of reality” (American Psychiatric

Association 2017).

Ethnic, spiritual, cultural, and socioeconomic influences

JP described that he was involved in Christianity and went to church on occasion as a

child. He stated that now he does not believe in Christianity anymore and sees himself as more

agnostic. JP stated that he does. Not look to any spiritual higher power to cope. JP is a caucasian

male and said that he does not have any kind of cultural influences surrounding his ethnicity.

Socioeconomically JP states that he and his girlfriend do struggle with finances due to his

disability of cluster headaches and not making a livable wage.

Evaluation of patient outcomes

Patients with schizoaffective disorder can have delusions, hallucinations, mania, and

depression which need managed to put them on the road towards recovery. It is a worry that

these patients may harm themselves or others because of their disturbed realities. The goal go

these patients to respond to treatment well and according to the Mayo Clinic, “people with

schizoaffective disorder generally respond best to a combination of medications, psychotherapy

and life skills training” (Mayo 2019). Typical medication use consists of antipsychotics, mood

stabalizers, and anti depressants. JP was taking depakote for mood, risperidone (antipsychotic),
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and trazodone (antidepressant) for sleep. He did state that he has no problem taking the

medications that they prescribe to him. Due to JP’s statements denying ever having any

psychological disturbances, it is difficult to track his progress since he was admitted to the unit.

Plans for discharge

JP’s plan for discharge is to go back to his home with his girlfriend and work on their

relationship and he want to see his sick cat. He never admitted to having any kind of

hallucinations or delusions but says that he will be compliant and take whatever medications that

they give to him. When JP was asked if he would follow up with his psychiatrist he said that he

would do what ever the staff recommended that he do. Social workers did connect JP to

community mental health resources.

Prioritized nursing diagnosis

i. Risk for suicide

ii. Risk for violence

iii. Altered thought process

iv. Ineffective coping

v. Anxiety

List of potential nursing diagnosis

i. Disturb sensory perception as evidenced by hallucinations

ii. Interrupted family process as evidenced by unstable relationships

iii. Disturbed thought process as evidenced by delusional thinking

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Conclusion

Schizoaffective disorder is a serious mental health diagnosis that has characteristics of

schizophrenia, like hallucinations and delusions, as well as mood disturbances such as depression

and mania. 33 year old patient JP had no prior psychotic features, only ADHD, OCD, and

anxiety. It appears to be likely that his acute psychosis and eventual diagnosis of schizoaffective

disorder, was brought on my his overdose of his Adderall prescription. It is unknown whether or

not these symptoms will subside. According to Videbeck one third of patient will see a complete

improvement, the second third will achieve remission, and the final third will not achieve any

improvement, time will tell how JP recovers. JP states that he will be compliant on his

medications and will follow up.

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References

American Psychiatric Association. (2017). Schizoaffective Disorder. In Diagnostic and

statistical manual of mental disorders: DSM-5 (pp. 105–106). essay. 

American Psychological Association. (2017). What is cognitive behavioral therapy? American

Psychological Association. Retrieved November 19, 2022, from https://www.apa.org/ptsd-
guideline/patients-and-families/cognitive-behavioral

Desai, S., Santos, E. L., Toma, A. E., Henriquez, A. A., & Anwar, A. (2022, July 26). Adderall-
induced persistent psychotic disorder managed with long-acting injectable haloperidol
decanoate. Cureus. Retrieved November 17, 2022, from
https://www.cureus.com/articles/104572-adderall-induced-persistent-psychotic-disorder-
managed-with-long-acting-injectable-haloperidol-decanoate 

Mayo Foundation for Medical Education and Research. (2019, November 9). Schizoaffective
disorder. Mayo Clinic. Retrieved November 19, 2022, from
https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/diagnosis-
treatment/drc-20354509

Miller, J., & Black, D. (2019, February 1). Schizoaffective disorder: A review. Europe PMC.
Retrieved November 17, 2022, from https://europepmc.org/article/med/30699217

Saldanha, D., Menon, P., Chaudari, B., Bhattacharya, L., & Guliani, S. (2013, July). Acute
psychosis: A neuropsychiatric dilemma. Industrial psychiatry journal. Retrieved November
17, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085811/

Videbeck, S. L. (2022). Psychiatric-Mental Health Nursing. Lippincott Williams & Wilkins.