Tacalan,John Vincent C.

Level 3 BS Nursing

CASE STUDY ON SCHIZOPHRENIA

You are working on an inpatient psychiatric unit and are to do an initial assessment on Brad P.,
who has just been admitted. He has a diagnosis of schizophrenia, paranoid type. He is 22 years old and
has been
attending the local university and living at home with his parents. He has always been a good student and
has been active socially. Last semester, his grades began declining, and he became very withdrawn. He
spends most of his time alone in his room. His grooming has deteriorated; he can go days without
bathing.

For several weeks before admission, he insisted on keeping all of the blinds and curtains in the
house closed. For the past 2 days, he has refused to eat, saying, “They have contaminated the food.” As
you approach Brad P., you note that he appears to be carrying on a conversation with someone, but there
is no one there. When you talk to him, he looks around and answers in a whisper but gives you little
information. He states, “They are watching me and told me not to cooperate.”

1. Explain what a “negative” symptom of schizophrenia is, and identify at least three negative symptoms
of schizophrenia that Brad P. might be experiencing.
ANSWER: Withdrawing from social situations, struggling with the basic aspects of daily life such
as not bathing, and extreme isolation.
Lack of motivation
Lack of communication
Reduced speech (alogia)

2. Explain what a “positive” symptom of schizophrenia is, and identify at least two positive
symptoms of schizophrenia that Brad P. might be experiencing.
ANSWER: Positive symptoms are changes in thoughts and feelings that are “added on” to a
person's experiences (e.g., paranoia or hearing voices).
Hallucinations & Paranoid Delusions

3. Give the definition of each of the following types of delusional thinking:

ANSWER:
A.Thought broadcasting- A condition that causes a person to believe that their thoughts can be heard or
known by people around them.
B.Thought insertion- Feelings as though one's thoughts are not their own but are someone else's and
were inserted into their mind.
C.Grandeur- A false or unusual belief about one's greatness. They may believe they are immortal,
famous, etc.
D.Ideas of reference- A perception that irrelevant, unrelated things in the world are referring to them
directly or have a personal significance.
E.Persecution- Persecutory delusions are when the person believes they are being persecuted despite
proof. Paranoia is similar and can include delusions of unwarranted jealousy, exaggerated self-
importance, etc.
F.Somatic delusions- A false belief that one's bodily function or appearance is grossly abnormal
4. What symptoms indicate that Brad P. has paranoid schizophrenia?
ANSWER: Paranoid Delusions - Believes food was contaminated and believes that he is being watched.

5. Why is it important to know Brad P.'s history before he is diagnosed with schizophrenia?
ANSWER:
Other factors or conditions can cause psychotic symptoms that are common with
schizophrenia. Drug use, certain medical or neurologic conditions, and alcohol withdrawal may
cause psychosis. It is common for people with schizophrenia to experience deterioration in
their level of functioning for up to a year before developing frank psychotic symptoms

6. What diagnostic screening is important in evaluating Brad P.?

ANSWER:
Family history: medical, neurologic, psychiatric
Mental status examination
Physical examination
Blood and urine drug screen; blood alcohol level
Complete blood count
Complete metabolic panel
Urinalysis

7. What are the most important initial interventions in treating Brad P.?
ANSWER:
Protect him from harm to self and others; create a supportive, structured environment
Engage in supportive and directive communications
Establish a relationship with the patient in which he feels safe
Perform acute symptom stabilization psychopharmacologic treatment

CASE STUDY PROGRESS

After a full mental status assessment, the psychiatrist orders close monitoring in the inpatient
setting and an antipsychotic medication.

8. Which class of antipsychotic medications is considered first-line therapy for schizophrenia?

ANSWER: Second-generation antipsychotics (SGAs) with an exception of clozapine. Clozapine is
not recommended because of its risk of agranulocytosis

9. Brad P. will need to be monitored closely. How will this be done?

ANSWER:
He can be guided to stay in community areas rather than in his room to be able to observe his
behaviors and whether he is improving or not.
Records of his signs and self-reports of symptoms can be kept daily to see if the medications are
working.
Labs would need to be drawn to monitor if the drug is within therapeutic range.
Many antipsychotics cause metabolic side effects so BMI, weight, waist circumference, and
nutritional lab values should be monitored.
10. What types of psychosocial treatments may be used to treat Brad P.'s schizophrenia?
ANSWER:
Cognitive Behavioral Therapy (CBT)
Social Skills Training
Social Support Groups
Psychotherapy
Cognitive Remediation
Individual therapy
Milieu therapy, family therapy, group therapy, recreational therapy, vocational therapy

CASE STUDY PROGRESS

Brad P. is started on olanzapine (Zyprexa). You inform Brad P. and his family about the common
side effects of the typical antipsychotics.
11. What are the common side effects of atypical antipsychotics such as olanzapine (Zyprexa)?
(Select all that apply.)
A. Tardive dyskinesia
B. Drowsiness
C. Dry mouth
D. Palpitations
E. Nausea
F. Weight gain

CASE STUDY PROGRESS

As you go in to give Brad P. his medication, he speaks to you in fragmented sentences. “Is that a
bird? The little flowers jump up and down. What says the moon?” Before you can say anything, he asks,
“Do you see that bird over my bed? She is telling me not to leave this room. If I move she will swoop
down and try to peck at my eyes. Be careful!”

12. Is he having an illusion or a hallucination? Explain your answer.

ANSWER:
He is experiencing both visual and auditory hallucinations. Hallucinations are a sensory
experience that the client is experiencing as he stated that “They are watching me and told me
not to cooperate.” The client appears to be carrying on a conversation with someone, but there
is no one there. Hallucinations are a perception not based on sensory input, whereas illusions
are a misinterpretation of a correct sensory input.

13. How will you respond?

ANSWER:
Respond in a calm, supportive manner. I will respond with, "Don't worry. I'm here. I'll protect
you. I'll take care of you."
I will encourage him to tell me more about what he is seeing.
I will tell the patient that the voice he is hearing is part of his illness and it can't hurt him.
I’ll try to turn the person's attention to music, conversation or activities that he will enjoy.
Be honest. For example, I will ask him "Do you see him?" and tell him that, "I know you see
something, but I don't see it." This way, we’re denying what the person sees or hears and avoid
an argument.
CASE STUDY OUTCOME
After 2 weeks of inpatient therapy, Brad P. is discharged back home to his parents and is enrolled
in a day treatment program. He hopes to move to a halfway house in the community.