Hawler Medical University

College of Nursing
Nursing Department
psychiatric clinic unit
2021-2022

schizophrenia
Prepared By: Supervised By: Dr. muslih
Abdulmalik fareeq saber
Case study project
 Outlines:
• Patients own speech
• Biographical data
• Source of referral
• Chief complain
• History of present illness.
• History of previous illness.
• Personal life history
• Family history
• Premorbid history
• Medical diagnosis
• Mental state examination
• Cognitive function
• Signs and symptoms
• Patients treatment
• Three nursing process
• Discharge planing
• Reference
 patients own speech
• My name is -------------------------, I have been admitted to chronic ward of Jmhury hospital three
times .I had a car accident in 2003 and I became unconscious immediately and then I visited Dr.
Hadnan Abdulwahabs clinic directly who is not alive now, and I was taking medications in that time
that was given by him to me and he asked me if I fainted after the accident or not ,I don`t remember
the name of those drugs. In Addition I have been admitted to chronic section 3 times in a row , first
time that was because of we had about 10.000$ at home in 2016 and I used this money for buying a
Taxi without my family`s permission and next they were angry at me and took the car back to the
owner and in response to that condition I was so aggressive and decided to go and buy a weapon
and I went a weapon shop but I regretted of buying it and after that my family had already warned
the securities about me and accused me by " I have lost my mind" and said" if you won`t be a good
person then hospital is your home!"
 Cont.
• and second time my brother had informed them to take me at home because I had an
argument with my family as I had no job and depressed in that time and third time I went
back to hospital because my condition was not good that’s why I came back to hospital. First
time I stayed for (8) months and second time for ( almost 4 months ) and third time I didn`t
stay, and I went back just for taking medications because I couldn`t sleep and I was
depressed I was angry sometimes and I was feeling that iam useless and I couldn`t cope with
my family like any other people do. How ever I knew that if I take medications I can sleep
well that was another reason .My oldest brother has a psychological disorder also and hasn`t
married yet and he keeps talking to himself and sometimes shout with no reason .
 Biographical Data:
• • Patient`s name : -----------------------
• Age : 37 years old sex: male occupation: unemployed
• Educational level: primary school income: good
• Martial status : single Nationality: iraqi Religion: muslim
• Date of admission: 2016
• Source of referral:
• Referred from: home who has come with: alone
 
 
• Chief complain: follow up + taking medications
 History of present illness

• He was feeling depressed and anxiety to not sleep well again in his mind and he was finding out that life is

beautiful and nice and also along ago he had a bad idea of suicide he was going to the middle of the streets so

that he will be killed by people and in case of having a car accidents .and he has a little anxiety in washing his

hands and praying , he feels that he hasn`t performed them well and sometimes repeat them twice or three

times. He has no rumination. He has a bad sleep, if he doesn`t take medications, he can`t sleep. He has bad

dreams sometimes but he doesn`t remember them. He has a good appetite. He has visited a lot of religious

places such as mala Ali ,mala Qasm, Saidi qalachoghan he visited them because of sever depression and being

an aggressive they were praying for him and he has taken a benefit from them. He was not taking any other

medications rather than psychological drugs. He was thinking if he takes those medications he gets better and

viceversa(if he doesn`t take them he gets worse. He believed that all conditions that have happened to him was

because of the car accident .before that time he hadn`t had any diseases.
 History of previous illness

• His age was (37) as mentioned before and he had admitted to psychiatric hospital since
2016 and his condition started after 2004.he had used drugs in 2004-2006 and then
neglected it till 2016 as his aggressiveness and being angry started. even because of
this condition he had broken windows and televisions at home. After getting pills I
again was brought back to normal condition. ECT is not used to him except when he
visited Mala Ali they had used a machine which was more likely an electrical machine
with a little power. He hasn’t any medical disease but has done an appendectomy in
1996. He had a car accident in 2003 and he became unconscious and he has never been
in a prison or been in a court because of any illegal act.
 Personal life history

• Birth and infancy: he was born through normal vaginal delivery.

And hadn`t any abnormal condition like anemia and jaundice or hypo
and hyperglycemia.
• Childhood: everything started normally crawling and walking were
on time he hadn`t any problems such as growth problem and anemia
bowel and urine control on time . no finer sucking and nail biting .was
a socialized child he was overactive child but lazy at studying .

prevention
• School age : he started school when he was about 6 years . he was lazy at school and he failed at
5th and 6th grade of primary school because he said that he was working in that time he hadn`t
time for studying. He was selling cigarettes. His overall score was almost 50 every year the same
result. He had a good relation ship with his teachers he has never been beaten by his teachers. He
has never broken windows and running at school and was not a talkative child and he wasn`t
fighting with other children .he was sitting in the last line. And has studied until 9th grade.

• Adolescent: everything went normal and he was like any other child with good relationship with
his family and outside world. He hadn`t been affected by substance abuse and he has never
experienced behavior problems.

• Occupation : he started working in 1993 . he has done different jobs such as selling cigarettes
and ice creams but he doesn`t work now he hasn`t worked since 2016 because of this
psychological condition and being at hospital and taking medication . he has 150.000 monthly
from the government for his situation. He wasn`t changing jobs often how ever, he hadn`t
experienced any bad memories during his job which makes him to quit.
is
• Psychosexual: he hadn`t married because of not having enough money and stable
job but if he had had money , he would have married.
• Martial history: no martial history because of not having marriage.

• Habits/dependencies: he hasn`t drunk alcohol and used tobacco and other illegal
drugs . only smoked for (1) week then left it just for experience as he started earlier
because of his friends and decided to quit because of wasting money.
• Forensic history: he has never done any illegal act and fought with anyone and has
never been to prison .
• present Social situation: their income is good and lives in a good environment and
happy to live with them.

better
• Daily activity: his daily activity is perfect and he does bath and buy

cloths without any warning by his family and if he wants to buy

something , he buys it directly without consulting anyone but he never

iron his cloths. He has a brother who hasn’t taken a bath since 12 days

he doesn`t shave his beard so often. His brother has visited hospital and

takes same medication as him but he doesn’t use drugs.

than
 Premorbid personality

• Premorbid personality:

• he describes himself as confident and quiet person before the condition but

after that he was changed to a rude and mistrust person. His relatives were

supporting and advising him to get better. He thinks he is an energetic

person and he had had a lot of hobbies starting to have a normal life with his

family to an optimistic future. He has always dreamed to act as a normal

person he is not a selfish person , and he is not a shy or jealous person.

 

A
 treatment
Family history
• His father has died but his mother is still alive. His fathers name was Fatah and he
died when he was almost 68 years old with heart attack. His father hadn`t had any
psychological condition but his grandmother and his aunt had sever psychological
disorder in other meaning its definitely a genetic condition. His father had
completed primary school and could read well (good reader). He was a servant at
mosque and had only 1 job in his life. He was a well behaved person with them and
with their mother during his young and old stage. He hadn`t any medical diseases.
His mothers age is 70 years now, and she is in active like her young age she can
stand and cook without any problems.
• She is a house wife. She has never studied and hadn`t had any psychological
condition during her young and old stage. She has diabetes and hypertension
while she was well behaved with them and with her husband . in case of
money they were good and not poor before and now as his brothers started to
work. He has 3 sisters and 6 brothers. And all his sisters have married and
only 2 of his brothers have married which means still 4 of them left because
of not having enough money for them and his oldest brother has
psychological condition he doesn`t work and hasn’t married the others are
normal. They don`t have any medical disorders and or haven`t done any
surgeries. His relationship with his relatives are absolutely good and they
don`t have any psychological disorders.
 Medical diagnosis
• Medical diagnosis: schizophrenia

• Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in

some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily

functioning, and can be disabling.

• People with schizophrenia require lifelong treatment. Early treatment may help get symptoms under control before

serious complications develop and may help improve the long-term outlook.

• Causes are :

• It's not known what causes schizophrenia, but researchers believe that a combination of genetics, brain chemistry and

environment contributes to development of the disorder.

• Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate,

may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous

system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they

indicate that schizophrenia is a brain disease.

 Mental state examination
 
• General appearance: he had worn a black jean with a white jacket they were not

ironed and with a bad smell because he hadn`t washed them for a 5 days.

• Facial expression: he had eye contact and he looked comfortable and alert.

• Behavior: no irritability no restlessness, his setting was appropriate and comfortable.

All movements were normal no mannerism no aggressiveness and destructiveness .

• Attitude towards an examiner: he was friendly and cooperative was answering

most of the questions with any hesitations .

• Speech: he has a pressure during speech with a normal and good tone . with a load

volume and relevant content .He was so coherent.

 Mood and affect

• Mood
• He was so comfortable while speaking to me and he was feeling happiness .

• Affect
• Its more likely parallel to the mood but when I saw him first time I felt like he was
confused and sad.
 Thought disorder
• Form of thought: no flight of idea ,no poverty of speech, no loosing associations perseverance, no evasiveness.

• Content of thought: Delusions like :

• Grandiose: no grandiose delusion

• Control: he sometimes feels that he is controlled by someone.

• Poverty: no poverty delusion

• Guilt: has guilt delusion and thinking that maybe he has done something bad and that happens to him right now is the

price for that thing but he doesn`t know where and when did he do that.

• Nihilistic: some time he feels that apart of his body is missing.

• Hypochondriacal : no hypochondrial delusion.

• Paranoid: in the past he was feeling that people hurt him but after taking medications he is better.

• Reference: no idea of preferences.

• Jealousy: no jealousy

• Amorous: no amorous

• Religion: no religion
 Perception disorders
• Illusion: no illusion

• Hallucination : we showed him a flash memory and he knew what was that.

• Auditory: no auditory

• Vision: before he was seeing things that was not present and he was the only one

who could see them (seeing people).

• Olfactory: no olfactory hallucinations

• Tactile: no tactile

• Gustatory: he was feeling this often . he was feeling that there are insects on his

skin but in reality there was not any.

•  
 Cognitive function
• Attention: he could count the days of the week vice versa with a little trying.

• Orientation: he could know the date and time and place greatly.

• Memory: we examined him based of (4) sections:

• Immediate : I told him my name he couldn`t remember when I asked him and his excuse was because of I asked him
a lot of questions.

• Recent: he answered that he had a tea with a piece of cheese.

• Experience: he had full information about the people around the news and TV.

• Remote: he could remember the days of school and all the staff including the name of the teachers and school.

• Judgment: we asked if the place that were talking gets fired what will be his judgment and he said I " I try to protect
people around myself and switch it off.

• Intelligence: we gave a mathematical equation 5+12 and he said 17.

• General knowledge: he knew the name of our president perfectly as we had provided the name of the president
question.

• Abstract thinking: he could read and write well.

 insight
• First and second time when he came to hospital he didn`t have insight but third time
he had insight but he was always repeating that sentence like " iam good now"
• He has hope that he gets better one day and has been better as in his view he says he
is %90 treated.
Signs and symptoms
Patients treatment
Nursing diagnosis
 Discharge planning
Discharge planning
-don`t stop of taking medications especially antipsychotic drugs.
-take your medicine as directed.
- follow up with your psychiatrist and write down your questions so that you ask in case of forgetting them.
-there are several programs they need after their discharge:
- A crisis residential program.
-Day treatment program.
-in an outpatient program.
-patient care program.
-there are several therapy they need:
-giving Assertive community treatment.
- cognitive behavior therapy.
-illness- management skill.
-family psychoeducation.
-social skill training.
-supported employment.
-get regular sleep and food.
-don`t drink alcohol.
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