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Undifferentiated Schizophrenia

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A Case Study Presented to the Faculty of Bukidnon State University College of Nursing

A Case Study on Schizophrenia Undifferentiated :

A Case Study on Schizophrenia Undifferentiated

INTRODUCTION :

INTRODUCTION Schizophrenia (from the Greek roots skhizein ("to split") and phrēn, phren- ("mind")) is a severe mental illness characterized by a variety of symptoms including but not limited to loss of contact with reality. Schizophrenia is not characterized by a changing in personality; it is characterized by a deteriorating personality. Simply stated, schizophrenia is one of the most profoundly disabling illnesses, mental or physical, that the nurse will ever encounter (Keltner, 2007). There are 5 subtypes of schizophrenia naming; paranoid, disorganized, catatonic, undifferentiated, and residual.

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One of the subtypes would be paranoid, prominent hallucinations and delusions are present. Delusion could be persecutory or grandiose. Paranoid has two criteria to meet, first, preoccupation with one one or more delusions or frequent auditory hallucinations. Second, none of the following I prominent: disorganized speech, disorganized or catatonic behavior, or flat affect. Disorganized type will manifest disorganized speech and behavior and flat affect. Person may appear disorganized and unkempt because basic everyday task like dressing oneself can not be accomplished.

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Expression of emotions may also either inappropriate to the content of what the client is saying. There three types of criteria that should be meet; disorganized speech, disorganized behavior and flat or inappropriate affect. Catatonic type is characterized by extreme psychomotor disruption. Client may display substantially reduced movement accompanied by negativism. Additional signs of catatonic type are when a client repeats what others say or mimic their movement. Catatonic has five criteria to meet, first, motor immobility as evidence by catalepsy or stupor

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Excessive motor activity, extreme negativism apparently client is motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved or mutism. Peculiarities of voluntary movement as evidence by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing. And also echolalia and echopraxia. Undifferentiated type, is when type a criteria should be met. Residual type a client who has had at least one documented episode of schizophrenia and who presents without prominent positive symptoms of the illness. Negative sympytoms like flat affect and inability to work but has prominent delusions, hallucinations and disorganized thoughts.

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It has 2 criteria, first is the absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. There is continuing evidence of the negative symptoms listed in criteria A for schizophrenia.

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Schizophrenia undifferentiated is the type of schizophrenia wherein characteristic symptoms (delusions. Hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms) are present, but criteria for paranoid, catatonic, or disorganized subtypes are not met. Schizophrenia is not a terribly common disease but it can be a serious and chronic one. Worldwide about 1 percent of the population is diagnosed with schizophrenia. About 1.5 million people will be diagnosed with schizophrenia this year around the world. (mentalhelp.net).

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Ninety-five percent (95%) suffer a lifetime; thirty-three percent (33%) of all homeless Americans suffer from schizophrenia; fifty percent (50%) experience serious side effects from medications; and ten percent (10%) kill themselves (Keltner, 2007). According to study done 697,543 out of 86,241,697 of Filipinos or approximately 0.8% are suffering from schizophrenia (cureresearch.com). Here in Davao, Dr. Padilla said that the Davao Mental Hospital receives an average of eight to 10 patients a day suffering from schizophrenia, depression and bi-polar illnesses (Positivenewsmedia.net).

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Schizophrenia Ranks among the top 10 causes of disability in developed countries worldwide (World Health Organization, www.who.int) Schizophrenia is a disease that typically begins in early adulthood; between the ages of 15 and 25. Men tend to get develop schizophrenia slightly earlier than women; whereas most males become ill between 16 and 25 years old, most females develop symptoms several years later, and the incidence in women is noticeably higher in women after age 30. The average age of onset is 18 in men and 25 in women. Schizophrenia onset is quite rare for people under 10 years of age, or over 40 years of age (schizophrenia.com).

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The patient, J un Pyo , not his real name, was one of the patient admitted at Davao Mental Hospital due to Schizophrenia Undifferentiated. The group chose Jun Pyo as their subject primarily because his case posed as a very intricate case requiring due understanding and knowledge. Making this case is a good avenue to broaden the proponents’ knowledge about the mental illness involved.

OBJECTIVES :

OBJECTIVES General Objective: The main goal of the group is to be able to present an extensive and comprehensive case study of our chosen client that would present a comprehensive discussion of Schizophrenia Undifferentiated to yield important information for the case study.

Specific Objectives In order to meet the general objective, the group aims to::

Specific Objectives In order to meet the general objective, the group aims to: Cognitive: interpret the pertinent data gathered from the patient and his significant others; present the anamnesis by thorough gathering of the client’s pertinent personal data determine the etiology factors (precipitating and predisposing) of the mental disorder; evaluate the presence or absence of signs and symptoms seen in the patient in relation to the mental disorder;

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present the psychodynamics of the client’s diagnosis by recognizing its predisposing and precipitating factors with appropriate rationales; To track down the significant events during the client’s developmental stage as shown in the psychodynamics; thoroughly define the complete diagnosis of the patient; formulate effective, specific, measurable, attainable, realistic and time-bounded nursing care plans base on identified actual and potential nursing problems; arrive to a general realistic prognosis drawn from the information gathered and factors affecting the patient’s condition;

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Psychomotor: gather pertinent data about the client through detailed chart taking, and effective therapeutic communication and interaction with the client and his significant others; trace the health history of the client and family illnesses (past and present) through a genogram ; assess client’s mental status thoroughly during the orientation and termination phase as well as the Multi-Axial diagnosis; present the medications given to the client, including their respective modes of action, indications, contraindications, side effects, adverse reactions, nursing responsibilities, and importance to the client’s condition;

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render quality nursing care in line with the formulated nursing care plans; Affective: establish rapport to the patient and the patient’s significant others; and establish a trusting nurse-patient relationship with the client and his significant others through provision of holistic care toward the client and use of appropriate verbal and non-verbal therapeutic communication skills with the client and significant others during the data gathering;

ANAMNESIS :

ANAMNESIS PATIENT’S DATA CODE NAME: JUN PYO AGE: 41 SEX: Male BIRTHDAY: November 8, 1968 BIRTHPLACE: Jerom castillo , Tangigue Street, Lapu lapu Village, Agdao Davao City ADDRESS: Jerome Castillo, Tangigue Street, Lapu lapu Village, Agdao Davao City ORDINAL RANK: 1st CIVIL STATUS: Single

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NATIONALITY: Filipino RELIGION: Catholic EDUCATIONAL ATTAINMENT: 3rd Year High School OCCUPATION: None NUMBER OF CHILDREN: 0 NUMBER OF BROTHERS: 3 NUMBER OF SISTERS: 0 MOTHER: Mama AGE: 65 EDUCATIONAL ATTAINEMNT: High School Level OCCUPATION: Housewife

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FATHER: Papa Age: 64 years old EDUCATIONAL ATTAINMENT: High School Level OCCUPATION: Mediaman/Radio Commentator WARD/SERVICE: Open Ward/Psychiatry ADMITTING PHYSICIAN: GIOIA FE D. DINGLASAN, M.D ADMITTING DIAGNOSIS: Schizophrenia, undifferentiated/MD-moderate PRINCIPAL DIAGNOSIS: Schizophrenia, undifferentiated DATE OF ADMISSION: MARCH 9, 2010 DATE OF DISCHARGE: INSTITUTION: Davao Mental Hospital

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b. Genogram c. INFORMANT’S DATA INTERVIEW Informant #1 Name: Wu Bin Age: 39 years old Address: Jerome Castillo, Tangigue Street, LapuLapu Village, Agdao Davao City Sex: Male Civil Status: Single Relationship to Client: Brother Length of Time Known by the Patient: Since Birth up to Present (39 years)

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Apparent Understanding of the Present Illness of the Client: According to Wu bin , Jun Pyo started to act differently when he stopped schooling ,that was summer when he was 3 rd year high school. Jun Pyo was a shy, quiet and reserve type of person. He usually stays at home and help his parents with all the work since he is the oldest. He follow orders with no complains and used to look for his younger brothers when their parents are not around. He has been a good son and a good older brother. In school he is doing good with his grades but he had small number of friends. You would rarely see him socializing with his classmates. He goes home immediately after classes. In his community, he rarely participate with the activities. He notices that Jun Pyo changes a liitle bit. He noticed unusual behaviours of him. Jun Pyo used to shout all day and never get out the house.

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FAMILY HISTORY Maternal and Paternal Lineage: Direct bilateral lineage of the patient show one condition of mental illness. On the paternal side, prominent family illnesses only concern some members having hypertension. Aside from the condition, no other illnesses run the family. On the maternal line, an illness is reported to run in the family having mental illness as a matter of fact the sister of the patients mother do have the same mental illness Jun Pyo have and one family member having diabetes mellitus type 2, an illness condition occurring singularly to be considered familial.

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There is also hypertension that run in the family. Generally, only one mental illness can be traced on maternal side of the family. Father The father was a silent type. He was not said to be a good disciplinarian because he was very busy with his work as a radio announcer. He goes to work early in the morning and went home late seven days a week. He doesn’t have enough time to mingle with his kids due to his busy schedule. He is the only one working to support the needs of the whole family. His income wasn’t that enough.

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Mother As our informant wu bin say his mother helps in the house. His mother is a plain housewife. The mother says that she brought her children up in discipline and love; she said she doesn’t spank her children because it does them no good. Like the father, she doesn’t also believe in punishing her children through spanking and the like when they do something wrong. She was hands on to Jun Pyo since he was the first child. She used to breastfeed him and send him to school.

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Siblings The family is composed of four siblings; Jun Pyo being the eldest, followed by the informant, wu bin,, then by Ray, and Edwin. with his siblings is not so good. As a child, although they were the only ones that he would play with, he would still isolate himself when with them. He never shares his thoughts with them. But he used to take care of them and look after them especially if their parents were not around. Furthermore, when they grew up and the illness took place, the siblings gradually got irritated with him because of his hostility towards others.

Personality History:

Personality History a. Prenatal The mother has completed the pre-natal check-up at the health center. She was able to comply all the requirements needed during pregnancy. Birth The mother delivered the patient full-term via normal spontaneous vaginal delivery at home. No complications was noted. Psychosexual History Age of sex awareness was at the age of 9. Age of circumcision was at 8 years old.

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Play Life Jun Pyo does not engage so much in cooperative play and prefers solitary play. He would only sit by himself and play alone in a corner. His playmates were his siblings and would choose to play only in their yard. As a child, he is not talkative, he is uncooperative and becomes aggressive when forced to play with other kids. Furthermore, he likes being a follower in a game rather than a leader.

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School History Age of entering school was at six years old. He only finished 3 rd year high school. He regularly attend classes. . Religious and Social Adaptability He don’t have much friends because he was very silent, aloof. He preferred to stay at home. During Sundays he rarely go to church. Onset of the present illness Patient was admitted several times at Davao Mental Hospital. His recent was last May 2009.

COURSE IN THE HOSPITAL :

COURSE IN THE HOSPITAL a. MENTAL STATUS EXAMINATION GENERAL DESCRIPTION APPEARANCE a. The patient appears to be younger than his real age which is 41. During the interview at Crisis Intervention Unit in Davao Mental Hospital, he wore a striped shirt and a blue shorts and is poorly groomed. Patient appeared to be untidy Patient is drooling. b. Posture and Gait – The patient slumps when walking and sitting. When he is sitting he still maintains the posture.

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c.Facial Expression – The patient’s facial expressions are somewhat appropriate to his verbal responses during the interview. He was composed and receptive to whatever the group asks him. d.Eye contact – The patient can’t maintain eye contact. B. BEHAVIOR/ACTIVITY Patient is hostile and agitated. He is sometimes restless and irritable. He used to have this repeated purposeless movements- stamping of the feet. His not taking any interest in anything or not bothering to do anything.

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C.SPEECH a. Patient is hesitant to answer. When you asked him he would not answer directly he just watches you closely. Has slurred speech and talks softly but aloud. He responds late. b. Style and Vocabulary – Patient is shy. He answers questions one at a time though responses are late but its direct to the point. c. Stream of Talk Patient talks slowly. When he talks, sometimes he’s unable to continue.

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d. Organization of Talk Patient is incoherent, he is unable to express feelings clearly or logically. Patient manifest Associative Looseness he jumps from one idea to another with little or no evident relation between the thoughts. Tangentiality is one characteristic of the patient wandering off the topic and never providing information. Patient used to repeat words and phrases over and over again. He has flight of ideas. D.MOOD Patient used to have mood swings- labile and is unpredictable. E.AFFECT Patient has a blunted affect. His showing little or slow to responds facial expression.

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F.RANGE OF AFFECTIVE EXPRESSION Patient is labile. G.HALLUCINATIONS Patient is having auditory and visual hallucinations. H. THOUGHT CONTENT Homicidal-patient used to threaten person when he was forced to do something. I. ORIENTATION Patient was oriented to date and place as well as the time and people.

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I.MEMORY Based on his chart his memory is unimpaired the remote, recent part, recent and immediate. Upon interview he was able to answer questions and can remember situations and person clearly over and over. J. NEURO-VEGETATIVE FUNCTIONING Patient is having early insomnia. His appetite is increased resulting to weight gain. K. ABSTRACT THINKING ABILITY Patient has an intact and good ability to think abstractly.

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L. JUDGEMENT Judgement is unimpaired. The insight belongs to level 1.There is partial impairment. M. ABILITY TO CONCENTRATE Patient can easily be distracted and has a short attention span. N. ROLES AND RELATIONSHIPS Patient has a good relationship towards his family but when symptoms started to appear little by little his behaviour and attitudes towards them becomes different. His role being the eldest is impaired and he can no longer performed some of the task.

b. Progress Notes and Observations :

b. Progress Notes and Observations Upon receiving, the patient Jun Pyo is naked and untidy. Some injuries and scarring are noted on his body particularly on his feet and back. Upon observation Jun Pyo seems uncooperative and unwilling to participate in any nurse- patient interactions. He is also a serious and silent type of person. He rarely speaks and he is not fond of conversations and there is a latency of response. Also he looks agitated all the time but he seems not hostile. Jun Pyo seems restless and not able to remain in his position but as time goes on while conducting activities and nurse – patient interactions, Jun Pyo is surprisingly cooperative, most of the time that is. Although he is hesitant, he is able to answer directly to the questions of the assigned student – nurse.

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He sometimes participates in the activities more often he exert effort to cooperate on us during the activity and most especially during nurse-patient interaction and the therapies that were rendered by the student nurses. Like any other psychiatric patients, Jun Pyo is really active when its eating time and he has good appetite. While doing continually rapport to Jun Pyo he was able to build trust which is very important aspects that a psychiatric patient should posses for better interaction. Jun Pyo becomes more interested on every activities we had prepared for them but during the time we inform him about the termination phase we noticed that he becomes lonely and he told us the he will be going to miss the time that we able to interact with him.

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PSYCHODYNAMICS

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Predisposing Factors Present/ Absent Rationale Justification Family History Present Individuals with schizophrenia seem to inherit a predisposition to the disorder because schizophrenia runs in families, but it is a less partially inherited disease. The first degree relatives have a 10-15% risk of having schizophrenia than chance would allow. Schizophrenia is present in the first degree relative of the patient specifically, his aunt in the mother side according to the patient’s younger brother.

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Neurostructural Anomalies ( Keltner , N. Psychiatric Nursing. Chapter 4.) Absent The theorists have proposed that schizophrenia, is a direct effect of three nuerostructural defects. Ventricular enlargement, brain atrophy and dysfunctional cerebral blood flow. These anatomical anomalies in the brain play a major role in the illness. The patient’s chart did not show any laboratory results to confirm the existence of such anomalies if such are present in the patient.

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Although an amazing amount of resources have been directed at finding the genetic cause of schizophrenia, the results are far from specific. In fact, almost every chromosome has been linked with schizophrenia.

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PRECIPITATING FACTORS PRESENT OR ABSENT RATIONALE JUSTIFICATION Environmental and Interpersonal Stressors Present According to Humanistic-Interactional Theories ,an interactional model for understanding schizophrenia that has received wide acceptance is the stress-vulnerability model, which suggest that people with schizophrenia have a genetically based, biologically mediated vulnerability, to personal, family and environmental stress.( Neuchterlein et.al. 1992) Patient has been diagnosed of having schizophrenia. In the family runs the said mental illness. Patient also experience psychobiological stressors causing altered attention and and perception, his motivation and energy. Also he is having difficulty socializing with other people.

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PRECIPITATING FACTORS PRESENT OR ABSENT RATIONALE JUSTIFICATION Disordered Family Communication Present According to Family Theories, disordered Family Communication (the inability to focus on and clearly share and observation or thought) causes schizophrenia only in the presence of a genetic predisposition to the disease. Living with this pattern of family communication during early development is thought to impair the schizophrenic person’s ability to perceive the environment and communicate with others about it ( Miklowits 1994). Communications within the family members were not that effective. Interaction especially between the patient and his father. Brought by the busy schedule of his father they have no time to interact and talk for a while

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Precipitating Factors Present/ Absent Rationale Justification Intake of drugs, substances or chemicals which increase levels of dopamine. Present/Absent Dopamine is known to be the neurotransmitter which is prominently affecting the occurrence of schizophrenia. In patients with schizophrenia, dopamine levels are invariably high. Therefore, intake or use of drugs, substances and chemicals which promote the elevation of dopamine levels in the brain would trigger schizophrenia. Example of these are levodopa , ampethamines and marijuana. Keltner , N. Psychiatric Nursing. Chapter 4 . The patient admitted to take marijuana in 3rd year high school but withdraw his admission afterwards.Our only informant,his brother stated that they dont know that Jun Pyu was taking marijuana.

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Precipitating Factors Present/ Absent Rationale Justification Perinatal Factors Absent Some researchers believe that schizophrenia can be linked to perinatal exposure to influenza, birth during winter, exposure to lead, minor malformations during early gestation, exposure to viruses from house cats and complications of pregnancy, particularly during labor and delivery. Keltner, N. Psychiatric Nursing. Chapter 4. We weren’t able to gather sufficient data to justify if their is any complications during pregnancy and birth. But according to Jun Pyu’s chart his mother delivered via Normal Spontaneous Vaginal Delivery in their house to a healthy baby boy.

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Precipitating Factors Present/ Absent Rationale Justification Developmental Factors Identity vs role confusion Present - His father was busy working. He always got home late at night . He is obliged to care of his siblings instead of playing outside. Developmental factors include the internal reaction of an individual to life stressors or conflicts. Three theorists could be considered here: Meyer, Freud and Erikson. For Meyer, events in early life can cause problems that are as severe as schizophrenia. For Freud, developmental factors include poor ego boundaries, fragile ego, inadequate ego development, superego dominance, regressed or id behavior, - Jun Pyo didn’t enjoy his adolescent years because of being the eldest in the family he was given a role not fit for his age. Results to, role confusion.

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Intimacy vs isolation - Since jun pyo was diagnosed when he was 15 years old , he never experience to be in a romantic relationship. And his family rarely visit him at the hospital. ambivalent relationships and arrested psychosexual development. Furthermore, Erikson believed that eight-stage model of human development starting from Trust Vs. Mistrust highly influences development of the condition. Autonomy vs. s. Shame s accomplishment or failure in the levels affect a person’s developmental aspect. Keltner,N . Psychiatric Nursing. Chapter pp. - It results isolation and he doesn’t feel comfortable with the crowd. And at his age he is not engaged with any relationship. Jun Pyo is emotionally distant to his family.

Ideal Diagnostic Exams :

Ideal Diagnostic Exams 1. PET (positron emission tomography) Scan -with 18F deoxyglucose - shows metabolic activity in a horizontal section of the brain in a control subject. Noninvasive , cross sectional image of regional metabolism is obtained. Color -coded cathode-ray tube representation of the distribution of gamma radiation given off in the collision of electrons in cells with positrons emitted by radionuclides incorporated into metabolic substances.

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2 .CT (computed tomography) Scan - radiography in which a three dimensional image of a body structure is constructed by computer from a series of plane cross-sectional images made along an axis.

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3. MRI (magnetic resonance imaging ) - noninvasive diagnostic technique that produces computerized images of internal body tissues and is based on nuclear magnetic resonance of atoms within the body induced by the application of radio waves.

DIAGNOSIS :

DIAGNOSIS MULTI-AXIAL SYSTEM OF DIAGNOSIS AXIS I Schizophrenia Undifferentiated AXIS II Mental Retardation- Moderate Schizoid Personality Disorder ( Premorbid ) AXIS III (not applicable) AXIS IV Poverty Role Confusion Inferiority Complex AXIS V 35- (31-40) , some impairment in reality testing and communication. Such as illogical speech at times, flight of ideas, auditory and visual hallucinations as well. He is also aloof and withdraws himself from social activities for he prefers to be alone rather than joined in the crowd.

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B. AXIS I Patient was diagnosed to have Schizophrenia Undifferentiated. Based on his Mental Status Examination, on general appearance he is poorly groomed, his behaviour and psychomotor activities are inappropriate; he had a labile mood, agitated and a blunted affect. With his neurovegetative function, he was suffering from early insomnia. His appetite is increased resulting to weight gain. He has poor attention span. He can’t focus on a single idea and he does not respond properly, apathetic and aloof. With his thought process he has looseness of association, tangentiality and flight of ideas.

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AXIS II Along with the diagnosis stated above, patient was also diagnosed of having Mental Retardation- Moderate. Moderate Mental Retardation has an IQ level of 35-49.Jun Pyo can perform some activities independently but requires supervision. Patient is capable of academic skill. As adult, he may be able to contribute to own support in sheltered workshop. Patient experience some limitation in speech communication. Difficulty adhering to social convention may interfere with peer relationships. Motor development is fair. Patient has a Schizoid type of personality ( Premorbid ). Patient is noted to have small number of friends and was very functional at home. He is known to be silent type.

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AXIS IV The family have low income. His mother don’t have work and his father is out for work all day long. They have no chance to talk on some issues. Being the eldest he was expected to perform the role of his father. He was obligated to take care of his younger brothers. He doesn’t feel comfortable to be in a crowd of people instead he prefers to be alone. AXIS V Jun Pyo scored 35 in the Global Assessment of functioning from the scale of 0-100. It is based from the fact that he has some impairment in reality testing and communication. Such as illogical speech at times, flight of ideas, auditory and visual hallucinations as well. He is also aloof and withdraws himself from social activities for he prefers to be alone rather than joined in the crowd.

Medical Management :

Medical Management

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Therapies: The medical treatments for treating schizophrenia are electroconvulsive therapy (ECT) which is the treatment of mental disorder and especially depression by the application of electric current to the head of a patient. Anesthetized patient that induces unconsciousness and convulsive seizures in the brain and the insulin shock therapy which is an ideal treatment for schizophrenia by insulin in doses sufficient to produce deep coma and also called insulin coma therapy. Psychosurgery were used in cerebral surgery employed in treating psychic symptoms.

Drug study:

Drug study

Ideal Nursing Care plan :

Ideal Nursing Care plan Disturbed Thought Processes Risk for Self Directed Violence High risk for Self Mutilation Imbalanced Nutrition less than Body Requirements Impaired Verbal Communication Risk for Suicide

Actual Nursing Care plan :

Actual Nursing Care plan Disturbed thought process related to disintegration thinking. Alterations in Sensory Perception related to disturbance in thought process as evidenced by auditory and visual hallucinations. Self care deficit: bathing / hygiene related to lack of motivation. Situational low self-esteem related to cognitive impairment Risk for Violence directed to others related to Lack of development of trust and appropriate interpersonal relationships

PROGNOSIS:

PROGNOSIS

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GOOD FAIR POOR JUSTIFICATION Onset of the illness ☻ Jun Pyo first experiences the signs and symptoms of schizophrenia when he was 15 years old. The family noticed that Jun Pyo was silent then becomes hostile. Since then people who were close to him also noticed that he has illogical speech and flight of ideas. It was after 5 months,1994 that they decided to admit Jun Pyo to the Davao Mental Hospital.The onset of illness was poor since the family waited that the situation of Jun Pyo worsened and did not immediately seek medical advice.Specially when they noticed his illogical speech and flight of ideas.

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Duration of illness ☻ The client has been diagnosed with schizophrenia undifferentiated moderate 26 years ago since then the patient had several admission in Davao Medical Hospital. His last admission was on May 2009.As we can see, the duration of illness has been very long since it was years ago since he manifested the signs and symptoms of schizophrenia, thus rating him with poor prognosis.

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Precipitating factors ☻ Genetics was one of contributing factor, another was the poverty of their family since his father was the bread winner of the family with the four children to raise. Another factor was peer pressure. Being the eldest of the four siblings he had responsibilities and it led him to ignore his own interest as an adolescent such as he never joined any community activities and only had selected friends. The proponent of this area rated as poor. In his development,Jun Pyo developed mistrust, shame and doubt, guilt, inferiority, role confusion, and isolation which rated him poor.

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Mood and Affect ☻ During the interview, Jun Pyo has appropriate mood and affect therefore rating him with good prognosis. Family Support ☻ For the whole duration of his admission his family only visited him a few times. But now that his mother is admitted in the hospital due to hypertension, no one is visiting him. Specially that his father is busy and his younger brothers are taking turns in taking care of their mother in the hospital. He has fair prognosis since he is not totally abandoned by his family and still visited by his mother when she was not yet admitted in the hospital.

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Willingness to take medications and treatment ☻ Jun Pyo was known to comply to his medications without missing any single dose. He is taking the proper regimen.Because of this, Jun Pyo was rated with good prognosis with the willingness to take the medication and treatment.

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Depressive Features ☻ During the interview, the patient does not show any depressive features. Jun Pyo knew that something is wrong with him and he need medical attention. Even though he is aware that something is wrong with him, he is still not depressed with this fact. Not getting the things he wants won’t make him depress but instead, Jun Pyo becomes hostile. His depressive feature is good since he doesn’t manifest depression.

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Total 3 1 3 Computation : Poor: (3*1)/7 = 3/7 Fair: (1*2)/7 = 2/7 Good: (3*3)/7 = 9/7 Total: 2.00 General Prognosis: 1-1.6 = POOR 1.7-2.3 = FAIR 2.4-3.0 = GOOD

Rationale for Fair Prognosis: :

Rationale for Fair Prognosis: Jun Pyu has a fair prognosis therefore he has small chance, according to the calculation, of recovering from his illness. The onset of illness was 26 years ago. He was not immediately brought to the hospital but they waited 5 months and decided to bring him to the hospital because of illogical speech and flight of ideas. And during his development, he developed mistrust, shame and doubt, guilt, inferiority, role confusion, and isolation which rated him poor.

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He submits himself to the regimen, taking the medications promptly without missing single dose of his medications. Furthermore, during the interview, Jun Pyu has appropriate mood and affect therefore rating him with good prognosis. He had a fair family support. His father is supporting him financially but because of his work he couldn’t visit Jun Pyu . Lastly, the patient does not show any depressive features. Jun Pyu knew that something is wrong with him and he need medical attention. Even though he is aware that something is wrong with him, he is still not depressed with this fact. Not getting the things he wants won’t make him depress but instead, Jun Pyu becomes hostile.

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Banquet

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