PART A: HISTORY
Andy was a 21-year-old gentleman who lived with his roommates in college at that time. He had been referred to the psychiatrist by his doctor since he had shown signs of mental illness. The patient claimed that a device had been implanted in his body by his roommates who allegedly were working for M15. He further states that he realized this when he went home and found out that they had moved the TV to the other side of the room. He asserted that a new lecturer in the campus that worked for MI5 incited his housemates to turn up against him. He had not experienced any mental condition before, and he claimed to be in good health. Andy was not under any medication and had not experienced any scandals with the police before. His family was not aware of what he was going through, however, he tried to explain to his mother but she failed to believe him. The patient was under drug influence since he told the psychiatrist that he took small amounts of alcohol, smoked cannabis and took a bit of speed. He also disclosed that he felt safe at his parents’ house, and claimed that he was in the hospital to avoid his mother from getting worried.
PART B: MENTAL STATE EXAMINATION
Appearance
Throughout the interview, Andy appeared to be distressed and frowned. He sat inclining towards the front and was quite insecure since he kept turning his head. He was also very restless and failed to maintain eye contact with the psychiatrist.
Behavior
He generally had a disorganized behavior and a very isolative behavior, since he stayed in his room most of the time and only left when his housemates went to buy food. He was also very insecure around his roommates.
Affect
He had a flat affect since most of the time he spoke in a monotonous voice and his facial expressions seemed to diminish.
Mood
He was in a very low mood as he spoke. Andy looked quite depressed and helpless. He was also not stable emotionally
Speech
The patient’s speech came out to be rather disorganized. He kept on murmuring most of the time, and he repeated his words severally. He also failed to make complete sentences.
Thought form
Andy’s thoughts were quite incompetent as seen from his speech. He was very paranoid and experienced bizarre thoughts since he asserted to have thoughts that were not his and claimed that his roommates put thoughts in his head. He also experienced hallucinations since he claimed to hear his roommates speaking during the interview.
Thought content
He thought that his roommates worked for MI5 under the influence of a new lecturer who worked for the same. It dawned on him when he found out that they had moved the TV to the other side of the room. He also thought that his roommates were out to get him and that they poisoned his food.
Perception
He perceived that his roommates were always talking about him and that they were after him. He neither believed that he was ill nor the drugs he took affected him.
Cognition/intellectual functioning
Andy supposed that his housemates were out to get him and filled his brain with thoughts that were not his. He believed that the chip was placed on his head and he could feel a physical sensation.
Insight and Judgment
He strongly believed that his roommates had implanted a device in his body that was used to track him. He also believed that the drugs were a separate entity from what he was going through.
Risk assessment
Andy handled this condition with fear since he always isolated himself and failed to eat much as he used to. He also carried with him a knife and a baseball bat as his “weapons”, although he never used them at any instance. He also thought of getting pills but he withdrew.
Formulation
Andy’s mental health was of great concern since there were high possibilities that he was having schizophrenia. The psychiatrist discovered that he had auditory and somatic hallucinations, running commentary as well as delusions (Theochari, Tsaltas & Kontis 2017). The psychiatrist also examined Andy on how he was able to handle the situation, and she found out that he was always “armed”. He also experienced thought insertion and kept fidgeting. His judgment was poor since he did not accept the fact that he was ill.
Provisional diagnosis
It was evident that Andy had auditory hallucinations since he claimed to hear his roommates talking about him as well as running commentary which is a major sign for schizophrenics. (Moskowit, Mosquera, & Longden 2017). It was noted that he experienced thought insertion since he believed that his housemates put thoughts in his brain. He also had an isolative behavior since he could not leave his room frequently.
Need for referral
Andy was referred to the psychiatrist by his family doctor as a result of symptoms that he showed. His family doctor realized that Andy was very paranoid and quite insecure about his surroundings. His thoughts could not match reality and he assumed that he had a mental condition and thus there was a need for a referral.
PART C: CARE PLAN
Medical intervention
Schizophrenia was the first mental illnesses that Andy was suspected to have. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM – 5) outlines various ways of diagnosing schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association (2013), (Hurley, 2108). I delineate that schizophrenia is highly prevalent among people who are in their mid-teens and mid-thirties, which highly relates to Andy since he is twenty-one years old (Kilgore, 2017). The lifetime occurrence of this condition could be relatively 0.3% to 0.7% (Riva, 2018). Some of the symptoms include anxiety disorders, depersonalization, and derealisation (Granholm & Harvey, 2018). These symptoms were quite established into Andy and made schizophrenia be the high possibility.
The drugs administered to people with schizophrenia are antipsychotic drugs. Other patients could opt for the “medication noncompliance” that involves long-term injections that keep the patient away from taking regular drugs (Koutsouleris et al, 2015). This medication could have negative side effects such as weight gain restlessness, nausea, and low blood pressure. Symptoms such as tremor and tics could occur but not with Andy since they are experienced by older people (Hurley, 2018).
Psychosocial intervention
Cognitive behaviour therapy and psychoeducation are the main forms of psychosocial intervention that applied in Andy’s case. Cognitive behaviour therapy majorly involves identifying the different behaviours that the patient exhibits and recognizing the beliefs that come with them and replacing those beliefs with appropriate ones (Lim & Penn 2018). If Andy underwent this therapy, the possible outcomes were that he was able to socialize more and had an increased appetite.
Psychoeducation deals with emotions, perception, relaxation, and self-care. If Andy underwent this, there would be a high likelihood of his thoughts changing. He would also keep off his “armaments” and being a drugs and substance abuser his health would improve greatly.
Nursing intervention
For proper diagnosis of patients, nurses ought to have a reliable source of information. In Andy’s situation, the mother was of great help in providing information. A mental examination should be done prior to anything to capture the symptoms. For instance, Andy showed signs of delusion and auditory hallucination. The nurse should be able to refer to the Nursing Interventions Classification (NIC) that outlines the ways in which a conducive and therapeutic environment could be provided in such cases (Guedes de Pinho, 2017). The nurse should also agree with the patient most of the time, however, she should also try and bring in reality into the patient’s mind (Rund, 2018).
The nurse should ensure that the patient has taken their medication and food, since they may be reluctant to think that the medication or food has poison as it is in the case of Andy. (Tas, 2017). They should be able to establish a therapeutic nurse-patient relationship that is aimed at reducing the symptoms and coming up with a lasting solution (Evans, Nizette& Elsevier, 2016). However, this comes with its own challenges. She should be very patient and able to understand the patient’s condition. She should also be able to see beyond the patient’s thoughts and also have the ability to predict the patient’s moves (Segal, Guy & Furber, 2017).
References:
Edition, F., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing.
Evans, K., Nizette, D., & O’Brien, A. (2016). Psychiatric and mental health nursing (4th ed.). Elsevier.
Granholm, E., & Harvey, P. D. (2018). Social Skills Training for Negative Symptoms of Schizophrenia. Schizophrenia Bulletin, 44(3), 472-474.DOI: 10.1093/schbul/sbx184
Guedes de Pinho, L. (2017). Nursing Interventions in Schizophrenia: The Importance of Therapeutic Relationship. Nursing & Care Open Access Journal, 3(6). doi: 10.15406/ncoaj.2017.03.00090
Hurley, K. (2018). What is Schizophrenia? DSM-5 Schizophrenia Definition & Symptoms. Retrieved from https://www.psycom.net/schizophrenia-dsm-5-definition/
Kilgore, C. (2017). New Guidelines with Schizophrenia Diagnosis. Caring for the Ages, 18(6), 3.doi10.1016/j.carage.2017.05.004
Koutsouleris, N., Meisenzahl, E., Borgwardt, S., Riecher-Rössler, A., Frodl, T., & Kambeitz, J. et al. (2015). Individualized differential diagnosis of schizophrenia and mood disorders using neuroanatomical biomarkers. Brain, 138(7), 2059-2073. doi: 10.1093/brain/awv111
Lim, M., & Penn, D. (2018). Using Digital Technology in the Treatment of Schizophrenia. Schizophrenia Bulletin, 44(5), 937-938. doi: 10.1093/schbul/sby081
Moskowitz, A., Mosquera, D., & Longden, E. (2017). Auditory verbal hallucinations and the differential diagnosis of schizophrenia and dissociative disorders: Historical, empirical and clinical perspectives. European Journal of Trauma & Dissociation, 1(1), 37-46. doi: 10.1016/j.ejtd.2017.01.003
Riva, G. (2018). CELLSYNCIRCUITS: Understanding the Root Causes of Mental Disorders. Cyberpsychology, Behavior, And Social Networking, 21(5), 340-340. doi: 10.1089/cyber.2018.29113.ceu
Rund, B. (2018). The association between schizophrenia and violence. Schizophrenia Research. doi: 10.1016/j.schres.2018.02.043
Segal, L., Guy, S., & Furber, G. (2017).. What is the current level of mental health service delivery and expenditure on infants, children, adolescents, and young people in Australia? Australian & New Zealand Journal Of Psychiatry, 52(2), 163-172. doi: 10.1177/0004867417717796
Ta?, S., & Bulduko?lu, K. (2018). Early period self-care ability and care requirements of schizophrenia patients after discharge. Journal of Psychiatric Nursing, 9(1), 11-22.
Theochari, E., Tsaltas, E., & Kontis, D. (2017). The association of schizophrenia symptoms clusters with obsessive-compulsive symptoms. European Psychiatry, 41, S385-S386. doi: 10.1016/j.eurpsy.2017.02.425
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