Case+Study+5+Schizophrenia


 * ​NUR 154/SP2010: Case Study #5: Schizophrenia**


 * Read the following case study and fill in the blanks with the description of the information that is underlined and numbered in the text. Content submitted after 0840 on March 3, 2010 will not be considered for grading.**

Sandra, a 37-year-old woman was picked up by the police after she ran away from her parents’ home. Sandra has a 17 year history of paranoid schizophrenia. She has had numerous hospitalizations.

Police were called when Sandra began wandering through a local park and screaming at everyone. “I know you are possessed by the devil.” During her initial interview, she is __very guarded and suspicious of the nurse__ (1). __“I can read your mind, you know.”__ (2),

Sandra is assigned to a room and oriented to the unit. At 5:00PM, the nurse says to Sandra, “Sandra it’s time for dinner.” __Sandra responds, “time for dinner; time for dinner; time for dinner.”__ (3) __The nurse notices that each time she wipes her mouth__ __with her napkin at dinner, Sandra does the same.__ (4)

Sandra’s mother reports that Sandra stopped taking her medicine about a month ago, stating, “__When you don’t have a brain__, (5) you don’t need medicine.” Shortly afterward, she became totally despondent, __taking no pleasure in activities she had always found enjoyable.__ (6) She stayed in her room, sitting on the bed __moving back__ __and forth in a slow, rhythmic fashion.__ (7) Sometimes she would not even get up to go the bathroom, __instead soiling herself in an infantile manner__. (8) She seemed to experience a total __lack of energy for usual activities of daily living__. (9) On the unit Sandra __appears disinterested in everything around her__. (10) She sits alone, __talking and laughing to herself.__ (11). At one point she hears a laugh track on TV and states, “__They’re laughing at me. I know they are__.” (12)

1. changes in affect <~could this be persecution's as well? (in the fact that one may believe others may be "out to get them") Yeah, I think persecution is a better answer. I would go with that. i'm agreed too, persecution is an alteration of thinking (delusion). Positive Symptom: Delusional: Persecutory I'm going with persecution also.

2. Grandeur-the belief that one is a very powerful person

3. disorganized thinking, associative looseness. "echolalia." impaired verbal communication, impaired social interaction, risk for lonliness. it may indicates that pt is feeling increased anxiety / overwhelmed by poorly/ disorganized thinking. 4. Echopraxia-mimicking of movements of another

I think noting both four five are also seen with catatonia which coinincides with seven, Catatonia is a pronounced increase or decrease in the rate of movement. Also we should include Positive Symptom: Delusional 5 stigma, need for teaching. - caregiver role strain, deficient knowledge, compromised family coping .<~i also this may //possibly// relate to somatic delusions (belief that one's body is changing in an unusual way)?! possibly. but wouldn't deficient knowledge cover that? she might having delusion but it is not anosognosia? (inability to realize she is ill) What about Positive Symptom: Somatic Delusion? or a cognitive symptom illogical thinking? somatic delusion because she believes her body has change. 6. withdrawl from previously enjoyed activities. social/occupational dysfunction. anergia. Avolition .<~anheodina-i thought this may be anheodina in which the patient has the inablity to experience pleasure in activities that usually produce it. it cause self-care deficit r/t lack of motivation. anhedonia is a better choice. 7. echopraxia <~i understand the movement part, but, who was she mimicking? I thought this may be an example of stereotyped behaviors, repeated motor behaviors that do not presently serve a logcial purpose? it is not catatonia? (increased rate and amt of movement) I think catatonia can apply as defined in the book it can be an increase or decrease in rate of movement and there are different states. in the text it says that that the mimicking can be seen in catatonia but i think echopraxia is a better choice. but who knows it could be either. 8. self-care deficit .<~I also thought this was an exaple of the defense machanism, Regression. we can use both right? It;s kind of hard to know which ones are which, because some are up for interpretation. Why don't we all post what we think it is than just discuss it. I think i went with regression for this one. 9. anergia and avolition. i only chose anergia. 10. this could be anhedonia (inability to experience pleasure in activities). 11. hallucinations/delusions. autisum - disturbed sensory perception. <~Disorganized speech/word salad-words that may be meaningless to the listener auditory hallucination? 12. paranoria - ideas of reference ( significance to event such as staff talking to another = them plotting to kill.) disturbed thought process. <~ Ideas of Reference :) i agree with idea of reference.