Schizophrenia Case Study

Schizophrenia Case Study
As part of his internship, Trey is working night intake at a psychiatric hospital in a
medium-sized college town. It’s been pretty quiet all evening until a little after 1 am,
when he hears shouting in the outer hallway.
Trey looks at Lisa, his fellow student intern, who says, “What’s going on out there?”
A moment later the doors burst open, and a young man, who looks about 18 years old, is
escorted in to the intake desk. He is agitated and has tears on his face, but he is not
showing signs of violence or aggression, beyond the brief shouting he did out in the
hallway.
He plunks himself down in the chair across from the intake desk and buries his face in his
hands, rocking slightly and moaning. He has a slight body odor and is perspiring heavily.
“He’s all yours,” Lisa whispers.
Trey ignores her and moves quickly to the intake desk. Lisa runs off to find the
supervising nurse, who has gone on break.
“Hey there,” Trey says calmly, bending over to look into the patient’s eyes. “I’m Trey.
What’s up?”
He is almost surprised when the patient stops rocking, sits up, and lowers his hands.
“Hey,” he says quietly. “I’m Matt, and this is hell, dude.”
“Not quite,” Trey smiles. “I’m here to help. Can you tell me what’s happened?”
“I’m going all to pieces,” Matt says, “little screws and bolts and debris flying off
everywhere.”
Trey says nothing; he just waits.
“I had kind of a breakdown in my dorm,” Matt says. “I threw my laptop out the window.”
“Ooh, that’s rough. Bad night, huh?”
“Bad week, bad month, bad year, bad bad life. Bad bad bad bad bad bad bad bad BA-A-
A-AD.”
“What happened?”
“Where you wanna start?”
In fits and starts, Matt conveys small clues that hint at his story.
Matt has always been a “nerd,” he says, according to his older brothers. As a child he
often withdrew from play groups at school to play on his own. In isolation, he has always
managed to perform well academically, but in group work or group assignments, he has
tended to resort to outbursts and a refusal to participate. He says that he has always
been awkward in social situations and has always found it hard to carry on “a good,
rewarding conversation.”
“And I’m freakin’ clumsy. Klutzy. A klutz,” he says, looking everywhere but at Trey. “I’m
the opposite of an athlete, the opposite of my brothers.”
Although his speech is frequently eccentric, Matt manages to convey a very brief picture
of how, because of his withdrawal, negative thoughts, and social awkwardness, people
tend to leave him on his own, both at large extended family gatherings or social
functions in his family’s community and place of worship.
In his senior year of high school, Matt’s grades and SAT scores gained him entrance to a
leading Midwest university—despite his disruptive problems.
Matt had been looking forward to going away to school, hoping that part of his problems
“fitting in” had to do with his family’s “obscenely proper prominence” in the community,
and his older brothers’ “super-dude images, which,” he says, “I will never live up to.”
“At the same time,” he says during intake, “I was also pretty nervous, pretty stressed,
pretty freaked out, pretty freaky.”
In his first week of college, Matt found orientation week “disorienting,” he jokes with a
slight smile. “Orientation disoriented me. It dissed me. I got dissed. There were people
everywhere, like climbing-the-walls-and-on-top-of-you everywhere.”
Except when Trey first initiated conversation, Matt, for the most part, has worked to
avoid eye contact and continually bounces his left leg nervously. He is gripping the arms
of his chair and looks as if he’s about to fly right out of it.
“My roommate is a jock,” he says. “Jocular jock. Oh, Jocularity, wouldn’t you know they’d
put me with a jocular—not-so-very-jocular—jock. They plan that stuff, you know. Just to
keep me from escaping, from making a fresh start. Guy’s a jerk, and now, here I am.” He
grins and expands his arms, gesturing the psychiatric ward around him.
“And now here I am, just 8 weeks into my first semester away from home, and I’ve just
been admitted for totally breaking down, shooting laptop missiles from the second
freakin’ floor. They win.”
1. Where should Trey focus Matts attention and conversation during the intake
assessment (Name 2)? Is allowing Matt to discuss childhood information
beneficial? Why or Why not?
2. What information acquired during the interview about Matts behavior are
significant in terms of potential for psychosis or schizophrenia (Name 4)

Answer

  1. Where should Trey focus Matt’s attention and conversation during the intake assessment

To make a comprehensive assessment, Try should focus Matt’s attention and conversation on his history and current mental status. According to Carniaux Moran (2008), acquiring the bio psychosocial history of a client offers the nurse with their physical, psychological and social history. This is from information about their education, family, and chief complaint among others. Focusing on Matt’s mental status will help identify his mood, emotions, through process, behavior and knowledge among others.

Allowing Matt to discuss childhood information

Allowing Matt to discuss childhood information is beneficial as it may provide clues and links to when the behaviors started and also help in making a diagnosis. According to Carniaux Moran (2008), childhood traumas may affect brain development which may cause a psychiatric illness. In addition, the information will help the psychiatric nurse determine the client’s ability to sustain relationships. Those with wide social networks are identified to have a less severe mental illness than those who have no social network.

Information acquired during the interview about Matts behavior that is significant in potential diagnosis for psychosis or schizophrenia.

  1. Bizarre behavior and posture where he throws laptop out the window, sits in the chair and grips on the arms looking as if he is about to fly right out of it.
  2. He has delusions and is convinced that ‘they’ (including the roommate) are planning to keep him from escaping and making a fresh start.
  3. He has an irregular eccentric speech where he gives his story in fits and starts meaning his thinking is disorganized.
  4. He doesn’t make eye contact with Trey, has socially isolated, seems to have neglected his personal hygiene as he has body odor and has lost interest in daily activities. According to American Nurse (2016), these are negative symptoms that may help in diagnosis.

Describe primary, secondary, and tertiary care for Schizophrenia Disorders and how each can be applied to Matt.

According to the NCLEX client needs category, Matt needs a Safe, Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity and Physiological Integrity (National Council of State Boards of Nursing, 2004).  After the assessment and diagnosis by the primary care psychiatric nurse, antipsychotic medication may be offered to Matt to reduce severity of psychotic symptoms. However, he will also be assigned secondary care from a specialist team comprising a psychiatrist, psychologist and a social worker. They will provide further treatment, special care and support. However, if the mental illness is still severe, Matt may be admitted to a psychiatric ward for intense monitoring and to protect others.

References

American Nurse. (2016). Psychiatric assessment strategies for inpatients: Resources with a purpose. Retrieved from: https://www.myamericannurse.com/psychiatric-assessment-strategies-inpatients-resources-purpose/

Carniaux Moran, C. (2008). The psychiatric nursing assessment. Psychiatric mental health nursing: An introduction to theory and practice, Chapter 3. Retrieved from: https://samples.jblearning.com/0763744344/44344_CH03_039_064.pdf

National Council of State Boards of Nursing. (2004). NCLEX-RN® examination test plan. Chicago: NCSBN Retrieved from: https://www.cgfns.org/wp-content/uploads/2018/03/Client-Needs-Categories.pdf

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