Running head: SCHIZOPHRENIA CASE STUDY 1

Schizophrenia Case Study Psychiatric Mental Health

Bradley Woodley

Youngstown State University

SCHIZOPHRENIA CASE STUDY 2

Abstract

This psychiatric mental health comprehensive case study investigates the case of a 25-

year-old male, M.S., diagnosed with schizophrenia and depression. The purpose of this mental

health case study is to discuss, describe, analyze and evaluate the patients psychiatric condition

and the care being provided on the psychiatric unit to return the patient to pre-admission baseline

status. Objective and subjective data of the patient was gathered on the date of care and

additional research was done to write this comprehensive case study. Actual nursing diagnoses,

as well as a list of potential nursing diagnoses for this patient is included. The date of care took

place 3 days after admission.

SCHIZOPHRENIA CASE STUDY 3

Schizophrenia Case Study Psychiatric Mental Health

Patient M.S. is diagnosed with schizophrenia and depression, admitted on 2/1/2020. He

is a 25-year-old male with no known allergies, currently staying involuntary. He is on unit

restrictions, patient self-harm precautions and SAP. He was here previously a day ago but has

since came back seeking help. I had the pleasure to work with M.S. on 2/4/2020, and talked

with him for 45 minutes. Looking at his labs he had a TSH of 1.83, T4 of .85, ALT of 107, AST of

47, BUN of 8, Creatinine of 1.05, he was positive for cannabinoids in his drug screen and had a

116 glucose.

His appearance and behaviors were a little abnormal. His facial expression was

animated, he was slouching the whole time (45 minutes), he was dressed in hospital clothes

and they were clean and neat. His hair was unkempt and all over the place, his beard was

unkempt as well. He would have small series of facial grimacing when he would block a certain

subject, usually when bringing up family. He would put his head down and squeeze his eyes very

hard shut, almost in an effort not to cry. He would also go through random phases of random

inappropriate laughing, and when asked about what he was laughing about he would only reply

“I see people for who they really are”. He had appropriate motor activity, no signs of akathisia or

akinesia. He was friendly and accepting to talk to outside of family matters. Patient does have

hypertension and appears obese.

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Medications

Acetaminophen Tylenol Analgesic Mild Pain 1-3

Aripiprazole Abilify Antipsychotic ???
Aripiprazole Aristada Antipsychotic ???
Benzodiazepine Cogentin Anticholinergic ???

Mesylate
Clonazepam Klonopin Benzodiazepine ???
Haloperidol lactate Haldol – PO & Antipsychotic Acute/Severe

IV psychotic behavior
Ibuprophen Motrin NSAID 400-600mg 4-6 & 7-10 pain
Lithium Carbonate Eskalith Antimanic Bipolar/Schizophrenia
Metoprolol carbonate Lopressor Beta-adrenergic blocker Increased BP and

anxiety
Nicotine Nicoderm Autonomic Drugs Nicotine withdrawal
Trazadone HCl Trazadone HCl Antidepressant Sleep Aid
Hydroxyzine Antarax Anxiolytic/Sedative Anxiety

Summarize

The Mayo Clinic defines schizophrenia as “a serious mental disorder in which people

interpret reality abnormally. This can be accompanied by hallucinations, delusions, disordered

thinking, disordered speech and most require lifelong treatment”. The patient showed this with

abnormal laughing, hallucinating and seeing things that weren’t there, not thinking or knowing

anything was wrong and showing no signs of distress. Schizophrenia is most commonly

diagnosed in late adolescence through early adulthood, when symptoms begin to appear.

Biological, psychological and environmental factors can all be predisposing factors (Townsend &

Morgan, p. 341-347, 2017).

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The Mayo Clinic defines depression as “an alteration in mood that is expressed by

feelings of sadness, despair and pessimism. There is a loss of interest in usual activity and

somatic symptoms may be evident. Changes in appetite, sleep and cognition are common”. The

patient showed this with unkempt physical appearance, not sleeping well and having an

increase in blood glucose.

Identify

M.S. was released from the hospital the day prior for paranoia, was released and

returned after smoking marijuana. The marijuana gave him extreme paranoia, which led to his

father bringing him to Trumbull’s emergency room. The patient stated he was thinking about

family issues and he used the marijuana to help calm him down, which just led to the paranoia.

M.S. has a history of paranoia, increased liver enzymes, hypertension, acute psychosis,

cardiomegaly, hallucinogen abuse, cannabis abuse, suicidal ideation, leukocytosis, tobacco

dependency and substance induced psychotic & mood disorder.

Discuss

M.S. was previously admitted in Trumbull Memorial, was released and came back a day

later. He has a history of hallucinogen abuse, cannabis abuse and substance induced psychotic

behavior. He says he still currently smokes marijuana which keeps throwing his mind all over the

place and giving him extreme paranoia. Mental illness is not new to M.S., some due to the drug

abuse which he has not tried to fix, he stated “I took every drug I could get my hands on

including mushrooms, acid, meth, crack, pills and marijuana”, although none of them were on

his drug test. I did not notice anything in the charts about a history of family mental illness and I

could not get anything family related out of him due to him consistently blocking the subject.
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M.S. did say he enjoys playing football although he doesn't play it much or even watch it

anymore. He is motivated to get back to work and says it is a very easy job because he just

drives to pick the Amish up and drop them off at work, so he gets to sit on his phone most of

the day while they work.

M.S. is a diagnosed chronic cannabis user, although he doesn’t know how long he has

been smoking it for, he isn’t ready to quit. There is research connecting cannabis use

throughout adolescence, when the brain is still developing, to the development of

schizophrenia later on in life. According to Bossong & Niesink (2010) in their research article

“Adolescent brain maturation, the endogenous cannabinoid system and neurobiology of

cannabis-induced schizophrenia” it is known that the use of high-dose cannabis can cause an

acute psychosis state on an individual, that can eventually lead to a diagnosis of schizophrenia.

Describe

The psychiatric unit the patient was admitted into had a milieu environment. The priority of

safety was maintained for each patient. Group attendance and participation was encouraged

and M.S. attended both groups that I was in. He sat there without saying anything at all, but he

also wasn't spoken to, other than introducing himself. During the shift M.S. didn't make any

interactions with anyone, he just aimlessly walked around, almost like he was lost. He was

prescribed his daily medications at the prescribed times with no issues. Although the following

week when he was going to be discharged into a long term care facility, he was much more

talkative and appeared excited to get more help for himself during group.

The evidence based nursing care provided towards an individual in an acute psychiatric

unit can be help for a long duration. Jeste, Palmer, and Saks (2017), researchers at the
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Department of Psychiatry at the University of California, determined that the evidence based

practice of positive psychiatry can benefit longer remissions without psychiatric admittance in

schizophrenia patients. In their research article “Why we need positive psychiatry for

Schizophrenia and other psychotic disorders” (2017), they defined positive psychiatry as “the

science and practice of psychiatry that focuses on study and promotion of mental health and

well-being through enhancement of positive psychosocial factors” (Jeste, Palmer, & Saks p. 227).

It is designed that positive implementations during a psychiatric admission will produce positive

results. Some factors that contribute to positive psychiatry that can be implemented into

practice can be intelligence, optimism, hope and resilience (Jeste, Palmer & Saks, 2017). Positive

psychiatry should be implemented on psychiatric units by the interdisciplinary team as evidence

based practice due to the improved results and long term outcomes that can benefit our

patients.

Analyze

M.S. does have a job driving the Amish to and from work, where he said he sits on his

phone all day at work. He does enjoy where he works and is eager to go back. He graduated

high school a couple years ago. He is currently single and lives with his father. He has a high

amount of family issues and blocked the conversation every time the subject of family arose. He

misses his relationship with his brother and almost cried bringing it up every time. He stated

something about his brother doing something to the family dog that no one else knew about

except him and his brother. They no longer talk anymore which upsets him and he hopes to one

day reignite their relationship. M.S. did not have anything to say about spiritual influences other
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than he believes in a higher power although he doesn't know what exactly, indicating no real

influence on him.

Evaluate

Time in acute care psychiatric unit is meant to return the patient back to their pre-

admission baseline. M.S. describes his time on the psychiatric unit as helpful to him and he says

the medications really help him but he knows he needs additional help. At the time neither him

or I knew when he would be discharged but he did indeed get discharged the following week to

go to a longer term facility. For this patient a good start for him was to get back onto a

medication schedule and being in the facility helped stay away from marijuana and other drugs.

The patient was excited to get back to work although he didn't know when that would be. Care

for this patient involved proper medication regimen, which proved to be effective.

Summarize

M.S. had plans of going home within 2-3 days following the day I was with him. The

nurses and doctors seen small improvements, medications helping him the most. Education is a

focal point for him because he needs to continue taking his medications and try some new

coping mechanisms or he could end up back on the unit again. The patient did not have many

positive coping mechanisms, he enjoyed playing video games, collecting Pokémon cards and

playing football. He also stated he smoked marijuana but that gives him extreme anxiety and is

a negative coping strategy. According to Holubova et al., faculty at the department of psychiatry

at multiple universities in the Czech Republic, individuals diagnosed with schizophrenia are

highly susceptible to precipitating stressors that increase their chance for relapse (2016). These

people have maladaptive coping techniques. Another study performed by Holubova et al.
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(2016) revealed that people diagnosed with schizophrenia may have negative coping techniques

due to there never being a resolution to their situation. It is also found that the more severe the

mental illness is in and individual, the less positive coping techniques that individual will use

(Holubova et al., 2016). The patient was actually on the floor the following week on 2/11/2020

so I got to say hello again to him. He was leaving that day to go to a long term care facility

stating “I can’t deal with this myself and I need help”. I believe he is going Riverbend but I am

unsure for how long. His totally stay this time at Trumbull was 10 days.

Prioritized

List of actual diagnoses include:

- Risk for suicide related to psychiatric illness as evidenced by psychological diagnoses and

cannabis abuse

- Impaired social interaction related to impaired communication patterns and disturbed

thought process

- Ineffective coping related to inadequate coping skills as evidenced by poor concentration

and risk taking (Ackley & Ladwig, 2014)

- Insufficient support system related to poor family support and insufficient coping

mechanisms

List

Potential nursing diagnoses include:

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- Ineffective activity planning related to compromised ability to process information as

evidenced by lack of sequential organization and impaired social interaction

- Deficient diversional activity related to social isolation as evidenced by psychiatric unit

environment

- Risk for interrupted family process related to inability to express feelings about family

- Risk for ineffective health maintenance related to cognitive impairment

- Risk for disturbed personal identity due to schizophrenia diagnosis

Conclusion

M.S. was diagnosed with schizophrenia and depression. He has had multiple visits on

psychiatric units but his time he came in on 2/1 and stayed until 2/11. He was admitted via his

father taking him to the emergency room and getting signed involuntary. Him smoking marijuana

and getting paranoia led his father to bring him to the emergency department. M.S. is diagnosed

with schizophrenia and depression. The patient is in need of education on coping strategies,

medication compliance and negative effects of drug abuse. The psychiatric mental health

comprehensive case study on a patient with schizophrenia is concluded.

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References

Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: an evidence-based guide to

planning care. Tenth edition. Maryland Heights, Missouri: Mosby Elsevier.

Bossong, M. G., & Niesink, R. J. M. (2010). Adolescent brain maturation, the endogenous

cannabinoid system and the neurobiology of cannabis-induced schizophrenia. Progress in

Neurobiology, 92(3), 370-385. https://doi.org/10.1016/j.pneurobio.2010.06.010

Depression (major depressive disorder). (2018, February 3). Retrieved from

https://www.mayclinic.org/diseases-conditions/depression/symptoms-causes/syc-

20356007

Holubova, M., Prasko, J., Hruby, R., Latalova, K., Kamaradova, D., Marackova, M., … Gubova,

T. (2016). Coping strategies and self-stigma in patients with schizophrenia-spectrum

disorders. Patient Preference & Adherence, 10, 1151-1158.

https://doi.org/10.2147/PPA.S106437

Jeste, D., Palmer, B., & Saks, E. (2017) Why we need positive psychiatry for Schizophrenia and

other psychotic disorders. Schizophrenia bulletin vol. 43(2): 227-229.

https://doi.org/10.1093/schbul/sbw184

National Alliance on Mental Illness. (March 2015). Schizophrenia. Retrieved from

https://www.nami.org/NAMI-Media/Images/FactSheets/Schizophrenia-FS.pdf

Townsend, M. and Morgan, K. (2017). Essentials of psychiatric mental health nursing: Concepts

of care in evidence-based practice (7th ed). Philadelphia, PA: F.A. Davis.

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Case Study Comment Sheet 4842

Student Name_____________________________________
Pt Identifier______________
Date(s) of Care_____________

__________ Objective Data presentation the patient, treatments, medications

___________ Discuss patient / family history of mental illness

___________ Identify stressors and behaviors that precipitated current hospitalization

___________ Summarize the psychiatric nursing interventions with rationales

___________ Evaluate patient outcomes for nursing care provided

___________ Analyze ethnic, spiritual and cultural influences that impact care of the
patient

___________ Summarize discharge plans and community care

__________ Actual nursing diagnoses, prioritized, using R/T and a.e.b.

___________ List of potential nursing diagnoses

___________ Conclusion paragraph

____________ Style, spelling, grammar, clarity, organization, APA format