I.

INTRODUCTION

Schizophrenia is an extremely complex mental disorder: in fact it is probable much illness masquerading as one. A biochemical imbalance in the brain is believed to cause symptoms. Recent research reveals that schizophrenia may be result of faulty neuronal development in the fetal brain, which develops into full-blown illness in the late adolescence or early adulthood. There are different related disorders of Schizophrenia; one of these related disorders is Schizoaffective Disorder. According to Videbeck, a client with schizoaffective disorder may exhibit the symptoms of psychosis and at the same time all the feature of mood disorder, either depression or mania. (Videbeck, 2008). In this case, our patient experience depression due to the death of his mother. He hasnt recovered from that incident because one of his strength in his life was his mother. Due to poor coping skills of the patient it led him to become a mentally ill person (schizoaffective disorder). Schizoaffective disorder is a psychiatric diagnosis that describes a mental disorder characterized by recurring episodes of elevated or depressed mood, or of simultaneously elevated and depressed mood, which alternate with, or occur together with, distortions in perception. It is most commonly affects cognition and emotion. Auditory hallucinations, paranoia, bizarre delusions, or disorganized speech and thinking with significant social and occupational dysfunction are typical. The division into depressive and bipolar types is based on whether the individual has ever had a manic, hypomanic or mixed episode. Symptoms usually begin in

early adulthood, which makes diagnosis prior to age 13 rare. Although the causes of schizoaffective disorder are unknown, it is suspected that this diagnosis represents a heterogeneous group of individuals, some with aberrant forms of schizophrenia and some with very serious forms of mood disorders. There is little evidence that schizoaffective disorder is a distinct variety of psychotic illness. Consequently, the disorder appears to be comorbid or (co-occurring) schizophrenia and mood disorder. Schizoaffective disorder thus appears to exist on a continuum in-between schizophrenia and severe bipolar disorder and severe recurrent unipolar depression. It follows then that the etiology is probably more similar to that of schizophrenia in some cases and more similar to severe mood disorders in other cases. Many different genes may be contributing to the genetic risk of acquiring this illness. In addition, many different biological and environmental factors are believed to interact with the person's genes in ways which can increase or decrease the person's risk for developing schizoaffective disorder. Schizophrenia spectrum disorders (of which schizoaffective disorder is a part) have been marginally linked to advanced paternal age at the time of conception, a common cause of mutations. The physiology of patients diagnosed with schizoaffective disorder appears to be similar but not identical to that of those diagnosed with schizophrenia and severe bipolar disorder. The peek incidence of onset is 15-25 years of age for men and 25-35 years of age for women. The prevalence rate of Schizophrenia is approximately 1.1 % of the population over the age of 18 or in other words, at any one time as 51 million people worldwide

suffers from Schizophrenia. In the Philippines almost over 97,000 was diagnosed with Schizophrenia Disorder particularly Schizoaffective Disorder. Choosing this case is a challenge to nursing students, dealing with them is not that easy. This study will help the nursing students to dig deep about schizophrenia. This study will also help to increase the knowledge and understanding of the disease process; to the families, caregivers, and community members especially to nursing students on how to give care to patients with schizophrenia. Through this study the nursing students will be equipped with knowledge, attitude, and skills on the care of clients with mental disorder, particularly Schizoaffective Disorder. The study will also help them grow personally and professionally as future nurses and will guide them in providing quality therapeutic care to patients with Schizoaffective Disorder.

II. OBJECTIVES After the completion of the case study, the student-nurse will be able to gain adequate knowledge, skills, and attitude in the care of a Schizoprenic patient. specifically, the student-nurse will be able to: 1. explain the nature and occurence of schizoprenia and its impact

III. NURSING ASSESSMENT

3.1 Patients Health History/Profile A case of Mistermiss, 24 years old, a Roman Catholic, single, born at Pandal, Balamban, Cebu City. Mistermiss was admitted last December 2, 2010 at 5:09 pm with the chief complaints of Nigahi siya, ginerbyos siya ug di na matulog og di nasad mukaon as verbalized by his brother. He was under the service of Dr. Joy Adolfo with the final diagnosis of DSM IV-TRSchizoaffective Disorder, ICD IVF-Schizoaffective Disorder. 3.2 Nursing/ Health History 3.2.1 Present Health History Two months prior to admission patient was admitted in Vicente Sotto Memorial Medical Center for Behavioral Sciences and was discharged and improved after 46 days. However the physician ordered drugs such as Haloperidol, Biperiden, Chlorpromazine, Carbamazepine, Flupherazine Decanoate but the patient was not able to comply the drugs. Ten days prior to admission, patients older brother noted changes on his brothers attitude. Nigamay iya kaon, nag sige-sige ug lakaw,naa siya nakitan nahadlok siya as verbalized by his brother. He would keep silent and mumbles to himself. His brother scolded him to sit down. Few days prior to admission, di na xia maligo og manghapak sa lamisa og bong-bong as verbalized by his brother. Two days prior to admission, patient does not eat anymore. Di na siya mokaon, di na siya matulog as verbalized by his brother. Patient is now taking Haloperidol 20mg/tab 1 tab BID; Biperiden 200g/tab, 1 tab OD Chlorpromazine 100mg/tab, 1 tab q HS; 1 tab Carbamazepine 200mg/tab. 1 tab BID. Patient undergo laboratory test like CBC, SGPT and SGOT. He is very cooperative during therapy. 3.2.2 Past Health History Patient has no history of hypertension, diabetes mellitus, and bronchial asthma. He was admitted at VSMMC on 2009 and October 15, 2010 due to schizophrenia.

3.2.3 Family Health History Patients mother died at the age 56 last 2007 due to breast cancer. His father was a former reflexologist. A familial disease of hypertension on maternal side and diabetes mellitus on both maternal and paternal side was present. Patient has no history of mental illness as states in chart. 3.3.4 Personal and Social History In his childhood days, the patient was a silent type person. He has an award in elementary and high school level. He was able to take 1 semester BSED at Cebu Normal University and needed to stop due to his condition. Patients havent used tobacco and alcohol. He hasnt known allergies. 3.2.5 Mental Status Examination I. GENERAL APPEARANCE AND BEHAVIOR During our first interaction, patient has already taken a bath but he still wore dirty clothes. He said that the supplies office was still closed that is why his clothes were dirty. Patient has a poor eye contact with me in our first day of interaction. On the next day of our interaction, patient was well groomed. He had taken a bath and wore new clean clothes already. He has a good eye contact in every interaction. The patient showed a sad face and sometimes stops talking if we talked about sad stories. He had an audible voice, and if, he was asked closed-ended questions, he would directly answer it, but he would give additional information about the topic. He kept on biting his lips every time he stops talking and tends to be silent in the middle of interaction. II. MOOD AND AFFECT Patient becomes silent in the middle of our conversation. The client showed a sad face every time that we will be talking about sad moments of his life. He would smile and laugh at times, bitten his lips and wondering till he became silent. III. THOUGHT PROCESS AND CONTENT Patient experienced delusion sometimes because he told me that his mother was a beauty queen and has a twin on the female ward of the center. Patient also experienced tangential thinking

because he will wonder if he could not able to answer the question and sometimes thought blocking because he will stopped giving ideas in the middle of interaction. IV.SENSORIUM AND INTELLECTUAL PROCESS ORIENTATION Patient was oriented to time, date, year and place. He was able to remember the name of his father; mother and knew when his birthday and birthplace. Patient knew his name and the address where he lived. MEMORY Patient has a fair memory because he knew who the wife of President Marcos was, he knew when was Gloria Diaz crowned as Ms. Universe and could still remember his activity yesterday, such as they had their dance therapy and art therapy. When I assessed his memory why he had stopped in his study he could still remember the reason and it was the death of his mother. ABILITY TO CONCENTRATE The patient can spell his name MISTERMISS forward and backward. He was able to answer correctly if you let him subtract 100 by 7, 93 by 7, and so on. He was able to memorize the days of the week forward and backward. He was able to follow the instruction given to him such as instructing him to read the writings in the wall and he was able to read it perfectly. ABSTRACT THINKING AND INTELLECTUAL ABILITIES He was given a situation where in, if he saw a wallet on the road and I asked him what to do in that situation he answered akong puniton, akong Ipa broadcast sa radio kung kinsa ang tag iya. SENSORY PERCEPTUAL ALTERATION Patient has good sensory perception but sometimes experienced delusion. V. INSIGHT AND JUDGMENT Patient has ability to judge things based on what his perception. Patient has a fair insight because when I asked him why he has been scolded by his brother, he answered kay dili man ko ganahan ug laban ni Pacquio. Siya kay ganahan man,nag lalis mi.

VI. SPEECH AND LANGUAGE He could speak Bisaya, Tagalog and English. He could read and write well. He speaks clearly. He was talkative and answered my question if asked. Sometimes he was the first one who approaches me to have a talk magtabi na ta as he verbalized. VII. LEVEL OF CONSCIOUSNESS Patient is conscious and awake. He is very active during therapy. Patient was also willing to interact with me when he saw me in the ward. VIII. ATTITUDE He was very cooperative and respects his student nurse. He was also responsible to the tasked given to him example panghugas sa kamot mistermiss ug mukaon... cooperate sa sunod na student nurse na naka assign nimo ha. The next day of our duty, I asked my fellow student nurse if our patient cooperated with her, she answered yes, and he told me that our patient was kept on asking her if she knew me. IX. SUICIDALITY AND HOMICIDALITY Patient showed attempted suicide as evidenced by having presence of scars in the left hand but no homicidally actions noted. He really wanted to go home. Sometimes he has an instinct to escape in the center. nagadlas ko kay nikatkat man ko sa koral kay ganahan nako muoli . as verbalized. X. ROLES AND RELATIONSHIP Patient stated that he was closed to his mother. One factor why he suffered mental illness its because of the death of his mother. Naundang man ko sa akong pag skwela pagkamatay sa akong mama nabuang ko ato kadali. As verbalized. Patient was still confused with his sexualityganahan ko ug lalakibabaye sad .as verbalized.

3.2.6 Physical Examination

Body Part Skin

Inspection  Fair complexion  Absence of lesions

Palpation  When pinched, skin returns to its normal state (2 seconds)

Hair

 Evenly distributed  Thick, short hair  Absence of lice

Nails

 Intact epidermis

Scalp

 No visible flakes

Head

 No lesions

 Absence of nodules and masses

 rounded

Face

 symmetrical facial features

 symmetrical nasolabial folds

 symmetrical facial movements

Forehead

 flat

EYES

Eyebrows

 evenly distributed

 skin is intact

Eyelids  no discharges

 skin is intact

Eyelashes

 slightly curled outward

Conjunctiva

 pale pink in color

Lacrimal gland

 no discharges

Visual fields

 can read in a 6-10 feet distance approximately 18 font size

EARS

Auricles

 color same as facial skin

 Not tender  No masses

Gross hearing acuity

 can hear in a normal tone of voice with 2 feet distance

NOSE  uniform in color

 no discharges MOUTH

Lips

 ability to purse lips

 pale lips Buccal mucosa  moist Gums  reddish in color Tongue  reddish tongue Teeth  has loose teeth in the upper and lower part Neck  lymph nodes not Chest visible

Abdomen

 not inspected

Genitals

 not inspected

 not inspected

EXTREMITIES

Upper extremities

 No masses  Skin returns to normal  (-) edema  No lesions  Fair skin complexion state when pinched

Lower extremities

 No nodules / masses  Skin returns to normal  Absence of lesions  Skin intact state when pinched

 Presence of scars (left wrist)

3.3 Level of Growth and Development 3.3.1 Normal Development of a Young Adult Young adults (20-40 years) The age at which a person is considered an adult depends on how adulthood is described. Legally a person in the United States can vote at 18 years. The legal age for alcohol consumption outside the home varies among states from 18 to 21 years. Another criterion of adulthood is financial independence, which is also highly variable. Some adolescents support themselves as early as 16 years of age, usually because of family circumstances. By contrast, some adults are financially dependent on their families for many years. Adulthood may also be indicated by moving away from home and establishing ones own living arrangements. Yet this independence also varies greatly. Some adolescence leaves home because of family problems. In recent years, however, more young adults have been choosing to remain at home. In addition, many adults under 30 have returned to their parents homes to live. The factors contributing to this trend include high housing costs, high divorce rates, high unemployment rates, and the many problems resulting from drug abuse. Some young people who are employed full time receive only minimum wage and are unable to earn enough money to be totally self supporting. Maturity is the state of maximal function and integration, or the state of being fully developed. Many other characteristics are generally recognized as representative of maturity. Mature individuals are guided by an underlying philosophy of life. They take many perspectives into account and are tolerant of the views of others. A comprehensive philosophy allows a person to make sense out of life and thus helps that person maintain a sense of purpose and hope in the face of human tragedies. Mature persons are open to new experiences and continued growth; they can tolerate ambiguity, a flexible, and can adapt to change. In addition, mature people have the equality of self-acceptance; they are able to be reflective and insightful about life and to see themselves as others see them. Mature persons also assume responsibility for them and expect others to do the same. They confront the task of life in a realistic and mature manner, make decisions, and accept responsibility for those decisions.

Young adults are typically busy people who face many challenges. They are expected to assume new roles at work, in the home, and in the community, and to develop interest, values, and attitudes related to these roles. Physical Development People in their early 20s are in their prime physical years. The musculoskeletal system is well developed and coordinated. This is the period when athletic endeavors reach their peak. All other systems of the body (e.g. cardiovascular, visual, auditory, and reproductive) are also functioning at peak efficiency. Although physical changes are minimal during this stage, weight and muscle mass may change as a result of diet and exercise. Psychosocial Development In contrast to the minimal physical changes, psychosocial development of the young adult is great. Young adults face a number of new experiences and changes in lifestyle as they progress toward maturity. Choices must be made about education and employment, about whether to marry and share living arrangement and certain expenses. Some people who are gay or lesbian commit themselves legally to a partner as in marriage. Although nontraditional lifestyle is becoming more acceptable in society, attitudes toward these various lifestyle can contribute social pressures that lead to social responses. The multiple roles of adulthood (citizen, worker, tax payer, home owner, wife/husband, daughter/son, parent, friend, and so on) may also create stress as a result of role conflict. Cognitive Development Piaget believes that cognitive structures are complete during the formal operations period, from roughly 11 to 15 years. From that time, formal operations (for example, generating hypotheses) characterize thinking throughout adulthood and are applied to more areas. Egocentrism continues to decline; however, according to Piaget these changes do not involve a change in the structure of thought, only a change in its content and stability.

Recently, researchers in the field of psychology have suggested that Piagets formal operational stage is not the last stage of human development. Some have proposed a concept of post formal thought. Post formal thought, sometimes called the problem finding stage, is characterized by creative thought in the form of discovered problems, relativistic thinking, the formation of generic problems, the raising of general questions from ill-defined problems, the use of intuition, insight, and hunches, and the development of significant scientific thought. In addition to the adolescent ability to think in abstract terms, post formal thinkers possess an understanding of the temporary or relative nature of knowledge. They are able to comprehend and balance arguments created by both logic and emotion. Moral Development Young adults who have mastered the previous stages of Kohlbergs theory of moral development now enter the post-conventional level. At this time, the person is able to separate self from the expectations and rules of others and to define morality in terms of personal principles. When individuals perceive a conflict with societys rules or laws, they judge according to their own principles. For example, a person may intentionally break the law and join a protest group to stop hunters from killing wildlife conversation justifies the protest action. This type of reasoning is called principled reasoning. Gilligan argues that as individuals approach young adulthood, men and women tend to define moral problems somewhat differently. Men often use an ethic of justice and define moral problems in terms of obligation to care and to avoid hurt. Spiritual Development According to fowler, the individual enters the individuating-reflective period, the individual focuses on reality. A 27 year old adult may ask philosophic questions regarding spirituality and may be selfconscious about spiritual matters. The religious teaching that the young adult had as a child may now be accepted or redefined.

3.3.2 The Ill Young Adult Late adolescence and early adulthood are the peak years for the onset of schizoaffective disorder, although it has been diagnosed (very rarely) in childhood. Schizoaffective disorder is a mental illness characterized by recurring episodes of mood disorder and psychosis. Psychosis is defined by paranoia, delusions and hallucinations. Mood disorders are defined by discrete periods of clinical depression, mixed episodes and manic episodes. Individuals with the disorder may experience psychotic symptoms before, during or (commonly) after their depressive, mixed or manic episodes. The illness tends to be difficult to diagnose since the symptoms are similar to other disorders with prominent mood and psychotic symptoms like bipolar disorder with psychotic features, recurrent depression with psychotic features and schizophrenia. By contrast, in schizoaffective disorder, as it is presently defined, psychosis must also occur during periods without mood symptoms. In schizophrenia, mood episodes have been thought to be absent or less prominent than in schizoaffective disorder. Since these differences can be difficult to detect, a firm diagnosis of schizoaffective disorder may thus require an extended period of observation and treatment. Untreated, the individual with schizoaffective disorder may experience delusions. It should be noted that delusions in schizoaffective disorder are acute manifestations of an active psychosis and are not personality traits; that is, they go away when the psychosis subsides. Manifestations of delusions include the individual being convinced that he or she is Jesus or the Antichrist, has some special purpose or destiny (such as to save the world), or is being monitored, watched or persecuted by something (commonly government agencies), when in reality they are not. Individuals may also feel extremely paranoid. Other delusions may include the belief that an external force is controlling the individual's thought processes. (See thought insertion.) Hallucinations involving all five senses can also occur in untreated or undertreated schizoaffective disorder. That is, the individual may see, hear, smell, feel or taste things that aren't there. For example, the individual may see overt visual hallucinations such as monsters, the devil or more subtle ones such as shadowy apparitions. Individuals may hear voices or, in some cases, music. Things may look or sound different. Individuals may also experience strange

sensations. These hallucinations may worsen when the individual is intoxicated. The untreated individual may quickly change their mind about their romantic partner, friends or family if they hear something negative being said about them; as a result they may attack or, conversely, isolate themself from the person or group until they regain normal thoughts. Comorbid or co-occurring anxiety disorders may also play a role in the subjective experience of schizoaffective disorder and thus may shape the individual's delusional thought content. For example, the individual may feel anxious, have trouble swallowing, and then believe that outside forces are controlling their throat functions. They may also suffer from various phobias which may also manifest as delusions. There may be a decline in work or school functioning during episodes of illness. As stated above, individuals with schizoaffective disorder may withdraw socially and become isolated. The untreated individual may sleep too much, or be unable to sleep. Difficulties with executive function may also be a problem for individuals with schizoaffective disorder. This may include difficulties with concentration, attention, logical reasoning and impulse control. Without treatment, the individual with schizoaffective disorder may further worsen in their delusional thought processes. With comprehensive treatment, many individuals with schizoaffective disorder may recover much, most or even all of their functionality.

IV. PATHOPHYSIOLOGY AND RATIONALE 4.1 Anatomy and Physiology of the Central Nervous System

The Brain is the part of the central nervous system that includes all the higher nervous centers which are enclosed within the skull. It is responsible for one's thoughts and feelings and is considered the seat of the faculty of reason. The human brain is indeed an example of the complexity and uniqueness that caused the psalmist to describe our workings as both fearfully and wonderfully made. The brain is the most complex part of the human body. This threepound organ is the seat of intelligence, interpreter of the senses, initiator of body movement, and controller of behavior. Lying in its bony shell and washed by protective fluid, the brain is the source of all the qualities that define our humanity. The brain is the crown jewel of the human body.

The brain has seven divisions in all, each with a specific job. The mesencephalon is what connects the hindbrain to the brain stem. This is sometimes referred to as the midbrain. The mesencephalons functions include sight, pupil dilation, eye movement, body movement, and hearing. Prosencephalon is also known of as the forebrain, its functions include chewing, smell, taste, salivation, and swallowing-to name a few. Two smaller divisions of the prosencephalon are the diencephalon and telencephalon. The diencephalon controls vision, facial sensation, phonotation, and vision. The Telencephalon is the division with the important job of determining intelligence, personality, sensory impulses, motor functions, planning, organization, smell, and touch. The rhombencephalon, or hindbrain, is located in the latter part of the brains stem. It is also divided into two smaller divisions. The first is called the metencephalon, which is in control of balance, muscle tone, arousal, circulation, and sleep. It is located above the medulla oblongata and it consists of the brain's cerebellum and pons. Pons act as neuron pathways that conduct messages from the cerebellum and spinal cord. Pons also help monitor the body's respiratory actions. Each cerebral hemisphere can be divided into sections, or lobes, each of which specializes in different functions. To understand each lobe and its specialty we will take a tour of the cerebral hemispheres, starting with the two frontal lobes, which lie directly behind the forehead. When you plan a schedule, imagine the future, or use reasoned arguments, these two lobes do much of the work. One of the ways the frontal lobes seem to do these things is by acting as short-term storage sites, allowing one idea to be kept in mind while other ideas are considered. In the rearmost portion of each frontal lobe is a motor area, which helps control voluntary movement. A nearby place on the left frontal lobe called Brocas area allows thoughts to be transformed into words. When you enjoy a good mealthe taste, aroma, and texture of the foodtwo sections behind the frontal lobes called the parietal lobes are at work. The forward parts of these lobes, just behind the motor

areas, are the primary sensory areas. These areas receive information about temperature, taste, touch, and movement from the rest of the body. Reading and arithmetic are also functions in the repertoire of each parietal lobe. As you look at the words and pictures on this page, two areas at the back of the brain are at work. These lobes, called the occipital lobes, process images from the eyes and link that information with images stored in memory. Damage to the occipital lobes can cause blindness. The last lobes on our tour of the cerebral hemispheres are the temporal lobes, which lie in front of the visual areas and nest under the parietal and frontal lobes. Whether you appreciate symphonies or rock music, your brain responds through the activity of these lobes. At the top of each temporal lobe is an area responsible for receiving information from the ears. The underside of each temporal lobe plays a crucial role in forming and retrieving memories, including those associated with music. Other parts of this lobe seem to integrate memories and sensations of taste, sound, sight, and touch. All together, these incredible regions of the body's most sophisticated organ work in harmony to distinguish humans as unique beings created in the image of God. Coating the surface of the cerebrum and the cerebellum is a vital layer of tissue the thickness of a stack of two or three dimes. It is called the cortex, from the Latin word for bark. Most of the actual information processing in the brain takes place in the cerebral cortex. When people talk about "gray matter" in the brain they are talking about this thin rind. The cortex is gray because nerves in this area lack the insulation that makes most other parts of the brain appear to be white. The folds in the brain add to its surface area and therefore increase the amount of gray matter and the quantity of information that can be processed. Deep within the brain, hidden from view, lie structures that are the gatekeepers between the spinal cord and the cerebral hemispheres. These structures not only determine our emotional state, they also modify our perceptions and responses depending on that state, and

allow us to initiate movements that you make without thinking about them. Like the lobes in the cerebral hemispheres, the structures described below come in pairs: each is duplicated in the opposite half of the brain. The hypothalamus, about the size of a pearl, directs a multitude of important functions. It wakes you up in the morning, and gets the adrenaline flowing during a test or job interview. The hypothalamus is also an important emotional center, controlling the molecules that make you feel exhilarated, angry, or unhappy. Near the hypothalamus lies the thalamus, a major clearinghouse for information going to and from the spinal cord and the cerebrum. An arching tract of nerve cells leads from the hypothalamus and the thalamus to the hippocampus. This tiny nub acts as a memory indexersending memories out to the appropriate part of the cerebral hemisphere for long-term storage and retrieving them when necessary. The basal ganglia (not shown) are clusters of nerve cells surrounding the thalamus. They are responsible for initiating and integrating movements. Parkinsons disease, which results in tremors, rigidity, and a stiff, shuffling walk, is a disease of nerve cells that lead into the basal ganglia. The brain contains four ventricles, one median cavity, two of them lateral and the other normal, minor when compared to the other three. Each of the ventricles is filled with a cerebrospinal fluid which makes up the choroid plexuses. The choroid plexuses are made up of tiny blood cells grouped together, these are what make up the sides and tops of the ventricles. The median cavity ventricle (third ventricle) is held down by the hypothalamus and the thalamus. The two lateral ventricles (first and second ventricles), positioned in the cerebral hemispheres in the middle of the brain, form a triangular shape with four horn-like figures. This ventricle sends signals to the third ventricle via the inter ventricular foramen. The lowest in importance of the ventricles (the fourth ventricle) stretches from the middle of the brain to the central canal located at the top of the spinal cord. It serves a bridge-like purpose transmitting information and releasing the cerebrospinal fluids into the subarachnoidal area, courtesy of the two Luschka orifices, along with the orifice of Magendie.

Everyone's brain has a special system that keeps out most molecules and which only allows certain substances to enter the brain. The brain needs oxygen and glucose and other nutrients, but must be very carefully protected from the entry of bacteria, and even from the entry of most molecules, especially ions. This barrier is very important to our continued survival and ability to think. It hampers doctors, who would like to be able to have certain medications enter the brain. Recently, researchers found that cells called pericytes are especially important in maintaining the barrier. Many are found near blood vessels in the brain to help ensure that immune system molecules which cause inflammation and swelling are prevented from entering the brain, though those molecules are necessary for other parts of the body. Previously, many researchers thought that cells called astrocytes were most likely the ones that maintain the blood brain barrier, but the new research shows that the pericytes are more important and are present long before birth. The blood brain barrier is present well before we are born.