Disor Schiz

8/19/2019 Disor Schiz

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Xavier University – Ateneo de Cagayan

College of Nursing

In Partial fulfilment of the Requirements in

NCM 10!1

"u#mitted to$

Ms! Ma! %esse&a P! Monsanto' RN MAN

"u#mitted #y$

(alo' Noreen )aye (!

(ensig' Ra&helle *ve A!

Cadi+' %an Clari&e M!

,alarrita' Re-imee "heen P!

,i&araya' Mar. Niel ,!

,utierre+' /ernanne Marie !

Pamisa' Chrysler II (!

ue2ada' *li+a Mae P!

Ro&he' Cheney %ane A!

"oto' enise Marla C!

3e#ruary 40' 401



CASE ANALYSISisorgani+ed "&hi+o5hrenia

An 167year7old girl 8"amantha9' :as admitted to the Child and Adoles&ent Psy&hiatry

Unit in the e5artment of Pediatri&s' Mari#or ;ea&hing /os5ital' Mari#or' "lovenia' for

sus5e&ted disorgani+ed 8formerly &alled he#e5hreni&9 s&hi+o5hrenia! A year earlier' at the age of 1<' she had #egun to laugh :ithout reason' and her #ehavior

had #e&ome silly and disorgani+ed! "he had 5hases of in&oherent s5ee&h as manifested #y

mum#ling :ords! /er emotional res5onses :ere ina55ro5riate! "he started grima&ing and

#e&ame 5aramimi& and 5arathymi&! "he :ithdre: so&ially and #egan to shut herself in her

room! "he had auditory hallu&inations' &onsisting of a running &ommentary on her #ehavior

8:hi&h she found 5leasant9! At that time' there :ere no &hanges in her s&hool 5erforman&e' :hi&h :as already

&onsistently #elo: average= ho:ever' her s&hool 5erforman&e deteriorated three months #efore

admission to hos5ital' :hen she #e&ame una#le to do any s&hool:or.! "he also #e&ame

disoriented as to her :herea#outs and got lost several times! ;here had #een no a#errations in

her develo5mental milestones!Until re&ently' she had not had any disease or needed any medi&al &are! >n &areful

testing and analysis' the 5atient :as diagnosed :ith disorgani+ed 8he#e5hreni&9 s&hi+o5hrenia!

"amantha :as given an aty5i&al anti5sy&hoti& drug &alled ris5eridone' t:i&e a day! It sho:ed

&onsidera#ly s5eedy im5rovement!

MENTAL STATUS EXAM

I. Presentation/Appearance



?ithdra:ing so&ially and #eginning to isolate herself :ould manifest im5airements in

their a#ility to 5erform a&tivity of daily living in&luding self &are su&h as ina55ro5riate dress' dry

s.in' oily s&al5' 5oor oral hygiene 5resen&e of #ad #ody odor!

II. Stream of Talk/Bea!ior

A year earlier' at the age of 1<' the 5atient had #egun to laugh :ithout reason' and her

#ehavior had #e&ome silly and disorgani+ed! It is very &ommon for 5atients :ith isorgani+ed

"&hi+o5hrenia to have in&oherent s5ee&h as :ell! As :hat :as stated in the &ase' the 5atient

:as mum#ling in&oherently :hi&h is a manifestation termed as s&hi+o5hasia or :ord salad

:herein there is in&oherent mi-ture of :ords or 5hrases!

III. Emotional State an" #eaction

A year #efore she :as sus5e&ted of disorgani+ed s&hi+o5hrenia' she had #egun to laugh

:ithout reason' and her #ehavior had #e&ome silly and disorgani+ed! /er emotional res5onses

:ere ina55ro5riate! "he started grima&ing and #e&ame 5aramimi& and 5arathymi&! ,enerally'

her #ehavior' s5ee&h and ver#ali+ed thoughts had #een in dis&ordan&e or la&. of harmony

#et:een her voi&e and movements! >ne of the hallmar. signs for disorgani+ed s&hi+o5hrenia is

that of :hi&h the 5atient manifests ina55ro5riate emotional rea&tion!

I$. %ist&r'ance in Tinkin(

;he 5atient had disorgani+ed thin.ing as manifested #y the in&oherent s5ee&h or :ord

salad! ;he 5atient also had delusional ideations :hi&h &onsisted of thought #road&asting or a

running &ommentary on her #ehavior :hi&h she found 5leasant!

$. %ist&r'ance in Perception



In 5atients :ith disorgani+ed s&hi+o5hrenia' the 5er&e5tion is distorted as eviden&ed #y

one of the hallmar. 5ositive or hard sym5tom :hi&h is hallu&inations 8false sensory 5er&e5tions'

or 5er&e5tual e-5erien&es that do not e-ist in reality9! A&&ording to )ir.5atri&. and ;e. 84009

there are various ty5es of hallu&inations and one ty5e is auditory hallu&inations :hi&h the

5atient manifested! It is the most &ommon ty5e' involving hearing of sounds' most often voi&es'

tal.ing to or a#out the 5atient! ;here may #e one or multi5le voi&es= a familiar or unfamiliar

5erson@s voi&e may #e s5ea.ing! "amantha had auditory hallu&inations! Although hallu&inations

&an #e threatening and frightening for the 5atient= less frequently' 5atients re5ort hallu&inations

as 5leasant!

$I. Ne&ro!e(etati!e State

;he 5atient :ithdre: herself so&ially and has shut herself in her room' due to this :hi&h

made her have &hanges in her 5sy&ho5hysiologi& fun&tions su&h as nutritional inta.e has

lessened' energy level de&reased' slee5 5atterns irregular' and #o:el fun&tioning has also

de&reased! ;o this' the 5atient resulted to lo:er a&ademi& and s&hool 5erforman&e than #efore

and has #e&ome una:are of her :herea#outs :hi&h led her to #eing lost at times!

$II. )eneral Sensori&m an" Intellect&al Stat&s

;he 5atient has #een e-5erien&ing signs and sym5toms of a disorgani+ed ty5e

"&hi+o5hrenia :herein most of the ideal signs and sym5toms are 5resent :ithin her! ;hese are

hallu&inations' grima&ing' #eing disorgani+ed' ina55ro5riate emotional res5onses'

disorientation' laughing :ithout reason' and :ithdra:al to so&iety! ;here :ere no &hanges on

the 5atients s&hool 5erforman&e :hi&h :as already &onsistently #elo: average' ho:ever' it

deteriorated three months #efore her admission! "he finds the auditory hallu&inations ad

5leasant :hi&h is not ideally normal! "he is 5aramimi& :hi&h means the use of gestures



unsuited to the :ords that they a&&om5any! ;his disorientation &aused her to get lost several

times!

$III. Insi(t/*&"(ment

Patient "amantha :as una:are of her illness and need for treatment! "he manifested

disorgani+ed sym5toms su&h as &ognitive defe&ts as eviden&ed #y the deterioration of her

s&hool 5erforman&e B months #efore admission and #e&ame disoriented and getting lost! ;his

&ognitive defe&ts manifested #y 5atient "amantha &ould already #e the #asis for la&. of insight

for 5atients :ith s&hi+o5hrenia! /o:ever' "amantha has #een ta.ing Ris5eridone t:i&e a day

and eventually sho:ed s5eedy im5rovement! "amantha is more li.ely to have a 5oor 2udgment!

"he has #een so&ially :ithdra:n and shut herself in her room' and manifested sym5toms of

&ognitive defe&ts' :hi&h &ould #asi&ally influen&e her 2udgment' either so&ially or &ognitively!



NU#SIN) %IA)N+SES AN% INTE#$ENTI+NS

1! istur#ed thought 5ro&ess related to delusions4! istur#ed sensory 5er&e5tion related to auditory hallu&inationsB! "o&ial isolation related to altered mentation

! Ris. for violen&e dire&ted to:ards self and others related to hallu&inations and delusions

#E,E#ENCES

)hila:ala' R! 8400D9! A &ase on disorgani+ed s&hi+o5hrenia$ "ym5toms of disorgani+ed

s&hi+o5hrenia! Retrieved from htt5$EE:::!#u++le!&omEarti&lesEsym5toms7of7

disorgani+ed7s&hi+o5hrenia!html

)ir.5atri&.' (!' F ;e.' C! 84009! "&hi+o5hrenia$ Clini&al features and 5sy&ho5athology

&on&e5ts! In (! %! "ado&. F G! A! "ado&.' 6 th edition' Com5rehensive te-t#oo. of

5sy&hiatry' 1' 55! 11H–1BH! Philadel5hia$ i55in&ott ?illiams F ?il.ins!

Gide#e&.' "! 840119! Psy&hiatri& – mental nursing' th edition! China$ i55in&ott ?illiams F

?il.ins!

"hives' ! 81DD9! ;he Nursing Pro&ess$ Assessment of Psy&hiatri& Patients! In (asi& Con&e5ts

of Psy&hiatri& Mental /ealth Nursing 8Brd ed!' Gol! 1' 5! HB9! Philadel5hia$ %!( i55in&ott!



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