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. this is very typical behavior for the paranoid schizophrenic. they have difficulty trusting those around them. 7.

2.this is probably a delusion of grandeur, the pt believes she is all powerful. 8.

3.this is an example of echolalia, repeating the nurse's words. 9.pt is experiencing signs of avolition, reduced motivation and inability to initiate daily tasks of grooming and ADL's

4. 10."On the unit Sandra __appears disinterested in everything around her__."- This is a negative symptom of schizophrenia, which is the "absence of something that should be present but is not." In this case the patient appears to be experiencing apathy, lack of energy and anhedonia. 5 11."She sits alone, __talking and laughing to herself" .__This is a positive symptom of schizophrenia,bizarre behavior. 7. I believe this is stereotyped behavior- the repeted rocking on her bed 8. This appears to show that the pt enters a catatonic state when she doesn't get out of bed, and soils herself. It could also be negativism, she is being asked to use the bathroom, and either actively soiling herself, or it's passive and she is unintentionally not cooperating. 11. Sitting alone talking and laughing to herself, would suggest she is experiencing auditory or visual hallucinations. 6. pt was showing signs of anhedonia, a lack of pleasure or joy. 12. pt is exhibiting signs of the delusion of ideas of reference, she believes the people on the TV are laughing at her. she is giving personal significance to a trivial event.

7. Pt is ver guarded from the nurse because of the paranoia. The patient probably believes that the nurse is not there to help her but to hurt her or critize her. So she will be very suspisious of the nurse. 1

8. When a person has paranoid schizophrenia it's hard for them to do any activities that they might have enjoyed. Since this patient when off her medication she is probably paranoid that people will be staring at her, talking about her, or plotting against her. She will probably think that everyone is out to get her. Therefore she will not participate in any activities that require being in a social setting.