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Schizophrenia cannot be deferred as a single illness, it is thought of a syndrome or a disease process with many different varieties and symptoms. It causes bizarre thoughts, perceptions, emotions, movements and behavior. (Videbeck, 2013 pg. 266) While talking to some of the patients at Harris County Psychiatric Center some of these symptoms were present in most of them. One patient was admitted to the hospital by law enforcement. They found him on the street talking to self, and was making remarks about killing self.
The patient’s inability to cope with life and the hallucinations spiraled into trying to commit suicide. He attempted to commit suicide by drug overdose, which led to his admission to Harris County Psychiatric Center. For decades, the public vastly misunderstood schizophrenia, fearing it as dangerous and uncontrollable and causing wild disturbances and violent outburst. (Videbeck, 2013 pg. 266)
(Paus T, et al. Nat Rev Neurosci. 2008.)
Most with Schizophrenia learn to cope with life by learning different coping mechanisms, in order to be able to function normally in life, to continue to their daily activities and responsibilities.
Schizophrenia usually is diagnosed in late adolescence or early adulthood. It rarely manifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women.
(Videbeck, 2013 pg. 266) The Prevalence of Schizophrenia is estimated about 1% of the total population. In the United States this translates to nearly 3 million people who are, have been, or will be affected by the disease. The incidence and the lifetime prevalence are roughly the same throughout the world. (Thacker, 2009) The prevalence of Schizophrenia among adolescents has been estimated to be at least 0.5%. Bipolar disorder (type 1) is less common in adolescents. In many other countries its lifetime prevalence is about 0.6%. (Merikongas KR, et al. Arch Gen Psychiatry, 2011)
Although the symptoms of Schizophrenia are always severe the long-term course does not always involve progressive deterioration. The clinical course varies among clients. (Videbeck, 2013 pg. 267) The onset of the course may be abrupt or insidious, but most clients slowly and gradually develop signs and symptoms such as social withdrawal, unusual behavior, lost of interest in school or work, and neglected hygiene. (Videbeck, 2013 pg. 267) Immediate course the client experience ongoing psychosis and never fully recover, although symptoms may shift in severity over time. (Videbeck, 2013 pg. 267) Some clients with long-term impairment regain some degree of social and occupational functioning. (Jablensky, 2009) Some people retrieve treatment at Harris County Psychiatric Center with medication and therapy and recover in a short amount of time, and others require treatment for a lifetime. It depends on the severity of the disorder and the individual’s response to treatment.
Interpersonal theorists suggested that Schizophrenia resulted from dysfunctional relationships in early life and adolescence. None of this has been proven. The never scientific studies are finding more evidence to support neurologic/ neurochemical causes. (Videbeck, 2013 pg. 268) Newer scientific studies began to demonstrate that schizophrenia results from a type of brain dysfunction. These neurochemical/ neurologic theories are supported by the effects of antipsychotic medications, which help to control psychotic symptoms and neuroimaging tools such as computed tomography, which have shown that the brain of people with schizophrenia differs in structure and function from the brain of control subjects. (Videbeck, 2013 pg. 268)
The primary medical treatment for schizophrenia is psychopharmacology. In the past electroconvulsive therapy, insulin shock therapy, and psychotherapy were used, but since the creation of Chlorpromazine (Thorazine) in 1952, other treatments modalities have become all obsolete. (Videbeck, 2013 pg. 270) During my clinical experience at Harris County Psychiatric Center the treatments that I saw were medications and group therapy. My patient was involved in in recreational group therapy along with spiritual group therapy. It takes a combination of treatments to be effective such as medications, psychological counseling, and self-help resources. Antipsychotic medications, also known as neuroleptics, are prescribed primarily for their efficacy in decreasing psychotic symptoms. They do not cure schizophrenia; rather, they are used to manage the symptoms of the disease. (Videbeck, 2013 pg. 270)
There is currently no known cure for schizophrenia and a full recovery from schizophrenia is unusual, with only approximately 15% returning to previous functioning capabilities. However, most individuals with the condition are able to live a meaningful and satisfying life, in the presence or absence of symptoms. For most patients, the symptoms tend to change over time and the impact they have on the life and daily activities of each individual may vary significantly. In general, women patients are more likely than men to maintain improvement of symptoms. (New-Medical, 2004)
Certain Labs and Diagnostic studies are to be done to the patient to see what the cause was and how they were diagnosed with this disease. A physical exam was done to rule out other symptoms that may have cause the complication. Tests and screening were also done such as CT scan and MRI. Along with Psychiatric evaluation to check the patient mental status. The DSM-5 was also used to make the diagnosis. (Mayo-clinic, 2018)
Do not stop taking suddenly. Stopping abruptly may cause serious side effects. You may gain weight or have high cholesterol and triglycerides while taking this medicine.
While taking Seroquel call your doctor immediately if you develop muscle stiffness, confusion, irregular or rapid heartbeat, excessive sweating, and high fever. These are signs of neuroleptic malignant syndrome (NMS), a serious and potentially fatal reaction to the drug.
Short-term goal: Patient will demonstrate decreased anxiety level 24 to 48 hrs.
Subjective: Patient states “I’m hearing voices, I’m going to kill myself.”
Objective: Patient was pacing the floor back and forth from his room to the day room.
Assessment: Patient agrees to participate in group therapy while hospitalized.
Plan: Patient will sit in the dayroom for about an hour with his peers.
Long-term goal: Patient will be free from Hallucinations or demonstrate the ability to function without responding to persistent Hallucinations.
Teaching: Teach the patient different coping mechanism in order for him to function in the world normally.
Interventions: Initially, do not argue with the client or try to convince the client that the delusions are false or unreal. Interact with the client on the basis of real things; do not dwell on delusional material. Encourage the client to talk with you, but do not pry for information.
Short-term goal: Patient will engage in social interactions, for example, verbally interact with other clients for specified periods or specified frequency, for example, for 5 minutes at least twice a day within 2 days.
Subjective: Patient stated, “I don’t like to be around a lot of people at one time.”
Objective: Patient was seen in the day room sitting alone talking to himself.
Assessment: Patient recognizes needs to cope with life.
Plan: Patient is willing to participate in different group therapies to solve problems and handle her stress.
Long-term goal: Patient will demonstrate appropriate emotional responses by the end of discharge.
Discharge Teaching: Explore with the client different ways to cope with being around a lot of people. Teach Patient that regular exercise is good for health and for insomnia. Teach to maybe exercise with a partner. Teach the client to eat a well-balanced meal its helps to improve sleep pattern.
Develop trusting relationship with the client. Show empathy, concern, be honest and keep all promises. Teach patient to take all meds as directed, do no skip a dose, you may take with food to prevent GI upset.
Assist client in problem solving as he or she attempts to determine methods for coping with life. Follow up with PCP if signs of NMS occur such as muscle stiffness, confusion, irregular or rapid heartbeat, excessive sweating, and high fever. Evaluate the patient by the end of discharge to see if he is able to demonstrate different coping mechanism to cope with different life experiences.
Interventions: Provide attention in a sincere, interested manner. Avoid trying to convince the client verbally of his own worth. Talk with the client about his interactions and observations or interpersonal dynamics.
Short-term goal: Patient will demonstrate decrease hallucinations with 24 to 48 hours.
Subjective: Patient stated, “I hear voices and it telling me to kill myself.”
Objective: Patient was seen in the day room sitting alone and talking to self.
Plan: Patient is willing to sit in the day room and eat with peers and communicate.
Long-term goal: Patient will verbalize plans to deal with hallucinations, if they recur.
Teaching: Explore different type of defense mechanisms in order for the patient to cope.
Interventions: Be aware of all surrounding stimuli, including sounds from other room. Encourage the client to tell staff members about hallucinations. Maintain simple topics of conversation to provide a base in reality.
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