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BULACAN STATE UNIVERSITYMojon, City of Malolos, Bulacan

COLLEGE OF NURSING

A Case Study of a 32 years oldMale Client with a Diagnosis of

Undifferentiated Schizophrenia


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ACKNOWLEDGEMENT

The group wishes to express theirdeepest gratitude and warmest appreciation tothe following people, who, in any way gave usthe possibility making this case study a success:

First of all, to the Almighty God, who nevercease in loving us and for the continuedguidance and protection.

To the groups clinical instructor, Mrs. MariaOngleo, RN, Mrs. Leila Calma, RN, Mrs. Edna

Anez, RN and Mr. Clark Ian Francisco, RN fortheir guidance and support in the duration of thestudy and during the psychiatric nursingexposure , whose help, stimulating suggestionsand encouragement helped us in all the time ofmaking this case study.


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The group also wishes to acknowledge theinvaluable assistance and cooperation of thestaff of the Mariveles Mental Hospital(MMH),especially those who are in the acutecrisis intervention service (ACIS) for allowing usto conduct this study, for essential assistancein reviewing the patient files and giving us theopportunity to care for the mentally-ill patients.

Special appreciation is extended to theclient subjected for this study and otherinformants for their selfless cooperation, timeand entrusting personal information needed forthis study.

To our parents who have always been veryunderstanding and supportive both financiallyand emotionally.

And lastly, to our dear pan

elist for sharing their time and giving usadditional knowled e which are not ust found


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INTRODUCTIONThis is the case of Mr. R.F., 32 years old

male client that was admitted at MarivelesMental hospital last March 6, 2013 andwas diagnosed with undifferentiated

schizophrenia. The patient was admitted atthe Acute Crisis Intervention Service( ACIS ) due to the complaints of the

informant that the client harms otherpeople, stabbed his uncle, has poor sleep,refuses to take medications and isirritable.


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One of the most positive areas of

schizophrenia research today is

in the area of identification ofearly risk factors for

development of schizophrenia,

and prevention of schizophrenia

in those people who are

predisposed to the disease.(source:NeuropsychiatryReview)

.


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There are 5 subtypes ofschizophrenia naming; paranoid,

disorganized, catatonic,undifferentiated, and residual.Paranoid type is characterized by

persecutory or grandiose delusions,hallucinations and occasionallyexcessive religiosity hostility andaggressive behaviour. Disorganized

type is characterized by inappropriateor flat affect, disorganized speech anddisorganized behaviour.


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The catatonic is characterized bymarked psychomotor disturbance,either motionless or excessive motoractivity. Motor immobility may bemanifested by waxy flexibility or

stupor. Excessive motor activity isapparently purposeless and notinfluenced by external stimuli. Other

features include extreme negativism,echolalia, echopraxia or even mutism.


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The residual is characterized by theabsence of prominent delusions,

hallucinations, disorganized speechand grossly disorganized or catatonic

behavior. Our client was classified and

diagnosed as schizophrenia,undifferentiated type. Which means,that she demonstrated mixed

schizophrenic symptoms of others butnot enough of them to define itsparticular type.


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Schizophrenia undifferentiated isthe type of schizophrenia wherein

characteristic symptoms (delusions.Hallucinations, disorganized speech,grossly disorganized or catatonic

behavior, and negative symptoms)are present, but criteria for paranoid,catatonic, or disorganized subtypes

are not met.


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According to AmericanAccreditation HealthCareCommission risk factors of

schizophrenia are thefollowing:


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AGESchizophrenia can occur at any age, but it tends tofirst develop (or at least become evident) betweenadolescence and young adulthood. Schizophrenia inchildren is likely to be severe. Although the risk ofschizophrenia declines with age, its incidence has

been known to peak in those who are about 45years old, and again in people who are in their mid-60s (mostly women). Late-onset schizophrenia thatdevelops in the 40s is most likely to be the paranoidsubtype with fewer negative symptoms or learningimpairment. Such patients usually have functionedat a near-normal level until structural deficits in the

brain break down.


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GENDERAlthough schizophrenia affects both men and women,there are some differences:Men tend to developschizophrenia between the ages of 15 - 24. Paranoidschizophrenia may be more common in men, andsymptoms tend to be more severe.The onset in womenis usually slightly later, between ages 25 - 34, and thesymptoms tend to be less severe. The earlier a girl startsmenstruation, the longer she is protected againstschizophrenia. Schizophrenia is more severe during awoman's menstrual cycle when estrogen levels are low.Such findings and other evidence suggest that estrogenmay have nerve-protecting properties. For example, thehigher the estrogen levels in female patients withschizophrenia, the better their mental functions.


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INTELLIGENCEPeople with schizophrenia span the full

range of intelligence. In fact, one studyreported that a higher than expectednumber of people who develop

schizophrenia had been intellectuallygifted children. Research suggests,however, that a decline in IQ scores

during childhood may be a sign ofpotential psychotic symptoms in adults.


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CULTURAL AND GEOGRAPHICFACTORSNo cultural or geographic group is immune

from schizophrenia, although the course ofthe disease seems to be more severe indeveloped countries. However, the content

of delusions may vary depending on aperson's culture. According to one study,European patients were more apt to have

delusions of poisoning or religious guiltwhile in Japan the delusions were mostoften related to being slandered.


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SOCIOECONOMIC FACTORSSchizophrenia occurs twice as often in

unmarried and divorced people as in marriedor widowed individuals. Furthermore, peoplewith schizophrenia are eight times more likelyto be in the lowest socioeconomic groups.

However, these findings are likely to be aresult of schizophrenia rather than a cause.Nevertheless, low income and poverty

increases the risk for delayed diagnosis andtreatment, and such delays could lead to moresevere disease in patients with fewerresources.


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FAMINE AND MALNUTRITIONPrenatal malnutrition may also play a role in thedevelopment of schizophrenia. Some studies havefound that people who are born during times offamine are more than twice as likely to developschizophrenia as those born during years ofadequate food. The association between famineand schizophrenia illustrates how environmentaland biologic factors are connected. For example,scientists think that malnourished mothers may notget enough folate in their diet. Folate is amicronutrient important for genetic processes.Folate deficiencies may cause genetic mutations inthe developing fetus that can lead to schizophrenia.


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OTHER FACTORS ASSOCIATEDWITH SCHIZOPHRENIABeing Left- or Mixed-Handed. The rateof left-handedness or mixed-handedness issignificantly higher among patients withschizophrenia than the general population.

This suggests that some neurologic patternthat may be responsible for each. (A largeminority of the population is non-right

handed, and very few of these peopledevelop schizophrenia.)


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Obsessive-Compulsive Disorder.Obsessive compulsive disorder (OCD)affects a significant number of schizophrenic

patients. OCD is an anxiety disorder markedby obsessions (recurrent or persistent mentalimages, thoughts, or ideas) that may result in

compulsive behaviors, repetitive, rigid, andself-prescribed routines that are intended toprevent the manifestation of the obsession.Some doctors believe the behaviors exhibitedin the disorder may actually be protective inpeople with schizophrenia in early stages.


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Behavioral and Motor Problems inChildhood.

Children who later developschizophrenia often suffer from thefollowing certain problems, including

excessive shyness or minor earlyphysical and motor-control problems.Such problems are so common,

however, that their presence without anyother risk factors is no cause for concern.


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Fathers Age.According to some studies, the older a

father is when a child is born, the greaterthe risk is for schizophrenia in hisoffspring, perhaps because of a greater

chance of genetic mutations in the spermthat can be passed on. In one study,children of fathers who were 50 years

old or more faced a three-fold risk forschizophrenia compared to children offathers who were 25 or younger.


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Epilepsy.A family history of epilepsy increases

the chance for developing schizophreniaor similar psychosis. Scientists think thatepilepsy and schizophrenia may share

similar genetic or environmental factors.(www.urac.org).


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Schizophrenia is not

a terribly commondisease but it can be a

serious and chronicone.

S hi h i R k th t 10


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Schizophrenia Ranks among the top 10causes of disability in developed countriesworldwide (source: The global burden of

disease: a comprehensive assessment ofmortality and disability from diseases,injuries, and risk factors in 1990 andprojected to 2020. Cambridge, MA:Published by the Harvard School of PublicHealth on behalf of the World HealthOrganization and the World Bank, Harvard

University Press,1996. http://www.who.int/msa/mnh/ems/dalys/intro.htm )

S hi h i i f


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Schizophrenia is a severe formof mental illness affecting about

7 per thousand of the adultpopulation, mostly in the agegroup 15-35 years. Though theincidence is low (3-10,000), the

prevalence is high due to

chronicity (www.hon.ch).

S hi h i i t t bl di d


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Schizophrenia is a treatable disorder,treatment being more effective in itsinitial stages(www.hon.ch).More than 50% of persons withschizophrenia are not receiving

appropriate care(www.hon.ch).90% of people with untreated

schizophrenia are in developingcountries(www.hon.ch).


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Worldwide about 1 percent

of the population isdiagnosed withschizophrenia. About 1.5

million people will bediagnosed with schizophrenia

this year around the world.(mentalhelp.net).


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Ninety-five percent (95%)suffer a lifetime; thirty-three

percent (33%) of all homelessAmericans suffer from

schizophrenia; fifty percent(50%) experience serious sideeffects from medications; and

ten percent (10%) killthemselves (Keltner, 2007).

A di t t d d 697 543 t f


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According to study done 697,543 out of86,241,697 of Filipinos or approximately0.8% are suffering from schizophrenia

(cureresearch.com).There are 697,543 cases of schizophrenia inthe Philippines, 75% are males and the restare females. And 51 million peopleworldwide suffer from schizophrenia inwhich males have the most number ofpercent. This statistics shows that males have

the greater risk to develop psychiatricdisorder such as schizophrenia because oftheir lifestyle and keeping their emotions.


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Here in Mariveles Mental

Hospital the total numbersof in patients are 491andaccording to the record

section the most prevalentcase is Schizophrenia.


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We have chosen this case for thereason that we want to gain more

knowledge about the disorderwhich is undifferentiatedschizophrenia and also to enhancethe knowledge we had learn fromPsychiatric Nursing in relation toits application in actual setting.


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objectivesGeneral Objectives:

This case presentation aims to identifyand determine general health problems andneeds of patient with Undifferentiated

Schizophrenia. This also intends to presentan extensive and comprehensive case studyof our chosen client that would present aninclusive discussion of Undifferentiated

Schizophrenia to yield importantinformation and gain additional knowledgewhich can be utilize on the future.


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objectives

Student-Centered

After the case presentation, the students

will be able to:Knowledge

Define and discuss various theories of

etiology of Undifferentiated SchizophreniaAnalyze data using the nursing process in

the care of client with UndifferentiatedSchizophrenia


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objectives

Skills

Present relevant and valid data that weregathered in an organized manner.

Implement appropriate interventions such ashealth teaching to client withUndifferentiated Schizophrenia, givingspecial considerations to the chief complaint

of the client related to his condition.

Utilize effective therapeutic communicationskills to the client.

Provide teaching to client, families and


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objectives

Attitude

Establish therapeutic communication and

rapport with the client for effective nurse-patient interactions all throughout the careproviding process.

Manuever own emotions while in the actualfield of duty.

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