Psychiatric Case Study

Tarlac State UniversityCOLLEGE OF NURSING

Lucinda CampusTarlac City

A CASE STUDY

On

PARANOID SCHIZOPHRENIA

Presented by:

Espinosa, Rachael Ann B.Granadozin, Chenee L.

Tapnio, Reselda

April 22, 2008

TABLE OF CONTENTS

Chapter 1 …………………………………………………………….

Introduction Theoretical Framework Personal Data History of present Illness Past Personal History Family History

Chapter 2 ……………………………………………………………

General appearance Motor behavior Sensorium and Cognities Perception Attitude and Behavior Defense Mechanism Affective State Speech Thought Process and Content

Chapter 3 …………………………………………………………….

Psychopathology Related Literature and Studies Drug Study

Chapter 4 …………………………………………………………….

Process Recordings Prioritized Psychiatric Nursing Diagnoses

Chapter 5 ……………………………………………………………

Psychotherapies Implemented

CHAPTER 1

Introduction

Paranoid schizophrenia is the most common type of schizophrenia in most parts

of the world. The clinical picture is dominated by relatively stable, often paranoid,

delusions, usually accompanied by hallucinations, particularly of the auditory variety,

and perceptual disturbances. Disturbances of affect, volition, and speech, and catatonic

symptoms, are not prominent.

With paranoid schizophrenia, your ability to think and function in daily life may

be better than with other types of schizophrenia. You may not have as many problems

with memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious,

lifelong condition that can lead to many complications, including suicidal behavior.

(http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862)

Patients who have paranoid schizophrenia that has thought disorder may be

obvious in acute states, but if so it does not prevent the typical delusions or hallucinations

from being described clearly. Affect is usually less blunted than in other varieties of

schizophrenia, but a minor degree of incongruity is common, as are mood disturbances

such as irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms such

as blunting of affect and impaired volition are often present but do not dominate the

clinical picture.

The course of paranoid schizophrenia may be episodic, with partial or complete

remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is

difficult to distinguish discrete episodes. The onset tends to be later than in the

hebephrenic and catatonic forms. (http://www.schizophrenia.com/szparanoid.htm)

According to the World Health Organization, It describes statistics about mental

disorders of year (2008). Schizophrenia is a severe form of mental illness affecting about

7 per thousand of the adult population, mostly in the age group 15-35 years. Though the

incidence is low (3-10,000), the prevalence is high due to chronicity. According to the

facts it reveals Schizophrenia affects about 24 million people worldwide.

Schizophrenia is a treatable disorder, treatment being more effective in its initial stages.

More than 50% of persons with schizophrenia are not receiving appropriate care.90% of

people with untreated schizophrenia are in developing countries. Care of persons with

schizophrenia can be provided at community level, with active family and community

involvement.

Schizophrenia affects men and women with equal frequency. Schizophrenia often

first appears in men in their late teens or early twenties. In contrast, women are generally

affected in their twenties or early thirties.

In the U.S., mental disorders are diagnosed based on the Diagnostic and

Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

(http://www.howstuffworks.com/framed.htm?parent=schizophrenia.htm&url=http://

www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-

america.shtml)

In the Philippine setting, the disability survey done in 2000 by the National

Statistics Office (NSO) found out that mental illness was the 3rd most common form of

disability in the country. The prevalence rate of mental disorders was 88 cases per

100,000 population and was highest among the elderly group. This finding was supported

by a more recent data from the Social Weather Station Survey commissioned by DOH in

2004. It reveals that 0.7 percent of the total households have a family member afflicted

with mental disability. The Baseline Survey for the National Objectives for Health in

2000 stated that the more frequently reported symptoms of an underlying mental health

problem were sadness, confusion, forgetfulness, no control over the use of cigarettes and

alcohol, and delusions.

The most recent study on the prevalence of mental health problems was

conducted by the National Epidemiology Center (DOH-NEC) in 2006 which showed

revealing results though the target population was limited only to government employees

from the 20 national agencies in Metro Manila. Among 327 respondents, 32 percent were

found to have experienced a mental health problem at least once in their lifetime. The

three most prevalent diagnoses were: specific phobias (15 %), alcohol abuse (10%),

depression and schizophrenia (6%). Mental health problems were significantly associated

with the following respondent characteristics: ages 20-29 years, those who have big

families, and those who had low educational attainment. The prevalence rate generated

from the survey was much higher than those that were previously reported by 17 percent.

(http://72.14.235.132/search?q=cache:sGh-NeA_KcUJ:home.doh.gov.ph/ao/ao2007-0009.pdf+epidemiology+of+schizophrenia+in+the+philippines&cd=6&hl=tl&ct=clnk&gl=ph)

Currently, there is no method for preventing schizophrenia and there is no cure.

Minimizing the impact of disease depends mainly on early diagnosis and, appropriate

pharmacological and psycho-social treatments. Hospitalization may be required to

stabilize ill persons during an acute episode. The need for hospitalization will depend on

the severity of the episode. Mild or moderate episodes may be appropriately addressed by

intense outpatient treatment. A person with schizophrenia should leave the hospital or

outpatient facility with a treatment plan that will minimize symptoms and maximize

quality of life.

This introduced psychiatric case was chosen primarily because it is the most

interesting amongst the cases that were encountered by the group members. It posts

relevant manifestations that are psychiatric in nature and the entire case is highly possible

to be studied comprehensively within the limited time available.

Theoretical Framework

Maslow's hierarchy of needs is predetermined in order of importance. It is often

depicted as a pyramid consisting of five levels: the first lower level is being associated

with physiological needs, while the top levels are termed growth needs associated with

psychological needs. Deficiency needs must be met first. Once these are met, seeking to

satisfy growth needs drives personal growth. The higher needs in this hierarchy only

come into focus when the lower needs in the pyramid are met. Once an individual has

moved upwards to the next level, needs in the lower level will no longer be prioritized. If

a lower set of needs is no longer being met, the individual will temporarily re-prioritize

those needs by focusing attention on the unfulfilled needs, but will not permanently

regress to the lower level. For instance, a businessman at the esteem level who is

diagnosed with cancer will spend a great deal of time concentrating on his health

(physiological needs), but will continue to value his work performance (esteem needs)

and will likely return to work during periods of remission.

The lower four layers of the pyramid are what Maslow called "deficiency needs"

or "D-needs": physiological, safety and security, love and belonging, and esteem. With

the exception of the lowest (physiological) needs, if these "deficiency needs" are not met,

the body gives no physical indication but the individual feels anxious and tense.

(http://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs)

Personal Data

Name of the Patient: Mr. X

Age: 40 years old

Gender: Male

Address: Nueva Ecija

Civil Status: Single

Nationality: Filipino

Religion: Roman Catholic

Birthday:

Date admitted: January 31, 2009 (2:35 pm)

Admitting Diagnosis: Paranoid Schizophrenia

History of Present Illness

Patient has previous admission at Mariveles Mental Hospital. He was discharged

from male ward on December, 2007. He had 1-2 consultations with Dra. Medina. His

parents cannot afford to bring him in Cabanatuan.

Upon discharge he resumed smoking and after few months he resumed alcohol

intake and he became suspicious and verbally assaultive when not giving cigarettes.

After few hours upon admission, he heard his female cousin and a neighbor

talking to each other and felt rejuvenated. He went down the house and with carrying an

ice pick. He stabbed at his cousin who sustained several abrasions in the forearm and she

got a scar on the head and on her right lower quadrant of abdomen. The neighbor placed

him in restraints and informed his father who was out in the farm.

History of Previous Illness

The patient was first admitted on October 4, 200 at Mariveles Mental Hospital

with chief complaints of poor appetite, cannot able to sleep and hears a female voice on

his ear. A year prior to admission, the patient used illegal drug such as shabu. After using

shabu, few months prior to admission he was engaged to abused substances like alcohol

and cigarettes. He started to become violent and shouts to his parents. Few hours upon

admission, he was saw laughing by him only, becomes aggressive and always shouting.

His father took him to MMH hence the reason for his admission.

His condition becomes better and he was discharged on August 19, 2001. But he

was then readmitted on November 15, 2002 for the reason of he took things from the

stores and insisted that it was his property. On the nest seven succeeding years, he was in

and out of MMH with an admitting diagnosis of Undifferentiated Schizophrenia. But

early this year, January 9, 2009, he was again readmitted with a new diagnosis of

Paranoid Schizophrenia.

Family Health and Psychiatric History

Chapter 2

MENTAL STATUS ASSESSMENT

A. General Appearance

Criteria Day 1 Day 2 Day 3 Day 4Good grooming ☺Appropriate facial expression ☺ ☺ ☺ ☺

Appropriate posture ☺ ☺ ☺ ☺Maintains eye contact ☺ ☺

During nurse-patient interaction, the patient’s grooming was not good prior to

morning care but on the later part he improves and shows good grooming. Most of the

time, he exhibited appropriate facial expressions and posture during interactions. At first,

he cannot display eye contact which may show lack of focused and interest on the topic.

As days passes by student nurse established trust on the patient and he maintains good

eye contact.

B. Motor Behavior

Criteria Day 1 Day 2 Day 3 Day 4Automatism ☺ ☺ ☺ ☺HyperkinesthesiaWaxy FlexibilityCataplexyCatalepsyStereotypeCompulsionPsychomotor RetardationEchopraxiaCatatonic StuporCatatonic excitementTics and spasmsImpulsivenessChoreiform movements

Automatism is defined as repeated purposeless behaviors often indicative of

anxiety, such as drumming of fingers, twisting of locks of hair or tapping of foot. All

through out the 4 day nurse-patient interaction, the patient presented automatism. No

other motor behaviors were noted.

C. Sensorium and Cognitive

Criteria Day 1 Day 2 Day 3 Day 4Orientation ☺ ☺ ☺ ☺ Time ☺ ☺ ☺ ☺ Place ☺ ☺ ☺ ☺ Person ☺ ☺ ☺ ☺Concentration ☺ ☺ ☺ ☺Memory ☺ ☺ ☺ ☺ Remote ☺ ☺ ☺ ☺ Recent ☺ ☺ ☺ ☺ Immediate retention ☺ ☺ ☺ ☺

Sensorium and cognities consist of the assessment of orientation, concentration,

and memory. Orientation refers to the client’s recognition of person, place and time. That

is, knowing who and where he or she is and the correct day, date and year. (Videbeck,

Psychiatric Mental Health Nursing). Memory is an organism's mental ability to store,

retain and recall information which is divided into recent and remote memory. Short-term

memory allows recall for a period of several seconds to a minute without rehearsal.

Long-term memory can store much larger quantities of information for potentially

unlimited duration (sometimes a whole life span).

During the 4 day nurse-patient interaction, patient’s orientation and memory are

stable. He can recall memories from the past and aware of the place, who is he, time, day,

and year. Based from the above definition of memory, he has an intact recollection of the

past events in his life.

D. Perception

Criteria Day 1 Day 2 Day 3 Day 4Hallucination Visual Olfactory Auditory Tactile Gustatory Liliputian

IllusionsDelusions ☺ ☺ ☺ ☺

In the most recent Diagnostic and Statistical Manual of Mental Disorders, a

delusion is defined as a false belief based on incorrect inference about external reality

that is firmly sustained despite what almost everybody else believes and despite what

constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is

not one ordinarily accepted by other members of the person's culture or subculture.

From the 1st up to 4th day of nurse-patient interaction, the patient manifest

presence of delusions wherein he always claims that he was the husband of Sheryl

Cosim. Other perceptions were not noted.

E. Attitudes and Behavior

Criteria Day 1 Day 2 Day 3 Day 4Cooperation ☺ ☺ ☺ ☺Outgoing ☺ ☺ ☺ ☺WithdrawnEvasiveSarcasticAggressivePerplexedApprehensive ☺ ☺ ☺ ☺ArrogantDramaticSubmissiveFearfulSeductiveUncooperativeImpatientResistantImpulsive

Attitude is a position of the body or manner of carrying oneself. It is a position or

posture of the body appropriate to or expressive of an action, emotion

The patient exhibited cooperation in the whole duration of duty and able to

answers all questions asked to him and participates in all activities. It was also observed

that he was outgoing with other patient and student nurse. He also shows

apprehensiveness throughout the interaction.

F. Defense Mechanism

Criteria Day 1 Day 2 Day 3 Day 4Denial ☺ ☺RepressionSuppressionRationalization ☺ ☺Reaction FormationSublimationCompensationProjectionDisplacementIdentificationInterjectionConversionSymbolizationDissociationUndoingRegressionSubstitutionFantasy ☺ ☺ ☺ ☺

Defense mechanisms are psychological strategies brought into play by various

entities to cope with reality and to maintain self-image. Healthy persons normally use

different defenses throughout life. An ego defense mechanism becomes pathological only

when its persistent use leads to maladaptive behavior such that the physical and/or mental

health of the individual is adversely affected. The purpose of the Ego Defense

Mechanisms is to protect the mind/self/ego from anxiety, social sanctions or to provide a

refuge from a situation with which one cannot currently cope.

The patient manifests fantasy from day 1 to day 4 and shows also denial and

reaction formation on the later days of interaction.

G. Affective State

Criteria Day 1 Day 2 Day 3 Day 4Euphoria

Flat affect ☺ ☺BluntingElationExultationEcstasyAnxietyFearAmbivalenceDepersonalizationIrritabilityRageLabilityDepression

Affect is a grouping of physic phenomena manifesting under the form of

emotions, feelings or passions, always followed by impressions of pleasure or pain,

satisfaction or discontentment , liking or disliking, joy or sorrow.

(/www.cerebromente.org).

Flat affect: A severe reduction in emotional expressiveness. People with

depression and schizophrenia often show flat affect. A person with schizophrenia may

not show the signs of normal emotion, perhaps may speak in a monotonous voice, have

diminished facial expressions, and appear extremely apathetic. (www.medterms.com)

The patient sometimes shows flat affect during the whole interaction.

H. Speech

Criteria Day 1 Day 2 Day 3 Day 4VerbigerationRhymingPunningMutismAphasiaUnusual rates of speechUnusual Volume of speechUnusual Intonation Unusual Modulation

Speech refers to the processes associated with the production and perception of

sounds used in spoken language.

During the interaction, the patient does not show any alteration in his speech

pattern. He did not experience verbigeration, aphasia, other speech problems.

I. Thought Process and Content

Criteria Day 1 Day 2 Day 3 Day 4BlockingFlight of IdeasWord SaladPerserverationNeologismCircumstantialityEcholaliaCondensationDelusion ☺ ☺ ☺PhobiaObsession ☺ ☺ ☺ ☺Hypochondriac

During the first part of our nurse-patient interaction, the patient shows delusion. He also manifested obsession wherein he keeps on insisting that his wife is Sheryl Cosim who is a famous news anchor.

Chapter 3

PsychopathologyBook-Based

Client-Based

Related Literature and Studies

What is Schizophrenia?

It is a mental illness which affects one person in every hundred. Schizophrenia

interferes with the mental functioning of a person and, in the long term, may cause

changes to a person's personality.

First onset is usually in adolescence or early adulthood. It can develop in older

people, but this is not nearly as common. Some people may experience only one or more

brief episodes in their lives. For others, it may remain a recurrent or life-long condition.

The onset of illness may be rapid, with acute symptoms developing over several

weeks, or it may be slow, developing over months or even years. During onset, the

person often withdraws from others, gets depressed and anxious and develops extreme

fears or obsessions.

Although an exact definition of schizophrenia still evades medical researchers, the

evidence indicates more and more strongly that schizophrenia is a severe disturbance of

the brain's functioning. In The Broken Brain: The Biological Revolution in Psychiatry,

Dr. Nancy Andreasen states "The current evidence concerning the causes of

schizophrenia is a mosaic. It is quite clear that multiple factors are involved.

These include changes in the chemistry of the brain, changes in the structure of

the brain, and genetic factors. Viral infections and head injuries may also play a

role....finally, schizophrenia is probably a group of related diseases, some of which are

caused by one factor and some by another." (p. 222).

There are billions of nerve cells in the brain. Each nerve cell has branches that

transmit and receive messages from other nerve cells. The branches release chemicals,

called neurotransmitters, which carry the messages from the end of one nerve branch to

the cell body of another. In the brain afflicted with schizophrenia, something goes wrong

in this communication system.

Sometimes schizophrenia has a rapid or sudden onset. Very dramatic changes in

behaviour occur over a few weeks or even a few days. Sudden onset usually leads fairly

quickly to an acute episode. Some people have very few such attacks in a lifetime; others

have more. Some people lead relatively normal lives between episodes. Others find that

they are very listless. depressed, and unable to function well.

In some, the illness may develop into what is known as chronic schizophrenia.

This is a severe, long-lasting disability characterized by social withdrawal, lack of

motivation, depression, and blunted feelings. In addition, moderate versions of acute

symptoms such as delusions and thought disorder may be present in the chronic disorder.

What are the symptoms of schizophrenia?

Major symptoms of schizophrenia include:

Delusions - false beliefs of persecution, guilt or grandeur or being under outside

control. People with schizophrenia may describe plots against them or of think

they have special powers and gifts. Sometimes they withdraw from people or hide

to avoid imagined persecution.

Hallucinations - most commonly involving hearing voices. Other less common

experiences can include seeing, feeling, tasting or smelling things which to the

person are real but which are not actually there.

Thought disorder - where the speech may be difficult to follow; for example,

jumping from one subject to another with no logical connection. Thoughts and

speech may be jumbled and disjointed. The person may think someone is

interfering with their mind.

Other symptoms of schizophrenia include:

Loss of drive - where often the ability to engage in everyday activities such as

washing and cooking is lost. This lack of drive, initiative or motivation is part of

the illness and is not laziness.

Blunted expression of emotions -where the ability to express emotion is greatly

reduced and is often accompanied by a lack of response or an inappropriate

response to external events such as happy or sad occasions.

Social withdrawal - this may be caused by a number of factors including the fear

that someone is going to harm them, or a fear of interacting with others because of

a loss of social skills.

Lack of insight or awareness of other conditions - because some experiences such

as delusions and hallucinations are so real, it is common for people with

schizophrenia to be unaware they are ill. For this and other reasons, such as

medication side-effects, they may refuse to accept treatment which could be

essential for their well-being.

Thinking difficulties - a person's concentration, memory, and ability to plan and

organise may be affected, making it more difficult to reason, communicate, and

complete daily tasks.

What causes schizophrenia?

No single cause has been identified, but several factors are believed to contribute to the

onset of schizophrenia in some people:

Genetic factors

A predisposition to schizophrenia can run in families. In the general population, only 1

per cent of people develop it over their lifetime. If one parent suffers from schizophrenia,

the children have a 10 per cent chance of developing the condition - and a 90 per cent

chance of not developing it.

Biochemical factors

Certain biochemical substances in the brain are believed to be involved in this condition,

especially a neurotransmitter called dopamine. One likely cause of this chemical

imbalance is the person's genetic predisposition to the illness.

Family relationships

No evidence has been found to support the suggestion that family relationships cause the

illness. However, some people with schizophrenia are sensitive to any family tension

which, for them, may be associated with relapses.

Environment

It is well recognised that stressful incidents often precede the onset of schizophrenia.

They often act as precipitating events in vulnerable people. People with schizophrenia

often become anxious, irritable and unable to concentrate before any acute symptoms are

evident. This can cause relationships to deteriorate, possibly leading to divorce or

unemployment. Often these factors are then blamed for the onset of the illness when, in

fact, the illness itself has caused the crisis. It is not, therefore, always clear whether stress

is a cause or a result of illness.

Drug use

The use of some drugs, especially cannabis and LSD, is likely to cause a relapse in

schizophrenia.

Source: www.mental-health-matters.com

Paranoid Schizophrenia

People with paranoid schizophrenia, the most common form of the disorder,

mainly experience hallucinations. They tend to believe that others are poisoning,

harassing, or plotting against them. They may also hear voices, which order them to do

things. Contrary to popular belief, people suffering from this type of schizophrenia are

actually not prone to violence; in fact, they generally prefer to be left alone.

Common Symptoms of Paranoid Schizophrenia

For people with paranoid schizophrenia, the primary symptoms are delusions or

auditory hallucinations. People with paranoid schizophrenia usually do not have thought

disorder, disorganized behavior, or affective flattening.

People with paranoid schizophrenia have grandiose delusions. For example, they may

believe that others are deliberately:

Cheating them

Harassing them

Poisoning them

Spying on them

Plotting against them or the people they care about.

Auditory hallucinations can include hearing "voices" that may:

Comment on the person's behavior

Order him or her to do things

Warn of impending danger

Talk to each other (usually about the affected person).

Paranoid Schizophrenia and Violence

People with paranoid schizophrenia are not especially prone to violence and often

prefer to be left alone. Studies show that if people have no record of criminal violence

before they develop schizophrenia and are not substance abusers, they are unlikely to

commit crimes after they become ill. Most violent crimes are not committed by people

with paranoid schizophrenia, and most people with schizophrenia do not commit violent

crimes. Substance abuse almost always increases violent behavior, whether or not the

person has schizophrenia.

If someone with paranoid schizophrenia becomes violent, their violence is most

often directed at family members and takes place at home.

Source: http://schizophrenia.emedtv.com

Drug Study

Name of drug

Date ordered/

Date started/

Date changed

Route/Dosage/

Frequency of administration

General action/mechanis

m of action

Indication/

Purpose

Client’s response to

medicine with actual s/e

Generic Name:

Clonazepam

Date Ordered:January 31 2009Date Started:January 31 2009

Date Ended:----------------------

Route of Administration: Per Orem

Dosage and Frequency:2mg HS

Chemical Effect:

May act by facilitating effects of inhibitory neurotransmitterGABA.

Therapeutic Effect:

Prevents or stops seizure activity.

For patients with acute manic episodes, panic disorders, or seizures.

Administration of the drug was not actually observed

NURSING RESPONSIBILITIES:

BEFORE: Explain the importance and action of the drugs.

Tell the possible reaction or side effects of the drugs.

Monitor patient for any adverse reaction.

DURING: The client may sip small amount of water

Stay with the client for at least 15-30 minutes after giving the drug

Be alert for adverse reaction and drug interaction

Name of drug

Date ordered

/Date

started/Date

changed

Route/Dosage/

Frequency of administratio

n

General action/mechanis

m of action

Indication/

Purpose

Client’s response to medicine

with actual s/e

Generic Name:

Haloperidol

Date Ordered:January 31, 2009Date Started:January 31, 2009

Date Ended:---------------------

Route of Administration:Per Orem

Dosage and Frequency:5mg tab tid

Chemical Effect: May block postsynaptic dopamine receptors in brain.Therapeutic Effect:Decreases psychotic behaviors.

This is given to the patient with chronically psychotic disorder who needs prolonged therapy.

Administration of the drug was not actually observed

NURSING RESPONSIBILITIES:

BEFORE: Explain the importance and action of the drugs.

Tell the possible reaction or side effects of the drugs.

Monitor patient for any adverse reaction.

DURING: Stay with the client for at least 15-30 minutes after giving the drug

Monitor patient for tardive dyskinesia, which may not appear until months or

years later and may disappear spontaneously or persists for life despite stopping

use of drug.

CHAPTER 5

PSYCHOTHERAPIES IMPLEMENTED

Psychotherapy- treatment of mental disorders and behavioral disturbances using verbal

and nonverbal communication, as opposed to agents such as drugs or electric shock, to

alter maladaptive patterns of coping, relieve emotional disturbance, and encourage

personality growth. Also called psychotherapeutics.

Individual Psychotherapy- Through one-on-one conversations, this approach focuses on

the patient's current life and relationships within the family, social, and work.

Group Psychotherapy- Group psychotherapy is a special form of therapy in which a

small number of people meet together under the guidance of a professionally trained

therapist to help themselves and one another. Group therapy helps people learn about

themselves and improve their interpersonal relationships. It addresses feelings of

isolation, depression or anxiety. And it helps people make significant changes so they

feel better about the quality of their lives.

REMOTIVATION THERAPY

Definition: A simple group therapy which aims to bridge the fantasy- world of the

Psychotics to the real world. Is a technique of simple group therapy, objective in nature,

used with a group of patients in an effort to reach the “unwounded” areas of each

patient’s personality & to get them back into reality.

Title of the poem: Ang Bulaklak

The short poem describes the importance of flower in our nature.

Goals:

To stimulate patients to be fellow explore the real world.

To develop their ability to communicated and share ideas and experiences with

the other people.

To develop feelings of acceptance.

To promote group harmony and identification.

Role of the nurse:

To be a facilitator in the activity

To encourage clients feeling about the topic

To present the reality to the client about the poem.

NEWSPAPER THERAPY

Definition: Newspaper therapy is giving information to the clients about events and what

is happening outside

Newspaper therapy is cutting clippings from newspaper and sharing this information to

the clients and knowing their feelings and ideas about the information given. Providing

basic information about places/events may motivate the clients to follow the medical

regimen to be well. The facilitator let the clients to read the topic, then ask them

questions.

Title of the cut news: Boxing

The news was all about boxing competition held in Araneta Coliseum & who won

for that competition.

Goals:

To give information to the clients on what is happening outside and to give latest

news today.

To encouraged emotions and reactions about the news

Role of the Nurse:

To introduce topics that will encourage clients participation/cooperation

To assess level of intelligence of the clients

To encourage the clients to express/verbalize feelings/ideas regarding to the topic

PLAY THERAPY

Definition: A form of psychotherapy used to help them express or act out their

experiences, feelings, and problems by playing with dolls, toys, and other play material.

Name of the Play: Ball catching

Procedure:

The clients are instructed to catch the ball with their respective partners.

Goals:

To establish rapport since it is the first recreational activity of the client

To encourage release/ express clients emotions

To let the client learn on how to cooperate

To let the client play freely and actively

Role of the Nurse:

To be the facilitator of the game

To let and encourage the clients to participate on the play

DANCE THERAPY

Definition Dance is the most fundamental of the arts, involving direct expression through

the body. Dance /movement therapy effects changes in feelings, cognition, physical

functioning, and behavior.

Title of the dance song: Cha-Cha-Cha

Facilitators are in the front, dancing different steps, in able for the client to follow

easily the facilitators.

Goals:

To encourage release/ express clients emotions

To let the client learn on how to dance in simple steps

To let the client dance freely and actively

Role of the Nurse:

To be the facilitator of the game

To let and encourage the clients to participate on the dance

SONG THERAPY

Definition: A kind of recreational therapy under the music category, which connects us

with our creativity, innate wisdom and our vast inner resources for growth and well-

being. It has a soothing and pleasing effect and provides for emotion and release.

Title of the song: Tag-ulan

Procedure:

Using the visual aids that has the written lyrics, the patients read it first.

The nurse sings the song with the use of guitars.

Nurses, together with the patients, sing the song.

Lastly, let the patients sing to the tune of guitars.

Goals:

Develop patient’s ability to read and reflect.

Develop patient’s listening skill.

To encourage them to participate and cooperate.

Patients will learn to express emotions and feelings.

Role of the Nurse:

Explain the procedure to the patients.

To be a good facilitator.

To be an active participant too.

To promote trust.

ART THERAPY

Definition: is the use of art materials for self-expression and reflection.

Name: House-Tree-Person

Procedure:

Patients are provided with crayons and 3 pieces of paper as drawing

materials.

They are then asked to draw a house, afterwards a tree, and lastly, a person

on each of the papers with the use of crayons.

Series of questions constitute the post drawing interrogations.

During post drawing phase, paients are given opportunity to define,

describe, and interpret the objects drawn.

Goals:

To obtain data concerning patient’s progress.

To aid in the establishment of rapport between the nurse and the patient.

Help the patients gain insight through interpretations.

Measure patient’s self perception and attitudes.

Role of Nurses:

Explain the procedure of the activity.

Provide the means of the therapy (crayons, papers).

Interrogate patients during post drawing phase.

Assessing and interpreting answers based on Buck’s HTP interpretation.

Develop a deeper nurse-patient relationship through building of trust.

OCCUPATIONAL THERAPY

Definition: Any activity, mental or physical, prescribed and guided to aid an individual’s

recovery from diseases or injury. This activity excludes competition and pressure. There

is opportunity for creativeness and produce something tangible out of patient’s own

thinking and imagination. Self confidence and personal achievements are also

experienced.

Title: Designing Picture Frame

Procedure: Designing Picture Frame

Nurses play a great role in making this therapy successful.

Nurses give picture frame.

Different shapes of cut cartolina & different styles of stickers are also

given along with the glue.

Patients are asked to design their picture frame wherever they like.

Goals:

Expose patients’ hidden abilities in designing and pasting.

Increase patients’ self confidence.

Assess patients’ motor and intellectual functioning.

Role of Nurses:

To select the most useful activity.

To facilitate the activity successfully.

To assist the patients.

To promote positive personality growth

BIBLIOGRAPHY

Videbeck, Psychiatric Mental Health Nursing, Third Edition

Shives, Isaacs, Basic Concepts of Psychiatric-Mental Health Nursing

Rebraca et. al., Psychiatric Mental Health Nursing, 5th Edition

Nurses Dictionary, Second Edition

7th Edition Nursing Diagnosis Handbook: A Guide to Planning Care by Betty J Auckley and Gail B. Ladwig

http://www.answers.com/topic/psychosis

http://www.emedicine.com/med/byname/brief-psychotic-disorder.htm

http://www.hawaii.edu/hivandaids/Philippines_Mental_Health_Country_Profile.pdf

http://en.wikipedia.org/wiki/Psychotic_disorder