Case Study
Case Study
Case Study
Michael Guterwill
Abstract
Schizophrenia is a disease that affects a person's ability to speak, feel, and act appropriate. Often
times this disease runs in the family. Many families struggle to cope with this disease whether
they are dealing with a loved one who has it or they themselves do. A person who is diagnosed
with this disease often has auditory or visual hallucinations which is a really hard thing to deal
with. Stay on medications when someone has schizophrenia is key and often times people with
schizophrenia feel like they should stop taking their current medications. This case study is about
D.M., a patient I had the opportunity to speak with and to learn about. This case study will cover
his background, nursing interventions, and potential nursing diagnoses for this particular patient.
SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 3
Objective Data
D.M. is a 48 year old Caucasian male admitted on September 29, 2018. The date of care
was on October 2, 2018. Based on DSM IV-TR, this patients current diagnosis is in Axis 1,
which is schizophrenia. Axis I, schizophrenia, is his acute reason for seeking care. He has
Schizotypal personality disorder from Axis II as he believes a higher power is constantly talking
to him and giving him information about people so he could help them in "miraculous ways".
Axis III is for medical conditions that could impact the patients mental disorder and make them
worse. In D.M.'s case he has insomnia, which he mentions he generally struggles with sleeping.
Axis IV is used to describe psychosocial and environmental factors affecting a person and in
D.M.'s case he has problems with a primary support group as he feels he is all alone and no one
understands him. He also has problems relating to the social environment. In addition he has
housing and economic problems. Axis V is a rating scale called the Global Assessment of
Functioning, which consists of a rating from 0 to 100. It is supposed to summarize how well a
person is functioning. D.M. came in with a score of 10. This meaning that he was in severe
danger of hurting himself or others. He was having auditory hallucinations with clear
expectations of death. He voluntarily arrived to the emergency room stating that he is hearing
voices and they were telling him to not eat anything. He stated that he decided to call 911 after
he cut his right arm in attempt to severely hurt himself. He said it has been a few days since he
had something to eat and he had lost a lot of weight. In addition, the voices he was hearing also
told him to hurt himself so he took a knife and made an incision down his right arm. He stated
that he stopped taking his medications for his schizophrenia, but cannot recall when he stopped
taking them. He believes that shortly after he stopped taking them he began having auditory
hallucinations. He reported that the voices were giving him suicidal thoughts was thinking about
SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 4
"ending it all" and was still currently having those thoughts on admission. He was placed in
suicidal precautions in the Emergency room. On the date of care he was no longer on suicidal
precautions. Jus the regular 15 minute checks they do for everyone on the mental health floor.
On the floor the he originally was given an injection of 5mg of haloperidol. Then he was
prescribed Aripiprazole 20mg PO daily to help with his psychotic features. He was prescribed
Trazodone 50mg PO daily at night to help with his insomnia. He was prescribed Hydroxyzine
which is an antihistamine. Finally they prescribed him Oxcarbazepine 300mg PO every 12 hour
Summarize
Schizophrenia is a chronic disease that affects a person's ability to think, feel, and behave
clearly. They often have auditory and visual hallucinations and delusions. Many times they feel
like there is someone always there telling them to do things that isn't considered socially
acceptable. Schizophrenia is often seen in individuals who have had traumatizing events while
growing up. It is also generally seen to run in families so it may get passed down from
generation to generation. The article Risk factors for Suicide in Schizophrenia: Systematic
Review and Clinical Recommendations" perfectly describes schizophrenia. The article states
and emotional dysfunctions. The diagnosis involves a constellation of signs and symptoms
associated with impaired occupational or social functioning" (2014, Popovic, pg. 419). This
helps summarize the disease by showing that they struggle with normal functions. They
sometimes act out and tend to isolate themselves. People with schizophrenia need to adhere to
their medications and if they don't they will behind to have more problems. An article I found
called " Problems with the Administration of Antipsychotic Drugs in Depot Formulations in the
SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 5
potential problem that may lead to higher relapse rates which in turn worsen long-term outcomes
and lead to poor prognosis" (2018, Rankovic, pg. 66) This helps to show that those with
schizophrenia live much better lives if they are able to stay on their medications. There is also
seen an increase in suicide with people with schizophrenia. The same article that was mentioned
before also stated "Approximately 2-12% of all suicides are attributable to schizophrenia" (2014,
Popovic, pg. 419). This is showing that those who are diagnosed with schizophrenia are
Discuss
D.M. was diagnosed with schizophrenia at 17 years old. He said he started hearing voices
around this time. According to him he had a very abusive childhood. His father would tell him
regularly that he would "amount to nothing" and there his life was worthless. He states that both
of his parents would beat him and there was no love for him in that household. Both of his
parents were addicted to drugs and alcohol. He mentioned that he spent a lot of time in foster
care, but he couldn't find a family for him and always went back to his parents even though they
abused him. An interesting article I read which may suggest an explaination to this is called
Exacerbation of Schizophrenia on Treatment over three Month’s Duration" and it states "One of
the most known aspects of this is the social amotivation. This is a classical deficit symptom in
which the individual appears to have no interest to have interaction with others and tries to avoid
social contact as much as possible" (2018, Arathil, Sharama, pg. 12). I think this shows why he
struggled to find a good fit in foster home. People with schizophrenia tend to try and isolate
themselves. He used to abuse drugs such as marijuana, cocaine, methamphetamine, and "acid".
SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 6
D.M. said that he used drugs whenever he felt isolated, as a way to self medicate. He states that
he is no longer addicted to drugs and hasn't used in months. There is no proof of any mental
illness in parents. They both died a few years ago. He said his father was killed by his mother
and his mother was never charged because she died from cancer before the trial was held. He
said that the death of his parents do not bother him, but states that he has forgiven his father. At
this point, it is hard to tell if he is making up his childhood based on what he thought had
happened due to having schizophrenia, or his childhood was an onset to cause his schizophrenia.
Identify
Prior to his hospitalization D.M. was living in a form of a group home. However, he said
he was basically homeless and was never there. He was spending most of his time with religious
activities. He had many stories of God telling him things that he shouldn't know about people
and then going up to them and helping them emotionally. During this time the voices in his head
were telling him not to eat. For many days he wasn't hardly eating anything due to these voices.
He states that he began noticing how much weight he was losing and that he felt very unhealthy.
However, he just continued on. Eventually the voices in his head started telling him to hurt
himself and to kill himself. This resulted with him cutting his right arm. This lead to him calling
Describe
When D.M. arrived to the hospital he was evaluated and then placed under suicidal
precautions. This is because of the state of mind he was in and when a patient feels like this they
need to be observed at all times. Suicide precautions means having a 1 on 1 sit there and watch
the patient to make sure they do not attempt to hurt their self. They also get a safety tray for
meals which just means that there are no cans or metal silverware that they could hurt themselves
SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 7
with. The staff will also remove any cords or unnecessary items from the room. The goal of this
nursing intervention is to keep the patient safe and prevent any sort of self harm from occurring.
The nurses also use milieu therapy on the floor to help him recover. The floor is a very calm
place with structured activities for him. There are many different groups to participate in and
these are all to help promote a healthy state of mind. They also have visiting hours and certain
times to make phone calls. This way they could still have contact with loved ones.
During the date of care D.M. participated in both groups. The first one was a spiritual
group and he showed up late. He was very outgoing in this group and told everyone his story. He
showed that he felt very close to God and that was how he was still alive today. He mentioned
that he is dedicating his life to God and they God speaks to him every day. He feels that he is still
here to change other people's lives. He was also comfortable enough to tell everyone about his
abuse past. After this group he participated in the social group where he was much more quiet.
He mostly kept to himself and barely participated. However, I feel these groups helped him
express himself and it showed that these groups are helping him with his mental health.
Analyze
D.M. is a very religious man. He claims religion is what keeps him here on this earth.
D.M. believes that he is one with God and is here to change the lives of others around him. He
told a story about him in a Denny's restaurant talking to a waitress. He said she was acting
cheerful on the outside, but then God told him that she is really broken on the inside. He
approached the waitress and told her what God had told him and she broke down crying asking
him for advice. He told her to give herself to God and everything will be fine. He was very proud
of this story and told me that he saw himself as a disciple whose job is to bring people closer to
God. Aside from his religious views, D.M. mostly group up in a foster home. This makes me
SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 8
believe it had a poor influence on his ability to function while growing up. He struggles in
Evaluate
feeling much better than when he originally arrived. The groups had helped him express himself
and he feels like the medications he had been receiving have been helping him feel better. He
Summarize
The plans for discharge start with getting D.M. back on his medications and to keep it
that way. It would be good to get him into an outpatient setting where he could get steady help to
keep him from ending up back on the mental health floor. He will have a 14 day follow up to see
how his medications have been working on him and that he is still taking them daily. D.M. will
hopefully find a positive coping strategy for when he begins acting out or when he feels like he
no longer needs his medications. It is very important for his health that he stays on this
medication regimen.
hallucinations.
SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 9
recurring hallucinations.
2. Interrupted family process related to being in foster care as evidence by stating he could
Conclusion
feel, and behave clearly. D.M. is a man suffering from this disease and is struggling with
staying on his medications. When he becomes stressed or feels isolated he feels the need
to stop taking those medications. An important part of daily living with schizophrenia is
adhering to your medications which he has hopefully learned while being on the mental
health floor. D.M. also needs to find better coping methods to deal with future stress and
feelings of loneliness.
SCHIZOPHRENIA MENTAL HEALTH CASE STUDY 10
References
D. P. (2014, August 14). Risk Factors for Suicide in Schizophrenia: Systematic Review and Clinical
https://eps.cc.ysu.edu:3287/pg_99?100248614475101::NO:99:P99_ENTITY_TYPE,P99_ENTIT
Y_ID:MAIN_FILE,22455476&cs=3wNuGxHOku0F-6b-
AqUFFAxg0xooBsdMWz6ky1cNGimK4w3f_Freh6AYDZmPwmHTijaljiMDmN28zNCeaFhyP
yg
Praveen, A., & Sharma, P. (2018, August). Relationship between Disability and Psychopathology
https://eps.cc.ysu.edu:3253/ehost/pdfviewer/pdfviewer?vid=2&sid=091d089a-15ad-4fec-8a29-
f22536e85cc0@sessionmgr120
Rankovic, A., & Jankovic, S. (2018). Problems with the Administration of Antipsychotic Drugs in
Depot Formulations in the Treatment of Schizophrenia. Retrieved October 10, 2018, from
https://eps.cc.ysu.edu:3253/ehost/pdfviewer/pdfviewer?vid=2&sid=8c22e3a1-fa21-4053-ad27-
c69d688dddc4@pdc-v-sessmgr05