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Schizophrenia and Related Disorders Case

 

A 17 yo male patient, J.P., is being transported to the local emergency department (ED) by EMS. The nurse receives in report that the adolescent’s parents called 911 when their son ran out into street traffic and started yelling out, waving his hands, and acting “worse than we’ve ever seen him”. When the EMS arrived, JP would not speak to them and attempted to jump over the hoods of cars to run away. The patient was yelling, “Don’t trust them! I told them to stop yelling at me. They are going to send people to get me.” and started yelling “shut up, stop talking” even though the EMS providers were not saying anything.

During your intake assessment, the patient appears hypervigilant and is scanning the room, giving the appearance that he is looking for things that you cannot see or hear. When you ask him if he is experiencing hallucinations, JP responds “You have no idea what you’re talking about. They know everything. I’m in danger, like that time I went hiking and got lost. This is real danger. That was just fun. We had gone camping and I just forgot a map back at our tent. I just couldn’t find the trail again, but it was right there and I found it.”

His mother tells you that his grades have been going down ever since the school started back up in August and JP hasn’t been interested in seeing his friends. She asks you if she should have pushed him out of the house more and made him study and participate in more activities. She is concerned that by allowing her son to isolate himself, she caused this to happen.

 

 1: 

Based on the patient’s presentation, what symptoms does it seem like he is experiencing? How would you classify these symptoms? Define positive and negative symptoms. 
How would you respond to the mother’s concerns and what would your family teaching plan include?

After evaluating the patient’s symptoms and history, the patient has been transferred to a psychiatric care unit and is being started on quetiapine (seroquel). His parents are concerned about the side effects, since the only medication they are aware of to treat psychosis is Haloperidol (Haldol) and they are worried haldol is “bad.”

 

 

2: 

What syndromes occur as a result of antipsychotic treatment and what are the symptoms associated with these syndromes? 
Which syndromes are more likely to occur with Haldol treatment? Which syndromes are more likely to occur with quetiapine (Seroquel) treatment? 

 

3:  

 Describe the expected disease course / trajectory for a patient with schizophrenia. 
Consider nursing interventions throughout the continuum of care, and explain how your assessment during an acute episode of psychosis may differ from providing care for an individual in an outpatient setting who is stable on an effective antipsychotic regimen. 

 

After 3 weeks, JP is stabilized and discharged from the hospital on quetiapine (seroquel). At discharge, his symptoms are still present but have a significant reduction in severity. After a month of outpatient treatment, he reports he is experiencing some low mood (dysphoria), and his parents are worried he is depressed. After an assessment, it is clear that, while dysphoric, JP is not experiencing all required criteria for a major depressive episode. At this time, the patient’s care team is confident that JP is suffering from schizophrenia.

 

 4:  

 What are the differences between schizophrenia, schizoaffective disorder, and delusional disorder? 
If the patient’s diagnosis does change to schizoaffective disorder, are there any assessments that would increase in priority because of this change? Are there any pharmacological treatments that would become more appropriate for the patient?

 

JP continues to return to care to monitor his antipsychotic effectiveness, and he begins to experience many of the common side effects of this medication. Additionally, you and the psychiatrist treating the patient notice that the patient is still experiencing distressing symptoms and has marked impairment on quetiapine (Seroquel). The psychiatrist mentions that the patient may be switched to clozapine (Clozaril) if treatment with quetiapine (seroquel) fails.

 

 

 

 5:  

What class of medication is quetiapine/seroquel? What are the expected side effects of this medication? What psychoeducation can you provide to this patient and his family to alleviate some of the medication side effects?

If the patient does eventually switch to clozapine (clozaril), what additional psychoeducation would 

 

 

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Personality and Personality Disorder 

 

Define the concepts of “personality” and “personality disorder.” 
How does personality become disordered? What role does culture play?

 

2

What features do the disorders in each cluster (A, B, C) share?
What teases those within a cluster apart?

 

3

Compare and contrast signs and symptoms between the cluster A personality disorders

 

4

Compare and contrast signs and symptoms between the cluster B personality disorders

 

 5

Compare and contrast signs and symptoms between the cluster C personality disorders

 

 6

A patient has been diagnosed with borderline personality disorder (BPD). Discuss clinical manifestations of this mental health disorder and important safety issues.

 

People with BPD have problems regulating their moods and maintaining interpersonal relationships. Discuss communication issues within the nurse-patient relationship for those with emotional dysregulation.

 

SCIENCE
HEALTH SCIENCE
NURSING
MENTAL HEA NRG2008

 

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