schizophrenia

1. schizophrenia – Jackie’s mother and sister brought her to the emergency psychiatric treatment for protective inpatient hospitalization. They worry about  her behavior, her safety, and family’s safety

2.NAMI (2015) defines schizophrenia as a severe mental health disorder that undermines the patient’s cognitive ability, emotional management ability, decision-making, and social skill. schizophrenia is a severe brain disorder that has affected individuals over the years. Schizophrenia patients usually hear sounds that other people cannot witness. The patients believe that other people may be manipulating them, and they might be in danger; thus, they are always terrified and feel withdrawn. Schizophrenia patients talk about nonsensible things, and they may sit in a stature position without talking for long hours. The patients appear subtle, but one may deduce a problem when they speak up their minds.

3.Schizophrenia affects men and women in an equal capacity. However, schizophrenia symptoms manifest earlier in men than in women (NIMH, 2015).

4.Schizophrenia symptoms like delusions and hallucinations start between 16 to 13 years (NIMH, 2015).

5.Tentatively, 1% of Americans have schizophrenia. Schizophrenia is not more prevalent in any particular ethnic group, but it occurs at a similar rate in all the global ethnic groups (NIMH, 2015).

6.NIMH (2015) indicates that during the active phase of schizophrenia, patients express psychotic behaviors that are not evident in healthy persons. At this stage, patients “lose touch” with what is happening in the surroundings. The symptoms may appear and disappear, and they may be severe or mild. The symptoms include;

Hallucinations; NAMI (2015) indicates that the patient hears voices, visualizes, and smells things that other people cannot perceive. The patient is intimidated by the voices, and they tend to feel endangered. The patients may perceive the voices as coming from the person they already know or from strangers. Loved ones get confused when they witness the patient hallucinating. Jackie accused her mother of trying to poison her; thus, she refuses to eat.

Delusions; These are false beliefs that an individual possesses, and it is hard to change an individual mind even if they are presented with facts or new ideas. Delusion limits concentration confuses, and makes individuals sense that they are barred from thinking straight (NAMI,2015). Jackie quit school as she believed that her professor did not want her to gain computer experience. She expressed to her parents that her professors were lowering her grades not to be better than other students. The family said that she accused her brother molested her as a young child and indicated that she was raped and tortured. Jackie regularly phones her sister-in-law to warn her against her brother.

Thought disorders; NIMH (2015) indicates that this entails impaired cognitive ability. However, disorders manifest through distorted thinking. It occurs when an individual experiences difficulty in logically organizing thoughts, thus speak confusingly. The family believes that Jackie possesses a “false memory” and indicates that she is a gifted storyteller, therefore difficult to tell what happened.

Movement disorders; Expressed as agitated body movements. The condition causes a person to either make repetitive motions or sit in a stature manner without talking. Jackie’s mother expresses that she sits and stares or pace the floor.

7.Hallucinations; During the assessment, Jackie pauses halfway the sentence and turns to sides as if she is listening to another person. She resumes the conversation with another train of thought or starts answering different questions. She is asked about her thoughts, and responds, “They look different. Don’t they?”. The psychiatric could not perceive what she was seeing.

Delusion; The patient believes her brother molested her while she was young, and the women who called the police were manipulated by her mother and sister to cover for her brother. She is sure that they brought her to the psychiatrist to conceal the abuse. She indicates that she wants safety for her sister-in-law and her niece against her brother’s abuse.

Movement disorders; the symptom is evident when she stops and stares at her for five minutes during the assessment.

The assessment notes also indicate that the patient has disorganized thoughts.

8. Negative symptoms impair the patients’ ability. The symptoms are associated with being emotionally flat, speaking in a confusing language, or social disconnect. Negative symptoms include a “flat affect” where the patient neither moves nor talks and upon talking, they express themselves in a confusing and monotonous voice. The patient loses interest in life events, they lose the ability to initiate and sustain activities, and they disconnect from other people (NIMH,2015). During the assessment. Jackie’s sister indicated that Jackie missed classes and would keep it to herself. Jackie stopped eating from the family kitchen after quitting school. Jackie lost interest in smoking, drinking, and drug use, and she joined Zen Buddhism. Jackie is socially disconnected and does not have friends or romantic relationships. She lost interest in reading.

9.The initial psychiatric assessment notes that the patients have a history of negative symptoms, including flat emotions and low social functions. The patient also has a record for cognitive alterations like difficulties in completing tasks, concentrating, and following instructions and memory loss. Low concentration is evident when the patient poses halfway through the sentence and drifts sideways. The patient’s history also indicates that she has a depressive mood. Anxiety and she have an account of inflicting harm to herself and possibly may harm other people.

10.The Wisconsin 51.20 is a statute for involuntary commitment to treatment for mentally ill individuals and individuals perceived as a threat. The regulation applies to Jackie as she demonstrates a history of self-harming behavior, thus rendering her a danger to herself and a potential threat to others. The evidence of cuts in her arms, abdomen, and thighs indicates that she prefers doing this since she was in the middle school supports the statue application. Jackie is admitted under 51.20 1(a)(2e) of the Wisconsin statute and held for forty-eight hours, and upon the court order, she will be held for 30-60 days commitment treatment.

11.Jackie’s medication includes; Haldol 5 MG/ML inform of Haloperidol lactate in an injectable solution, dose:2MG for acute psychosis or agitation. Risperdal 0.5 MG disintegrating oral tablet, dose:1 tablet. Ibuprofen 200 MG Oral Tablet, two pills for back pain. Bisacodyl 5MG Delayed-Release Oral Tablet, dose:5MG for constipation.

12. Anticholinergic effects are antipsychotic drug effects that entail the neurotransmitter blockage, acetylcholine (ACh)in the central and peripheral nervous system. Anticholinergic effects include; dry mouth, confusion, memory loss, hallucinations, constipation, and agitation.

13.Pseudoparkinsonism; This is a disorder that triggers movement, and they may include tremors. The condition results from the nerve cell’s damage, leading to; tremors in one hand, slow motion, muscle stiffness, and imbalance. The effect occurs when the patient uses second-generation medication compared to older drugs (Essentials, n.d.).

• Akathisia; The condition is characterized by restlessness, irritability, and unease mental status. A patient suffering from akathisia feels tense and uncomfortable. The patient continually rocks, paces the floor, shifts weight when standing, and cannot remain seated during clinical observation. The patient often engages in a repetitive movement (Essentials, n.d.).
• Dystonia

This condition is characterized by involuntary muscle contraction, thus causing repetitive movements or abnormal postures. Patients may experience pain during the activities, and some may have tremors. Dystonia manifests in different forms. Some may affect a single muscle, a selected group of muscles distributed throughout the body. Secondary dystonia may be acquired from brain damage or specific prescriptions (NIH, 2012).

16.Tardive dyskinesia

Tardive is a term for delays, while dyskinesia means abnormal movements. It is a disorder that is characterized by involuntary movements that affect the lower face. The condition results from neuroleptic medications, and the clinical manifestations include; the movement of a finger, repetitive chewing, thrusting of the tongue, and abnormal facial expressions. In most cases, the condition results from prolonged use of medication though it may still occur after a short-term medication use (NLM 2014).

17.

• Ensure not to leave the patient alone at any point during hospitalization. Assess the patient’s ability to contract for safety for 24 to 48 hours and explain the patient’s meaning of safety contract.
• Encourage and listen to Jackie about the reasons that make her want to inflict harm on herself.
• Educate Jackie’s mother and her sister on ways to recognize impending self-harm that the patient intends to commit.

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• Review the patient’s hallucination medication and check if the care plan needs to be reviewed.
• Monitor the behavior of the patient; This includes checking if the patient is watching an empty room with darting eyes, check if the patient is speaking to an invisible audience or murmuring things to herself and listening to someone else (Essentials, n.d.).

• Ask the patient if they are experiencing a hallucination. Ask them if they can hear the voices, whether it is a man’s or a woman’s voice, and avoid repeating the questions.
• Speak in clear and simple sentences to the patient since she may lose concentration due to hallucination (Essentials, n.d.).
• Help the patient identify the symptoms, the factors that trigger hallucinations, and educate them on symptom management strategies. For instance, ensure the patient is in a well-lit room with less external distractions. Explain the unfamiliar sounds and noise from the environment and let the patient know it is normal (Essentials, n.d.)..
• Help the patient cope with auditory hallucinations through diversions, for instance. Create a conversation, initiate simple projects and physical activities with the patient.
• Encourage the patient to adhere to antipsychotic medication, monitor medication compliance, recovery, and the patient’s general health, and encourage the family’s support during the recovery process (Essentials, n.d.).

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• Initial review the patient’s medication for delusion and follow up for the care plan to assess if there is a need to check the care plan (Essentials, n.d.).

• During the initial assessment, inquire about delusion. Ask the patient who is trying to hurt them, why someone would try to harm them, and how it might happen (Essentials, n.d.).
• Validate real delusional parts like indicating the presence of a doctor at the nurse’s desk who meant no harm for the patient (Essentials, n.d.).
• Do not disregard the patient’s thoughts. Respect the patient’s perceptions and provide insights or your impression of the situation. Listen keenly as the patient expresses their delusional feelings(Essentials, n.d.).
• Identify the factors that trigger delusion and help the patient with coping mechanisms against the stressors (Essentials, n.d.).,

• Monitor recovery, adherence to medication, and the physical health of the patient. Educate the patient about the side effects of the drug and develop appropriate interventions against the side effects (Essentials, n.d.).
• Education to the family about delusion and reassuring and validating their experiences with the patient. Encourage family members to be cautious and seek necessary support when the need arises (Essentials, n.d.).