Content List

Sr. No. Contents

1 Clinical objective

2 Definition of Mental Health

3 Definition of Mental illness

4 Schizophrenia

5 Onset

6 Positive or hard symptoms

7 Negative or soft symptoms

8 Case Study 1

• Assessment

• Presenting complains

• NCP

• Medication

9 Diagnostic criteria

10 Related disorders

11 Unusual speech patterns of clients with schizophrenia

12 Types of delusion

13 Types of hallucinations

14 Treatment:
.Psychopharmacology
.Maintenance therapy
15 Discharge plan

16 Reflective log

17 Conclusion
MENTAL HEALTH:

A state of emotional psychological and social well ness as evidenced by satisfying

interpersonal relationship, effective behavior and coping positive self-esteem/concept

and coping and emotional stability.

Mental Health has many components and a wide variety of factors influences M.H.

Factors:

• Individual

• Interpersonal

• Social/Culture
 Mental Illness:

Mental illness a clinically significant behavior, psychological syndrome or pattern

that occur an individual disability or with a significantly increased risk of suffering

death pain or loss of freedom.

Mental illness includes disorder that effect mood, behavior, thinking such as,

• Anxiety

• Schizophrenia

• Addictive disorder
• Bipolar Disorder

SCHIZOPHRENIA:
SCHIZOPHRENIA CAUSES DISTORTED and bizarre thoughts, perceptions, emotions, movements,
and behavior. It cannot be defined as a single illness; rather, schizophrenia is thought of as a
syndrome or as a disease process with many different varieties and symptoms, much like the
varieties of cancer

Onset:
Onset may be abrupt or insidious, but most clients slowly and gradually develop signs and
symptoms such as social withdrawal, unusual behavior, loss of interest in school or work, and
neglected hygiene
Diagnosis of schizophrenia is usually made when the person begins to display more actively
positive symptoms of delusions, hallucinations, and disordered thinking psychosis

POSITIVE OR HARD SYMPTOMS:

Ambivalence: Holding seemingly contradictory beliefs or feelings about the same person,
event, or situation
Associative looseness: Fragmented or poorly related thoughts and ideas Delusions: Fixed false
beliefs that have no basis in reality
 Echopraxia: Imitation of the movements and gestures of another person whom the client is
observing Flight of ideas: Continuous flow of verbalization in which the person jumps
rapidly from one topic to another
Hallucinations: False sensory perceptions or perceptual experiences that do not exist in reality
Ideas of reference: False impressions that external events have special meaning for the person
Perseveration: Persistent adherence to a single idea or topic; verbal repetition of a sentence,
word, or phrase; resisting attempts to change the topic
Bizarre behavior: Outlandish appearance or clothing; repetitive or stereotyped, seemingly
purposeless movements; unusual social or sexual behavior

NEGATIVE OR SOFT SYMPTOMS:

Alogia: Tendency to speak very little or to convey little substance of meaning (poverty of
content) Anhedonia: Feeling no joy or pleasure from life or any activities or relationships
Apathy: Feelings of indifference toward people, activities, and events
Asociality: social withdrawal, few or no relationships, lack of closeness
Blunted affect: Restricted range of emotional feeling, tone, or mood
Catatonia: Psychologically induced immobility occasionally marked by periods of agitation or
excitement; the client seems motionless, as if in a trance
Flat affect: Absence of any facial expression that would indicate emotions or mood
Avolition or lack of volition: Absence of will, ambition, or drive to take action or accomplish
tasks Inattention: Inability to concentrate or focus on a topic or activity

SCHIZOPHRENIA
DISORDER
Goals:

The aims to develop essential as well- as skillful nursing care which is evidenced

based and effective [Link] will serve the patient to promote health, reduce illness

and prevent such disease.

DEMOGRAPHIC DATA:

Name : Wajid Nizab –u-Din Sharafat Ali

Address : Azad-Kashmir Kasur

Phone # : //

Gender : Male

Date of Birth :

02-Feb-2021
D/of Admission
 MR # :

Martial Status: Married

Education : (5th) Primary

Occupation : Cook Security Guard

RESON OF SEEKING CARE:

Major Psychotic Problem

• Schizophrenia

PRESENTING COMPLAINS :

• Lack of insight
• Auditory hallunications
• Ideas of reference
• Suspiciousness
• Flattening of affect
• Voices speaking
• Delusional mood

PHYSICAL EXAMINATION

General Appearance:

A young middle aged male of 40 yr. with average body built, well oriented person.

Vital Signs:

Temperature : 98o F

Blood Pressure : 129/70

Pulse Rate : 82/-

Height : 5,6

Weight : 75kg

CV System : S1 + S2 + O
Respiratory System:
NVB

Ecastrointestinal System:
 Intact

Mental Status:
Disturbed
Carinal Nerves:
Intact
Motor:

Intact

Reflexes:

Intact

Cognitive Functions:
1. Consciousness Intact

2. Orientation Intact

3. Intelligence Intact (average)

4. Concrete Intact

5. Thinking Average

6. Insight Present

7. Judgment Disturbed

Good
8. General Knowledge

HISTORY OF PRESENT
ILLNESS

Past Medical History :

Past Psychatric History:

Family History:

Past Surgical History:

Social and Personal

 History:

COMPLICATIONS:

. Conflict
• Social isolation

• Unemployment

• Anxiety disorders

• Significant health problems

Diagnostic Criteria Schizophrenia
Related Disorders
Schizophreniform disorder: The client exhibits an acute, reactive psychosis for less than the 6 months necessary
to meet the diagnostic criteria for schizophrenia. If symptoms persist over 6 months, the diagnosis is changed to
schizophrenia. Social or occupational functioning may or may not be impaired. Catatonia: Catatonia is
characterized by marked psychomotor disturbance, either excessive motor activity or virtual immobility and
motionlessness. Motor immobility may include catalepsy (waxy flexibility) or stupor.
Delusional disorder: The client has one or more nonbizarre delusions—that is, the focus of the delusion is
believable. The delusion may be persecutory, erotomanic, grandiose, jealous, or somatic in content.
Brief psychotic disorder: The client experiences the sudden onset of at least one psychotic symptom, such as 433
delusions, hallucinations, or disorganized speech or behavior, which lasts from 1 day to 1 month.
Shared psychotic disorder (folie deux): Two people share a similar delusion. The person with this diagnosis
develops this delusion in the context of a close relationship with someone who has psychotic delusions, most
commonly siblings, parent and child, or husband and wife. The more submissive or suggestible person may rapidly
improve if separated from the dominant person.

Unusual speech patterns of clients with

schizophrenia
Types of Delusions:
Types of Hallucinations:
Visual hallucinations: involve seeing images that do not exist at all, such as lights or a dead
person, or distortions such as seeing a frightening monster instead of the nurse. They are the
second most common type of hallucination.
Olfactory hallucinations: involve smells or odors. They may be a specific scent such as urine or
feces or a more general scent such as a rotten or rancid odor. In addition to clients with
schizophrenia, this type of hallucination often occurs with dementia, seizures, or cerebrovascular
accidents.
Tactile hallucinations: refer to sensations such as electricity running through the body or bugs
crawling on the skin. Tactile hallucinations are found most often in clients undergoing alcohol
withdrawal; they rarely occur in clients with schizophrenia.
Gustatory hallucinations: involve a taste lingering in the mouth or the sense that food tastes like
something else. The taste may be metallic or bitter or may be represented as a specific taste.
Cenesthetic hallucinations: involve the client’s report that he or she feels bodily functions that
are usually undetectable. Examples would be the sensation of urine forming or impulses being
transmitted through the brain.
Kinesthetic hallucinations: occur when the client is motionless but reports the sensation of
bodily movement. Occasionally, the bodily movement is something unusual, such as floating
above the ground.
Treatment:
Psychopharmacology:
Antipsychotic medications, also known as neuroleptics, are prescribed primarily for their efficacy in decreasing
psychotic symptoms. They do not cure schizophrenia; rather, they are used to manage the symptoms of the
disease.

Maintenance Therapy:
Six antipsychotics are available as long-acting injections (LAIs), formerly called depot injections, for maintenance
therapy. They are:
. Fluphenazine (Prolixin) in decanoate and enanthate preparations
. Haloperidol (Haldol) in decanoate
. Risperidone (Risperdal Consta)
. Paliperidone (Invega Sustenna)
.Olanzapine (Zyprexa Relprevv)
. Aripiprazole (Abilify Maintena)

Discharge plan:
1. Medications:
Instructions:
a. Take medications as prescribed to prevent relapse.
b. Do not stop or change medication without consulting the doctor.
c. Report any side effects such as drowsiness, agitation, or tremors.
2. Follow-Up Appointments
  Psychiatrist Appointment:

 Therapist/Counselor Appointment:

 Primary Care Physician:

3. Psychoeducation & Support

4. Lifestyle & Social Support
5. Caregiver Instructions
 Monitor medication adherence and symptoms.
 Encourage social engagement and structured activities.
 Seek help if signs of relapse appear.

Reflective log
INTRODUCTION:

I am Fatimah Ismail it was my clinical day at the Punjab institute of mental hospital Lahore on the
scheduled day (13November 2024 17 November [Link] clinical rotation was done under the
supervision of our subject teacher ma’am Sumbal Majeed . I reached there with my fellow and
supervisor at 8AM. Pre-clinical conference was held at 8:30AM, in which objectives of clinical was
explained by ma’am Sumbal Majeed. After that, we were divided in to groups and allocated in
different departments.

Description of clinical days:

Female block was assigned to my group .When we entered in female department (Amina
Gayas) in which our instructor meet with the psychologist of female department who allocated
us members suffering from different mental disorder. On clinical days, I learned following
things:

• How to do nursing assessment?

• How to take history from patient (member)?

• How to make nursing diagnoses?

• How can we do psychosocial assessment?

• How can we make management plan for patient suffering from mental disorder?

Feelings: I felt comfortable with environment. I learned a lot. It was a good experience. I
learned how to deal patient with mental illness.

Analysis: I have learned how to manage patient suffering from Obsessive Compulsive
Disorder and provide mental health care by cognitive based therapy.

Conclusion:
Portfolio is very effective way of learning our clinical. I have learnt good techniques and skills to
provide better care in future.