CASE PRESENTATION

ON
SCHIZOPHRENIA

KIRTI MALHOTRA
MSc 2nd YEAR
HFCON
 SOCIODEMOGRAPHIC PROFILE
 Mrs. X 36 years old Female Married , belonging to nuclear family of middle
economic strata , completed her MSc in Economics , and resident of Vasant
Kunj New Delhi.
 Informant – Husband & Mother
 Information – Reliable and Adequate
CHIEF COMPLAINTS/ PRESENTING COMPLANINTS
 According to Patient
 Mujhe god gifted powers hai. jo m logo ko unka future bta skti hu . mujhe
alphabets or numbers ko god se connect karna aata hai. Mujhe society ko
clean karne ki liye god ne bheja hai taki m sb theek kar sku. But mere ghr
valo ko smjh hi nhi aata vo mujhse ladte rehte hai.mujhe kapdo se thread
nikalna pasand hai.mujhe lagta hai ki meri saas meri bitching karti hai mere
husband ko mere bare mai. Vo log mujhe marna cahthe hai.
 Since 1 month
According to informant:
 Suspiciousness
 Socially withdrawn
 Verbally abuse
 Threatening to harm since 1 month
 Removing Threats from clothes
 Sleep disturbed
 HISTORY OF PRESENT ILLNESS / NATURE
OF CURRENT EPISODE
 Mrs. X 36 years old Female,was brought in vimhans hospital by her Husband through involuntary admission
under section 89 MHCA 2017 and was admitted at 16/05/24 through emergency department with chief complains
of Suspiciousness, socially withdrawn, Believe she is being controlled, Verbally Abuse, sleep disturbed. She
refused to eat and didn’t participate in any activities of daily living. She didn’t take care of his personal hygiene.
She didn’t sleep last few days. She didn’t talk to anyone. The Patients appetite has greatly reduced. Patient was
apparently well few days back, her symptoms exaggerated when she is having conflact with her husband . After 2
days she is said that I am having super natural power , I can do anything. She is having start fight with her
husband and abuse her husband after the intercourse. Removing Threats from clothes ,harm to self and others .
Her husband seeing this changes in his behavior and admitted in vimhans hospital through emergency
department.
Precipitating Factor:
Precipitating Factor is Marriage Conflict.
Associated Disturbances
 No history of head injury, memory loss and disorientation. No history of
trauma or high grade fever, headache, vomiting, confusion.
Treatment history:
Patient is currently managed with
 T.Nexito 5mg TDS( ESCITALOPRAM)
 T.Olimat 2.5 mg ( OLANZAPINE)
 T. Lonazep MD 0.5mg (LONAZEPAM)
Since 8 month
 PAST HISTORY
 The Patient is known case of schizophrenia 1 years . she was apparently well
till May 2024, when she started showing symptoms of Suspiciousness ,
Socially withdrawn , Verbally abuse , Threatening to harm ,Removing
Threats from clothes , Sleep disturbed
 1 st Episode she has a history of Schizophrenia in August 2023 ,
Mrs. X was maintaining well but since May 2024 their was a change in her
behavior as she say she don’t need others & some time she was having
suspiciousness toward people at work place . she becomes irritable , aggressive
towards family members . these symptoms were gradually increasing day by
day & unmanageable at home . so her family took her to the nearby hospital and
they refer her for psychiatric consultation Near Vasant Kunj Delhi. After this ,
they brought mrs. X at CIMBS OPD ,there Dr. Jyoti attended the patient and
advised for the hospital admission about 1 month patient remain admitted in the
hospital and then she starting showing some improvement . she got discharge
and advised for the follow up.
 2 nd Episode in May 2024, she was apparently well few days back, one
day she went to the terrace and suddenly she feel some dizziness and
sudden changes in her body she says that she is feeling cold and showing to
bizarre behavior to her husband. She fights with her husband and verbally
abuse and showing aggression towards inlaws , husband. She started having
marriage conflict with her husband . She said that her husband is forcefully
getting intimate . After that she started removing her clothes and starting
removing thread from clothes and abuse her husband and said you are the
bad human and you are doing wrong things , I will improve you and make
you clean . She thought she is having super natural power gift by GOD and
now she can do any thing. She wants to clean the society & she connect the
alphabet or numbers with their fingers and showing the future to the
peoples. She is having suspiciousness towards her mother in law , she think
they want to kill her. She is isolated herself through the society. she is
having disturbance sleeping pattern, and Aggresvieness towards
family .Seeing changes in her behavior, her husband brought her in
Vimhans Hospital and now she is undertaking treatment.
 Past Medical & Surgical History: There is no
significant medical history.
 Surgical history: There is no significant Surgical
history.
 Mr. K Mrs. L

Mrs. M
Mrs.N Mrs. X Mr. Y
KEY WORDS

Married couple

Male

Female

Psychiatric Patient
Details of Family Functioning:
There is no psychiatric history in the family. The Patient lives in a in-laws
house. she belongs to middle class family. Head of the Family Mr. Y, Patient
doesn’t maintain good relationship with the family member. All the family
members are healthy and do not have any kind of disease condition. The
relationship among family members is in-cooperative.
PERSONAL HISTORY
Pre- natal History: The Patient is the 3rd order in birth and was a wanted
child. The mother didn’t any maternal infections and exposure to radiation. The
Patient’s mother had regular visit to ANC’s and had regular vaccinations.
Natal History:
Mrs. X was born at full term through normal vaginal delivery at hospital. Cried
at the time of birth, no sign of birth asphyxia present. There was no abnormality
and neonatal infections present. Immunization received.
Postnatal History:
The Patient does not have any history of birth defects and any post natal
complications like cyanosis, conversional / jaundice / neonatal infections, and
had regular breast feed upto 1 year of age.
Childhood History:
The Patient has regular feeding practices upto 1 year and was around 1 year of
age at weaning. There was no developmental milestones delays.
Behavioral emotional problems:
There was no history of thumb sucking, nail biting, temper tantrums,
bedwetting, stammering, smoking, tics, mannerisms, head banging, body
rocking, enuresis, somnambulism, night terrors, smoking, drug taking,
overweight , identity problems but has sleep disturbances during course of
treatment
Physical illness during childhood :
There were no history of physical illness specially epilepsy, meningitis,
encephalitis and malnutrition.
Home atmosphere during childhood and adolescence: The client’s home
atmosphere during childhood and adolescence was satisfactory.
Parental lack: There is no parental lack.
Anomalous family situation:
There is no history Anomalous Family situation. Educational History. she
started going to school at the are of 3 ½ years and studied till post graduation,
And has fair academic performance in the school, there is a good relationship
with peers and teachers ,no history of school phobia, no history of truancy and
termination of studies.
Play History:
The client had normal play history and played all games according to his age .
Emotional problems during adolescence: The client did not have any
emotional problem during adolescence like running away from home/
delinquency, smoking, substance abuse.
Occupational History: The client was working as researcher before onset of
illness.
Sexual History:
Patient achieved secondary sexual characteristics at the age of 12 years,
puberty starts at 14 yrs., no anxiety present, she came to know about sex in
higher secondary school.
Marital History: The client is unmarried.
Obstetrical History: There is no obstetrical history.
Retirement/old age: Not retired
PRE MORBID PERSONALITY
Interpersonal relationship: Patient was extrovert.
Attitude to others: Before the onset of disorder Mrs. X was maintaining a
good, trustworthy relationship with her friends, used to share every problem
with family members, used to do all the household activities and there is no
difficulty in taking role.
Attitude towards self: Attitude towards own health was positive, she use to
maintain personal hygiene properly, taking proper diet and sleep.
Attitude towards work and responsibility: she was responsible towards her
work and had good interpersonal relationaship with others.
Moral and religious attitudes and standard: she was believing in god.
Performing all the religious activity at home with their family members.
Predominant mood: Stability of mood present earlier.
Leisure activities and hobbies: During her leisure time she used to spend time
with family, loves to play basketball, cricket and going out with friends .
Fantasy life: No such day dreaming
Reaction pattern to stress: she was able to tolerate stress and frustration
related to family.
Habits: There was no significant bad habits of drug abuse, taking adequate
nutrition, sleep and living in a joint family, belongs to upper socio-economic
status.
 MENTAL STATUS EXAMINATION

GENERAL APPEARANCE
Patient is conscious and oriented. she appears appropriate to stated age. Body
built is endomorphic. Facial expression is blunted. Patient not maintain the
Personal Hygiene and she didn’t take bath daily. she was persuaded by her
husband for admission. she did not greet the examiner and attitude towards
examiner is guarded. she is hesitating in maintaining eye to eye contact with
examiner. Rapport was difficult to established with normal gesture and Shows a
Preoccupied Behaviour.
PSYCHOMOTOR ACTIVITIES
Psychomotor activities were decreased. Patient had open posture. Patient have
no other abnormal movements, Ecoprexia, negativism, catatonic posture,
involuntary movements, waxy flexibility, pseudo seizures and hallucinatory
behavior are absent. No signs of compulsive acts, dissociative signs, or
hallucinatory behaviors.
SPEECH
Initiation of speech: Minimal
Reaction time: increased
Rate: slow
Productivity: Elaborate Reply
Coherence: Coherent
Relevance: Relevant
Tone: normal tone
Volume: Normal
Manner: Relaxed
MOOD AND AFFECT
Mood (subjective)
Nurse: aapka mann aksar kaisa rehat hai?
Patient: theek rehta hai.
Inference: Mood is Dysphoria.
Affect (Objective)
Nurse: Abhi aapka mann kaisa hai?
Patient: abhi to calm hu.
Inference: Affect is Inappropriate.( Depressed ) Inference: Mood and Affect are
congruent to each other.
FORM OF THOUGHT
Nurse: Aapne kis chiz ki padhai ki hai?
Patient: I finished my masters degree.
Inference: form of thought is normal. Patient does not show , magical and
fantasy thinking. No self muttering and self talking present . no
circumstantiality, tangentiality, neologism, word salad, preserveration Present.
Autistic thinking and self smiling present.
FLOW OF THOUGHT
Nurse : kya aap abhe bhee kaam kar raha hai?
Patient: Nhi.
Inference: Stream of thought is normal, flight of ideas, ,thought retardation,
thought block, clang association ,Loosening of Association are absent.
CONTENT OF THOUGHT
DELUSION
Delusion of persecution
Nurse: kiya apko lgta h apko koi marna chatata h ?
Patient: Haa mujhe mere inlaws marna chahte hai .
Inference: Delusion of persecution is Present.
Delusion of reference
Nurse Kya apko esa lagta hai jab log apas me baat krte hai to vo apke bare me
bat krte hai?
Patient : haan , mujhe asa lgta hai ki vo mere bare m baat karte hai.
Inference: Delusion of reference is present.
Delusion of influence or passivity is absent.
Nihilistic delusion is absent.
Delusion of grandiosity
Nurse: Kya aapko lagta hai aap bahut mahaan ho ?
Patient: haa, m bhut Mahaan hu.
Inference: Delusion of grandiosity is Present.
Delusion of poverty is absent.
Delusion of Guilt is Absent.
Hypochondriasis is absent.
POSSESSION OF THOUGHT
Thought obsession is absent.
Phobia is absent.
Thought withdrawal is absent.
Thought insertion is absent.
Thought broadcasting
Nurse: Kya aapko aisa lagta hai ki aapk vichaar TV ya Radio par aa rahe hai?
Patient: haa asa hai .
Inference: Delusion of thought broadcasting is Present.
PERCEPTION
ILLUSION is absent.
HALLUCINATION
Auditory hallucination Is Absent.
Visual hallucination is absent.
Olfactory hallucination is absent .
Gustatory hallucination is absent.
Tactile hallucination is absent.
HIGHER COGNITIVE FUNCTIONS
CONSCIOUSNESS Patient is conscious and alert.
ORIENTATION
Time
Nurse: Abhi kya time ho rha hai?
Patient: 11 am.
Inference: patient is oriented to time.
Place
Nurse: Aapko pta ahi aap abhi kha ho?
Patient: yes I am in delhi.
Nurse: yeh jagaha konsi hai?
Patient: I am in vihmans hospital.
Inference: patient is oriented to place.
Person
Nurse: kya aapko pata hai ki main kaun hoon?
Patient: aap MSc student ho.
Inference: Patient is oriented to person.
ATTENTION AND CONCENTRATION
(Digit span test forward)
Nurse: Ab mai aapko kuch numbers bolungi usko apko repeat karna hai 876
Patient:876
CONCENTRATION (Digit span test backward)
Nurse: Acha mai jo numbers bolungi use apko ulta dohrana hai, 745
Patient:547
Serial subtraction test
Nurse: 100-7 kitna hota hai?
Patient: 93
Nurse: 93-7
Patient: 86
Nurse: 86-7
Patient: 79
Nurse: 79-7
Patient: 72
Nurse: 72-7
Patient: 65
Weeks : forward and backward
Nurse: Acha days of the week btao.
Patient: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday.
Nurse: Acha ab ye last se shuru kar k btao, matlab ulta btao.
Patient: Saturday, Friday, Thursday, Wednesday, Tuesday, Monday, Sunday.
Attention Inference: Patient attention is normally aroused .
Concentration Inference: Concentration is normally sustained.
MEMORY
Immediate memory
Nurse: Abhi mai 5 cheezein bolungi fir mere bolne k baad aap mujhe btana
maine kya kya bola hai (car, book, pen, apple, phone).
Patient: Car, book, pen,apple, Phone.
Inferenece: Immediate memory is intact.
Recent memory
Nurse: Kal aapne dinner mai kya khaya tha?
Patient: roti or sabji khayi thi .
Inference: Recent memory is intact.
Remote memory:
Nurse: Aapka janm kab hua tha?
Patient: in 8 jan 1985
Inference: Remote Memory is intact.
INTELLEGENCE
General Information
Nurse: Apko pta hai BHARAT ka Pradhan Mantri kon hai?
Patient: Narender Modi.
Inference: General information is good.
COMPREHENSION
Nurse: Agar aapko thand lag rhi hai to aap kya kroge?
Patient: agar mujhe thand lagatee hai to main kambal ya warm clothes pahan
loonga.
Inference: Comprehension is good.
SIMPLE ARITHMETIC
Nurse: Ye bato 6 mai 8 jood k kitna hota hai?
Patient: 14
Nurse: Or 50 mai se 12 gya to kitna hota hai?
Patient: 38
Inference: Simple arithmetic is known
ABSTRACT THINKING( Similarities and Difference)
Similiarities
Nurse: apple or ball m kiya similarities ?
Patient: apple or ball dono round hai.
Difference
Nurse: Apple or Ball m Difference?
Patient:Apple ko kha skte hai or ball ko nhi.
Proverb
Nurse: Acha ye btao pet mai chuhe kudne ka kya matlab hota hai?
Patient: bhut tej bhook lgna.
Inference: Abstract thinking is present.
JUDGEMENT
Personal judgement
Nurse: Yha se ghr ja kar kya kroge?
Patient: Study karunga , or medicine time se lunga.
Inference: Personal judgement is logical.
Social judgement
Nurse: Kya aapko social Gathering pasand hai?
Patient: nhi, mann nhi karta kisi se bhi milne ka .
Inference: social judgement is illogical.
Test judgement
Nurse: Agar aapko raste m letter milega with Mobile no. to ap kiya karge?
Patient: No. dekhr I call that person.
Inference: Test judgement is Logical.
INSIGHT
Nurse: Apko yha kyu laye hai?
Patient :kyuki mai inko god ki raste pe lekar ja rhe hu to inko vo acha nhi lg rha
isliye inhone mujhe yha dal diya ye bolkar ki m pagal hu .
Inference: Grade I : Complete Denial of Illness
SPECIAL POINT
SLEEP: Sleep pattern was disturbed. Patient didn’t sleep well.
BOWEL AND BLADDER: bowel and bladder movement is regular.
APPETITE: Appetite is good.
LIBIDO: Libido is normal.
IMPRESSION:
On examination Patient is conscious and oriented to time place and person.
Facial expression was a blunted, Psychomotor activities were Decreased.
Rapport was difficult to built and speech initiation Minimal, Reaction time is
increased, the rate is slow Elobrate reply ,there is no irrelevant talks and the
tone is normal pitch. Mood and Affect are congruent to each other. Delusion of
reference , Persecution ,Grandiosity is Present. social judgement are illogical.
Sleep pattern is disturbed .
CLINICAL DIAGNOSIS
According to ICD 10 F20.0 (PARANOID SCHIZOPHRENIA) SECTION 89 –
Admission and Treatment of Personal Mental Illness with High Support need in
Mental Health Establishment up to 30 days.
According to ICD 11 F20.0 (PARANOID SCHIZOPHRENIA) SECTION 89 –
Admission and Treatment of Personal Mental Illness with High Support need in
Mental Health Establishment up to 30 days.
SCHIZOPHRENIA
Schizophrenia is a psychotic condition characterized
by a disturbance in thinking, emotions, volitions and
facilities in the presence of clear consciousness,
which usually leads to social withdrawal.
ETIOLOGY
Many authorities suggest that multiple factors must cause schizophrenia,
because no single theory satisfactorily explains the disorder.
Biological Theories
Biologic explanations include biochemical, neurostructural, genetic, perinatal
risk factors and other theories.
Biochemical Theories
Dopamine hypotheses: This theory suggests that an excess of dopamine-
dependent neuronal activity in the brain may cause schizophrenia.
Neurostructural Theories
 Research suggests that the prefrontal cortex and limbic cortex may never
fully develop in the brains of persons with schizophrenia.
Genetic Theories
The disease is more common among people born of consanguineous marriages.
Studies show that relatives of schizophrenics have a much higher probability of
developing the disease than the general population .
Developmental Theories According to Freud, there is regression to the oral
stage of psychosexual development, with the use of defense mechanisms of
denial, projection and reaction formation. The individuals have poor ego
boundaries, fragile ego, inadequate ego development, superego dominance,
regressed ID behavior, love- hate (ambivalent) relationships and arrested
psychosexual development.
Family Theories
Family relationships act as major influence in the development of illness.
Mother-child relationship: Early theorists characterized the mothers of
schizophrenics as cold, over-protective, and domineering, thus retarding the ego
development of the child.
Dysfunctional family system: Hostility between parents can lead to a
schizophrenic daughter (marital skew and schism).
Double-blind communication (Bateson et al, 1956): Parents convey two or
more conflicting and incompatible messages at the same time.
Vulnerability-stress Model
This model recognizes that both biologic and psychodynamic predispositions to
schizophrenia, when coupled with stressful life events, can precipitate a
schizophrenic process
Social Factors
Studies have shown that schizophrenia is more prevalent in areas of high social
mobility and disorganization, especially among members of very low social
classes. Stressful life events also can precipitate the disease in predisposed
individuals.
Types of schizophrenia.
Paranoid schizophrenia
This is the most common type of schizophrenia. It may develop later in life than other forms.
Symptoms include hallucinations and/or delusions, but your speech and emotions may not be
affected.
Hebephrenic schizophrenia
Also known as ‘disorganised schizophrenia’, this type of schizophrenia typically develops when
you’re 15-25 years old. Symptoms include disorganised behaviours and thoughts, alongside
short-lasting delusions and hallucinations. You may have disorganised speech patterns and
others may find it difficult to understand you.
People living with disorganised schizophrenia often show little or no emotions in their facial
expressions, voice tone, or mannerisms.
Catatonic schizophrenia
This is the rarest schizophrenia diagnosis, characterised by unusual, limited and sudden
movements. You may often switch between being very active or very still. You may not talk
much, and you may mimic other’s speech and movement.
Undifferentiated schizophrenia
 Your diagnosis may have some signs of paranoid, hebephrenic or catatonic schizophrenia,
but it doesn’t obviously fit into one of these types alone.
Residual schizophrenia
 You may be diagnosed with residual schizophrenia if you have a history of psychosis, but
only experience the negative symptoms (such as slow movement, poor memory, lack of
concentration and poor hygiene).
Simple schizophrenia
 Simple schizophrenia is rarely diagnosed in the UK. Negative symptoms (such as slow
movement, poor memory, lack of concentration and poor hygiene) are most prominent early
and worsen, while positive symptoms (such as hallucinations, delusions, disorganised
thinking) are rarely experienced.
Cenesthopathic schizophrenia
 People with cenesthopathic schizophrenia experience unusual bodily sensations.
Unspecified schizophrenia
 Symptoms meet the general conditions for a diagnosis but do not fit into any of
the above categories.
 SIGN & SYMPTOMS
BOOK PICTURE PATIENT PICTURE
 Delusion Present
Delusion of persecution
Present
Delusion of reference
Delusion of jealousy Absent
Delusion of guilt Absent
Delusion of grandiosity Present
 Hallucination
Auditory hallucination
Absent
Olfactory hallucination
Gustatory hallucination Absent
Tactile hallucination Absent
Visual halucination Absent
 Excitement or agitation Absent
 Hostility or Aggressive behavior
Present
 Suspiciousness ideas of reference
Positive & Negative symptoms of
Schizophrenia
POSITIVE NEGATIVE
• Delusion • Affective flattening or blunting
• Hallucination • Avolition – apathy ( lack of
• Excitement or Agitation initiative)
• Hostility or Aggressive • Attentional impairement
behavior) • Anhedonia ( inability to
• Suspiciousness ideas of experience pleasure )
reference • Alogia ( lack of speech output )
• Possible suicidal tendencies
 DIAGNOSTIC EVALUATION

BOOK PICTURE PATIENT PICTURE

• History collection Done

• MSE Done
• Mini Mse Done
• MOCA Done
• Vitamin deficiencies Done
• Uremia Done
• Thyrotoxicosis Done
• Ct scan and MRI show enlarged MRI – Diffuse cerebral atrophy. Bilateral
ventricles enlargement of the sulci on the fronto-parietal lobe- focal ischemic
cerebral surface and atrophy of the changes.
cerebellum.
TREATMENT MODALITIES
PHARMACOTHERAPY
 An acute episode of schizophrenia typically responds to treatment with antipsychotic
agents, which are most effective in its E treatment. Conventional antipsychotics are now
used less frequently, because of their only partial efficacy and adverse effects. Some non-
compliant patients may receive fluphenazine or Haloperidol depot formulations. These
are long-acting IM doses that release the drug gradually over several weeks.
 Atypical antipsychotics control wider range of signs and symptoms than conventional
agents do and cause few or no adverse motor affects.
 Clozapine may cause agranulocytosis-a potentially fatal blood disorder marked by a low
white blood cell count and pronounced neutrophil depletion. Patient receiving Clozaine
requires routine blood monitoring to detect the disorder because it is reversible if caught
early .Other drugs which are used in the treatment of schizophrenia are antidepressants,
mood stabilizers, benzodiazepines, etc.
 TREATMENT
BOOK PICTURE PATIENT PICTURE
• Pharmacotherapy
 Chlorpromazine 300-1500 mg/day PRESENT
 Fluphenazine 25-50 mg im
 Haloperidol 5-100mg/day
 Trifluoperazine 15-60mg/day
 Clozapine 25-450 mg
 Lonazepam PRESENT( Lonazep MD 0.5 mgOD)
 Risperidone 2-10 mg
 Olanzapine 10-20 mg /day PRESENT( T. olimat 2.5mg OD)
 Quetiapine 150-750 mg/day
 Ziprasidone 20-80 mg
• Electro – convulsive therapy ABSENT
Psychological Therapies
 Group therapy. The social interaction, sense of cohesiveness, identification, and reality testing achieved within the group
setting have proven to be highly therapeutic for these individuals.
 Behavior therapy: Behavior therapy is useful in reducing the frequency of bizarre, disturbing and deviant behavior, and
increasing appropriate behaviors.
 Social skills training: Social skills training addresses behaviors such as poor eye contact, odd facial expressions and lack
of spontaneity in social situations through the use of videotapes, role playing and homework assignments.
 Cognitive therapy: Used to improve cognitive distortions like reducing distractibility and correcting judgment.
 Family therapy: Family therapy typically consists of a brief program of family education about schizophrenia. It has
been found that relapse rates of schizophrenia are higher in families with high expressed emotions (EE), where significant
others make critical comments, express hostility or show emotional over-involvement. The significant others are,
therefore, taught to decrease expectations and family tensions, apart from being given social skills training to enhance
communication and problem. solving.
 Psychosocial Rehabilitation
This includes activity therapy to develop the work habit, training in a new vocation or retraining in a previous skill,
vocational guidance and independent job placement..
NURSING PROBLEMS
 Delusion of reference
 Suspiciousness
 Self harming
 Violence /Aggression
 Disturbed sleeping pattern
NURSING DIAGNOSIS
 Disturbed Thought Process related to Biochemical factors as evidenced by Delusion of
Persecution.
 Social isolation related to altered mental status as evidenced by patient wants live alone &
don’t mingles to others.
 High risk for injury related to extreme hyperactivity and impulsive behavior, evidenced by
lack of control over purposeless and potentially injurious movements.
 Disturbed Sleep Pattern related to neurobiochemical variations as evidenced by patient
looks lethargic.
 Ineffective family coping related to highly ambivalent family relationship , impaired
family communication, evidenced by neglectful care of patient care.
 PROGRESS NOTE
DAY-1(16/06/2024)
Patient is active ,oriented and adequately groomed .psychomotor activites were
normal. Maintained eye to eye contact properly .Rate ,Tone, Volume is dereased,
tone . she looks pattern ,constipation present. Normal sleeping pattern.
NURSING CARE
 Established rapport with the patient.
 Vital signs checked and recorded.
 Oral medication given.
DAY-2(17/06/2024)
Patient is alert conscious and well groomed .Psychomotor activites were normal.
Maintained eye to eye contact properly .Rate ,Tone, Volume of speech is soft and
reaction time was normal . she looks tired and appetite is normal. Normal sleeping
pattern.Normal bowel and bladder pattern.
NURSING CARE
 Assess patient’s condition.
 Vital signs checked and recorded.
 Oral medication given.
DAY-3(18/06/2024)
Patient is alert conscious and well groomed .Psychomotor activates were normal.
Maintained eye to eye contact properly .Rate ,Tone, Volume of speech is soft and
reaction time was normal . she looks tired and appetite is normal. Normal sleeping
pattern. Normal bowel and bladder pattern.
NURSING CARE
 Assess patient’s condition.
 Vital signs checked and recorded.
 Patient participated in activates like prayer and art.
 Oral medication given.
DAY-4(19/06/2024)
Patient is alert conscious and well groomed .Psychomotor activates were normal.
Maintained eye to eye contact properly .Rate ,Tone, Volume of speech is soft and
reaction time was normal . she looks tired and appetite is normal. Normal sleeping
pattern. Normal bowel and bladder pattern.
NURSING CARE
 Assess patient’s condition.
 Vital signs checked and recorded.
 Patient participated in activates like prayer and art.
 Oral medication given.
 Patient started interacting with others patient and staff.
DAY-5(20/06/2024)
Patient is alert conscious and well groomed .Psychomotor activates were normal.
Maintained eye to eye contact properly .Rate ,Tone, Volume of speech is soft and
reaction time was normal . He looks tired and appetite is normal. Normal sleeping
pattern. Normal bowel and bladder pattern.
NURSING CARE
 Assess patient’s condition.
 Vital signs checked and recorded.
 Patient participated in activates like prayer and art.
 Oral medication given.
 Patient started interacting with others patient and staff.