Paranoid Schizophrenia Case Study
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Case study
In accordance with the NMC code of confidentiality (2015), the service user discussed about in this assignment will be referred to as Jack. Jack is a 70-year old gentleman. He has a diagnosis of paranoid schizophrenia and had lived with the disorder for three decades. When I engaged him in conversations he seemed intelligent and I found our conversations very educative as he gave different perspectives on varying topics, this aroused my interest to write about him.
Paranoid schizophrenia …show more content…
Schizophrenia is a severe mental health illness that affects about 24 million people worldwide (WHO 2011). Paranoid schizophrenia is a subtype of schizophrenia, characterized by preoccupation with prominent delusions such as persecutory and grandeurs delusions, auditory hallucinations and hallucinations of the senses. However, there is the absence of flattening, catatonic symptoms and incoherent speech (DSM 10 and LCD 10). Cognition and intelligence in areas not affected by their delusions and hallucinations remain intact. Their emotions and behaviours show less regression compared to other subtypes of schizophrenia, they may be tense, suspicious and sometimes hostile and aggressive (Sadock et al 2007). Their delusions are logical in contrast to delusional disorders (Noll 2007). Many individuals living with paranoid schizophrenia run the risk of not seeking medical attention because of their impaired thought process and lack of insight into their condition. They live in denial, and may resist seeking help on time, this is especially difficult if they do not have good support system (Diehl and Goldberg 2003).
Biological: There are several theories that proposes that schizophrenia is caused by structural and functional changes in the brain. E.g. abnormalities in neurotransmitters (chemical brain messengers of the brain), e.g. Dopamine, lp16944 acetylcholine, serotonin and glutamate (Diehl and Goldberg 2003). A study has shown smaller amgydala (nuclei of the temporal lobe) volume than a control of non-paranoid psychosis (Sumich et al 2002 and Stolerman 2010). In identical twins, if one of the twin develops schizophrenia then that individual tends to have a smaller thalamus (control centre of the brain) compared to his sibling (Andreason et al 1994 and Foster 2003).
Social: Paranoid schizophrenia has major consequences for the social aspects of an individual’s life. The disruptions of the disorder can make family and social relationships difficult. They are prone to restlessness and tend to move from one place to another, without being able to sustain being alone or being with people (Tomkins 2008). For example, Jack could spend hours charting and engaging with other service user and spend hours in isolation not wanting to be disturbed. Because of the effects of the condition most people end up unemployed as was the case with Jack (Foster 2003).
Psychology: Jack believes that there is a conspiracy between the police and the healthcare services to keep him imprisoned. He had left home and travelled to another city trying to escape from them. The delusions may seem credible when the individual’s cultural background is taken into consideration, for example Jack grew up in North east London with high crime rates and high police presence, so this might have reinforced his delusions as a culturally reasonable belief may blossom into a complex delusional system. Delusions are reflections of one’s environment and life experiences (Suhail and Cochrane 2002). Although Jacks delusion might seem improbable it might be grounded in fact.
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Spiritual: Spiritual and religious believes can play a contrasting role in the life of an individual living with paranoid schizophrenia, to some it instils hope and a purpose to their life.
To others it was a cause for spiritual despair. It may increase or decrease psychotic symptoms. In others it increased social integration, it could prevent or trigger suicidal attempts and reduced substance abuse. It may help relieve stress through providing social support. It may play a role in psychotherapeutic support. However, it may also be a source of guilt, pain, exclusion and may negatively impact the psychopathology of a disease (Huguelet and Koenig 2009). Jack had no spiritual affiliations, he was not religious. He did not believe in the supernatural and he explained rationally why there is no supernatural but he believes in doing what is right.
Assessment
Jack was brought into the hospital via a section 136, this section of the mental health act (1986) allows the police to take you a place of safety, if they think you have a mental illness and need care. Whilst in the hospital, Jack was assessed and transferred to a section 3, this is a section that allows you to be detained for treatment (mental health act 1986). Jack is known to the mental health services as he has had a few episodes that needed hospital admission in the past.
Clinical
intervention
It’s a well-known fact that one’s mental health influences their physical health and vise-versa. The mechanism for this interaction might be physiological or based on one’s health behaviour and both mechanisms are not mutually exclusive. For example, getting adequate sleep, regular exercise are health behaviours and can be affected by the individual’s mental state (WHO 2011). In Jacks case, he had very little sleep because he spent time reading, trying to figure out how mental health professionals were conspiring to keep him incarcerated. It is believed that individuals lp16944 with persecutory delusions experience insomnia and the rate of persecutory thinking is directly proportional to the rate of insomnia. This implies that interventions targeted at improving sleep could lessen paranoid experience (Freeman et al 2009). Jack was given some sleeping agents in addition to his antipsychotic to help improve sleep.
Schizophrenia is managed clinically with the use of antipsychotics to eliminate the symptoms, and prevent future relapse. Treatment with antipsychotic can consequently help the patient engage in psychosocial treatment (WHO 2001 and Biggs et al 2008). However, Jack refused to engage with his treatment plan, and appealed his section which was denied. He refused to accept his medications during the first few days, which was expected as explained by a family member but as time progressed he began take his medication.
Psychosocial treatment for psychosis includes training the individual in social skills, family psycho-education, cognitive therapy, and cognitive rehabilitation (Belleck 2001). Jack did not receive any of the above named psychosocial treatment whist under our care. However, the occupational therapist engaged him in ward activities, he declined initially, but after some time, he started to piece together a jigsaw puzzle that was left in the quiet room. This distracted him from his preoccupation with his delusions and I found this was very helpful in Jacks care. I realised that Jack did not like to be coaxed to accept help from people, he wanted to decide on his own.
Effects on Jack
Jack lacked insight into his illness, hence his reason for initially refusing his medications. He only started taking his medications because he thinks the health care professionals in charge of his care would not let him go. As far as he was concerned it was all part of the conspiracy to keep him imprisoned. After he started taking his medication, personally I did not see any change in his symptoms but this might be because I did not stay on the ward long enough to see the change.
He has a supportive family but during times when he is unwell, he paranoid delusions drives him away from them as he felt persecuted by is family members. lp16944
Jack hoped that he was included in his care more than he was. As stated earlier cognition is not greatly impacted. Jack says, ‘all they had to do was ask me and I will tell them, nobody knows me more than myself’. Things about Jacks past were uprooted for this admission, he felt that it was unfair for him to be judged by things he did ten years ago as times had changed. As a student nurse, I played a supportive role, I had conversations with him when he wanted to and let him be when he was preoccupied with other activities. I realised that he liked to make intellectual statements about geography, diversity, race, and politics. He told me at the end of my placement that he enjoyed our conversations.
Conclusion
Paranoid schizophrenia is a disabling disease which affects all areas of an individual’s life as described in this case study. In the case of Jack, it destabilized his family, regardless having a supportive partner. His relapses where based on non-concordance to medication. Jacks feels that he does not need his medication long term, as soon as gets better he weans himself off his medications. Antipsychotics are useful but due to non-concordance and side effects experienced. It is importance to assist patients in their recovery, to find positives ways to live fulfilling lives through developing a positive sense of self, built in hope and self-determination (Ristner 2011). I hope that a care plan would be made before Jack leaves hospital to help Jack remain concordant to his medication and prevent further relapse.
Case study
In accordance with the NMC code of confidentiality (2015), the service user discussed about in this assignment will be referred to as Jack. Jack is a 70-year old gentleman. He has a diagnosis of paranoid schizophrenia and had lived with the disorder for three decades. When I engaged him in conversations he seemed intelligent and I found our conversations very educative as he gave different perspectives on varying topics, this aroused my interest to write about him.
Paranoid schizophrenia …show more content…
Schizophrenia is a severe mental health illness that affects about 24 million people worldwide (WHO 2011). Paranoid schizophrenia is a subtype of schizophrenia, characterized by preoccupation with prominent delusions such as persecutory and grandeurs delusions, auditory hallucinations and hallucinations of the senses. However, there is the absence of flattening, catatonic symptoms and incoherent speech (DSM 10 and LCD 10). Cognition and intelligence in areas not affected by their delusions and hallucinations remain intact. Their emotions and behaviours show less regression compared to other subtypes of schizophrenia, they may be tense, suspicious and sometimes hostile and aggressive (Sadock et al 2007). Their delusions are logical in contrast to delusional disorders (Noll 2007). Many individuals living with paranoid schizophrenia run the risk of not seeking medical attention because of their impaired thought process and lack of insight into their condition. They live in denial, and may resist seeking help on time, this is especially difficult if they do not have good support system (Diehl and Goldberg 2003).
Biological: There are several theories that proposes that schizophrenia is caused by structural and functional changes in the brain. E.g. abnormalities in neurotransmitters (chemical brain messengers of the brain), e.g. Dopamine, lp16944 acetylcholine, serotonin and glutamate (Diehl and Goldberg 2003). A study has shown smaller amgydala (nuclei of the temporal lobe) volume than a control of non-paranoid psychosis (Sumich et al 2002 and Stolerman 2010). In identical twins, if one of the twin develops schizophrenia then that individual tends to have a smaller thalamus (control centre of the brain) compared to his sibling (Andreason et al 1994 and Foster 2003).
Social: Paranoid schizophrenia has major consequences for the social aspects of an individual’s life. The disruptions of the disorder can make family and social relationships difficult. They are prone to restlessness and tend to move from one place to another, without being able to sustain being alone or being with people (Tomkins 2008). For example, Jack could spend hours charting and engaging with other service user and spend hours in isolation not wanting to be disturbed. Because of the effects of the condition most people end up unemployed as was the case with Jack (Foster 2003).
Psychology: Jack believes that there is a conspiracy between the police and the healthcare services to keep him imprisoned. He had left home and travelled to another city trying to escape from them. The delusions may seem credible when the individual’s cultural background is taken into consideration, for example Jack grew up in North east London with high crime rates and high police presence, so this might have reinforced his delusions as a culturally reasonable belief may blossom into a complex delusional system. Delusions are reflections of one’s environment and life experiences (Suhail and Cochrane 2002). Although Jacks delusion might seem improbable it might be grounded in fact.
lp16944
Spiritual: Spiritual and religious believes can play a contrasting role in the life of an individual living with paranoid schizophrenia, to some it instils hope and a purpose to their life.
To others it was a cause for spiritual despair. It may increase or decrease psychotic symptoms. In others it increased social integration, it could prevent or trigger suicidal attempts and reduced substance abuse. It may help relieve stress through providing social support. It may play a role in psychotherapeutic support. However, it may also be a source of guilt, pain, exclusion and may negatively impact the psychopathology of a disease (Huguelet and Koenig 2009). Jack had no spiritual affiliations, he was not religious. He did not believe in the supernatural and he explained rationally why there is no supernatural but he believes in doing what is right.
Assessment
Jack was brought into the hospital via a section 136, this section of the mental health act (1986) allows the police to take you a place of safety, if they think you have a mental illness and need care. Whilst in the hospital, Jack was assessed and transferred to a section 3, this is a section that allows you to be detained for treatment (mental health act 1986). Jack is known to the mental health services as he has had a few episodes that needed hospital admission in the past.
Clinical
intervention
It’s a well-known fact that one’s mental health influences their physical health and vise-versa. The mechanism for this interaction might be physiological or based on one’s health behaviour and both mechanisms are not mutually exclusive. For example, getting adequate sleep, regular exercise are health behaviours and can be affected by the individual’s mental state (WHO 2011). In Jacks case, he had very little sleep because he spent time reading, trying to figure out how mental health professionals were conspiring to keep him incarcerated. It is believed that individuals lp16944 with persecutory delusions experience insomnia and the rate of persecutory thinking is directly proportional to the rate of insomnia. This implies that interventions targeted at improving sleep could lessen paranoid experience (Freeman et al 2009). Jack was given some sleeping agents in addition to his antipsychotic to help improve sleep.
Schizophrenia is managed clinically with the use of antipsychotics to eliminate the symptoms, and prevent future relapse. Treatment with antipsychotic can consequently help the patient engage in psychosocial treatment (WHO 2001 and Biggs et al 2008). However, Jack refused to engage with his treatment plan, and appealed his section which was denied. He refused to accept his medications during the first few days, which was expected as explained by a family member but as time progressed he began take his medication.
Psychosocial treatment for psychosis includes training the individual in social skills, family psycho-education, cognitive therapy, and cognitive rehabilitation (Belleck 2001). Jack did not receive any of the above named psychosocial treatment whist under our care. However, the occupational therapist engaged him in ward activities, he declined initially, but after some time, he started to piece together a jigsaw puzzle that was left in the quiet room. This distracted him from his preoccupation with his delusions and I found this was very helpful in Jacks care. I realised that Jack did not like to be coaxed to accept help from people, he wanted to decide on his own.
Effects on Jack
Jack lacked insight into his illness, hence his reason for initially refusing his medications. He only started taking his medications because he thinks the health care professionals in charge of his care would not let him go. As far as he was concerned it was all part of the conspiracy to keep him imprisoned. After he started taking his medication, personally I did not see any change in his symptoms but this might be because I did not stay on the ward long enough to see the change.
He has a supportive family but during times when he is unwell, he paranoid delusions drives him away from them as he felt persecuted by is family members. lp16944
Jack hoped that he was included in his care more than he was. As stated earlier cognition is not greatly impacted. Jack says, ‘all they had to do was ask me and I will tell them, nobody knows me more than myself’. Things about Jacks past were uprooted for this admission, he felt that it was unfair for him to be judged by things he did ten years ago as times had changed. As a student nurse, I played a supportive role, I had conversations with him when he wanted to and let him be when he was preoccupied with other activities. I realised that he liked to make intellectual statements about geography, diversity, race, and politics. He told me at the end of my placement that he enjoyed our conversations.
Conclusion
Paranoid schizophrenia is a disabling disease which affects all areas of an individual’s life as described in this case study. In the case of Jack, it destabilized his family, regardless having a supportive partner. His relapses where based on non-concordance to medication. Jacks feels that he does not need his medication long term, as soon as gets better he weans himself off his medications. Antipsychotics are useful but due to non-concordance and side effects experienced. It is importance to assist patients in their recovery, to find positives ways to live fulfilling lives through developing a positive sense of self, built in hope and self-determination (Ristner 2011). I hope that a care plan would be made before Jack leaves hospital to help Jack remain concordant to his medication and prevent further relapse.