Nursing [Instructor Name] Nursing Case: John aged 23, was assessed by the Crisis Resolution Team because his family had become concerned about his behaviour. Over the last 6 months he had terminated his part time work. He had also become increasingly reclusive by spending more time alone in his flat, and refusing to answer the door to see his friends…
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When they asked how he knew this, he replied that he heard the ‘men’s voices’ as ‘clear as day’ and that they continually commented on what he was thinking. He explained his suspicion as ‘all was not right’ was confirmed when he heard the neighbor’s dog barking in the middle of the night –at that point he knew ‘for certain’ that he was being interfered with. Prompted by nurses John also mentioned that a man in his local pub knew of this plight and had sent him a ‘covert signal’ when he overheard the man conversing about the dangers of nuclear experiments. He also admitted to ‘receiving coded information’ from the radio whenever it was turned on. The team found no evidence of abnormal mood, incoherence of speech or disturbed motor function. John was admitted to a psychiatric hospital. He agreed to a voluntary admission, as he was now afraid of staying alone at home. Mental Health Condition The patient “J” clearly meets the criteria of Schizophrenia given in the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). The patient is suffering from delusions and hallucinations which have lasted for almost a year. The diagnosis can further be specified in to Paranoid Type due to the presence of prominent delusion or auditory hallucinations without any “flattening or incongruity of affect, catatonic symptoms, or incoherent speech” (World Health Organization, 1993, p. 78), confirming the diagnosis for Paranoid Schizophrenia according to ICD-10 Manual. He also meets the criteria of Paranoid Schizophrenia given in the ICD 10 Manual. Signs and Symptoms According to the ICD-10 manual presence of any one of the following symptoms confirms the presence of Schizophrenia: “thought echo, thought insertion or withdrawal, or thought broadcasting”, delusions of control, delusional perception, hallucinatory voices, or persistent delusions that are culturally inappropriate or impossible (World Health Organization, 1993, p. 78). Other than this, schizophrenia may also be diagnosed if any two or more of the following symptoms are identifies: Persistent hallucinations in any modality (for at least one month) along with delusions (fleeting of half-formed) without clear affective content or with persistent over-valued ideas. Neologism Catatonic behavior Negative symptoms including apathy, paucity of speech, and blunting or incongruity of emotional response When diagnosing the patient, it must be made sure that the symptoms are not a result of any medication or meet the criteria of a mood disorder including manic or depressive episode. It must not also be a consequence of an organic brain disease and must not be a result of alcohol or drug abuse, dependence, or withdrawal (World Health Organization, 1993, p. 79). The symptoms of persistent auditory hallucination and prominent delusions are present in J. And since these symptoms are not accompanied by negative affect, it is confirmed that J is suffering from Paranoid Schizophrenia according to ICD-10. Etiology Genetics The main cause of schizophrenia has not yet been identified but the most acceptable cause among the scientists remains genetics. Even though it has not consistently been proven and there is ongoing research ...
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