The Distrustful Mind: A of Paranoid Schizophrenia - Case Study Example

The Distrustful Mind: A Case of Paranoid Schizophrenia Schizophrenia is a mental health disorder that causes alterations in thought process, perceptions, emotions, and behavior (Videbect, 2007). Theoretically, the condition should be seen as a combination of causes and symptoms rather than a single illness. In this paper, salient details about schizophrenia including signs and symptoms, causes, and a sample case study will be discussed thoroughly. The causes of schizophrenia can be safely regarded as a complex interplay of dynamic factors that vary with each individual (Weiser & Davidson, 2008). Genetics is seen as an important factor in determining the relative risk of certain individuals of committing the disease (Bulayeva et al., 2007). It has been shown that there is a 50% risk that the disease is shared between identical twins, and only about 15% between fraternal twins. Environmental and social factors are also indispensable factors to be considered for the etiology of the disease. While identical twins have exactly similar copy of genetic material, there is a 50% chance that a mentally healthy twin will not develop the condition (Videbect, 2007). On the other hand, conventional beliefs claim that the condition develops when there are disparities in the interpersonal relationships and psychosexual developmental process in the individual (Green et al., 2008). When specific tasks are not met or remain unsatisfied in the personal childhood history, psychological symptomatology that mimics schizophrenia may occur like having schizoid personality (Burgy, 2008). Neurobiological scientists are convinced that the condition is a result of brain tissue alterations, cerebrovascular insufficiency, and imbalance in brain chemical modulators, hormones, and neurotransmitters. Results of PET scans indicate that individuals with schizophrenia commonly have decreased glucose metabolism and oxygen in the frontal cortical structures in the brain. CT scans indicated decreased brain cortical tissue and enlarged ventricles. These changes in the brain physioanatomy can be brought about by physical trauma, infectious disease, or as a result of metabolic changes in chronic diseases. Furthermore, poor maternal nutrition, use of tobacco, alcohol, and unprescribed drugs in pregnancy also increase the risk of schizophrenia in an individual (Brown & Susser, 2008). Furthermore, the condition has a reputation of chronicity, severity, and profound functional disability. However, recent developments in mental health and psychiatry introduced psychotropic medications that significantly improved the prognosis of individuals with schizophrenia without experiencing severe adverse effects. Currently, people inflicted with the disease can manage the symptoms with the use of newer medicines and milieu therapy. Meanwhile, the onset of schizophrenia varies in age range per gender. The usual age for males afflicted with the condition can be as early as 15 up to 25 years old, while it can occur later in females at around 25 to 35 years old. The prevalence of the disease is estimated to be 1% of the total population in the world (Videbect, 2007). Interestingly, there are forms of psychosis in schizophrenia that are common only in a specific culture. These patterns of hallucinations, delusions, and impairment in perception may be the results of innate beliefs and practices of each culture. Hence, cultural differences are also significant factors to be assessed in the individuals exhibiting signs of schizophrenia. In addition, schizophrenia shows two major patterns of symptoms. Positive or hard symptoms are actually exaggerations from the normal perceptions of an individual. These include delusions, hallucinations, and remarkable disorganization of speech and behavior. Contrastingly, negative or soft symptoms are decreased manifestations from the normal patterns of a mentally healthy person. These include a notable degradation in a person’s mood and affect, lack of volition, and social isolation (Videbect, 2007). Identifying information J. B. is a 26 years old, female client diagnosed of having Schizophrenia, paranoid type. She transferred residence just recently after her adoptive father kept on insisting that she seek the help of a mental health professional. Referral source The client was initially admitted to the emergency room of the community health clinic for being potentially harmful to self and others. Since there was no baseline mental health record, a referral order was prescribed for the client to initiate an accurate assessment, diagnosis, and intervention plan by a qualified mental health professional. Presenting problem The client was admitted to mental hospital due to prolonged exaggerated delusions and hallucinations leading to pronounced malnutrition and high risk for violence directed to self and others. She experienced persecutory delusions severe enough that she rarely went outside her room to eat. In fact, she hated her father for being an “accomplice of the police department in tracking her recent activity”. Besides that, a remarkable loss of body fat and muscle mass is noted on her appearance. Furthermore, her body hygiene and tidiness of her room dwindled rapidly. She keeps unusual objects on her room like empty bottles, cans, rope, and broken glass. She threatens anyone who knocks at the door that she was holding bladed weapons inside her room. She believed she had to “defend herself from the enemies”. History of the problem The client fell deeply in love with a man for the first time in her life. She had not experienced any intimate relationship so she did not know how to act appropriately. All she knew was that she was in love and willing to do everything to make her man contented. Eventually, she got pregnant with her boyfriend and was willing to spend her life with him. Unfortunately, she found out that her boyfriend is a married man. At first, she did not know what to do. Her boyfriend’s wife pleaded her to stay away from her husband. She could not believe the situation she was in. She could not afford to be a home breaker. When she finally decided to leave her boyfriend, she became socially withdrawn and had miscarriage. In addition, there was a notable change in her personality and hygiene. She could not work well and was troubled with auditory hallucinations. Lastly, she was forced to quit her job and had lost interest with life. To cope up with the stress, she took illicit drugs that ultimately altered her perceptions, behavior, and control of emotions. Eventually, her hallucinations worsened, delusions became apparent, and had labile emotions. Family background The client was adopted by childless couple when she was seven years old. Her adoptive family has no history of major mental illness. Family support was adequate and she was very open especially to her mother about her feelings and emotions. Her mother died of hypertension as a complication of diabetes and she was left with no one to confide with. On the other hand, her biological family has some traces of mental health instability. Her paternal grandmother was diagnosed with Schizophrenia and died of mismanaged adverse reactions of antipsychotic drugs. Her biological parents could barely provide food for the family. In fact, they got divorced and her mother suffered from major depression. Genogram Legend: ♀- Diagnosed with Schizophrenia, died of adverse drug effects ♀- Diagnosed with Major depression ♀- Patient, diagnosed with paranoid- type Schizophrenia *Red line indicates the relationship of the patient with the adoptive parents. Personal history The client was a silent and conservative woman in her pre morbid years. She was an active member in the local church and teaches small kids about religious matters. She also worked as a clerk in a fast food chain for about two years. She finished a vocational course after graduating high school. Her first and only intimate relationship with a man resulted in an adversity. She had a miscarriage due to the severe psychosocial trauma of the relationship’s ending. Later, she used illicit drugs such as cocaine and marijuana in an attempt to forget away her suffering. Medical history The client has a history of hospital admission after a vehicular accident, one month after her breakup with her boyfriend. Aside from that, the client did not have a major medical condition that required a hospital admission. On the other hand, the client had recently lost a significant weight that required hospitalization. Her high risk of violence directed to self and others prompted emergency admission. Cultural history Biologically, the client comes from a Filipino descent but was adopted by an American couple. She grew up in a community where majority of the population is Caucasian and Latin Americans. Spirituality/Religion The client is a member of a Protestant church in the community. In the past six months, other church members noticed very disturbing changes with the client’s behavior and performance as the kids’ religious teacher. Apparently the client taught about the invasion of aliens and the impending end of the world. She began to exhibit religious delusions by claiming that “God sent angels to warn her of being involved with alien activity”. Mental Status and current functioning Rapid and severely debilitating alterations in the client’s mental status were illustrious in the overall appearance and behavior. The presence of auditory hallucinations had severely limited the client’s functioning. In fact, she had ignored proper hygiene and the importance of a pleasing physical appearance in her work. At worse, she was fired from being a clerk in a fast food chain where she previously worked because of the gross manifestations of paranoia. She was noted to be using harsh language towards her clients and her boss. Often she shouted the customers in the table because she thought they were talking about her. Being a conservative woman, she was always worried that people are talking about her having a relationship with a married man. She frequently took a break and crying out of guilt and insecurity. Sometimes, she expressed unsolicited apology to every female customer in their food chain about her breaking their family relationship. She would cry and even hurt herself about not having discerned that the man she was going out with was married. Shortly after, she would hear voices telling her offensive language that she was a whore and a home- breaker. Often she would hide from other people and panicked when being stared at. She was convinced that nobody tries to understand her situation even after explaining it to almost anyone she met. She wailed at anybody who did not listen to her story or showed unsatisfactory interest about her topic. Later on, she believed she was being enlisted as one of the most dangerous person by the CIA. Headlines seemed to refer to her. She thought that her neighbors, church members, and even friends were plotting to frame her up and kill her. In fact, she started to hate her adoptive father for not believing her story. Mood and affect The client demonstrated an inappropriate mood and affect. She laughed while talking about her the death of her mother and cried while talking about her favorite cartoon character. When her boyfriend was the center of conversation, she exhibited grossly inappropriate laughter with a blank facial expression. She looked distressed and unhappy with her life. Furthermore, she claimed to be regretful about not having “fulfilled her mission of protecting mankind and instead befriended aliens”. Motor activity The client appeared restless and unable to sit still. She was easily agitated and paced around the hallway. Sometimes, she shouted at someone else and subsequently ran fast and hid herself in the closet. Appearance The client appeared disheveled and unkempt. Obviously, she had no concern with hygienic measures. Her clothing was inappropriate that she wore short pants, sleeveless shirt, and running outside without footwear in an environmental temperature of 7°C. Sometimes, she was overly dressed and applied bold makeup at home. At the clinic, she sat only at the border of the chair and looked around suspiciously. Speech The client exhibited an unusual speech pattern and use of language. Most of the time, her sentences composed of poorly disorganized word syntax that form no meaning. However, there were also instances that the client expresses concern about the safety of the people around her. She claimed that people around might just be “involved unintentionally” with the unspecified crimes she insists she had committed. She also talked of incomprehensible words and phrases and she urged others to study alien's language. She whispered self- formulated words but warned not to "tell it to the enemies". She was convinced that somebody around was trying to decode her language and that she had "to be careful". Paranoid delusions were noted in her sentences that she constantly repeated that she is being followed, making her responses totally unrelated to the questions asked. Orientation The client kept herself a small old calendar in a wallet and admitted that she was still waiting for her boyfriend who promised to marry her. Other than that, the client was found to be oriented to place and time. Judgment Obvious changes were noted on the client’s judgment as a result of impaired perceptions. For instance, the client wears skinny clothes and short pants going outside a snowy environment. There were instances that the client went swimming in the ice cold beach by herself. She also admitted about eating only ice chips when she feels ill and feverish. In addition, she crossed the street and interpreted traffic lights in a different way. Ecomap DSM IV-TR diagnosis The client is diagnosed with Schizophrenia, Paranoid- type (Axis I 295.30). Diagnostic rationale Paranoid schizophrenia is a subtype under Schizophrenia domain characterized by intense and severely disturbing forms of hallucinations and delusions (Lake, 2008). Persecutory and referential delusions and auditory hallucinations are primarily the distinguishing features of paranoid schizophrenia from the other types. Other manifestations common with schizophrenia, but not with the paranoid- type, include flattened or inappropriate affect and bizarre behavior. In this case, the client was convinced of ideas of reference and persecutory delusions. The subjects of her delusions revolved around being “followed”, being “talked” about everywhere and God’s special interventions for her. All these manifestations of altered thought processes actually occurred for over a year, but became prominent and more intense in the past six months. Establishing the diagnosis of a paranoid- type schizophrenia also involve ruling out other possible diagnosis (Weiser & Davidson, 2008). To rule out mania in bipolar disorder, the history of the precedence of manifestations need to be considered. In a Bipolar Manic state, the excitement phase precedes the psychotic phase. In this case, the client presented psychotic episodes such as delusions and hallucinations simultaneously with paranoid manifestations. Some clients with major depression may manifest psychotic episodes of hallucinations and delusions. However, these psychotic episodes occur only when the depression becomes severe. In paranoid schizophrenia, no direct relationship can be established because psychotic episodes are always present regardless of the mood of the client. Paranoid schizophrenia can also be very difficult to distinguish from a delusional disorder and paranoid personality disorder (Lake, 2008). While Delusional disorder may present hallucinations, these episodes do not play a major role as compared with paranoid schizophrenia when the disorganization of behavior and perception is based on intense hallucinations and persecutory delusions. Furthermore, the presence of hallucinations and delusions explicitly excludes the diagnosis of paranoid personality disorder. References Brown, AS. & Susser, ES. (2008). Prenatal nutritional deficiency and risk of adult schizophrenia. Schizophrenia Bulletin, 34 (6), pp. 1054- 1063. doi:10.1093/schbul/sbn096 Bulayeva, KB., Glatt, SJ., Bulayev, OA, Pavlova, TA, Tsuang, MT. (2007). Genome- wide linkage scan of schizophrenia: A cross- isolate study. Genomics, 89, pp. 167-177. doi:10.1016/j.ygeno.2006.10.001 Burgy, M. (2008). The concept of psychosis: Historical and phenomenological aspects. Schizophrenia Bulletin, 34 (6), pp. 1200- 1210. doi:10.1093/schbul/sbm136 Green, MF., Penn, DL., Bentall, R., Carpenter, WT., Gaebel, W., Gur, RC., Kring, AM., Park, S., Silverstein, SM. & Heinssen, R. (2008). Social cognition in Schizophrenia: An NMIH workshop on definitions, assessment, and research opportunities. Schizophrenia Bulletin, 34 (6), pp. 1211- 1220. doi: 10.1093/schbul/sbm145 Lake, CR. (2008). Hypothesis: Grandiosity and guilty cause paranoia; Paranoia schizophrenia is a psychotic mood disorder; a review. Schizophrenia Bulletin, 34 (6), pp. 1151- 1162. doi: 10.1093/schbul/sbm132 Videbect, SL. (2007). Psychiatric mental health nursing (4th ed). New York: Lippincott Williams and Wilkins. Weiser, M. & Davidson, M. (2008). Using clinical data bases to study schizophrenia. Schizophrenia Bulletin, 34 (6), pp. 1033- 1034. doi: 10.1093/schbul/sbn122 Read More