Clinical Case Study: Paranoid Schizophrenia

Clinical Case Study: Paranoid Schizophrenia

Case study on mental health
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a case study which has to be done on a depression patient(Bipolar). you will need to write the scenario or case later. You can start from the Introduction. Evidence based guidelines are to be used which can be found in “australia newzealand college of psychology” or NICE. Important to know that The patient is currently under treatment and on ECT treatment. 6 ECTs done with some improvement and 6 more to go.Community service will be done by MAPS if you have to mention community services. The sample work is not of great quality and its for only an idea.
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Clinical Case Study: Paranoid Schizophrenia
1. Introduction
Schizophrenia is a serious and chronic mental health disorder, primarily characterized by psychotic
features such as significant disturbances in perception, thought content and processes, cognition,
social and occupational dysfunction (REF; REF). On average, schizophrenia affects approximately
1.5 % of the population world wide (REF; REF). The etiology of schizophrenia is not well
understood, but it appears that genetics and the combination of genes plus environmental
interaction account for around 80% of the probability of developing the disease (REF). The
experience of symptoms associated with this severe mental illness and the resultant effect that
physical, emotional and economic impairments have on ability to function in the community
presents a significant challenge to mental health agencies tasked with supporting these people to
remain well in the community and maximize their functional capacity and quality of life.
This paper presents the case study of a 54-year-old female, with a thirty-six year history and
primary diagnosis of continuous paranoid schizophrenia. For the purposes of the paper the case
subject will be referred to by the pseudonym of Mary. Mary is an informal (voluntary) patient who
lives alone in the community. Her last inpatient admission was five years ago. She is currently
managed by a Mobile Treatment and Support Team (MSTT) who supervises her medication daily
and assists Mary with weekly shopping and any other psychosocial issues. Mary’s relevant past
medical history includes morbid obesity; type two diabetes mellitus, hypercholesterolemia and
hypertension. The definition of Mary’s clinical diagnosis and the full DSM IV-TR diagnostic criterion
for continuous paranoid schizophrenia can be found in appendix 1. A detailed case description and
patient history is attached in appendix 2.
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The case subject described above was selected for this case study to highlight complexities and
commitment required to effectively integrate and manage a client with chronic schizophrenia in the
community. This paper focuses on the case subject’s clinical presentation, diagnostic criteria, and
examines the clinical manifestations and pathophysiology of schizophrenia. It will describe and
discuss the case subject’s current and future treatment plan (in the context of GP medical case
management and the REF), pharmacological management in the context of current evidence
based practice, and will also address the long term implications associated with chronic use of
antipsychotics. Finally, it discusses patient education requirements and strategies required to
address the case subject’s current and future mental, physical and psychosocial healthcare needs.
2. Clinical manifestations and pathophysiology
The negative symptoms often experienced by those with schizophrenia have a demonstrable
impact on the person’s ability to maintain normal function. Anhedonia, avolition, affect restriction
and alogia account for significant disturbances to personal, social and occupational functioning
(REF). The clinical manifestations which Mary experiences secondary to these negative symptoms
are discussed below.
2.1 Disturbances in appearance – Mary appeared overweight, dishevelled, inappropriately
dressed for the weather and her clothes are stained and dirty. Her disheveled and matted and she
presents malodorous. The diagnostic criterion (B) of the DSM IV-TR for schizophrenia is
dysfunction in one or more significant areas of psychosocial functioning, including self care and
activities of daily living (ADL) (REF). Avolition in particular represents a loss of motivational drive to
participate in goal directed activities such as self-care, nutrition, ADL’s, physical exercise (REF;
REF, REF). In Mary’s case it is evident that both her ability to maintain personal care and
motivation for physical activity have been adversely affected.
2.2 Disturbances in mood – Mary subjectively reports she feels ‘a bit down’ especially in the
mornings, but this feeling usually self-resolves by lunchtime. Emotional impairments such as
anhedonia represent a common negative symptom of schizophrenia and are related to the loss of
interest or the experience of pleasure (REF). A randomized controlled trial conducted by REF
(2010) reported that MRI scans of individuals with high anhedonia ratings demonstrated reduced
Example of clinical cases study (NUR5003)
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activation of the striatum and amaygdala in response to positive stimuli. The authors hypothesized
that this diminuted response may contribute to sym