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Tarlac State University

COLLEGE OF NURSING
Lucinda Campus
Tarlac City

A CASE STUDY

On

PARANOID
SCHIZOPHRENIA

Presented by:

Espinosa, Rachael Ann B.


Granadozin, Chenee L.
Tapnio, Reselda

April 22, 2008


TABLE OF CONTENTS

Chapter 1 …………………………………………………………….

 Introduction
 Theoretical Framework
 Personal Data
 History of present Illness
 Past Personal History
 Family History

Chapter 2 ……………………………………………………………

 General appearance
 Motor behavior
 Sensorium and Cognities
 Perception
 Attitude and Behavior
 Defense Mechanism
 Affective State
 Speech
 Thought Process and Content

Chapter 3 …………………………………………………………….

 Psychopathology
 Related Literature and Studies
 Drug Study

Chapter 4 …………………………………………………………….

 Process Recordings
 Prioritized Psychiatric Nursing Diagnoses

Chapter 5 ……………………………………………………………

 Psychotherapies Implemented
CHAPTER 1

Introduction

Paranoid schizophrenia is the most common type of schizophrenia in most parts


of the world. The clinical picture is dominated by relatively stable, often paranoid,
delusions, usually accompanied by hallucinations, particularly of the auditory variety, and
perceptual disturbances. Disturbances of affect, volition, and speech, and catatonic
symptoms, are not prominent.

With paranoid schizophrenia, your ability to think and function in daily life may
be better than with other types of schizophrenia. You may not have as many problems
with memory, concentration or dulled emotions. Still, paranoid schizophrenia is a serious,
lifelong condition that can lead to many complications, including suicidal behavior.
(http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862)

Patients who have paranoid schizophrenia that has thought disorder may be
obvious in acute states, but if so it does not prevent the typical delusions or hallucinations
from being described clearly. Affect is usually less blunted than in other varieties of
schizophrenia, but a minor degree of incongruity is common, as are mood disturbances
such as irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms such
as blunting of affect and impaired volition are often present but do not dominate the
clinical picture.

The course of paranoid schizophrenia may be episodic, with partial or complete


remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is
difficult to distinguish discrete episodes. The onset tends to be later than in the
hebephrenic and catatonic forms. (http://www.schizophrenia.com/szparanoid.htm)

According to the World Health Organization, It describes statistics about mental


disorders of year (2008). Schizophrenia is a severe form of mental illness affecting about
7 per thousand of the adult population, mostly in the age group 15-35 years. Though the
incidence is low (3-10,000), the prevalence is high due to chronicity. According to the
facts it reveals Schizophrenia affects about 24 million people worldwide.
Schizophrenia is a treatable disorder, treatment being more effective in its initial stages.
More than 50% of persons with schizophrenia are not receiving appropriate care.90% of
people with untreated schizophrenia are in developing countries. Care of persons with
schizophrenia can be provided at community level, with active family and community
involvement.

Schizophrenia affects men and women with equal frequency. Schizophrenia often
first appears in men in their late teens or early twenties. In contrast, women are generally
affected in their twenties or early thirties.

In the U.S., mental disorders are diagnosed based on the Diagnostic and
Statistical Manual of Mental Disorders, fourth edition (DSM-IV).
(http://www.howstuffworks.com/framed.htm?parent=schizophrenia.htm&url=http://www
.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml)

In the Philippine setting, the disability survey done in 2000 by the National
Statistics Office (NSO) found out that mental illness was the 3rd most common form of
disability in the country. The prevalence rate of mental disorders was 88 cases per
100,000 population and was highest among the elderly group. This finding was supported
by a more recent data from the Social Weather Station Survey commissioned by DOH in
2004. It reveals that 0.7 percent of the total households have a family member afflicted
with mental disability. The Baseline Survey for the National Objectives for Health in
2000 stated that the more frequently reported symptoms of an underlying mental health
problem were sadness, confusion, forgetfulness, no control over the use of cigarettes and
alcohol, and delusions.

The most recent study on the prevalence of mental health problems was
conducted by the National Epidemiology Center (DOH-NEC) in 2006 which showed
revealing results though the target population was limited only to government employees
from the 20 national agencies in Metro Manila. Among 327 respondents, 32 percent were
found to have experienced a mental health problem at least once in their lifetime. The
three most prevalent diagnoses were: specific phobias (15 %), alcohol abuse (10%),
depression and schizophrenia (6%). Mental health problems were significantly associated
with the following respondent characteristics: ages 20-29 years, those who have big
families, and those who had low educational attainment. The prevalence rate generated
from the survey was much higher than those that were previously reported by 17 percent.

(http://72.14.235.132/search?q=cache:sGh-NeA_KcUJ:home.doh.gov.ph/ao/ao2007-
0009.pdf+epidemiology+of+schizophrenia+in+the+philippines&cd=6&hl=tl&ct=clnk&g
l=ph)

Currently, there is no method for preventing schizophrenia and there is no cure.


Minimizing the impact of disease depends mainly on early diagnosis and, appropriate
pharmacological and psycho-social treatments. Hospitalization may be required to
stabilize ill persons during an acute episode. The need for hospitalization will depend on
the severity of the episode. Mild or moderate episodes may be appropriately addressed by
intense outpatient treatment. A person with schizophrenia should leave the hospital or
outpatient facility with a treatment plan that will minimize symptoms and maximize
quality of life.

This introduced psychiatric case was chosen primarily because it is the most
interesting amongst the cases that were encountered by the group members. It posts
relevant manifestations that are psychiatric in nature and the entire case is highly possible
to be studied comprehensively within the limited time available.

Theoretical Framework

Maslow's hierarchy of needs is predetermined in order of importance. It is often


depicted as a pyramid consisting of five levels: the first lower level is being associated
with physiological needs, while the top levels are termed growth needs associated with
psychological needs. Deficiency needs must be met first. Once these are met, seeking to
satisfy growth needs drives personal growth. The higher needs in this hierarchy only
come into focus when the lower needs in the pyramid are met. Once an individual has
moved upwards to the next level, needs in the lower level will no longer be prioritized. If
a lower set of needs is no longer being met, the individual will temporarily re-prioritize
those needs by focusing attention on the unfulfilled needs, but will not permanently
regress to the lower level. For instance, a businessman at the esteem level who is
diagnosed with cancer will spend a great deal of time concentrating on his health
(physiological needs), but will continue to value his work performance (esteem needs)
and will likely return to work during periods of remission.
The lower four layers of the pyramid are what Maslow called "deficiency needs"
or "D-needs": physiological, safety and security, love and belonging, and esteem. With
the exception of the lowest (physiological) needs, if these "deficiency needs" are not met,
the body gives no physical indication but the individual feels anxious and tense.
(http://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs)
Personal Data

Name of the Patient: Mr. X


Age: 40 years old
Gender: Male
Address: Nueva Ecija
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic
Birthday:
Date admitted: January 31, 2009 (2:35 pm)
Admitting Diagnosis: Paranoid Schizophrenia

History of Present Illness

Patient has previous admission at Mariveles Mental Hospital. He was discharged


from male ward on December, 2007. He had 1-2 consultations with Dra. Medina. His
parents cannot afford to bring him in Cabanatuan.
Upon discharge he resumed smoking and after few months he resumed alcohol
intake and he became suspicious and verbally assaultive when not giving cigarettes.
After few hours upon admission, he heard his female cousin and a neighbor
talking to each other and felt rejuvenated. He went down the house and with carrying an
ice pick. He stabbed at his cousin who sustained several abrasions in the forearm and she
got a scar on the head and on her right lower quadrant of abdomen. The neighbor placed
him in restraints and informed his father who was out in the farm.

History of Previous Illness

The patient was first admitted on October 4, 200 at Mariveles Mental Hospital
with chief complaints of poor appetite, cannot able to sleep and hears a female voice on
his ear. A year prior to admission, the patient used illegal drug such as shabu. After using
shabu, few months prior to admission he was engaged to abused substances like alcohol
and cigarettes. He started to become violent and shouts to his parents. Few hours upon
admission, he was saw laughing by him only, becomes aggressive and always shouting.
His father took him to MMH hence the reason for his admission.
His condition becomes better and he was discharged on August 19, 2001. But he
was then readmitted on November 15, 2002 for the reason of he took things from the
stores and insisted that it was his property. On the nest seven succeeding years, he was in
and out of MMH with an admitting diagnosis of Undifferentiated Schizophrenia. But
early this year, January 9, 2009, he was again readmitted with a new diagnosis of
Paranoid Schizophrenia.

Family Health and Psychiatric History


Chapter 2

MENTAL STATUS ASSESSMENT

A. General Appearance

Criteria Day 1 Day 2 Day 3 Day 4


Good grooming ☺
Appropriate facial expression ☺ ☺ ☺ ☺
Appropriate posture ☺ ☺ ☺ ☺
Maintains eye contact ☺ ☺

During nurse-patient interaction, the patient’s grooming was not good prior to
morning care but on the later part he improves and shows good grooming. Most of the
time, he exhibited appropriate facial expressions and posture during interactions. At first,
he cannot display eye contact which may show lack of focused and interest on the topic.
As days passes by student nurse established trust on the patient and he maintains good
eye contact.

B. Motor Behavior

Criteria Day 1 Day 2 Day 3 Day 4


Automatism ☺ ☺ ☺ ☺
Hyperkinesthesia
Waxy Flexibility
Cataplexy
Catalepsy
Stereotype
Compulsion
Psychomotor Retardation
Echopraxia
Catatonic Stupor
Catatonic excitement
Tics and spasms
Impulsiveness
Choreiform movements

Automatism is defined as repeated purposeless behaviors often indicative of


anxiety, such as drumming of fingers, twisting of locks of hair or tapping of foot. All
through out the 4 day nurse-patient interaction, the patient presented automatism. No
other motor behaviors were noted.
C. Sensorium and Cognitive

Criteria Day 1 Day 2 Day 3 Day 4


Orientation ☺ ☺ ☺ ☺
Time ☺ ☺ ☺ ☺
Place ☺ ☺ ☺ ☺
Person ☺ ☺ ☺ ☺
Concentration ☺ ☺ ☺ ☺
Memory ☺ ☺ ☺ ☺
Remote ☺ ☺ ☺ ☺
Recent ☺ ☺ ☺ ☺
Immediate retention ☺ ☺ ☺ ☺

Sensorium and cognities consist of the assessment of orientation, concentration,


and memory. Orientation refers to the client’s recognition of person, place and time. That
is, knowing who and where he or she is and the correct day, date and year. (Videbeck,
Psychiatric Mental Health Nursing). Memory is an organism's mental ability to store,
retain and recall information which is divided into recent and remote memory. Short-term
memory allows recall for a period of several seconds to a minute without rehearsal.
Long-term memory can store much larger quantities of information for potentially
unlimited duration (sometimes a whole life span).
During the 4 day nurse-patient interaction, patient’s orientation and memory are
stable. He can recall memories from the past and aware of the place, who is he, time, day,
and year. Based from the above definition of memory, he has an intact recollection of the
past events in his life.

D. Perception

Criteria Day 1 Day 2 Day 3 Day 4


Hallucination
Visual
Olfactory
Auditory
Tactile
Gustatory
Liliputian
Illusions
Delusions ☺ ☺ ☺ ☺

In the most recent Diagnostic and Statistical Manual of Mental Disorders, a


delusion is defined as a false belief based on incorrect inference about external reality
that is firmly sustained despite what almost everybody else believes and despite what
constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is
not one ordinarily accepted by other members of the person's culture or subculture.

From the 1st up to 4th day of nurse-patient interaction, the patient manifest
presence of delusions wherein he always claims that he was the husband of Sheryl
Cosim. Other perceptions were not noted.

E. Attitudes and Behavior

Criteria Day 1 Day 2 Day 3 Day 4


Cooperation ☺ ☺ ☺ ☺
Outgoing ☺ ☺ ☺ ☺
Withdrawn
Evasive
Sarcastic
Aggressive
Perplexed
Apprehensive ☺ ☺ ☺ ☺
Arrogant
Dramatic
Submissive
Fearful
Seductive
Uncooperative
Impatient
Resistant
Impulsive

Attitude is a position of the body or manner of carrying oneself. It is a position or


posture of the body appropriate to or expressive of an action, emotion
The patient exhibited cooperation in the whole duration of duty and able to
answers all questions asked to him and participates in all activities. It was also observed
that he was outgoing with other patient and student nurse. He also shows
apprehensiveness throughout the interaction.

F. Defense Mechanism

Criteria Day 1 Day 2 Day 3 Day 4


Denial ☺ ☺
Repression
Suppression
Rationalization ☺ ☺
Reaction Formation
Sublimation
Compensation
Projection
Displacement
Identification
Interjection
Conversion
Symbolization
Dissociation
Undoing
Regression
Substitution
Fantasy ☺ ☺ ☺ ☺

Defense mechanisms are psychological strategies brought into play by various


entities to cope with reality and to maintain self-image. Healthy persons normally use
different defenses throughout life. An ego defense mechanism becomes pathological only
when its persistent use leads to maladaptive behavior such that the physical and/or mental
health of the individual is adversely affected. The purpose of the Ego Defense
Mechanisms is to protect the mind/self/ego from anxiety, social sanctions or to provide a
refuge from a situation with which one cannot currently cope.
The patient manifests fantasy from day 1 to day 4 and shows also denial and
reaction formation on the later days of interaction.

G. Affective State

Criteria Day 1 Day 2 Day 3 Day 4


Euphoria
Flat affect ☺ ☺
Blunting
Elation
Exultation
Ecstasy
Anxiety
Fear
Ambivalence
Depersonalization
Irritability
Rage
Lability
Depression

Affect is a grouping of physic phenomena manifesting under the form of


emotions, feelings or passions, always followed by impressions of pleasure or pain,
satisfaction or discontentment , liking or disliking, joy or sorrow.
(/www.cerebromente.org).
Flat affect: A severe reduction in emotional expressiveness. People with
depression and schizophrenia often show flat affect. A person with schizophrenia may not
show the signs of normal emotion, perhaps may speak in a monotonous voice, have
diminished facial expressions, and appear extremely apathetic. (www.medterms.com)
The patient sometimes shows flat affect during the whole interaction.

H. Speech

Criteria Day 1 Day 2 Day 3 Day 4


Verbigeration
Rhyming
Punning
Mutism
Aphasia
Unusual rates of speech
Unusual Volume of speech
Unusual Intonation
Unusual Modulation

Speech refers to the processes associated with the production and perception of
sounds used in spoken language.
During the interaction, the patient does not show any alteration in his speech
pattern. He did not experience verbigeration, aphasia, other speech problems.

I. Thought Process and Content

Criteria Day 1 Day 2 Day 3 Day 4


Blocking
Flight of Ideas
Word Salad
Perserveration
Neologism
Circumstantiality
Echolalia
Condensation
Delusion ☺ ☺ ☺
Phobia
Obsession ☺ ☺ ☺ ☺
Hypochondriac

During the first part of our nurse-patient interaction, the patient shows delusion.
He also manifested obsession wherein he keeps on insisting that his wife is Sheryl Cosim
who is a famous news anchor.
Chapter 3

Psychopathology
Book-Based
Client-Based
Related Literature and Studies
What is Schizophrenia?

It is a mental illness which affects one person in every hundred. Schizophrenia


interferes with the mental functioning of a person and, in the long term, may cause
changes to a person's personality.

First onset is usually in adolescence or early adulthood. It can develop in older


people, but this is not nearly as common. Some people may experience only one or more
brief episodes in their lives. For others, it may remain a recurrent or life-long condition.

The onset of illness may be rapid, with acute symptoms developing over several
weeks, or it may be slow, developing over months or even years. During onset, the person
often withdraws from others, gets depressed and anxious and develops extreme fears or
obsessions.

Although an exact definition of schizophrenia still evades medical researchers, the


evidence indicates more and more strongly that schizophrenia is a severe disturbance of
the brain's functioning. In The Broken Brain: The Biological Revolution in Psychiatry,
Dr. Nancy Andreasen states "The current evidence concerning the causes of
schizophrenia is a mosaic. It is quite clear that multiple factors are involved.

These include changes in the chemistry of the brain, changes in the structure of
the brain, and genetic factors. Viral infections and head injuries may also play a
role....finally, schizophrenia is probably a group of related diseases, some of which are
caused by one factor and some by another." (p. 222).

There are billions of nerve cells in the brain. Each nerve cell has branches that
transmit and receive messages from other nerve cells. The branches release chemicals,
called neurotransmitters, which carry the messages from the end of one nerve branch to
the cell body of another. In the brain afflicted with schizophrenia, something goes wrong
in this communication system.

Sometimes schizophrenia has a rapid or sudden onset. Very dramatic changes in


behaviour occur over a few weeks or even a few days. Sudden onset usually leads fairly
quickly to an acute episode. Some people have very few such attacks in a lifetime; others
have more. Some people lead relatively normal lives between episodes. Others find that
they are very listless. depressed, and unable to function well.

In some, the illness may develop into what is known as chronic schizophrenia.
This is a severe, long-lasting disability characterized by social withdrawal, lack of
motivation, depression, and blunted feelings. In addition, moderate versions of acute
symptoms such as delusions and thought disorder may be present in the chronic disorder.

What are the symptoms of schizophrenia?

Major symptoms of schizophrenia include:

• Delusions - false beliefs of persecution, guilt or grandeur or being under outside


control. People with schizophrenia may describe plots against them or of think
they have special powers and gifts. Sometimes they withdraw from people or hide
to avoid imagined persecution.
• Hallucinations - most commonly involving hearing voices. Other less common
experiences can include seeing, feeling, tasting or smelling things which to the
person are real but which are not actually there.
• Thought disorder - where the speech may be difficult to follow; for example,
jumping from one subject to another with no logical connection. Thoughts and
speech may be jumbled and disjointed. The person may think someone is
interfering with their mind.

Other symptoms of schizophrenia include:

• Loss of drive - where often the ability to engage in everyday activities such as
washing and cooking is lost. This lack of drive, initiative or motivation is part of
the illness and is not laziness.
• Blunted expression of emotions -where the ability to express emotion is greatly
reduced and is often accompanied by a lack of response or an inappropriate
response to external events such as happy or sad occasions.
• Social withdrawal - this may be caused by a number of factors including the fear
that someone is going to harm them, or a fear of interacting with others because of
a loss of social skills.
• Lack of insight or awareness of other conditions - because some experiences such
as delusions and hallucinations are so real, it is common for people with
schizophrenia to be unaware they are ill. For this and other reasons, such as
medication side-effects, they may refuse to accept treatment which could be
essential for their well-being.
• Thinking difficulties - a person's concentration, memory, and ability to plan and
organise may be affected, making it more difficult to reason, communicate, and
complete daily tasks.

What causes schizophrenia?

No single cause has been identified, but several factors are believed to contribute to the
onset of schizophrenia in some people:

Genetic factors

A predisposition to schizophrenia can run in families. In the general population, only 1


per cent of people develop it over their lifetime. If one parent suffers from schizophrenia,
the children have a 10 per cent chance of developing the condition - and a 90 per cent
chance of not developing it.

Biochemical factors

Certain biochemical substances in the brain are believed to be involved in this condition,
especially a neurotransmitter called dopamine. One likely cause of this chemical
imbalance is the person's genetic predisposition to the illness.

Family relationships
No evidence has been found to support the suggestion that family relationships cause the
illness. However, some people with schizophrenia are sensitive to any family tension
which, for them, may be associated with relapses.

Environment

It is well recognised that stressful incidents often precede the onset of schizophrenia.
They often act as precipitating events in vulnerable people. People with schizophrenia
often become anxious, irritable and unable to concentrate before any acute symptoms are
evident. This can cause relationships to deteriorate, possibly leading to divorce or
unemployment. Often these factors are then blamed for the onset of the illness when, in
fact, the illness itself has caused the crisis. It is not, therefore, always clear whether stress
is a cause or a result of illness.

Drug use

The use of some drugs, especially cannabis and LSD, is likely to cause a relapse in
schizophrenia.

Source: www.mental-health-matters.com

Paranoid Schizophrenia

People with paranoid schizophrenia, the most common form of the disorder,
mainly experience hallucinations. They tend to believe that others are poisoning,
harassing, or plotting against them. They may also hear voices, which order them to do
things. Contrary to popular belief, people suffering from this type of schizophrenia are
actually not prone to violence; in fact, they generally prefer to be left alone.

Common Symptoms of Paranoid Schizophrenia

For people with paranoid schizophrenia, the primary symptoms are delusions or
auditory hallucinations. People with paranoid schizophrenia usually do not have thought
disorder, disorganized behavior, or affective flattening.
People with paranoid schizophrenia have grandiose delusions. For example, they may
believe that others are deliberately:

• Cheating them
• Harassing them
• Poisoning them
• Spying on them
• Plotting against them or the people they care about.

Auditory hallucinations can include hearing "voices" that may:

• Comment on the person's behavior


• Order him or her to do things
• Warn of impending danger
• Talk to each other (usually about the affected person).

Paranoid Schizophrenia and Violence

People with paranoid schizophrenia are not especially prone to violence and often
prefer to be left alone. Studies show that if people have no record of criminal violence
before they develop schizophrenia and are not substance abusers, they are unlikely to
commit crimes after they become ill. Most violent crimes are not committed by people
with paranoid schizophrenia, and most people with schizophrenia do not commit violent
crimes. Substance abuse almost always increases violent behavior, whether or not the
person has schizophrenia.

If someone with paranoid schizophrenia becomes violent, their violence is most


often directed at family members and takes place at home.

Source: http://schizophrenia.emedtv.com
Drug Study

Name of Date ordered/ Route/ General Indication Client’s


drug Date started/ Dosage/ action/mechanism of / response to
Date changed Frequency of action Purpose medicine with
administration actual s/e
Generic Date Ordered: Route of Chemical Effect: For Administratio
Name: January 31 2009 Administration: May act by patients n of the drug
Date Started: Per Orem facilitating with acute was not
Clonazepam January 31 2009 effects of manic actually
Dosage and inhibitory episodes, observed
Date Ended: Frequency: neurotransmitter panic
--------------------- 2mg HS GABA. disorders,
- Therapeutic or
Effect: seizures.
Prevents or
stops seizure
activity.

NURSING RESPONSIBILITIES:

BEFORE:
• Explain the importance and action of the drugs.
• Tell the possible reaction or side effects of the drugs.
• Monitor patient for any adverse reaction.
DURING:
• The client may sip small amount of water
• Stay with the client for at least 15-30 minutes after giving the drug
• Be alert for adverse reaction and drug interaction
Name of Date ordered/ Route/ General Indication Client’s
drug Date started/ Dosage/ action/mechanis / response to
Date changed Frequency of m of action Purpose medicine with
administration actual s/e
Generic Date Ordered: Route of Chemical Effect: This is Administratio
Name: January 31, 2009 Administration May block given to n of the drug
Date Started: : postsynaptic the patient was not
Haloperido January 31, 2009 Per Orem dopamine with actually
l receptors in brain. chronically observed
Date Ended: Dosage and Therapeutic psychotic
-------------------- Frequency: Effect: disorder
- 5mg tab tid Decreases who needs
psychotic prolonged
behaviors. therapy.

NURSING RESPONSIBILITIES:

BEFORE:
• Explain the importance and action of the drugs.
• Tell the possible reaction or side effects of the drugs.
• Monitor patient for any adverse reaction.
DURING:
• Stay with the client for at least 15-30 minutes after giving the drug
• Monitor patient for tardive dyskinesia, which may not appear until months or
years later and may disappear spontaneously or persists for life despite stopping
use of drug.
CHAPTER 5

PSYCHOTHERAPIES IMPLEMENTED

Psychotherapy- treatment of mental disorders and behavioral disturbances using verbal


and nonverbal communication, as opposed to agents such as drugs or electric shock, to
alter maladaptive patterns of coping, relieve emotional disturbance, and encourage
personality growth. Also called psychotherapeutics.

Individual Psychotherapy- Through one-on-one conversations, this approach focuses on


the patient's current life and relationships within the family, social, and work.

Group Psychotherapy- Group psychotherapy is a special form of therapy in which a


small number of people meet together under the guidance of a professionally trained
therapist to help themselves and one another. Group therapy helps people learn about
themselves and improve their interpersonal relationships. It addresses feelings of
isolation, depression or anxiety. And it helps people make significant changes so they feel
better about the quality of their lives.

REMOTIVATION THERAPY

Definition: A simple group therapy which aims to bridge the fantasy- world of the
Psychotics to the real world. Is a technique of simple group therapy, objective in nature,
used with a group of patients in an effort to reach the “unwounded” areas of each
patient’s personality & to get them back into reality.

Title of the poem: Ang Bulaklak


The short poem describes the importance of flower in our nature.

Goals:
 To stimulate patients to be fellow explore the real world.
 To develop their ability to communicated and share ideas and experiences with
the other people.
 To develop feelings of acceptance.
 To promote group harmony and identification.

Role of the nurse:

 To be a facilitator in the activity


 To encourage clients feeling about the topic
 To present the reality to the client about the poem.

NEWSPAPER THERAPY

Definition: Newspaper therapy is giving information to the clients about events and what
is happening outside
Newspaper therapy is cutting clippings from newspaper and sharing this information to
the clients and knowing their feelings and ideas about the information given. Providing
basic information about places/events may motivate the clients to follow the medical
regimen to be well. The facilitator let the clients to read the topic, then ask them
questions.

Title of the cut news: Boxing


The news was all about boxing competition held in Araneta Coliseum & who won
for that competition.

Goals:
 To give information to the clients on what is happening outside and to give latest
news today.
 To encouraged emotions and reactions about the news
Role of the Nurse:

 To introduce topics that will encourage clients participation/cooperation


 To assess level of intelligence of the clients
 To encourage the clients to express/verbalize feelings/ideas regarding to the topic

PLAY THERAPY

Definition: A form of psychotherapy used to help them express or act out their
experiences, feelings, and problems by playing with dolls, toys, and other play material.

Name of the Play: Ball catching

Procedure:
The clients are instructed to catch the ball with their respective partners.

Goals:
 To establish rapport since it is the first recreational activity of the client
 To encourage release/ express clients emotions
 To let the client learn on how to cooperate
 To let the client play freely and actively

Role of the Nurse:


 To be the facilitator of the game
 To let and encourage the clients to participate on the play

DANCE THERAPY
Definition Dance is the most fundamental of the arts, involving direct expression through
the body. Dance /movement therapy effects changes in feelings, cognition, physical
functioning, and behavior.

Title of the dance song: Cha-Cha-Cha


Facilitators are in the front, dancing different steps, in able for the client to follow
easily the facilitators.

Goals:

 To encourage release/ express clients emotions


 To let the client learn on how to dance in simple steps
 To let the client dance freely and actively

Role of the Nurse:

 To be the facilitator of the game


 To let and encourage the clients to participate on the dance

SONG THERAPY

Definition: A kind of recreational therapy under the music category, which connects us
with our creativity, innate wisdom and our vast inner resources for growth and well-
being. It has a soothing and pleasing effect and provides for emotion and release.

Title of the song: Tag-ulan

Procedure:

 Using the visual aids that has the written lyrics, the patients read it first.
 The nurse sings the song with the use of guitars.
 Nurses, together with the patients, sing the song.
 Lastly, let the patients sing to the tune of guitars.

Goals:
 Develop patient’s ability to read and reflect.
 Develop patient’s listening skill.
 To encourage them to participate and cooperate.
 Patients will learn to express emotions and feelings.

Role of the Nurse:

 Explain the procedure to the patients.


 To be a good facilitator.
 To be an active participant too.
 To promote trust.

ART THERAPY

Definition: is the use of art materials for self-expression and reflection.


Name: House-Tree-Person
Procedure:
 Patients are provided with crayons and 3 pieces of paper as drawing
materials.
 They are then asked to draw a house, afterwards a tree, and lastly, a person
on each of the papers with the use of crayons.
 Series of questions constitute the post drawing interrogations.
 During post drawing phase, paients are given opportunity to define,
describe, and interpret the objects drawn.
Goals:
 To obtain data concerning patient’s progress.
 To aid in the establishment of rapport between the nurse and the patient.
 Help the patients gain insight through interpretations.
 Measure patient’s self perception and attitudes.

Role of Nurses:
 Explain the procedure of the activity.
 Provide the means of the therapy (crayons, papers).
 Interrogate patients during post drawing phase.
 Assessing and interpreting answers based on Buck’s HTP interpretation.
 Develop a deeper nurse-patient relationship through building of trust.

OCCUPATIONAL THERAPY

Definition: Any activity, mental or physical, prescribed and guided to aid an individual’s
recovery from diseases or injury. This activity excludes competition and pressure. There
is opportunity for creativeness and produce something tangible out of patient’s own
thinking and imagination. Self confidence and personal achievements are also
experienced.

Title: Designing Picture Frame

Procedure: Designing Picture Frame


Nurses play a great role in making this therapy successful.

 Nurses give picture frame.


 Different shapes of cut cartolina & different styles of stickers are also
given along with the glue.
 Patients are asked to design their picture frame wherever they like.
Goals:
 Expose patients’ hidden abilities in designing and pasting.
 Increase patients’ self confidence.
 Assess patients’ motor and intellectual functioning.

Role of Nurses:
 To select the most useful activity.
 To facilitate the activity successfully.
 To assist the patients.
 To promote positive personality growth
BIBLIOGRAPHY

Videbeck, Psychiatric Mental Health Nursing, Third Edition

Shives, Isaacs, Basic Concepts of Psychiatric-Mental Health Nursing

Rebraca et. al., Psychiatric Mental Health Nursing, 5th Edition

Nurses Dictionary, Second Edition

7th Edition Nursing Diagnosis Handbook: A Guide to Planning Care by Betty J Auckley and Gail
B. Ladwig

http://www.answers.com/topic/psychosis

http://www.emedicine.com/med/byname/brief-psychotic-disorder.htm

http://www.hawaii.edu/hivandaids/Philippines_Mental_Health_Country_Profile.pdf

http://en.wikipedia.org/wiki/Psychotic_disorder