schizophrenia case study for nursing students

Quality and Safety Education for Nurses

Strategy submission, schizophrenia unfolding case study.

Amanda Eymard, Co-Author: Linda Manfrin-Ledet

Associate Professor

Institution:

Nicholls State University College of Nursing and Allied Health

[email protected]

Competency Categories:

Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s):

Pre-Licensure BSN

Learner Setting(s):

Strategy Type:

Independent Study

Learning Objectives:

Strategy Overview:

Submitted Materials:

Schizophrenia-Unfolding-Case-Study_2.ppt - https://drive.google.com/open?id=1-xNAUmNfVJmD3Zwv7nZ44oXcYhd53i0i&usp=drive_copy

Atypical-Antipsychotics-and-Metabolic-article.pdf - https://drive.google.com/open?id=1tshbJ4ljXk9TdySiRsw2xlqb-O3Tx5Oo&usp=drive_copy

Emyard-246-TS-final-approved.pdf - https://drive.google.com/open?id=1dHs32ZW2Jo_mRRNrZ-dFVgDosO1Ua6fu&usp=drive_copy

Additional Materials:

Evaluation Description:

Schizophrenia

Schizophrenia is a severe mental illness characterized by disruptions in thinking, perception, emotions, and social interactions. The disorder often emerges in late adolescence or early adulthood and can lead to significant impairments in a person’s ability to function in various aspects of life.

This nursing guide aims to provide a concise overview of schizophrenia, its symptoms, its different types, treatment, and nursing management.

Table of Contents

• What is Schizophrenia? 

Positive Symptoms

Negative symptoms.

• Cognitive Symptoms

Prodromal Phase

Active phase, residual phase, disorganized, undifferentiated, medical management, nursing assessment, nursing diagnoses, nursing care planning and goals, nursing interventions, documentation guidelines, external links & further reading, what is schizophrenia.

Despite it being one of the most common psychiatric disorders, schizophrenia is usually misunderstood. Here is how it is described and defined:

• Schizophrenia refers to a group of severe, disabling psychiatric disorders marked by withdrawal from reality, illogical thinking, possible delusions and hallucinations , and emotional, behavioral, or intellectual disturbance.
• These disturbances last for at least six (6) months. The level of functioning in work, interpersonal relationships , and self-care is markedly below the level since the onset of symptoms.
• Have difficulty distinguishing reality from fantasy . Their speech and behavior may frighten or mystify those around them.

Schizophrenia occurs in all societies without regard to class, color, and culture.

• It affects 1.1% of the population above age 18 , which is estimated to be 51 million people worldwide.
• In the United States alone, 2 million Americans each year are affected, with 7.2 in 1000 persons developing it during their lifetime.
• Affects both men (late teens or early 20s) and women (mid-20s to early 30s) equally
• Prevalence is higher than diabetes mellitus , Alzheimer’s disease, and multiple sclerosis .

Like many diseases, schizophrenia is linked to various factors.

• The precise cause is  unknown.
• There is currently no way to predict who will develop the disease.
• Genetic factors. It is believed that multiple genes (strongest evidence points to chromosomes 13 and 6) are involved in predisposition to schizophrenia. Other factors like prenatal infections, perinatal complications, and environmental stressors are also being studied. The manner of transmission of genetic predisposition is not clearly understood.
• Biochemical factors. Involves dopamine (the focus of most studies), serotonin , norepinephrine , and epinephrine . Excessive dopamine activity is linked to hallucinations, agitation, and delusion. High norepinephrine is linked to positive symptoms of schizophrenia.
• Other factors include structural brain abnormalities (e.g. enlarged ventricles), developmental (e.g. faulty neuronal connections), and other possible causes (e.g. maternal influenza during the second trimester of pregnancy, epilepsy of the temporal lobe, head injury , etc.)

Signs and Symptoms

Behaviors and functional deficiencies seen in schizophrenia vary widely among patients.

• Signs and symptoms are divided into three clusters: positive, negative, and cognitive symptoms.
• Positive symptoms are associated with temporal lobe abnormalities.
• Negative symptoms are associated with frontal cortex and ventricular abnormalities.
• Deviant symptoms. These are symptoms that are present but should be absent . They indicate that the patient has lost touch with reality.
• Primarily include delusions and hallucinations.
• Hallucinations are the most common feature of schizophrenia. These involve hearing , seeing, smelling, tasting, and feeling touched by things in the absence of stimuli. An example is hearing voices that command the patient to do certain things, usually abusive and self-destructive.
• Persecutory delusions. Patient thinks he is being tormented, followed, tricked, or spied on.
• Reference delusions. Patient thinks that passages in books, music, TV shows, and other sources are directed at him.
• Delusions of thought withdrawal/thought insertion . Patient believes others can read his mind, his thoughts are being transmitted to others, or outside forces are imposing their thoughts or impulses on him.
• Deficit symptoms. These symptoms reflect the absence of normal characteristics.
• Apathy is a lack of interest in people, things, and activities.
• Anhedonia is a diminished capacity to feel pleasure.
• Blunted affect is characterized by the patient’s face appearing immobile and inexpressive; this is the flattening of emotions and becomes more pronounced as the disease progresses.
• Poverty of speech is a speech that is brief and lacks content.

Cognitive Symptoms

• Reflect on the patient’s abnormal thinking, poor decision-making skills, poor problem-solving skills, ability to communicate, and strange behavior.
• Thought disorder is characterized by confused thinking and speech (e.g., incoherent ramblings, loose association, word salad, wandering).
• Bizarre behavior includes childlike silliness, laughing or giggling, agitation, inappropriate appearance, hygiene, and conduct.

Phases of Schizophrenia

Schizophrenia usually progresses through three distinct phases:

• Occurs before hospitalization or within the year.
• Characterized by a clear decline from his previous level of functioning.
• May withdraw from friends and families and hobbies and interests, exhibit peculiar behavior, and deterioration in work and school performance.
• Commonly triggered by a stressful event
• Characterized by the presence of acute psychotic symptoms (e.g. hallucinations, delusions, incoherence, and catatonic behaviors).
• Prognosis worsens with each acute episode.
• This is at this point in which the illness pattern is established, the disability level may be stabilized, and late improvements may occur.

Types of Schizophrenia

Schizophrenia is classified into five subtypes:

• Characterized by persecutory or grandiose delusional thought content and delusional jealousy.
• Stress may worsen patient symptoms.
• Experience frequent auditory hallucinations but lack symptoms of other subtypes like incoherence, loose associations, and affect problems.
• Tend to be less severely disabled than other schizophrenics and are more responsive to treatments.
• Marked by incoherent, disorganized speech and behaviors, and blunted or inappropriate affect.
• Usually includes extreme social impairment.
• Starts early and insidiously, with no significant remissions.

“Knowing that you’re crazy doesn’t make the crazy things stop happening.” –Mark Vonnegut, The Eden Express: A Memoir of Insanity

• A rare disease form characterized by fixed stupor or positions for long periods and periodically yielding to brief spurts of extreme excitement.
• Increased potential for destructive, violent behaviors when agitated.
• They remain mute and have refusal to move about or tend to personal needs.
• Presence of schizophrenic symptoms such as delusions and hallucinations in patients who does not fall to the category of the other subtypes.
• Muted form of the disease that stops short of recovery.
• No prominent psychotic symptoms.
• Has history of acute schizophrenic episodes and persistence of negative symptoms.

The basis for diagnosing schizophrenia is formed by mental status examination, psychiatry history , and careful clinical observation .

• Diagnostic test results. No definitive diagnostic tool for schizophrenia but certain tests like CT scans and MRIs may be ordered to rule out disorders that can cause psychosis (e.g. vitamin deficiencies and enlarged ventricles).
• Ventricular-brain ratio may find elevated VBR in schizophrenic patients. Brain scans reveal functional cerebral asymmetries in a reverse pattern.

Here’s how schizophrenia is medically managed:

• These prevent relapse of acute symptoms.
• Psychotic symptoms must be present 12 to 24 months before patients receive their first medical treatment.
• Examples of these drugs include the typical or conventional typical antipsychotic chlorpromazine (Thorazine) and the atypical
• Electroconvulsive Therapy. Rarely used but is for patients with acute schizophrenia and those who can’t tolerate or don’t respond to medication. It is effective in reducing depressive and catatonic symptoms of schizophrenia.
• Other treatments include compliance promotion programs, psychosocial treatment and rehabilitation, vocational counseling, supportive psychotherapy, and appropriate use of community resources.

Nursing Management

Here are the nursing responsibilities for taking care of patients with schizophrenia:

• Recognize schizophrenia. Note characteristic signs and symptoms of schizophrenia (e.g., speech abnormalities, thought distortions, poor social interactions).
• Establish trust and rapport. Don’t tease or joke with patients. Expect that patient is going to put you through rigorous testing periods. Introduce yourself and explain your purpose.
• Maximize level of functioning. Assess the patient’s ability to carry out activities of daily living (ADLs).
• Assess positive symptoms.  Assess for command hallucinations; explore answers. Assess if the client has a fragmented, poorly organized, well-organized, systematized, or extensive system of beliefs that are not supported by reality. Assess for pervasive suspiciousness about everyone and their actions (e.g., vigilant, blames others for consequences of own behavior, argumentative, threatening).
• Assess negative symptoms.  Assess for the negative symptoms of schizophrenia (as mentioned above).
• Assess medical history .  Assess if the client is on medications, what these are, and adherence to therapy.
• Assess support system.  Determine whether the family is well informed about the disease. Does the family understand the need for medication adherence?
• Impaired Physical Mobility related to depressive mood state and reluctance to initiate movement .
• Impaired Social Interaction related to problems in thought patterns and speech.
• Decreased Cardiac Output related to orthostatic hypotensive drug effects.
• Risk for Suicide related to impulsiveness and marked changes in behavior.
• Risk for Injury related to hallucinations and delusions.
• Risk for Imbalanced Nutrition: less than body requirements related to self- neglect and refusal for self-care.

Main Article: 6 Schizophrenia Nursing Care Plans

• Reduce severity of psychotic symptoms
• Prevent recurrence of acute episodes
• Meet patient’s’ physical and psychosocial needs
• Help patient gain optimum level of functioning
• Increase client’s compliance to treatment and nursing plan
• Establish trust and rapport. Don’t touch client without telling him first what you are going to do. Use an accepting, consistent approach; short, repeated contacts are best until trust has been established. Language should be clear and unambiguous. Maintain a sense of hope for possible improvement, and convey this to the patient.
• Maximize level of functioning. Avoid promoting dependence by doing only what the patient can’t do for himself. Reward positive behavior and work with him to increase his personal sense of responsibility in improving functioning.
• Promote social skills. Provide support in assisting him to learn social skills.
• Ensure safety. Maintain a safe environment with minimal stimulation.
• Ensure adequate nutrition .  Monitor patient’s nutritional status and if the patient thinks his food is poisoned, let him fix his own food if possible or offer him foods in closed containers that he can open. Institute suicide and/or homicide precautions as appropriate.
• Keep it real. Engage patient in reality-oriented activities that involve human contact (e.g., workshops, inpatient social skills training). Clarify private language, autistic inventions, or neologisms.
• Deal with hallucinations by presenting reality. Explore the content of hallucinations. Avoid arguing about the hallucinations. Tell them you do not see, hear, smell, or feel it but explain that you know that these hallucinations are real to him.
• Promote compliance and monitor drug therapy. Administer prescribed drugs and encourage the patient to comply. Ensure that patient is really taking the drug. Observe for manifestations that warrant hypersensitivity reactions and toxicity.
• Encourage family involvement. Involve family in patient treatment and teach members to recognize impending relapse (e.g. nervousness, insomnia , decreased ability to concentrate). Suggest ways how families can manage symptoms.
• Evaluate effectiveness of drug therapy (absence of acute episodes and psychotic symptoms).
• Evaluate compliance to health instructions (taking medications on time, showing independence in activities, involvement of family).
• Level of patient’s functioning (ability to engage in social interactions).
• Patient’s mental status (oriented to reality).

The following are to be documented in the patient’s chart:

• Document the assessed presenting signs and symptoms (e.g., positive and negative signs).
• In instituting suicide precaution, document behavior and your precautions.
• In instituting homicide precaution, document patient’s comment and who was notified. Be sure to notify the doctor and the potential victim.
• In using restraints, document time of application and release.
• Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
• Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
• Straight A’s in Psychiatric & Mental Health Nursing: A Review Series
• Schizophrenia – National Institute of Mental Health – provides up to date information about Schizophrenia.
• Psychiatric Mental Health Nursing Success: A Q&A Review Applying Critical Thinking to Test Taking (Davis’s Success)  – great if you’re reviewing for the NCLEX .

5 thoughts on “Schizophrenia”

Its a great honour to have such information.. Thank you fr it all

Amazing! felt interested to study

This was very helpful, thank you

It very useful and amazing piece.Thanks

Need more info on Schizophrenia nursing care plan at workplace

Leave a Comment Cancel reply

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Int J Environ Res Public Health

Perspectives of Nursing Students towards Schizophrenia Stigma: A Qualitative Study Protocol

1 School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China

Jingjing Su

2 World Health Organization Collaborating Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China

Daniel Thomas Bressington

3 College of Nursing & Midwifery, Charles Darwin University, Casuarina, NT 0810, Australia

Sau Fong Leung

Associated data.

This statement can be excluded as the study did not report any data.

Aim: This study aims to explore fourth-year nursing students’ knowledge of schizophrenia and their attitudes, empathy, and intentional behaviours towards people with schizophrenia. Design: This will be a descriptive qualitative study using focus-group interviews. Methods: Fourth-year nursing students on clinical placement in a hospital in Hunan province will be invited for focus-group interviews. Snowball and purposive sampling will be used to recruit nursing students for this study. Five focus-group interviews, each including six participants, will be conducted to explore participants’ knowledge, attitudes, intentional behaviours, and empathy towards schizophrenia. The interview will be conducted through the online Tencent video conference platform and the interview data will be collected through the same platform. All interviews will be recorded and transcribed verbatim and analysed with the approach of the content analysis supported by NVivo 12. Simultaneous data collection and analysis will be performed, and the interviews will be continued until data saturation is met. The findings of this study will be helpful in developing effective interventions to decrease the stigma toward schizophrenia among nursing students and those who study healthcare disciplines.

1. Introduction

Mental illness is a highly frequent disorder in which an individual’s cognition, emotion regulation, or behaviour is clinically significantly disturbed [ 1 ]. Mental illness stigma is defined as social stereotyping of, or discrimination against, people with mental illness [ 2 ]. A study involving 16 countries showed that the public had a high level of stigma towards people with mental illness [ 3 ]. Mental illness-related stigma is extremely damaging to people with mental illness, their families, and the health care system [ 4 , 5 ], and those with severe mental illness often face severe stigma [ 6 ]. Typical severe mental illnesses include schizophrenia, bipolar disorder, and major depression [ 7 ], of which schizophrenia is the most stigmatized mental illness [ 8 , 9 , 10 ].

Schizophrenia results in individuals’ significant impairments in perceiving reality and changes all aspects of their lives; it affects approximately 24 million people globally [ 11 ]. In China, an epidemiological study reported that the lifetime prevalence of schizophrenia among Chinese people was 0.6% between 2013 and 2015 [ 12 ]. A recent study reported that the age-standardized incidence rate of schizophrenia in China was 18.47/100,000 in 2019 [ 13 ]. The incidence rate implies that almost 8.46 million people in China had schizophrenia [ 14 ]. However, a huge number of people with schizophrenia were undetected by the healthcare system, as only 0.29 million (95% UI = 0.26 to 0.33 million) newly diagnosed schizophrenia cases were reported in 2017 in China [ 15 ]. Stigma is the main barrier to health-seeking behaviours, and the exploration of schizophrenia stigma is urgent.

People with schizophrenia face stigma in different aspects of their daily lives, such as in employment [ 16 , 17 ], friendships [ 18 ], romantic relationships [ 16 , 18 ], rehabilitation [ 19 , 20 ], social integration [ 20 ], and receiving medical treatment [ 21 ], which affects their life quality [ 10 , 22 , 23 ] and reduces their willingness to confide in others or ask for help [ 16 , 24 , 25 , 26 , 27 ]. Such stigmatisation can make them lose their self-esteem and ignore their own symptoms [ 24 , 28 , 29 ]. The loss of social status and familial respect caused by stigma [ 16 ] can even lead to suicide [ 30 ]. Meanwhile, stigmatising views held by health professionals can decrease their willingness to work in psychiatric departments [ 31 , 32 ], leading to a shortage of doctors and nurses [ 33 ].

Nurses constitute the largest occupational group in the healthcare sector globally [ 7 ]. Some nursing students in Mainland China also hold negative attitudes towards people with mental illness [ 34 , 35 , 36 ]. Compared with their USA peers, they were found to have poor knowledge of schizophrenia [ 37 ]. Nurses play a major role in the rehabilitation and treatment of people with schizophrenia [ 38 ]. Thus, exploring the perspectives towards people with schizophrenia among nursing students, as future nurses, will be invaluable in designing anti-stigma interventions for these students and ultimately improving the conditions of people with schizophrenia. Many quantitative studies have investigated nursing students’ knowledge of mental illness and/or their stigmatised attitudes and/or intentional behaviours towards people with mental illness [ 39 , 40 , 41 , 42 , 43 ]. Mental illness stigma is influenced by multiple factors [ 44 ], especially cultural factors [ 45 ]. But little quantitative research considers the cultural factors of stigma. Previous quantitative research often used some form of scale to assess the attitudes and intentional behaviours of nursing students’ stigma towards schizophrenia [ 46 ]. To develop specific and targeted interventions in decreasing nursing students’ stigma towards schizophrenia, it is necessary to understand their real perspectives. However, our knowledge of this area is lacking. Hence, a qualitative study will be more suitable for such an investigation. A qualitative descriptive research study generates data of three dimensions—who, what, and where—of events or experiences from a subjective perspective [ 47 ]. Philosophically, reality exists within a certain context, which is continuously changing and is perceived differently by different subjects. Thus, reality is characteristic of diversity and subjectivity, and it is highly recommended that the approach of constructionism and critical theories that use interpretative and naturalistic methods should be adopted in this research [ 48 ]. This study aims to obtain straightforward descriptions of nursing students’ experiences and perceptions towards schizophrenia. The qualitative descriptive approach is frequently used to provide straightforward descriptions of experiences and perceptions within a unique context [ 49 ]. In this type of research, the research process is inductive and dynamic, and the data collected from this phenomenon will not be over-transformed [ 49 , 50 ]. The advantages of the qualitative descriptive approach are both the questions’ subjective nature and participants’ diverse experiences, which can be recognized. Moreover, the outcomes will be reported straightforwardly, or in a way using similar terminology to the initial research question [ 51 ].

Some qualitative studies have explored the knowledge, attitudes, and behaviours of health professional students [ 52 , 53 ], nursing students [ 54 , 55 ], and medical students [ 56 ] towards mental illness. There is a lack of qualitative research focusing on schizophrenia stigma, even though schizophrenia is the most stigmatized mental illness [ 8 , 9 , 10 ], and the relationship between culture and stigma is given little attention in qualitative studies. Thus, further studies could be centred around nursing students’ perceptions of schizophrenia stigma. Unlike Western countries, China is a developing country with a culture of face-saving that is deeply influenced by Confucianism, Taoism, and Buddhism [ 57 , 58 ].

In view of the relationship between culture and the stigma, the development of anti-stigma interventions should be tailored to the Chinese culture. The findings of such a qualitative study may help to develop Chinese culture-specific interventions to decrease schizophrenia-related stigma among nursing students, as well as students of other healthcare disciplines and health professionals in China.

2. Theoretical Framework

In 2006, Thornicroft put forward the idea that three domains have constructed the problem of stigma: “knowledge, leading to ignorance; attitudes, leading to prejudice; and behaviour, leading to discrimination” [ 59 ]. Although stigma has been conceptualized differently, attitudes and behaviours are two core elements in most conceptualizations [ 60 ]. Stigma can be recognized as a negative attitude towards people with mental illness, and public stigma consists of three base components: stereotypes, prejudice, and discrimination [ 61 , 62 ]. Empathy is recognized as how an individual perceives other people’s thinking and feeling, and figures out what makes someone give a response to other people’s suffering with sensitivity and care [ 63 ]. According to a meta-analysis report, empathy is a mediator of the relationship between intergroup contact and reduced prejudice [ 64 ]. A study reported that empathy is inversely related to stigma and can be used to predict stigma [ 65 ]. Some studies also reported that improving empathy could decrease negative attitudes towards people with mental illness or other specific populations, and function as a potential protective factor that can reduce stigma [ 65 , 66 , 67 ]. In different cultures, people have different understandings of stigma, treat it in different ways, and yield different results [ 68 ]. Culture and beliefs will affect people’s views towards mental illness [ 69 ]. “Notions of stigma are bound by culture” ([ 70 ] p. 1). Studies have shown that sociocultural and religious factors strongly influence stigmatising attitudes [ 71 , 72 , 73 , 74 , 75 ]. It is difficult to measure peoples’ real behaviours towards schizophrenia [ 76 ]. Thus, intentional behaviours will be measured instead. It is envisaged that understanding how nursing students’ knowledge, attitudes, intentional behaviours, empathy, and the cultural influence on them affect their perspectives of schizophrenia and support the future development of interventions to decrease schizophrenia-related stigma among nursing students.

This study will explore fourth-year nursing students’ knowledge of schizophrenia and their attitudes, empathy, and intentional behaviours towards people with schizophrenia.

4. Methods and Analysis

4.1. study design and setting.

This qualitative study will adopt a descriptive design focusing on fourth-year nursing students’ knowledge of schizophrenia and their attitudes, empathy, and intentional behaviours towards people with schizophrenia. The study will be conducted at a tertiary first-class hospital in mainland China that provides clinical training for more than 250 fourth-year nursing students from across the country each year. Data collection will be conducted through focus-group interviews based on an online interview platform (Tencent meeting, a very popular online interview platform in China).

It is recognized that focus-group interviews can help generate deeper and richer data in many scenarios, as they involve group interactions [ 77 ]. These data can help to construct the key components of the intervention [ 78 ]. Through focus-group interviews, data from the researcher and each participant can be collected, and new questions and answers can be generated through interactive verbal communication among the group members. Researchers can thus know their participants’ needs and feelings and explore the influence of cultural values and beliefs on them [ 79 ]. The consolidated criteria for reporting qualitative research [ 80 ] will be used to guide the reporting of the focus-group interviews and the writing of the qualitative protocol.

As mentioned above, it is widely recognized that cultural values influence the stigma surrounding mental illness. Focus groups involving in-depth interviews of a particular population group on a certain topic can be used to develop or modify relevant intervention protocols [ 77 ]. Thus, we chose focus-group interviews to collect the data from 25 July 2022 to 30 September 2022. Apart from the focus-group interviews, individual interviews will also be offered to any participant who does not feel comfortable discussing the sensitive topic of stigma in a group setting.

4.2. Participants, and Recruitment

All the participants of this study will be fourth-year nursing students. WeChat or emails will be used for recruitment purposes. The principal investigator will be responsible for recruiting eligible participants and collecting their written informed consent. The inclusion and exclusion criteria are as follows:

Inclusion Criteria:

Nursing students who (1) are on clinical placement at the hospital involved in this study; (2) are 18 years old or above; (3) can communicate in Mandarin; and (4) agree to participate in this study.

Exclusion Criteria:

Nursing students who (1) have no access to a computer, a smartphone, or any electronic device for joining the online interview.

4.3. Sampling

“In focus-group research, the strategy is to use purposeful sampling whereby the researcher selects participants based on the purpose of the study [ 79 ] p. 452.” To gain rich information and to achieve maximum variation sampling from the participant, we will enrol fourth-year nursing students who satisfy the criteria and, if possible: (1) have contact experience with people with schizophrenia or mental illness, (2) are of male gender (most nursing students are female; thus, we want to enrol some male nursing students), (3) come from different provinces (it would be best to include some from ethnic minority groups), and (4) are very interested in studying mental health and willing to discuss their perspectives on our research topic. However, due to the COVID-19 pandemic and without contact information for the potential participants, it will be challenging and difficult to recruit a purposeful sample. Thus, the initial participant recruitment will adopt the snowball sampling method. Interested nursing students will be recruited through the affiliation of the principal investigator with a nursing college which can promote the study.

If possible, we will also ask the participants to help us recruit their peers who can meet the inclusion criteria of the aforementioned purposeful sampling.

4.4. Sample Size

A sample size of 4–12 participants is recommended for focus-group interviews. However, as it will be challenging to manage more than 12 participants in online focus-group interviews, we will divide the participants into two or three independent focus groups [ 81 ], with six participants per group [ 79 ]. It is suggested that data collection should be controlled as data collection after data saturation leads to a waste of time and resources [ 82 ]; therefore, concurrent data analysis will be adopted. Data saturation determines the sample size; thus, an exact sample size cannot be determined before the focus-group interviews [ 83 ]. It is reported that the first 5–6 participants produce the majority of new information in the dataset, while little information is gained from the later participants, and 80–92% of early information is identified within the dataset from the first 10 participants [ 84 ]. Little new information will be collected when the sample size is close to 20 interviews [ 85 ]. Thus, we expect around 5 groups of focus-group interviews (about 30 participants) will achieve data saturation, (i.e., when no new codes or themes emerge). The focus-group interviews will be stopped upon reaching data saturation.

4.5. Data Collection

An interview guide will be prepared for focus-group interviews based on a literature review and a research-group discussion. To make the interview questions clearer and easier to understand for nursing students, pilot interviews were used to collect suggestions about the interview questions, and then the interview guide was adjusted. The details of the questions included in the interview guide are provided in Table 1 .

Interview guide of the focus groups.

Tencent Video Conference will be used to conduct and record the online focus-group interviews. A sociodemographic questionnaire will be used to collect participants’ demographic information. The principal researcher, who has received postgraduate research training, will conduct the focus-group interviews. Meanwhile, one research assistant will use field notes to record the non-verbal expressions and emotional states of all of the participants. Since this will be an online focus-group interview, all participants are free to choose a comfortable place for themselves during the interview. When the interview starts, some warm-up questions will be raised first to build rapport between all participants. Each focus group interview will last approximately 1–1.5 h. All of the interviews will be recorded and transcribed. A research assistant and the principal researcher will check the transcripts’ accuracy by comparing the transcripts word-by-word with the recorded videos independently. They will compare the difference between the two versions and check the video recording together before agreeing on a final version. The final version of the transcripts will be shared with the participants to correct any discrepancies and provide additional clarification that might improve data accuracy. Non-verbal responses will also be recorded in the transcripts [ 86 ].

4.6. Data Analysis

Data analysis will be conducted after completing the data transcripts and the coding will be done as early as possible. The principal researcher will read the transcription many times to ensure his familiarity with the data, which will be helpful for the subsequent data analysis. The dimensions of analysis will rely on the interview data and focus on the specific objectives to explore participants’ knowledge, attitudes, empathy, and intentional behaviours towards people with schizophrenia.

4.6.1. Descriptive Statistics

The demographic characteristics of the participants will be presented with descriptive statistics, including means, standard deviations, and percentages, where appropriate.

4.6.2. Qualitative Content Analysis

Content analysis is widely used in qualitative research to discover the underlying meaning of words by quantification [ 87 ]. An inductive approach will be used for content analysis in this study, as it involves detailed readings of the raw data to derive concepts and themes, which allows findings to emerge directly from the analysis of the raw data, rather than from a priori expectations or models [ 88 ]. Furthermore, in qualitative content analysis, systematic coding is used to describe the meaning of the qualitative data [ 89 ]; the two most common approaches are manifest content and latent content analyses [ 90 ]. Manifest content analysis involves examining the surface structure of the text, while latent content analysis involves exploring hidden meanings of the text [ 91 ]. Both manifest content and latent content analyses have advantages in text interpretation, and a combination of both may ensure more consistent and accurate findings than either approach alone [ 91 , 92 ]. Thus, both types of content analysis will be adopted in this study to understand participants’ true views about schizophrenia. Simultaneous qualitative data collection and analysis have been reported to enhance the depth and quality of data analysis [ 93 ]. Thus, concurrent data analysis will be used in the interviews, and the interviews will be stopped upon reaching data saturation.

The five steps of qualitative content analysis are described below: data preparing and organising, reading and memoing, data coding, generating categories, and presenting the description and themes [ 86 ].

NVivo 12, a qualitative data analysis software, will be used to manage the data. An experienced qualitative researcher will also be invited to code the transcripts independently, and the coding outcomes of the principal researcher and the qualitative researcher will be compared. If some disagreement occurs, the research team will discuss the themes and findings, and make modifications until a consensus is reached. An outline of this focus-group interview study is shown in Figure 1 .

Outline of the focus-group interview study.

4.7. Issues of Data Trustworthiness

Qualitative validity refers to the extent to which the study findings are accurate at every step of the analysis, while qualitative reliability refers to the extent to which the study findings are consistent between different researchers and projects [ 93 ]. Credibility, dependability, transferability, and confirmability are the four criteria that determine the trustworthiness of a rigorous qualitative study [ 94 ]. Peer-debriefing, member-checking, and all interview data will be transcribed into Chinese by a research assistant independently. Different categories and subcategories will be established after all data are analysed, and the research findings will be translated into English. This process will help to decrease the loss of meaning during translation and thus improve the credibility of the findings [ 95 ]. A sound audit trail and analytical memos will be maintained, and details of each step of the study will be recorded to ensure the dependability of this study. The information on the demographic and clinical characteristics and study context will be provided in detail, and the transferability of the findings will be increased in this study [ 96 ]. The researcher will reflect upon his actions to determine whether he has provided any misleading cues to the participants. Meanwhile, a research assistant will examine the video recordings of the interviews to identify any instances where the researcher might have manipulated the participants’ responses. Peer-debriefing will be used to examine the data-analysis process. Two trained research assistants will examine the processes of discussion and analysis to improve the confirmability of the data [ 97 ].

4.8. Ethical Issues and Data Safety

Ethical approval has been obtained from the Research Ethics Committee of The Hong Kong Polytechnic University (HSEARS20220127002 on 22 February 2022) and the Research Ethics Committee of the Hospital (KE202203129 on 18 March 2022) to conduct this study. Written informed consent will be obtained from eligible participants before data collection. Before filling in the information sheet, the participants will be reminded of the voluntary nature of their participation in the study, and their right to withdraw from the study at any time without any consequences for their clinical rotation. All information of the participants will be kept confidential and destroyed three years after completing the study.

5. Discussion

Exploring nursing students’ perspectives of schizophrenia stigma is a significant research topic, due to the lack of relevant knowledge. The findings of this qualitative study can inform the development of a Chinese culture-specific intervention to decrease schizophrenia-related stigma in China. Focus-group dynamic interaction is one of the methods to deal with sensitive, potential, and unpredictable questions within a group interview setting [ 98 ], whereas individual interviews may gain profound and accurate information of sensitive issues from participants. Most of our participants will be interviewed in focus groups as Chinese students might feel shy to express their opinions over a sensitive topic and would feel more at ease when accompanied by peers [ 99 ]. However, given the face-saving tendencies of some Chinese people [ 58 ], we will also consider offering individual interviews for students who feel uncomfortable with a focus-group interview. To ensure the data trustworthiness of this study, particular attention will be paid to data coding and data analysis, as highlighted in the earlier sessions. All interviews will be strictly transcribed by the principal researcher and a research assistant into written form to avoid the loss of information. Agreement on the codes and themes will be ensured among the research team members. More importantly, we will invite our participants to examine the findings of this data analysis and determine whether these findings reflect their real perspectives or opinions.

6. Limitations and Strengths

Nursing students with strong stigmatised views towards people with schizophrenia may be unwilling to participate in this study due to perceptions related to social desirability. This could lead to bias in participant recruitment. In addition, only fourth-year nursing students (from different universities) will be included in the focus-group interviews in view of the students’ theoretical knowledge of mental health. Thus, our sample may not be representative of the whole nursing student population spanning all degree years. However, the fourth year is the final year of the nursing degree, when nursing students’ stigma towards people with schizophrenia may affect their choice of nursing specialisation and their care for such patients in the years to come. Thus, we believe that exclusively including fourth-year nursing students is a potential strength of this study, as its results may guide the development of specific interventions to decrease these students’ stigma towards schizophrenia and encourage more graduating nurses to work in mental health departments.

7. Conclusions

To the best of our knowledge, this study will be the first to explore the perceived effect of Chinese culture on the stigma towards schizophrenia among nursing students. The study findings will inform the development of culture-specific interventions to decrease this stigma in Chinese nursing students and the nursing workforce. The findings may also stimulate the development of such interventions for decreasing the stigma towards other mental illnesses among nursing students, as well as students of other healthcare disciplines and health professionals in China.

Funding Statement

This research received no external funding.

Author Contributions

All the authors contributed to the design and methodology of this study. X.C. drafted the initial version of this manuscript and all the other authors were involved in the writing, reviewing, and editing. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Hong Kong Polytechnic University (protocol code HSEARS20220127002) and Xiang Ya Hospital (protocol code KE202203129) for studies involving humans.

Informed Consent Statement

Informed consent will be obtained from all participants involved in the study.

Data Availability Statement

Conflicts of interest.

The authors have no conflict of interest to declare.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Module 11: Schizophrenia Spectrum and Other Psychotic Disorders

Case studies: schizophrenia spectrum disorders, learning objectives.

• Identify schizophrenia and psychotic disorders in case studies

Case Study: Bryant

Thirty-five-year-old Bryant was admitted to the hospital because of ritualistic behaviors, depression, and distrust. At the time of admission, prominent ritualistic behaviors and depression misled clinicians to diagnose Bryant with obsessive-compulsive disorder (OCD). Shortly after, psychotic symptoms such as disorganized thoughts and delusion of control were noticeable. He told the doctors he has not been receiving any treatment, was not on any substance or medication, and has been experiencing these symptoms for about two weeks. Throughout the course of his treatment, the doctors noticed that he developed a catatonic stupor and a respiratory infection, which was identified by respiratory symptoms, blood tests, and a chest X-ray. To treat the psychotic symptoms, catatonic stupor, and respiratory infection, risperidone, MECT, and ceftriaxone (antibiotic) were administered, and these therapies proved to be dramatically effective. [1]

Case Study: Shanta

Shanta, a 28-year-old female with no prior psychiatric hospitalizations, was sent to the local emergency room after her parents called 911; they were concerned that their daughter had become uncharacteristically irritable and paranoid. The family observed that she had stopped interacting with them and had been spending long periods of time alone in her bedroom. For over a month, she had not attended school at the local community college. Her parents finally made the decision to call the police when she started to threaten them with a knife, and the police took her to the local emergency room for a crisis evaluation.

Following the administration of the medication, she tried to escape from the emergency room, contending that the hospital staff was planning to kill her. She eventually slept and when she awoke, she told the crisis worker that she had been diagnosed with attention-deficit/hyperactive disorder (ADHD) a month ago. At the time of this ADHD diagnosis, she was started on 30 mg of a stimulant to be taken every morning in order to help her focus and become less stressed over the possibility of poor school performance.

After two weeks, the provider increased her dosage to 60 mg every morning and also started her on dextroamphetamine sulfate tablets (10 mg) that she took daily in the afternoon in order to improve her concentration and ability to study. Shanta claimed that she might have taken up to three dextroamphetamine sulfate tablets over the past three days because she was worried about falling asleep and being unable to adequately prepare for an examination.

Prior to the ADHD diagnosis, the patient had no known psychiatric or substance abuse history. The urine toxicology screen taken upon admission to the emergency department was positive only for amphetamines. There was no family history of psychotic or mood disorders, and she didn’t exhibit any depressive, manic, or hypomanic symptoms.

The stimulant medications were discontinued by the hospital upon admission to the emergency department and the patient was treated with an atypical antipsychotic. She tolerated the medications well, started psychotherapy sessions, and was released five days later. On the day of discharge, there were no delusions or hallucinations reported. She was referred to the local mental health center for aftercare follow-up with a psychiatrist. [2]

Another powerful case study example is that of Elyn R. Saks, the associate dean and Orrin B. Evans professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California Gould Law School.

Saks began experiencing symptoms of mental illness at eight years old, but she had her first full-blown episode when studying as a Marshall scholar at Oxford University. Another breakdown happened while Saks was a student at Yale Law School, after which she “ended up forcibly restrained and forced to take anti-psychotic medication.” Her scholarly efforts thus include taking a careful look at the destructive impact force and coercion can have on the lives of people with psychiatric illnesses, whether during treatment or perhaps in interactions with police; the Saks Institute, for example, co-hosted a conference examining the urgent problem of how to address excessive use of force in encounters between law enforcement and individuals with mental health challenges.

Saks lives with schizophrenia and has written and spoken about her experiences. She says, “There’s a tremendous need to implode the myths of mental illness, to put a face on it, to show people that a diagnosis does not have to lead to a painful and oblique life.”

In recent years, researchers have begun talking about mental health care in the same way addiction specialists speak of recovery—the lifelong journey of self-treatment and discipline that guides substance abuse programs. The idea remains controversial: managing a severe mental illness is more complicated than simply avoiding certain behaviors. Approaches include “medication (usually), therapy (often), a measure of good luck (always)—and, most of all, the inner strength to manage one’s demons, if not banish them. That strength can come from any number of places…love, forgiveness, faith in God, a lifelong friendship.” Saks says, “We who struggle with these disorders can lead full, happy, productive lives, if we have the right resources.”

You can view the transcript for “A tale of mental illness | Elyn Saks” here (opens in new window) .

• Bai, Y., Yang, X., Zeng, Z., & Yang, H. (2018). A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy. BMC psychiatry , 18(1), 67. https://doi.org/10.1186/s12888-018-1655-5 ↵
• Henning A, Kurtom M, Espiridion E D (February 23, 2019) A Case Study of Acute Stimulant-induced Psychosis. Cureus 11(2): e4126. doi:10.7759/cureus.4126 ↵
• Modification, adaptation, and original content. Authored by : Wallis Back for Lumen Learning. Provided by : Lumen Learning. License : CC BY: Attribution
• A tale of mental illness . Authored by : Elyn Saks. Provided by : TED. Located at : https://www.youtube.com/watch?v=f6CILJA110Y . License : Other . License Terms : Standard YouTube License
• A Case Study of Acute Stimulant-induced Psychosis. Authored by : Ashley Henning, Muhannad Kurtom, Eduardo D. Espiridion. Provided by : Cureus. Located at : https://www.cureus.com/articles/17024-a-case-study-of-acute-stimulant-induced-psychosis#article-disclosures-acknowledgements . License : CC BY: Attribution
• Elyn Saks. Provided by : Wikipedia. Located at : https://en.wikipedia.org/wiki/Elyn_Saks . License : CC BY-SA: Attribution-ShareAlike
• A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy. Authored by : Yuanhan Bai, Xi Yang, Zhiqiang Zeng, and Haichen Yangcorresponding. Located at : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851085/ . License : CC BY: Attribution

Perspectives of Nursing Students towards Schizophrenia Stigma: A Qualitative Study Protocol

Affiliations.

• 1 School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
• 2 World Health Organization Collaborating Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
• 3 College of Nursing & Midwifery, Charles Darwin University, Casuarina, NT 0810, Australia.
• PMID: 35954931
• PMCID: PMC9368375
• DOI: 10.3390/ijerph19159574

Aim: This study aims to explore fourth-year nursing students' knowledge of schizophrenia and their attitudes, empathy, and intentional behaviours towards people with schizophrenia.

Design: This will be a descriptive qualitative study using focus-group interviews.

Methods: Fourth-year nursing students on clinical placement in a hospital in Hunan province will be invited for focus-group interviews. Snowball and purposive sampling will be used to recruit nursing students for this study. Five focus-group interviews, each including six participants, will be conducted to explore participants' knowledge, attitudes, intentional behaviours, and empathy towards schizophrenia. The interview will be conducted through the online Tencent video conference platform and the interview data will be collected through the same platform. All interviews will be recorded and transcribed verbatim and analysed with the approach of the content analysis supported by NVivo 12. Simultaneous data collection and analysis will be performed, and the interviews will be continued until data saturation is met. The findings of this study will be helpful in developing effective interventions to decrease the stigma toward schizophrenia among nursing students and those who study healthcare disciplines.

Keywords: culture; focus groups; nursing students; schizophrenia; social stigma.

• Education, Nursing, Baccalaureate* / methods
• Qualitative Research
• Schizophrenia*
• Social Stigma
• Students, Nursing*

Grants and funding

Schizophrenia Case Study (45 min)

Watch More! Unlock the full videos with a FREE trial

Included In This Lesson

Study tools.

Access More! View the full outline and transcript with a FREE trial

A 21-year-old male is found outside of a gas station and according to bystanders, he was constantly talking for hours straight about the end of the world and the conspiracy of the government to control our minds. The patient appears to not have taken a shower in a long time; his hair is matted, his skin is dirty, he has a strong body odor and his nails are long with dirt under them. The patient is quoting the bible and asking everyone who enters the room if God has saved them yet. The nurse is assessing this patient and is asked if she could get Jesus a glass of water.

How should the nurse respond to the patient?

• Ask the patient if they can see Jesus and if Jesus is telling the patient to do something.
• Safety first! Assessing the reality of a patient is more important than re-orienting them.
• Re-orienting them happens after the nurse knows the patient doesn’t think Jesus is saying to kill everyone

The patient states, “Don’t you know who Jesus is? He will kill you if he wanted to. Don’t upset Jesus and get him a glass of water.” What should the nurse do at this point?

• Inform the patient that the only people you can see are the patient and yourself.
• Do not say you see the patient’s hallucination or validate the patient’s idea by getting ‘Jesus’ a glass of water.
• Try to divert the conversation back to the assessment and avoid getting stuck talking about the delusion.

The patient cooperates and is answering the nurse’s questions. Vital signs are stable and the patient tells the nurse that he has never been treated for any mental health problems before. He also tells the nurse that he is running away from home because people keep breaking into his apartment to laugh at him and steal his peanut butter and all of his writings because they will lead people to the secrets the government has been keeping. The nurse asks about medications the patient takes at home and the patient replies, “I don’t take that poison.” 

All of a sudden the patient starts to question the nurse and accuse the nurse of trying to trick the patient into taking poison and make him conform to the societal norms that the government wants us to do. The patient becomes very anxious and is staring at the door.

What is the nurse’s priority at this time?

• Confirm an exit plan for and make sure that the nurse is not in any danger of being trapped in the room with the patient and no way out.
• Do not let the patient get between you and the door

How should the nurse handle the new found mistrust with this patient?

• The nurse should make positive statements and then move the focus of the conversation such as, “I will not poison you, I promise. You seem nervous, do you want to take a break for a few minutes?”
• Allowing the patient a break can help interrupt the concerning thoughts the patient was having

What is the most important thing for the nurse to do at this time?

• Get out of the room and call security.
• Do NOT attempt to take the pencil away or question the patient about the drawing before making sure you the nurse are safe and secure.
• Do not go into the room without a security officer present.
• And chart Chart CHART everything that is happening.
• This patient will need to be with a sitter one and one as well as alarms and safety protocols implemented.

What kind of antipsychotic medication (Typical or Atypical) do you think this patient should be on?

• Typical antipsychotics because this patient is experiencing positive symptoms of schizophrenia .

View the FULL Outline

When you start a FREE trial you gain access to the full outline as well as:

• SIMCLEX (NCLEX Simulator)
• 6,500+ Practice NCLEX Questions
• 2,000+ HD Videos
• 300+ Nursing Cheatsheets

“Would suggest to all nursing students . . . Guaranteed to ease the stress!”

Nursing Case Studies

KeithRN Clinical Reasoning Case Studies

Prepare students for nextgen nclex and professional practice..

NextGen / Skinny / Unfolding

Heart Failure

Acute coronary syndrome, gastroenteritis, ob hemorrhage, schizophrenia.

All KeithRN Clinical Reasoning Case Studies (CRCS) have been completely revised with new scenarios, clinical data, and a unique interactive format that simulates clinical realities with patient data that unfolds – just like clinical practice.

Each case study uses a consistent framework of open-ended questions with rationale so students can practice clinical decision-making and faculty can evaluate student thinking.

NEW KeithRN Clinical Judgment Rubric!

Nurse educators must create a curriculum that ensures students develop expected levels of clinical judgment to pass the NCLEX and provide safe patient care after graduation. Use KeithRN Clinical Reasoning Case Studies and score students’ performance with a powerful tool that quantitatively measures and assesses students’ clinical judgment skills.

Sign up to receive a free KeithRN NextGen Reasoning Case Study, the new KeithRN Clinical Judgment Rubric, a scoring sheet, and a faculty guide.

" * " indicates required fields

Three Case Study Levels

The three complementary levels of KeithRN CRCS (NextGen-Skinny-Unfolding Reasoning) integrate the nursing process and the four clinical reasoning processes of noticing, interpreting, responding, and reflecting of Tanner’s Clinical Judgment Model (CJM).

NextGen Reasoning

This innovative format replicates the essence of an NGN six-question unfolding case study using open-ended responses with a rationale for each response to evaluate student thinking. Each topic has a student version to post responses and a separate medical record. Suitable for all levels.

Interested in learning more? Watch a demonstration!

Skinny reasoning.

Builds on Nextgen Reasoning with twenty open-ended clinical reasoning questions providing a concise, immersive patient care simulation. Students benefit from integrated assessment images and audio files of breath and heart sounds that replicate practice realities. Suitable for all levels.

Unfolding Reasoning

The most in-depth level expands on Skinny Reasoning by adding additional open-ended questions on dosage calculation, priority setting, and an unfolding change of status requiring the student to determine the current priority and plan of care, simulating a full patient day . Suited for advanced students.

Case Study Levels

Compare the three levels of KeithRN Clinical Reasoning Case Studies: NextGen, Skinny, and Unfolding Reasoning.

Purchase a Think Like a Nurse Membership and never pay for another case study.

Get the best value: Unlimited access to KeithRN faculty teaching and student learning resources.

• Contact & Support
• Think Like a Nurse Support
• Can Caring Be Taught?
• Bullying and Incivility
• Volunteering in the Nations
• Men in Nursing
• About Keith

Sign up now to receive the latest updates and offers from KeithRN!

Copyright © 2024 KeithRN.com - All Rights Reserved

• About KeithRN
• KeithRN’s Story
• KeithRN Team
• KeithRN for Good
• The Problem
• Solution: Clinical Reasoning Case Studies
• Solution: Think Like a Nurse Textbooks
• Clinical Reasoning Case Studies
• Membership – Think Like a Nurse
• Book – Teach Students to THINK Like a Nurse
• Workbook – Faculty Guide to Develop Clinical Judgment

Students/New Nurses

• Vol 1 – Laying Foundation
• Vol 2 – Building Knowledge Base
• Vol 3 – Developing Clinical Judgment

Copyright © 2023 KeithRN.com

Case Study on Schizophrenia

The Case Study Answer Report that you generate should be in APA format, approximately three pages in length, double spaced, written in complete sentences, and free from spelling, grammatical and punctuation errors. The case study is attached with questions. CASE STUDY for Schizophrenia and Other Psychotic Disorders Janet Three months into Janet’s freshman year, her parents were summoned by the dean of the small out-of-town college she was attending to come and pick up their daughter. The dean said Janet was behaving strangely. She had begun to wander around the campus at night, barefoot and dressed only in a short nightgown. According to her roommate, Janet had “not been herself” for the past six weeks. She had stayed in her room continuously, hoarded food, wrote incessantly, and refused to attend classes except for one taught by Dr. M., an older married man with whom Janet had become intensely preoccupied. She acted a if she were in her own world. She was unapproachable and was irritated by her roommate’s attempts to converse. During the past few weeks, Janet had talked to herself frequently. It sounded to her roommate like one-half of a dialogue about what Janet and Dr. M. should do, and whether he was angry with her. Janet’s parents found their daughter in an extremely agitated state. She was dressed in a bizarre way, wearing all kinds of mismatched clothing that was inappropriate for the weather as well as for the setting. She was unkempt and obviously had not bathed. At first she was unresponsive and barely acknowledged her parents’ presence. When she did speak she became overexcited. She explained repeatedly that she had to stay at college because Dr. M. was passionately in love with her. She said he was unable to come to her because his wife kept him imprisoned at home at night. She reported that “voices” commanded her to unite with Dr. M at any cost in order to save the world from destruction. Janet also was convinced that Dr. M.’s wife was reading her thoughts and now intended to harm her. When Janet’s parents told her they were taking her home, she became violent. She attacked them and wrecked her dorm room. Her words indicated that she was experiencing her parents’ efforts as an attack by some dangerous beings, and she argued vehemently but incoherently with these persecutors. The police were called and Janet was taken to the emergency room of the local hospital. The threatening and acutely alarming nature of her hallucinations led staff psychiatrists to conclude that Janet was a danger to herself and others. Immediate hospitalization was advised. Upon admission, Janet was so out of control she had to be put in restraints until the medication she was given began to take effect. Janet was especially fearful that the hospital staff was collaborating with Dr. M.’s wife. She thought they were incarnations of evil forces intent on keeping Janet and Dr. M. apart so that they could not save the world. Janet became more subdued as her medication took effect, but she continued to be uncommunicative around the ward. Although the acute phase of condition passed, the general prognosis for full recovery was guarded because of indications that this episode was only one part of a long and insidious process of deterioration. Clinical Discussion Several features of the acute onset of Janet’s disordered condition are typical of schizophrenia, including her rapid deterioration and its occurrence during her first major separation from home. Her parents reported that she always had been a shy and socially awkward and sensitive girl. For a time around age seven, she had refused to go to school. The whole family had undertaken a brief therapy designed to enable Janet to return to school. This seemed to clear up her behavior enough for her to attend school, but she she was not happy. During early adolescence, Janet began to have frequent arguments with her mother. On several occasions, these arguments culminated in a self-destructive act. On one occasion Janet scratched her wrists with a razor blade in front of her mother, following which the school psychologist referred her to therapy. Janet refused to go, although her more provocative and worrisome behavior decreased after this episode. Janet continued to behave eccentrically, like needing to engage in complex rituals in order to go to sleep, or not wanting to be seen eating, but these behaviors were accommodated by her family and others. The depth of Janet’s anxiety and the rigidity and fragility of her coping mechanisms, therefore, were masked while she remained at home. These quickly broke down, however, when she left the safety and supportive atmosphere of her accustomed surroundings and family. Within her unfamiliar new environment, Janet found it impossible to feel safe. Her “substitute reality” enabled her to feel more secure. In her fantasies, she attained the special status of being desired by an important person, Dr. M. Also, dwelling exclusively on this one relationship helped limit her focus so that she felt less overwhelmed by all the new surroundings. She explained her anxiety about the imagined danger she was in as due to threats to her ties with Dr. M. She saw these threats as coming both from his wife and from the hospital staff. The pervasive sense of terror that accompanied her internal disintegration required a broader explanation, however, which became her conviction of impending world destruction. Her preoccupation with Dr. M. was a desperate attempt to save herself from this psychological catastrophe. The theme of salvation in her delusional system (Janet and Dr. M. were to unite to save the world) illustrates her hope of being rescued. Her parents, the dean, her roommate, and the hospital staff all were part of a threatening system that stood between Janet and the safer alternative reality she had constructed. The elaborateness of Janet’s alternative reality makes it a systematized delusion. In this complex story Janet uses a paranoid type of delusion to try to make sense of her anxiety and thereby to control it. Accompanying the delusional system is Janet’s overall decline in hygiene, daily functioning, appearance, and ability to manage her impulses in response to being challenged. The broad sweep of these disruptions indicates that the delusional system was failing to contain her overall breakdown. The appearance of mistaken sensory perceptions (in this case hearing voices) indicates the presence of auditory hallucinations, which often are part of a schizophrenic process. While delusions reinterpret the meanings of things, hallucinations change the actual intake of reality through the perceptions. Janet’s hallucinations instruct her about increasingly terrifying inner experiences (called command hallucinations). These, in turn, give rise to a concern that she might endanger herself or others because she ins unable to use judgment and reality testing, and because she is fearful and reacts explosively to anything she views as a threat. This explains why she was hospitalized, even though she wasn’t voicing a direct threat at the moment. The outcome for Janet is unsure. While some of her more florid symptoms may be controlled by medication, indications of weakness in her adaptation are long-standing and began years before the onset of the acute schizophrenic phase. Her ability to resolve this crisis effectively is in doubt, less because of the presence of delusions and hallucinations than because of her long history of weakness in psychosocial functioning. Case Questions 1. What is the precipitating stressor event that probably triggered the onset of Janet’s schizophrenic episode? What other factors may have contributed? 2. Identify Janet’s primary delusion. How can we understand this as a way that Janet is trying to “make sense” of her collapsing world? How do her hallucinations fit together with her delusion? 3. Janet’s hospitalization both makes her available for treatment and protects her and others. Explain the nature of danger to Janet and others that exists in her current acute condition.

Is this the question you were looking for? If so, place your order here to get started!

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related posts

Nurs – 6630n psychopharmacologic approaches to treatment of psychopathology.

NURS – 6630N Psychopharmacologic Approaches to Treatment of Psychopathology NURS – 6630N Psychopharmacologic Approaches to Treatment of Psychopathology Walden – NURS 6630 – Psychopharmacologic Approaches To Treatment Of Psychopathology Essay Assignment At times, psychotherapy is not enough to alleviate...

New Technologies in Nursing

New Technologies in Nursing New Technologies in Nursing Introduction The current nursing technologies have transformed how nurses conduct their duties. Evidently, such technologies and new healthcare systems have endured establishing better services to patients. According to the reports of...

Blog , Nursing Blog

Experience of Disorder Symptoms Nursing Research Paper

Experience of Disorder Symptoms Nursing Research Paper Experience of Disorder Symptoms The study was approved by an Institutional Review Board as it is a requirement of the journal where it was published. Notably, the article is peer-reviewed. Though it...

• General Nursing
• Nursing Specialties
• Nursing Students
• United States Nursing
• World Nursing
• Boards of Nursing
• Breakroom / Clubs
• Nurse Q&A
• Student Q&A
• Fastest BSN
• Most Affordable BSN
• Fastest MSN
• Most Affordable MSN
• Best RN to BSN
• Fastest RN to BSN
• Most Affordable RN to BSN
• Best LPN/LVN
• Fastest LPN/LVN
• Most Affordable LPN/LVN
• Fastest DNP
• Most Affordable DNP
• Medical Assistant
• Best Online Medical Assistant
• Best Accelerated Medical Assistant
• Most Affordable Medical Assistant
• Nurse Practitioner
• Pediatric NP
• Neonatal NP
• Oncology NP
• Acute Care NP
• Aesthetic NP
• Women's Health NP
• Adult-Gerontology NP
• Emergency NP
• Best RN to NP
• Psychiatric-Mental Health NP
• RN Specialties
• Best RN Jobs and Salaries
• Aesthetic Nurse
• Nursing Informatics
• Nurse Case Manager
• Forensic Nurse
• Labor and Delivery Nurse
• Psychiatric Nurse
• Pediatric Nurse
• Travel Nurse
• Telemetry Nurse
• Dermatology Nurse
• Best NP Jobs and Salaries
• Family NP (FNP)
• Orthopedic NP
• Psychiatric-Mental Health NP (PMHNP)
• Nurse Educator
• Nurse Administrator
• Certified Nurse Midwife (CNM)
• Clinical Nurse Specialist (CNS)
• Certified Registered Nurse Anesthetist (CRNA)
• Best Free Online NCLEX-RN Study Guide
• The Nursing Process
• Question Leveling
• NCLEX-RN Question Identification
• Expert NCLEX-RN Test-Taking Strategies
• Best Scrubs for Nurses
• Best Shoes for Nurses
• Best Stethoscopes for Nurses
• Best Gifts for Nurses
• Undergraduate
• How to Become an LPN/LVN
• How to Earn an ADN
• Differences Between ADN, ASN, AAS
• How to Earn a BSN
• Best MSN Concentrations
• Is an MSN Worth It?
• How to Earn a DNP
• MSN vs. DNP

Schizophrenia for case study

Nursing Students Student Assist

Published May 5, 2008

i'm here again asking for help,

please tell me or give me an idea about Schizophrenia disorganized type for my case presentation. I just need it's psychopatho and information all about it. thanksss for the extended help.

• + Add a Comment

Below are the website link for your quick reference:

http://adam.about.com/encyclopedia/infectiousdiseases/Schizophrenia.htm?once=true&

http://www.drugs.com/enc/schizophrenia-disorganized-type.html

http://www.mentalhealth.com/dis1/p21-ps01.html

http://www.umm.edu/ency/article/000937.htm

http://www.psychnet-uk.com/dsm_iv/schizophrenia_disorder.htm

I hope these websites will help you out.

sayitaintso

"A beautiful mind" is a great movie about schizophrenia, if you have time maybe you could rent it

Daytonite, BSN, RN

1 Article; 14,604 Posts

1,263 Posts

See if your library has any videos about schizophrenia. There is a series on The Brain by the John & Catherine Mc Arthur? Foundation that was so impressive my Psych professor used it in our class after I showed it to her.