Question

Case Study #3: Schizophrenia

S: Marshall is a 22-year-old diagnosed with schizophrenia, paranoid type. He was just admitted today, his parents had him mental health arrested (MHA). He has been observed to be carrying on a conversation with someone, but then this morning there was a stand-off in the kitchen where Marshall was just yelling at his parents “Don’t come near me! – I will have to defend myself, I know how to defend myself!” He then grabbed a knife from the drawer, and his parents describe that he looked “psychotic” and not like their Marshall, they feared for his safety, but also their own safety.

B: College student, lives at home. Parents report that the first semester went well for Marshall with good grade and friends. This second semester he has withdrawn – he does not go out with friends or come out of his room often; his hygiene is poor and for the past two days he has refused to eat because he thinks his food has been contaminated.

A: VS taken on admission were stable, he is afebrile. He continues to refuse food.

R: His admission assessment needs to be completed. He needs a shower, fresh clothes. The psychiatrist recommended that he remain 1:1 for 24 hours at least, he also ordered medications.  

1. What conditions need to be met to be mental health arrested?

2. What is the priority nursing intervention for Marshall?

Narrative: The psychiatrist has diagnosed Marshall with paranoid schizophrenia

3. List the “negative symptoms” of schizophrenia that Marshall is/may be experiencing.

4. List any “positive symptoms” of schizophrenia that Marshall is/may be experiencing.

5. What symptoms would indicate that Marshall has paranoid schizophrenia?

Answer 1

1)

• If the person refuses to co operate with attending staff/ ambulance staff, then MHA warrants are issued. It ncludes taking alternative power by officers like arresting to prevent breach of place .
• Provision of mental health act cannot be used in person who is at the risk of injury including overdose.
• In urgent situations where health services and health care providers are at the site, and urgent assistance is required.

2)

• Create a therapeutic nurse patient relationship - mutual learning and corrective emotional experience for the patient.
• Show trust, empathy, Respect and authenticity.
• Listen to them and seek clarity.
• Encourage self disclosure and increase self worth of patient.

3)

• Marked apathy
• Paucity of speech
• Blunting of emotional response
• Avoiltion- reduction in interests, desires and goals
• Asociality- lack of involvement in social activities.

4)

• Delusions
• Hallucinations

5)

• Delusion seems real
• Feeling like parents are trying to kill marshel
• Thinking strangers are going to hurt, staying inside home alone.