Xavier University Ateneo de Cagayan

College of Nursing

In Partial fulfilment of the Requirements in

NCM 105.1

Submitted to:
Ms. Ma. Jesseca P. Monsanto, RN MAN

Submitted by:
Balo, Noreen Kaye B.
Bensig, Rachelle Eve A.
Cadiz, Jan Clarice M.
Galarrita, Reximee Sheen P.
Gicaraya, Mark Niel G.
Gutierrez, Hernanne Marie D.
Pamisa, Chrysler II B.
Quejada, Eliza Mae P.
Roche, Cheney Jane A.
Soto, Denise Marla C.

February 20, 2015

CASE ANALYSIS
Disorganized Schizophrenia
An 18-year-old girl (Samantha), was admitted to the Child and Adolescent Psychiatry
Unit in the Department of Pediatrics, Maribor Teaching Hospital, Maribor, Slovenia, for
suspected disorganized (formerly called hebephrenic) schizophrenia.
A year earlier, at the age of 17, she had begun to laugh without reason, and her behavior
had become silly and disorganized. She had phases of incoherent speech as manifested by
mumbling words. Her emotional responses were inappropriate. She started grimacing and
became paramimic and parathymic. She withdrew socially and began to shut herself in her
room. She had auditory hallucinations, consisting of a running commentary on her behavior
(which she found pleasant).
At that time, there were no changes in her school performance, which was already
consistently below average; however, her school performance deteriorated three months before
admission to hospital, when she became unable to do any schoolwork. She also became
disoriented as to her whereabouts and got lost several times. There had been no aberrations in
her developmental milestones.
Until recently, she had not had any disease or needed any medical care. On careful
testing and analysis, the patient was diagnosed with disorganized (hebephrenic) schizophrenia.
Samantha was given an atypical antipsychotic drug called risperidone, twice a day. It showed
considerably speedy improvement.

MENTAL STATUS EXAM

I.

Presentation/Appearance

Withdrawing socially and beginning to isolate herself would manifest impairements in

their ability to perform activity of daily living including self care such as inappropriate dress, dry
skin, oily scalp, poor oral hygiene presence of bad body odor.
II.

Stream of Talk/Behavior
A year earlier, at the age of 17, the patient had begun to laugh without reason, and her

behavior had become silly and disorganized. It is very common for patients with Disorganized
Schizophrenia to have incoherent speech as well. As what was stated in the case, the patient
was mumbling incoherently which is a manifestation termed as schizophasia or word salad
wherein there is incoherent mixture of words or phrases.
III.

Emotional State and Reaction

A year before she was suspected of disorganized schizophrenia, she had begun to laugh

without reason, and her behavior had become silly and disorganized. Her emotional responses
were inappropriate. She started grimacing and became paramimic and parathymic. Generally,
her behavior, speech and verbalized thoughts had been in discordance or lack of harmony
between her voice and movements. One of the hallmark signs for disorganized schizophrenia is
that of which the patient manifests inappropriate emotional reaction.
IV.

Disturbance in Thinking
The patient had disorganized thinking as manifested by the incoherent speech or word

salad. The patient also had delusional ideations which consisted of thought broadcasting or a
running commentary on her behavior which she found pleasant.
V.

Disturbance in Perception

In patients with disorganized schizophrenia, the perception is distorted as evidenced by

one of the hallmark positive or hard symptom which is hallucinations (false sensory perceptions,
or perceptual experiences that do not exist in reality). According to Kirkpatrick and Tek (2005)
there are various types of hallucinations and one type is auditory hallucinations which the
patient manifested. It is the most common type, involving hearing of sounds, most often voices,
talking to or about the patient. There may be one or multiple voices; a familiar or unfamiliar
person's voice may be speaking. Samantha had auditory hallucinations. Although hallucinations
can be threatening and frightening for the patient; less frequently, patients report hallucinations
as pleasant.
VI.

Neurovegetative State
The patient withdrew herself socially and has shut herself in her room, due to this which

made her have changes in her psychophysiologic functions such as nutritional intake has
lessened, energy level decreased, sleep patterns irregular, and bowel functioning has also
decreased. To this, the patient resulted to lower academic and school performance than before
and has become unaware of her whereabouts which led her to being lost at times.
VII.

General Sensorium and Intellectual Status

The patient has been experiencing signs and symptoms of a disorganized type

Schizophrenia wherein most of the ideal signs and symptoms are present within her. These are
hallucinations,

grimacing,

being

disorganized,

inappropriate

emotional

responses,

disorientation, laughing without reason, and withdrawal to society. There were no changes on
the patients school performance which was already consistently below average, however, it
deteriorated three months before her admission. She finds the auditory hallucinations ad
pleasant which is not ideally normal. She is paramimic which means the use of gestures

unsuited to the words that they accompany. This disorientation caused her to get lost several
times.
VIII.

Insight/Judgment

Patient Samantha was unaware of her illness and need for treatment. She manifested
disorganized symptoms such as cognitive defects as evidenced by the deterioration of her
school performance 3 months before admission and became disoriented and getting lost. This
cognitive defects manifested by patient Samantha could already be the basis for lack of insight
for patients with schizophrenia. However, Samantha has been taking Risperidone twice a day
and eventually showed speedy improvement. Samantha is more likely to have a poor judgment.
She has been socially withdrawn and shut herself in her room, and manifested symptoms of
cognitive defects, which could basically influence her judgment, either socially or cognitively.

NURSING DIAGNOSES AND INTERVENTIONS

1.
2.
3.
4.

Disturbed thought process related to delusions

Disturbed sensory perception related to auditory hallucinations
Social isolation related to altered mentation
Risk for violence directed towards self and others related to hallucinations and delusions

REFERENCES
Khilawala, R. (2009). A case on disorganized schizophrenia: Symptoms of disorganized
schizophrenia.

Retrieved

from

http://www.buzzle.com/articles/symptoms-of-

disorganized-schizophrenia.html
Kirkpatrick, B., & Tek, C. (2005). Schizophrenia: Clinical features and psychopathology
concepts. In B. J. Sadock & V. A. Sadock, 8 th edition, Comprehensive textbook of
psychiatry, 1, pp. 14161436. Philadelphia: Lippincott Williams & Wilkins.
Videbeck, S. (2011). Psychiatric mental nursing, 5th edition. China: Lippincott Williams &
Wilkins.
Shives, L. (1994). The Nursing Process: Assessment of Psychiatric Patients. In Basic Concepts
of Psychiatric Mental Health Nursing (3rd ed., Vol. 1, p. 63). Philadelphia: J.B Lippincott.