JR and A Manu

A CASE STUDY OF
SUBSTANCE- INDUCED PSYCHOSIS
In Partial Fulfillment of the Requirements

in Nursing Care Management 102
Presented to the level III Clinical Instructors

Of Davao Doctors College
General Malvar Street
Davao City
By:
Abregana, Sheryl; Alinas, Kareen; Aparri, Alona; Cole, Sharon; Danque, Jobelle
Marie; Ebus, Jockra; Eguna, Jay-ar; Esteban, Carl
TABLE OF CONTENTS
Page no.
CHAPTER I INTRODUCTION……………………………………………1
CHAPTER II OBJECTIVES OR PURPOSE……………………………...4
CHAPTER III ANAMNESIS…………………………………..…………...5
A. Informants…………………………………………………5
B. Family Tree……………………………………………….15
a. Maternal and Paternal Lineage…………………………………15
b. Parents…………………………………………….………………15
c. Subject………………………………………………………….…17
CHAPTER IV COURSE IN THE HOSPITAL………………………..….18
A. Mental Status Examination
upon Initial and Final Introduction……………..……..18
B. Progress Notes and other Observations
on the Succeeding Interaction……….………………..26
CHAPTER V PSYCHODYNAMICS………………………………….…...36
A. Tabular Presentation……………………………….……………36
B. Schematic Presentation…………………….…………..38
CHAPTER VI LABORATORY EXAMINATIONS and RESULTS
of PSYCHOLOGICAL TESTING…………………….….40
A. Neuropsychological Test………………………….…...40
B. Laboratory Test…………………………………...….…41
CHAPTER VII DIAGNOSIS………………………………………………..42

CHAPTER VIII MEDICAL MANAGEMENT……………………………….
CHAPTER IX NURSING CARE PLAN…………………………………..
CHAPTER X PROGNOSIS and RECOMMENDATIONS……………..
CHAPTER XI BIBLIOGRAPHY…………………………………………...
2
I. INTRODUCTION
Those aspects of clinical nursing care that involve interpersonal

relationship with individuals and group as well as a variety of other activities
characterize the practice of Psychiatric Nursing. Direct nursing care functions
may involve individual psychotherapy, group psychotherapy, family therapy
and sociotherapy. Our knowledge about the causes of mental disorders is
limited and until we know more, it will be difficult to measure with confidence
the results of prevention efforts. Certain life experiences are almost universal
and they are of such a critical nature that each can be examined as a unique
phenomenon. The persons involved would have developed mental illness had
one intervention not been made, it is not unreasonable to assure that
reduction of the intensity of stress associated with the experience by making
many of the “unknown” known lowers the likelihood of maladaptive behavior
and future unhealthy coping practices. (Manfrela and Krampity, Psychiatric
Nursing, 10th Edition)
A substance-induced psychotic disorder is sub-typed or categorized

based on whether the prominent feature is delusions or hallucinations.
Delusions are fixed, false beliefs. Hallucinations are seeing, hearing, feeling,
tasting, or smelling things that are not there. In addition, the disorder is sub-
typed based on whether it began during intoxication on a substance or during
withdrawal from a substance. A substance-induced psychotic disorder that
begins during substance use can last as long as the drug is used. A
substance-induced psychotic disorder that begins during withdrawal may first
manifest up to four weeks after an individual stops using the substance. The
effects of drugs including alcohol, medications, and toxins directly cause a
substance-induced psychotic disorder, by definition.
3
Psychotic symptoms can result from intoxication on alcohol,
amphetamines (and related substances), cannabis (marijuana), cocaine,
hallucinogens, inhalants, opioids, phencyclidine (PCP) and related
substances, sedatives, hypnotics, anxiolytics, and other or unknown
substances. Psychotic symptoms can also result from withdrawal from
alcohol, sedatives, hypnotics, anxiolytics, and other or unknown substances.
The speed of onset of psychotic symptoms varies depending on the type of
substance. For example, using a lot of cocaine can produce psychotic
symptoms within minutes. On the other hand, psychotic symptoms may result
from alcohol use only after days or weeks of intensive use. (Kaplan, Harold I.,
M.D., and Benjamin J. Sadock, M.D. Kaplan and Sadock's Synopsis of
Psychiatry: Behavioral Sciences, Clinical Psychiatry. 8th edition. Baltimore:
Williams and Wilkins, 2002.)
Substance abuse problems are serious medical and public health

issue responsible for increasing levels of morbidity and mortality as well as
considerable burden of disease in the united states and world wide (Holman,
English, Milne, & Winter, 1996). The 1996 US Preventative Services Task
Force recommended screening for alcohol dependence, abuse and risky or
harmful drinking by health care workers (Conigliaro , Lofgreen , & Hanusa,
1998). The National Institute on Alcohol Abuse and Alcoholism [NIAAA]
(2003, 2005) recommended that all primary care patients be screened for
alcohol use. The New York City Department of Health and Mental Hygiene
(2005) offered a continuing medical medication program to New York State
licensed physicians and nurse practitioner (NPs) promoting screening and
brief intervention (SBI) of all primary care patients for alcohol problems.
Screening and brief intervention is a clinician delivered counseling technique
that helps patients reduce risky behavior (NIAAA, 2005). It is a 4 step non
confrontational, non judgmental, and matter of fact approach that assesses
4
current alcohol use, assesses for current abuse or dependence problem
( American Psychiatric Association, 2000), abuse or dependence problem
( American Psychiatric Association, 2000), provides patient with advice And
assistance to maintain healthy use, and provides follow up to support efforts
to maintain positive changes. The principles of SBI maybe applied to address
problematic use of other drug abuse.
The NIAAA (2005) standards identify problem drinker as those who
consume more than the recommended daily, weekly, or per occasion
amounts of alcohol. Maximum recommendation are 1 standard drink per day (
12 oz. of beer, 5 oz. of wine, or 1.5 oz. of distilled 80% proof spirits) for adult
women and persons older than 65 years not to exceed 7 drinks per week and
2 drinks per day for adult men not to exceed 14 drinks per week. Risky or
binge drinking is identified as intake of more than 4 drinks per drinking
episode for women and 5 drinks for men, not necessarily exceeding the
weekly maximum of 14 drinks recommended by the NIAAA.
Illicit drug use is a contributing factor to many health related
consequences, including the transmission of HIV/AIDS, Hepatitis B and C,
and Tuberculosis (National Institute of Drug Abuse, 2003). In this project, any
illicit drug use was classified as problematic; including abuse of prescription
medication and use of illicitly procured street drugs. (Lori A. Neushotz and
Joyce J. Fitzpatrick: Improving Substance Abuse Screening and Intervention
in a Primary Care Clinic, Archives of Psychiatric Nursing, Vol. 22, No. 2
(April), 2008: pp 78-79)
5
II. OBJECTIVES
General objectives:
In three weeks span of care, the proponent of the study will develop a
thorough perception about on A selective case, which is schizophrenic type
and to comply with requirements in nursing care management 102.
Specific objectives:
1. Compose an introduction and gather the background information of our
case as well as the brief history of the patient’s case that might affect her
present condition.
2. Formulate specific, measurable, attainable, realistic, and time bounded
objective to serve as our guide in making the case study;
3. Trace the anamnesis of the patient by assessing psychological and
physiologically, collecting subject and objective data, gathering information in
the physical, psychological, social, familial and other aspect of health status
of the client and assessing her in great detail in a holistic manner.
4. Evaluate the client using the mental status examination the map out
progress notes of the client;
5. Present the predisposing and precipitating factors manifested by the client
and draw the schematic presentation;
6. Present laboratory examinations and diagnostic evaluation relevant to the
condition of the patient.
7. Discuss the patient’s medical diagnosis based on the clinical judgment,
conclusion and review of related information;
8. Discuss patient differential diagnosis and interpret it appropriately
9. Present the medical management the therapies appropriate to the client’s
case;
10. Enumerate the identify drugs its action and the nursing responsibilities
accompanied by it;
6
11. Present prognosis on the care towards the patient;
12. Present recommendation on the care towards the patient;
13. Present the sources used necessary for the completion of this case study.
7
II. ANAMNESIS
A. Informants
Informant 1
Name: A.M.S.
Age: 86 years old
Address: Lot 19 Block 22 Pink St. Corner Orange Rojo, Dacoville Subd. Toril,
Davao City
Relationship to patient: Father
Length of time known of the patient: 56 yrs.
Apparent understanding of present illness of patient: The father verbalized,

“Gipa-admit namu na siya sa Babista tungod naga-wild na siya pag mahubog.
Kada adlaw na lang jud na siya ga-inom, ug makasakit na ug lain pag
mahubog na.”
Other Characteristics and Attitude of the Informant: The informant is friendly

and accommodating all throughout the interview. His thoughts are
preoccupied with low self-concept, negativism or hopelessness, and death-
related topics. He is not so orientated to time since he easily forgets. His
speech is sparse, repetitive and slow response.
8
Informant 2
Name: A.M.J
Address: Lot 19 Block 22 Pink St. Corner Orange Rojo, Dacoville Subd. Toril,
Davao City
Relationship to patient: Younger Brother
Apparent understanding of present illness of patient: During the interview, he

verbalized, “Katong adlawa buntag sayo iyang gina-bang ang door pabalik-
balik. Gibadlong nako siya, nasuko siya ug iya ko gilabay ug bato. Dili na
gyud normal iyang nilihukan, dapat na gyud namo siya ipaadmit usab kay
dilikado na basig kami pa madisgrasya niya. Abnormal naman pud kaayo
nilihukan niya ato. Mao gipasulod nalang gyud namo siya sa Babista kay
murag nituyok naman gud utok niya sa iyang mga bisyo. ”
Other characteristics and attitudes: The informant is the primary care taker of
the patient. He is friendly and cooperative all throughout the interview. He
answered the questions spontaneously and with confidence.
9
Informant 3
Name: Er. G
Address: Lansona, Matina, Davao City
Relationship to the patient: Sister
Apparent understanding of the present illness of the patient: As verbalized by

his sister, “Naay kaisa gitawag na siya sa iyang amigo, unya pagbalik niya
kay nag kurog-kurog na siya. Ingon siya sa amo dal-a ko ninyo sa doctor kay
taas na kaayo ko”. “Ngano nakaingon man siya nga taas na siya ma’am,
naunsa diay siya ato?”, asked by the student nurse. “Nag gamit man gud sila
drugs unya injection pa jud, mao jud to nakadaot sa iyang utok.” answered by
the informant. Unsa pud iyang gamit na injection ma’am sa imong nahibaw-
an? “Nubain”, informant answered.
Other characteristic & attitude of the informant: The informant does not know
more about the client because she’s not the one who took good care of the
client. She was studying when the client became violent. She is also younger
than Mr. Vin. Although, throughout the interview, she answered the questions
and there were instances also that she defended her parents the way her
parents raised Mr. Vin.
10
Informant 4
Name: Raffy Aron

Address: Dacoville, Toril Davao City
Relationship to the patient: Neighbor
Apparent understanding of the present illness of the patient: “Dili mana nako
siya ginatagaan og tuba kung mupalit kay kabalo man me sa iyahang sakit na
kung mahubog mutukar na siya” , as verbalized by their neighbor.
Other characteristic & attitude of the informant: The informant is the “Tuba”
vendor in their place. He is cooperative throughout the interview and
answered all the questions being asked by the student nurse.
11
Informant 5
Name: Eve
Apparent understanding of the present illness of the patient: “Mu adto na siya
diri magdala ug tanduay. Diri na niya gina inom siya ra pud isa atubangan sa
amo tindahan. Dili na namo ginatagaan ug tuba kay basig unsa na pud
buhaton pag mahubog, mutuyok na pud iyang utok.”, as verbalized by the
informant.
Other characteristic & attitude of the informant: This informant is the wife of
“Tuba” vendor in Dacoville. She is also cooperative and direct to the point
answering all the questions I asked.
12
Informant 6
Name: Dodong
Apparent understanding of the present illness of the patient: The informant

verbalized,”Magsige man gud na sila gamit ug marijuana, mao jud tong
nakadaot sa iyang utok ba.”
Other characteristic & attitude of the informant: The informant is confident and
direct to the point in answering the question with eye-to-eye contact.
13
Informant 7
Name: Zen
Apparent understanding of the present illness of the patient: “Kana si Vinz

mao naingon-ana siya kay tungod sigeg gamit marijuana, mao tong
nakapatuyok sa iyang utok. Pag mahubog pud mag maoy”,as verbalized by
the informant.
Other characteristic & attitude of the informant: The informant was very warm
and opens to everyone. He was cooperative throughout the interview and
answered all the questions being asked.
14
Informant 8
Name: Carlito
Apparent understanding of the present illness of the patient: “Si Vinz buotan
man na siya, mag sakaysakay sa akong tricycle na walay bayad-bayad. Kung
naay pasahero gusto musakay dili na lang kay naa man si Vinz nanimaho kay
wala man siya’y ligo ug ilis”
Other characteristic & attitude of the informant: This informant is the one who
saw Mr. Vinz in Dacoville. He is a tricycle driver. He is very cooperative and
he shared all the details he knows about Mr. Vinz.
15
Informant 9
Name: Rodi
Apparent understanding of the present illness of the patient: “Maglakaw-lakaw

man na siya magsige’g yawyaw bisag walay kaistorya , nakit-an pud nako
siya na naghubo tanan, kung mahubog siya mag ma-oy, usahay muadto siya
diri sa balay mangayo ug pagka-on gina tagaan naku siya pero sa gawas ra
nako gina pakaon basig mag wild diri sa sulod. Tapulan pud kaayo na si
Vincent gana-gana lang mu trabaho”
Other characteristic & attitude of the informant: This informant is the long time
friend of the father of Mr. Vinz. He shared the information he knows about Mr.
Vinz, he is interactive with eye-to-eye contact.
16
Informant 10
Name: Mel
Apparent understanding of the present illness of the patient: “Mag istorya lang
man na si Vinz siya lang isa, ginalabay niya ang botilya sa tanduay gawas sa
ilahang gate kung mahuman ug inum sa tanduay, makig istorya man siya
usahay pero kaisa nadunggan nako iyahang papa nangayo ug tabang, dali-
dali dayon ku ug gawas kay ge tabangan nako iyang papa nga puspusan
unta niya ug kahoy na bangko, nagpatunga ku sa ilaha pero ge labay gihapon
ni Vinz ang bangko likod sa iyahang papa.”
Other characteristic & attitude of the informant: This informant is the one who
witnessed what Mr. Vinz can do to his father. He shared to us all the details
that he knows.
17
a. Maternal and Paternal Lineage
According to Mr. Vin’s father, their family has no known history of

hereditary illnesses either mental, nervous, cardiopulmonary and other
illnesses. In addition, they have no history of drug addiction and suicide, since
he said that he strived hard to survive and sustain his family’s needs.
However, they have history of alcoholism. The Grandfather of Mr. Vin is a
former Guerilla member during the Japanese era. Yet, he has joined the
Armed Forces of the Philippines after the Japanese Colonization and World
War II and was killed by Japanese soldiers during the war. He also added that
his wife’s lineage is known to be asthmatic and has hereditary illnesses of the
heart. It was further added by A.M.J.(8th child) that there is a history of
alcoholism, delinquency and drug addiction on their mother’s side since they
have a cousin (mother’s niece) who is known to be admitted in a rehabilitation
center due to drug addiction.
b. Parents
The father of Mr. Vin is a retired Colonel of the Armed Forces of the
Philippines. He was not always present during his growing years because of
his occupation, which is very unstable in terms of location. When asked how
he is as a father/husband, he said that he is kind, hardworking and a good
provider to his family. He said that Mr. Vin once beaten by a broomstick
during his teenage years. However, he often gives consideration to Mr. Vin
despite his son’s superiority, vices and delinquency.
When Mr. Vin was imprisoned for many times when he was still in
high school, he said that he always went home to bail out his son. But there
was a time when he left his son in jail to teach him a lesson, but his wife cried
and persuaded him to get Mr. Vin out of jail. His philosophy about a husband
18
and wife relationship, involves each of them in supporting the children’s
financial and basic need, and family planning should not be practiced. For
him, he is the provider of the family in terms of money while the mother is the
one giving guidance to their children. In upbringing their children, he is always
away from home due to his job so he seldom bond with his children even on
important occasions in the family. He is financially stable and can adequately
provide the needs of his family. He was not able to finish his law education so
he ended up as a noble soldier. He was a former Guerilla member during the
Japanese era. His failures as a father are: 1. showing too much consideration
to Mr. Vin which made his son spoiled; 2.his lack of physical presence in
disciplining his children; 3. The way he transferred his family from one place
to another because of his work and; 4. The time when he brought along the
young Mr. Vin to a war in Sulu when he was 16 years old. According to the
father, he has no liking to alcoholism and has no experience in drug addiction.
He plays ma-jong and gambles sometimes but not to the point of sacrificing
his family’s finances. He also said that he is very loyal to his wife despite of
being away from her most of the time.
The mother of Mr.Vin, as described by the father is so kind, caring

and loving. She worked as an elementary teacher and has been a principal
also at Magallanes Elementary School, for additional supplement for their
family’s budget. She did not entrust the care for her children to relatives or
neighbors. When we asked the father who took care of Mr. Vin during his
infancy, he said that it was the eldest child, E.M. Mr. Vin’s mother disciplines
her children from the eldest down to Mr. Vin by just talking, confronting and
telling the right thing to do.
However, this method of disciplining has changed over time

because of how Mr. Vin became so manipulative and superior to the family.
She then became so strict and practiced intensive corporal punishment to the
other younger siblings of Mr. Vin. According to A.M.J. (8th child), their mother
19
had miscarriage twice. The first was between Mr. Vin and El.M (4 th child).
while the second was between L.M. (5th child) and Mi.M. (6th child).
c. Subject
Patient Name: Mr. Vin

Address Dacoville, Toril Davao City
Birthday: January 22, 1954
Age: 56 y.o.
Sex: Male
Civil Status: Single
Date of Admission: January 7, 2010 (2:25pm)
Previous work: Company driver in Johnson & Johnsons
Siblings:
Order Name Age in Occupation
yrs.
1 E. M. Deceased on year 1993 due to asthma
2 M.M. Deceased on 1994 due to bone fracture
3 Patient 56 None
4 El. L 54 Central Bank of Cebu( Accountancy)
5 L.M. 52 Pastor and Assistant of one of the Councilor
in Davao
6 Mi. M. 50 Contractual Worker at Holcim
7 Er. G.* 49 O.I.C.: City Planning of Davao
8 A.M.J. 47 Out from Task Force
*
9 T.M. 45 Liason Officer (J Marketing)
* able to be interviewed.
Personal and Social History:
20
Infancy – born in Laoag and delivered via Normal Spontaneous
Vaginal Delivery in mixed feeding both bottle fed and breastfed. Informant
cannot recall patient immunization records.
Pre-school - Informant cannot recall.
Adolescent – Patient is an honor student, good in declamation, good

in singing and guitar playing. At the age of 14, he started to have “barkadas”
and participated in “gangs”. He started to drink and smoke.
Adulthood
a.) Social – At the age of 14, patient started drinking and smoking with his
“barkadas”. When he was 15 years old he started using marijuana and he
finished his highschool at the age of 18. When he reached 22 he started to
use injectable which is nubain. Before, patient worked in Johnson and
Johnsons as an employee but his informant cannot recall further information.
b.) Baccalaureate– Patient took up customs in RMC up to 3 years in college
but he stop in that time because he admitted in the DMH due to visual and
auditory hallucinations.
c.) Sexual – There was a time when Mr. Vin brought her girlfriend to their
house at the age of 24. “Kaisa lang man to siya nagdala ug uyab sa balay.
Pagkahuman ato wala nako kabalo”, as verbalized by the younger brother.
History of present Illness- would hurt (“Gibunalan ang amahan ug

giguba ang pultahan.” Persistence of the condition prompted his sister and
brother to bring him in Davao Mental Hospital through the help of the
policeman. On January 1, 2010, patient attended their family reunion and he
was shy at that time enjoying singing on videoke. Prior to patient admission
this morning of January 7, 2010, patient threw a stone to his brother because
“Naa daw siya gipangayo na wala nahatag,” as verbalized by the informant.
Pre-morbid history:
21
Sometime in 1980, patient was influenced by his peers to use
prohibited substance like cigarette smoking and alcohol drinking at the age of
14 and when he reached 15 he started using marijuana. Because of this,
patient develops behavioral changes like talking to self and became
suspicious to others. Later on his in 1981, he was brought to Davao Mental
Hospital.
1981 – During his college years, he met Luis Santos and they become
friends for several years. He influenced the patient to take marijuana as his
drug of choice at the same time, it influenced him to drink and smoke cigars
but the informant cannot recalled the exact amount of it and the times or
frequency the patient is doing it. The patient has been admitted of Davao
Mental Hospital several times since 1981 and last admission was on 1990’s
with no maintenance medication. Since then, the patient is non-functional at
home since he was manageable and non-hostile. Patient started to talk to
himself alone and became hostile and violent when his demands are not
provide by his parents. Informant stated that “Gitutukan niya ug kutsilyo
amuang mama” then the family prompted the patient to brought him to Taguig
City because his father stayed and worked there as a Colonel in Manila and
was admitted to Taguig Rehabilitation prior to that incident. No visitation was
made by his family except for a phone call done by his father.
Patient’s words = “Gidala man ko nila sa rehab.”

Companion words = “Gilabayan man niya ug batong among brother”
22
Patient history of previous admission:
Date in year Hospital / Duration Age of Patient

Rehabilitation (in years)
Center
1981-1990’s Davao Mental several times 27
Hospital (unrecalled
dates)
1992 Taguig 9 years 38
Rehabilitation
Center
2003 St. Elizabeth (unrecalled 49
Rehabilitation date)
Center
2005 Dela Rosa 1 month 51
Psychiatric
Facility
2010 NDRC
2001 – After patient was discharged on Taguig Rehabilitation and brought

back in their house here in Davao. He was able to do household works suh as
cooking and cleaning their house. Patient has poor personal hygiene.
Informant stated “Ginabalik-balik niya iyang ginasuot, unya masuko siya pag
tagan namo ug bag-o na suoton.”
No followed up check up was made and sometimes visited by a
doctor for his monthly injection as verbalized by his sister but she cannot
recalled the Doctor’s name and the medicine that was given. Patient
constantly drinks and smoke cigarette. He is able to consumed 1 Jr. Lapad of
Tanduay and 1 pack of cigarettes daily and after he was drunk, patient got
23
sleep. Patient also drinks caffeinated beverages such as coffee for about 4-5
cups/day as mentioned by his sister.
2003 – Patient was admitted to St. Elizabeth Rehab somewhere in San Pedro
St. due to hostility, informant verbalized, “Gituok niya si Papa.” Patient was
discharged and stayed in their house again; continued with his social life with
good relationship with neighbors. Patient still drinks and smokes as he got
used to and he was given an allowance of P50.00 everyday from his father.
As, recalled by his sister, she saw the patient again talking to himself alone.
Patient is writing to a paper with observed words such as “Shit!” and
“Bullshit.” And the patients younger brother forgot the name of the medicine.
2005 – Patient was admitted to dela Rosa Psychiatric Facility for 1 month.
Patient was doing well and was discharged; still followed up check up and
maintenance as verbalized by the informant.
4 weeks prior to admission – Patient is easily irritable and has low attention
span as stated by his sister. The present condition started about 4 weeks
himself and was restless. The patient was non-hostile, with good sleep and
good appetite. About a 2 weeks prior to admission, there was persistence of
the above condition; this time assessed with hostility such that he threatened
his family, he was irritable and anxious and would hurt others. (“Gibunalan
ang amahan, giguba ang pultahan”). Persistence of the condition prompted
his mother to bring him in this institution through the help of the policeman.
IV. COURSE IN THE HOSPITAL

A. Mental status examination upon initial introduction
DAVAO DOCTORS COLLEGE
Gen. Malvar St., Davao City
COLLEGE OF NURSING
24
NCM 102 CMO#30 2ND SEMESTER SY 2009-10
PSYCHIATRIC NURSING (Maladaptive Pattern of Behavior)
MENTAL STATUS EXAMINATION FORM
INITIAL
NAME: ______Mr. Vin_______ DATE: __Jan. 22, 2010__
I. PRESENTATION:
A. GENERAL APPEARANCE ____Mr. Vin is wearing a violet shirt and blue
shorts with blue slippers. Good grooming was noted with trimmed fingernails.
Normal posture and gait is observed and patient is smiling during the
conversation.
B. GENERAL MOBILITY
1. Posture & Gait (√) Normal ( ) Appropriate ( ) Inappropriate
Describe: The client walks with good posture and the gait is normal. He
neither walks slowly nor fast. Flexion and extension of knees while
walking is of good range of motion._______________________________
2. Activity (√) Normoactive ( ) Hyperactive, Restlessness

( ) Agitated ( ) Psychomotor Retardation
3. Facial Expression: (√) Appropriate ( ) Inappropriate

Quantity:
( ) Smiling ( ) Worried ( ) Angry ( ) Happy
( ) Tensed ( ) Suspicious ( ) Ecstatic ( ) Frightened
( ) Tearful ( ) Fearful ( ) Sad ( ) Distant
Describe: The facial expression of the client is happy and its congruent on what
he is saying.
C. BEHAVIOR
(√) Friendly ( ) Impulsive ( ) Sullen ( ) Embarrassed
( ) Dramatic ( ) Negativistic ( ) Seductive ( ) Indifferent
( ) Withdrawn
Describe: The client is friendly because he is showing kindness.
D. NURSE-PATIENT INTERACTION (√) Cooperative ( ) Uncooperative
( ) Initially only (√) Throughout Interview ( ) Later only
Quality: ( ) Warm ( ) Distant ( ) Suspicious
( ) Talkative ( ) Hostile
25
Describe: The client able to answer the questions given throughout the interview.
II. STREAM OF TALK
A. CHARACTER OF TALK ( /) Spontaneous ( ) Deliberate
( ) Blocking ( ) Pressured
Describe: The client can
B. ORGANIZATION OF TALK
( ) Relevant ( ) Loose of Association ( ) Flight of Ideas
( ) Circumstantial (√) Tangential ( ) Perseveration
( ) Neologism ( ) Clang Association ( ) Echolalia
( ) Echopraxia
Describe: The client was answering but his answers were not related to the
question.
C. ACCESSIBILITY ( ) Good (√) Fair ( ) Self-Absorbed
( ) Inaccessible ( ) Defensive ( ) Mute
Describe: The client cooperates with the student nurse fairly.
III. EMOTIONAL STATE AND REACTION
A. MOOD: (√) Euthymic ( ) Depression ( ) Euphoric

The client is neither depressed nor feels euphoria.
B. AFFECT: ( ) Appropriate ( ) Inappropriate

Quality: ( ) Flat ( ) Elated ( ) Histrionic ( ) Angry
(√) Blunted ( ) Labile ( ) Anxious
C. DEPERSONALIZATION & DEREALIZATION
( ) Present (√) Absent
The client neither see himself as another person nor feels that some part of his
body is missing. He is retained or remain in contact with reality.
E. SUICIDAL POTENTIAL ( ) Present (√) Absent

The client does not show signs or means of communicating in a suicidal way. He
also said that he does not allow anything to harm himself.
F. HOMICIDAL POTENTIAL ( ) Present (√) Absent
26
The client does not show actions of hurting others. In fact, he is friendly and
calm.
IV. THOUGHT CONTENT

A. DELUSIONS: ( ) Present (√) Absent
Type: ( ) Thought control, Broadcasting, Insertion
( ) Influence ( ) Paranoia-persecutory, grandiose
( ) Somatic
The client does not have fixed false beliefs.
B. IDEAS OF REFERENCE
Absent - The client said that he does not feel or thinks that the reason of a
certain conflict or catastrophe is him. Furthermore, he does not think/believe that
news/shows on the television is talking to him.
C. PREOCCUPATION, RUMINATION
( ) Preoccupied ( ) Rumination ( ) Rituals
( ) Intrusive thoughts ( ) Phobias ( ) Dejavu & Jamais Vu
Absent – The client is not pre-occupied of something or someone. He also does
not ruminate or talk something over and over again.
V. PERCEPTION
A. ILLUSIONS ( ) Present (√) Absent
Absent – The client do not think a certain stimuli as another thing.
B. HALLUCINATION
Type: ( ) Auditory ( ) Visual ( ) Olfactory ( ) Gustatory
( ) Kinesthetic/ Tactile
The client does not report anything that he sees/hears/smells/feels/tastes

something without a stimuli.
VI. NEUROVEGETATIVE DYSFUNCTION
A. SLEEP (√) Normal ( ) Hyperinsomnia ( ) Insomnia
27
( ) Early ( ) Late ( ) Mixed
B. APPETITE: Mr. Vin’s appetite is good as he said that he was able to eat their
lunch meal fully without left-overs and as observed during snack time that he
eats the food being served to him without hesitation or left-overs.
C. WEIGHT:_ 65Kg_
D. DIURNALVARIATION: Client is sometimes hyperactive especially during
therapy and when he was asked to dance, and sometimes during
therapies he felt drowsy.
E. ATTENTION SPAN: (/) Good ( ) Fair

Mr. Vin is attentive and cooperative during activities of Recreational Therapy,
Remotivational Therapy, Occupational Therapy and Music Therapy only for a
short period of time.________________________________________________
F. LIBIDO:
The client shows enthusiasm and is appropriately cheerful all throughout the
activities especially that it is his birthday.________________________________
VII. GENERAL SENSORIUM & INTELLECTUAL STATUS

A. ORIENTATION: (√) Time (√) Place (√) Person (√) Situation
The client knows that it is his birthday today and is aware of the date and the day
of the week. He is aware that he is in NDRC and he was able to distinguish his
relatives who came to celebrate his birthday. He knows exactly the situation in
which the family is present for his birthday and that SNs will come to do activities.
B. MEMORY:
REMOTE (√) Unimpaired ( ) Impaired
28
Client was able to answer when he was asked, “ Ika pila ka sa inyong
mag-igsuon migo?.” Client: “kinamanghuran man ko.”
RECENT (√) Unimpaired ( ) Impaired

Client was able to answer when he was asked, “ Unsa sud-an nimo
ganiha migo?” Client: “ pinakbet man to maam.”
IMMEDIATE (√) Unimpaired ( ) Impaired

Client was able to answer the question given by the student nurse when
he was asked to spell the word FLOWER backwards.
C.CALCULATION: Progressive Subtraction of 7’s from 100

(√) Good ( ) Fair ( ) Poor
Mr. Vin is able to progressively subtract 7’s from 100 without hesitation and
mistakes._________________________________________________________
D.GENERAL INFORMATION
The client is able to answer correctly that the current president of the nation is
President Gloria Macapagal-Arroyo.
E. ABSTRACT THINKING ABILITY

The patient was asked about how he understand the proverb “Aanhin pa ang
damo kung patay na ang kabayo and he replied “Aanhin pa ang kabayo kung
wala na ang damo.”_The client only rephrase the sentence.
F. JUDGEMENT AND REASONING: ( √) Unimpaired ( ) Impaired

__He said that if he saw a wallet he will return it to the owner._______________
VIII. INSIGHT
__Impaired. He said that he was admitted to that institution because he took a
coconut wood from their backyard and thus, he was caught and brought there. He
29
also added that it was about a family problem and a personal matter, then he
hesitated to talk._____________________________________________________
IX. SUMMARY OF MENTAL STATUS EXAMINATION

A. DISTURBANCE IN ( ) Presentation
(√) Stream of Talk
(√) Emotional state and reaction
( ) Thought
( ) Perception
( ) Neurovegetative dysfunction
(√) General Sensorium and Intellectual state
(√) Insight
( ) Positive signs of Organicity
B. DIAGNOSTIC CATEGORY
(√) Functional ( ) Organic (√) Psychotic
( ) Non-psychotic ( ) both Functional and Organic

Gen. Malvar St., Davao City
COLLEGE OF NURSING
NCM 102 CMO#30 2ND SEMESTER SY 2009-10
PSYCHIATRIC NURSING (Maladaptive Pattern of Behavior)
MENTAL STATUS EXAMINATION FORM
FINAL
NAME: ______Mr. Vin_______ DATE: __Jan. 29, 2010__
I. PRESENTATION:
A. GENERAL APPEARANCE ____Mr. Vin is wearing a violet shirt and blue
shorts with black slippers. Good grooming was noted with trimmed fingernails.
Normal posture and gait is observed and patient is smiling during the
conversation.
30
B. GENERAL MOBILITY
2. Posture & Gait (√) Normal ( ) Appropriate ( ) Inappropriate
Describe: The client walks with good posture and the gait is normal. He
neither walks slowly nor fast. Flexion and extension of knees while
walking is of good range of motion._______________________________
3. Activity (√) Normoactive ( ) Hyperactive, Restlessness
( ) Agitated ( ) Psychomotor Retardation
4. Facial Expression: (√) Appropriate ( ) Inappropriate
Quantity:
( ) Smiling ( ) Worried ( ) Angry ( ) Happy
( ) Tensed ( ) Suspicious ( ) Ecstatic ( ) Frightened
( ) Tearful ( ) Fearful ( ) Sad ( ) Distant
C. BEHAVIOR
(√) Friendly ( ) Impulsive ( ) Sullen ( ) Embarrassed
( ) Dramatic ( ) Negativistic ( ) Seductive ( ) Indifferent
( ) Withdrawn
D. NURSE-PATIENT INTERACTION (√) Cooperative ( ) Uncooperative
( ) Initially only (√) Throughout Interview ( ) Later only
Quality: ( ) Warm ( ) Distant ( ) Suspicious
( ) Talkative ( ) Hostile
II. STREAM OF TALK

A. CHARACTER OF TALK ( ) Spontaneous ( ) Deliberate
(√) Blocking ( ) Pressured
B. ORGANIZATION OF TALK
( ) Relevant ( ) Loose of Association ( ) Flight of Ideas
( ) Circumstantial (√) Tangential ( ) Perseveration
( ) Neologism ( ) Clang Association ( ) Echolalia
( ) Echopraxia
The client hesitates to verbalize on certain matters of his life especially when
asked about the cause of his admission. He does answer certain questions such
as his age and is still on denial stage.__________________________________
C. ACCESSIBILITY ( ) Good (√) Fair ( ) Self-Absorbed
31
( ) Inaccessible ( ) Defensive ( ) Mute
III. EMOTIONAL STATE AND REACTION
A. MOOD: (√) Euthymic ( ) Depression ( ) Euphoric

The client is neither depressed nor feels euphoria.________________________
B. AFFECT: (√) Appropriate ( ) Inappropriate

Quality: ( ) Flat ( ) Elated ( ) Histrionic ( ) Angry
( ) Blunted ( ) Labile ( ) Anxious
C. DEPERSONALIZATION & DEREALIZATION

( ) Present (√) Absent
The client neither see himself as another person nor feels that some part of his
body is missing. He is retained or remain in contact with reality. ______________
E. SUICIDAL POTENTIAL ( ) Present (√) Absent

The client does not show signs or means of communicating in a suicidal way. He
also said that he does not allow anything to harm himself.___________________
F. HOMICIDAL POTENTIAL ( ) Present (√) Absent

The client does not show actions of hurting others. In fact, he is friendly and
calm.____________________________________________________________
IV. THOUGHT CONTENT

A. DELUSIONS: ( ) Present (√) Absent
Type: ( ) Thought control, Broadcasting, Insertion
( ) Influence ( ) Paranoia-persecutory, grandiose
( ) Somatic
The client does not have fixed false beliefs._
B. IDEAS OF REFERENCE
32
Absent - The client said that he does not feel or thinks that the reason of a
certain conflict or catastrophe is him. Furthermore, he does not think/believe that
news/shows on the television is talking to him.
C. PREOCCUPATION, RUMINATION
( ) Preoccupied ( ) Rumination ( ) Rituals
( ) Intrusive thoughts ( ) Phobias ( ) Dejavu & Jamais Vu
Absent – The client is not pre-occupied of something or someone. He also does
not ruminate or talk something over and over again. ______________________
V. PERCEPTION
A. ILLUSIONS (√) Present ( ) Absent
The client thinks a certain stimuli as another thing.____________ ___________
B. HALLUCINATION
Type: ( ) Auditory ( ) Visual ( ) Olfactory ( ) Gustatory
( ) Kinesthetic/ Tactile
The client does not report anything that he sees/hears/smells/feels/tastes
something without a stimuli.__________________________________________
VI. NEUROVEGETATIVE DYSFUNCTION
A. SLEEP (√) Normal ( ) Hyperinsomnia ( ) Insomnia
( ) Early ( ) Late ( ) Mixed
B. APPETITE: Mr. Vin’s appetite is good as he said that he was able to eat their
lunch meal fully witout left-overs and as observed during snack time that he ate
the food being served to him without hesitation or left-overs._________________
C. WEIGHT:_______65Kg___________________________________________
D. DIURNALVARIATION: The usual day to day activities (from morning to night)

of the client involves the following: Taking a bath →Breakfast →Therapeutic
Activities with SNs of morning shift →Lunch →Rest →Therapeutic Activities with
SNs of afternoon shift →Taking a half bath →Dinner →Sleep time by 9pm. There
is also a variation in his ADLs when Exercise time (before taking a bath in the
33
morning) is present if the climate is good or is being cancelled if raining. The
client is able to adjust or adapt to it.____________________________________
E. ATTENTION SPAN: ( ) Good (√) Fair

Mr. Vin is attentive and cooperative to conversation and in activities of
Recreational Therapy, Remotivational Therapy, Occupational Therapy and Music
Therapy._________________________________________________________
F. LIBIDO:
The client shows enthusiasm and is appropriately cheerful all throughout the
activities.________________________________
VII. GENERAL SENSORIUM & INTELLECTUAL STATUS

A. ORIENTATION: (√) Time (√) Place (√) Person (√) Situation
The client is aware of the date and the day of the week. He is aware that he is in
NDRC and he was able to distinguish his SNs and nurses. He knows exactly the
situation in which SNs will come to do activities.
B. MEMORY:
REMOTE (√) Unimpaired ( ) Impaired
The client is able to name his father and his relatives.
RECENT (√) Unimpaired ( ) Impaired
The client is able to describe is usual ADLs of yesterday.___________________
IMMEDIATE (√) Unimpaired ( ) Impaired
The client is able to memorize easily the yells/cheering of the group.__________
C.CALCULATION: Progressive Subtraction of 7’s from 100

(√) Good ( ) Fair ( ) Poor
34
Mr. Vin is able to progressively subtract 7’s from 100 without hesitation and
mistakes.
D.GENERAL INFORMATION
The client is able to answer correctly that the current mayor of Davao City is
Mayor Rody Duterte.
E. ABSTRACT THINKING ABILITY

The student nurse asked, “ unsa may pagsabot nimo anang, Don’t
judge the book by its cover?”. The client answered, “ dili dayon ta
muhusga og tao maam.” The client answer the question based on her own
understanding.
F. JUDGEMENT AND REASONING: ( √) Unimpaired ( ) Impaired

He said that if he found a wallet he will return it to the owner.
VIII. INSIGHT
The patient has a good insight since he understands that he has an illness
and needs to be in the institution to be cured.
IX. SUMMARY OF MENTAL STATUS EXAMINATION

A. DISTURBANCE IN ( ) Presentation
(√) Stream of Talk
( ) Emotional state and reaction
( ) Thought
(√) Perception
( ) Neurovegetative dysfunction
(√) General Sensorium and Intellectual state
(√) Insight
( ) Positive signs of Organicity
B. DIAGNOSTIC CATEGORY
(√) Functional ( ) Organic (√) Psychotic
35
( ) Non-psychotic ( ) both Functional and Organic
36
37
C. Progress notes and other observations on the succeeding interaction.
12/1/10
S = “Birthday naku ugma.”
= “Mabuti man ako, ma’am.”
= “Masaya ako ngayon ditto sa recovery center.”
= “Sana bumisita sila, ma’am, sa aking birthday.”
= “ Ako si (stated name)”
= “ Happy ako ngayon”
O = calm tone of voice
= smiling face was noted
= patient is happy
= warm
= poor insight
= (+) for denial
A = Improving but still in denial stage
P = Refer to Dr. A.M.B.
= for psychiatric education on 1/22/10
= One on one counseling
38
Gen. Malvar st., Davao City
College of Nursing
NCM 102 LEVEL III 2ND SEMESTER SY 2008-09

PSYCHIATRIC NURSING (Maladaptive patterns of Behavior)
NURSING MANAGEMENT
INITIAL
NURSE-PATIENT INTERACTION
Name of the Patient : Mr. Vin
Date of Admission : Jan. 7, 2010
Place of Interaction : NDRC
Age : 56 years old
Date & Time of Interaction : Jan.22, 2010/1-5PM
Sex : Male
Civil Status : Single
Diagnosis : Schizophrenia
General Objectives:
39
At the end of our 3 weeks exposure the patient will be able to build a
trusting relationship between the patient and the student nurse.
Specific Objectives:
• To be able the patient to rechanneled unwanted feelings that is kept deep
in him.
• To let the patient feel self belongingness to others.
• To be able the patient to have increase self-esteem.
• To be able to assess the client feelings and anxiety.
• To be able the client to express his problems, thoughts and feelings.
NURSE PATIENT ANALYSIS DOCUMENTATION
“Maayong hapon The Student nurse Giving recognition.

Greeting the client by
migo” recognizes the
name, indicating
presence of the awareness of change,
or noting efforts the
patient.
client has made all
show that the nurse
recognizes the client
as a person, as an
individual. Such
recognition does not
carry the notion of
value, that is, of being
“good” or “bad”.
(Videbeck, Sheila;
Psychiatric-Mental
Health Nursing; fourth
edition; page 108)
Accepting. An
“Maayong The client
accepting response
hapon pud responds to the indicates the nurse
has heard and
maam” student nurse
followed the train of
greetings. thought. It does not
indicate agreement
but is nonjudgmental.
40
Facial expression,
tone of voice, and so
forth also must
convey acceptance or
the words lose their
meaning. (Videbeck,
Sheila; Psychiatric-
Mental Health
Nursing; fourth
edition; page 107)
“Migo, ako diay si The student nurse
Giving information.
Maam sai-sai starts to enter in Informing the client of
facts increases his or
kauban nako si the introductory
her knowledge about
Maam Khae. phase and begins a topic or lets the
client know what to
Kami imong mga to give information
expect. The nurse is
student nurse such as the functioning as a
resource person.
karon Migo gikan student’s nurse
Giving information
ala una sa hapon name. In this way also build trust with
the client. (Videbeck,
hangtod alas she could
singko sa hapon, establish rapport. Mental Health
Nursing; fourth
og naa pud me
edition; page 107)
diri migo kada
huwebes,
biyernes og
sabado sa ing ani
nga oras
gihapon.
Makauban me
nimo migo sa tulo
ka semina. Kutod
lng me diri
karong petsa
Enero 6, 2010
migo og mao na
41
nga adlaw ang sa
atong
culmination.’
The client is trying
“Kauban ninyo Seeking information.
tong to interact with the The nurse should
kaganinang seek clarification
student nurse.”
buntag maam?” throughout
interactions with
clients. Doing so can
help the nurse to
avoid making
assumptions that
understanding have
occurred when it has
not. It helps the client
to articulate thoughts,
feelings, and ideas
more clearly.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 108)
“Kamusta man The student nurse Encouraging
expression. The nurse
imong tulog is starting in
asks the client to
kaganina migo?” establishing consider people and
events in light of his or
rapport to the
her own values. Doing
client. so encourages the
client to make his or
her own appraisal
rather than to accept
the opinion of others.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 107)
Giving information.
“Ok lng man The client
Informing the client of
maam, sayo ko responds to the facts increases his or
her knowledge about
nakatulog” student nurse
a topic or lets the
question. client know what to
42
functioning as a
resource person.
Giving information
also build trust with
Mental Health
Nursing; fourth
edition; page 107)
“Unya Migo The Student nurse
Seeking information.
kamusta man starts seeking The nurse should
seek clarification
imong adlaw information from
throughout
karon?” the client. interactions with
help the nurse to
avoid making
assumptions that
understanding have
feelings, and ideas
more clearly.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 108)
Encouraging
“Ok lng man The client
maam” responds to the asks the client to
consider people and
student nurse
question. her own values. Doing
so encourages the
her own appraisal
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 107)
43
“Migo kame man
Offering self. The
imong mga The student nurse
nurse can offer his or
student nurse is still establishing her presence, interest,
and desire to
karon kong naa rapport to the
understand. If is
kay kailangan client. important that this
offer is unconditional,
naa lang me diri
that is, the client does
ha para not have to respond
verbally to get the
mutabang sa
nurse’s attention.
imoha kong (Videbeck, Sheila;
Psychiatric-Mental
kailangan na me
nimo”. edition; page 108)
“O maam”. Client fully
Accepting. An
accepted the offer accepting response
indicates the nurse
presented by the
has heard and
student Nurse. followed the train of
thought. It does not
indicate agreement
Facial expression,
forth also must
meaning. (Videbeck,
Mental Health
Nursing; fourth
edition; page 107)
“Migo unsa gane The student nurse Seeking information.

The nurse should
imong tinuod nga still seeking
seek clarification
pangalan? Taga information to the throughout
interactions with
asa pud ka client.
migo? Pila na help the nurse to
avoid making
pud gane imong
assumptions that
edad migo? understanding have
44
feelings, and ideas
more clearly.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 108)
Giving information.
“Vincent R. The patient replied
Moran maam, the student nurse facts increases his or
her knowledge about
taga Dacoville questions in
a topic or lets the
ko maam akong complete details. client know what to
edad kay 48.”
functioning as a
resource person.
Giving information
Mental Health
Nursing; fourth
edition; page 107)
Broad Opening. Broad

“Migo unsa man The student nurse
Openings make
imong gusto allowing the client explicit that the client
has the lead in the
istoryahan nato to take the
interaction. For the
karon? initiative in client who is hesitant
about talking, broad
introducing a
openings may
topic. stimulate him or her
take the imitative.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 107)
Silence. Silence often

“Silence” The client using a encourages the client
45
therapeutic to verbalize, provided
that it is interested
communication in
and expectant.
a silent way. Silence gives the
client time to organize
thoughts, direct the
topic of interaction, or
focus on issues that
are most important.
Much nonverbal
behavior takes place
during silence, and
the nurse needs to be
aware of the client
and his or her own
nonverbal behavior.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 109)
“Migo nganong The student nurse Seeking information.

The nurse should
ako man validating the
seek clarification
magbuot ikaw clients answer. throughout
interactions with
diay?”
help the nurse to
avoid making
assumptions that
understanding have
feelings, and ideas
more clearly.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 108)

“Silence” The client using a encourages the client
to verbalize, provided
therapeutic
communication in and expectant.
46
a silent way. Silence gives the
are most important.
Much nonverbal
during silence, and
aware of the client
and his or her own
nonverbal behavior.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 109)
“Migo nganong
naa man ka diri? Suggesting
collaboration. The
“Gusto ka Student nurse
nurse seeks to offer a
istoryahan nato seeks more relationship in which
the client can identify
na migo?” information by
problems in living with
exploring past others, grow
emotionally, and
experiences of the
improve the ability to
client. form satisfactory
relationships. The
nurse offers to do
things with, rather that
for, the client.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 109)
“Naa lang
Suggesting
gamay nga The client is
collaboration. The
problema
partially nurse seeks to offer a
maam”
relationship in which
cooperative and
with hesitation problems in living with
others, grow
considering the
emotionally, and
people and events improve the ability to
47
in light of his past form satisfactory
relationships. The
experiences.
nurse offers to do
for, the client.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 109)
“Unsa mana
Exploring. When
imong gamay The student nurse
clients deal with topics
nga problem tries to validate superficially, exploring
can help them
amigo?” the clients answer.
examine the issue
mere fully. Any
problem or concern
can be better
understood if explored
in depth. If the client
expresses an
unwillingness to
explore a subject,
however, the nurse
must respect his or
her wishes.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 107)
“Wala man
maam” Giving information.
The client is
answering facts increases his or
her knowledge about
respond to the
a topic or lets the
question of the client know what to
student nurse.
functioning as a
resource person.
Giving information
Mental Health
Nursing; fourth
48
edition; page 107)
Suggesting
‘Migo muapil ta The student nurse collaboration. The
sa mga activities encourages the
karon ha?” client to the client can identify
participate the
others, grow
activities during emotionally, and
the program.
form satisfactory
relationships. The
nurse offers to do
for, the client.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 109)
“O maam
muapil ko” The patient replied Accepting. An
accepting response
to the student
indicates the nurse
nurse actively. has heard and
indicate agreement
Facial expression,
forth also must
meaning. (Videbeck,
Mental Health
Nursing; fourth
edition; page 107)
“Unya migo unsa The student nurse
Encouraging
man imong gibati encourages the
sa atong mga patients to asks the client to
consider people and
gipangbuhat verbalize her
ganina?’ feelings about the her own values. Doing
49
activity done. so encourages the
her own appraisal
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 107)
“Nalipay ko Alogia. Tendency to

The client
mam kay speak very little or to
nalingaw pud verbalizes his convey little
ko ganina”. subdtance of
Feelings towards
meaning. (Videbeck,
the activity given. Sheila; Psychiatric-
Mental Health
Nursing; fourth
edition; page 269)
“Migo ugma na The student nurse
Giving information.
pud ha, ing ani doing the Informing the client of
gihapon nga termination phase
her knowledge about
oras. Mao and giving the a topic or lets the
client know what to
gihapon to ang information for the
atong mga next day activity. functioning as a
resource person.
pagabuhaton.
Giving information
Bye-bye migo”. also build trust with
Mental Health
Nursing; fourth
edition; page 107
“Sige maam
ugma na pud, Accepting. An
The patient replies
bye-bye pud accepting response
maam”. the student nurse indicates the nurse
has heard and
directly.
indicate agreement
Facial expression,
50
forth also must
meaning. (Videbeck,
Mental Health
Nursing; fourth
edition; page 107)

Gen. Malvar st., Davao City
College of Nursing
NCM 102 LEVEL III 2ND SEMESTER SY 2008-09

PSYCHIATRIC NURSING (Maladaptive patterns of Behavior)
NURSING MANAGEMENT
FINAL
NURSE-PATIENT INTERACTION
Name of the Patient : Mr. Vin Date
of Admission : Feb. 05, 2010_______
Place of Interaction : NDRC ___________________
Age: 56 years old______________
Date & Time of Interaction : 1-5pm/Jan.22, 2010 _________ Sex:
Male____________________
Civil Status : Single ____________________
Diagnosis: Schizophrenia_____________
51
General Objectives:
At the end of our 3 weeks exposure the patient will be able to build a
trusting relationship between the patient and the student nurse.
Specific Objectives:
• To be able the patient to rechanneled unwanted feelings that is kept deep
in him.
• To let the patient feel self belongingness to others.
• To be able the patient to have increase self-esteem.
• To be able to assess the client feelings and anxiety.
• To be able the client to express his problems, thoughts and feelings.
NURSE PATIENT ANALYSIS DOCUMENTATION
“Maayong hapon The Student nurse Giving recognition.

Greeting the client by
migo” recognizes the
name, indicating
presence of the awareness of change,
or noting efforts the
patient.
client has made all
show that the nurse
recognizes the client
as a person, as an
individual. Such
recognition does not
carry the notion of
value, that is, of being
“good” or “bad”.
“Maayong
(Videbeck, Sheila;
hapon pud Psychiatric-Mental
maam” The client
edition; page 108)
responds to the
Accepting. An
student nurse
accepting response
52
greetings. indicates the nurse
has heard and
indicate agreement
“Migo, ako diay si Facial expression,
Maam sai-sai
forth also must
kauban nako si convey acceptance or
Maam Khae. The student nurse
meaning. (Videbeck,
Kami imong mga starts to enter in Sheila; Psychiatric-
Mental Health
student nurse the introductory
Nursing; fourth
karon Migo gikan phase and begins edition; page 107)
ala una sa hapon to give information
Giving information.
hangtod alas such as the Informing the client of
singko sa hapon, student’s nurse
her knowledge about
og naa pud me name. In this way a topic or lets the
client know what to
diri migo kada she could
huwebes, establish rapport. functioning as a
resource person.
biyernes og
Giving information
sabado sa ing ani “Kauban ninyo also build trust with
tong the client. (Videbeck,
nga oras
kaganinang Sheila; Psychiatric-
gihapon. buntag maam?” Mental Health
Nursing; fourth
Makauban me
edition; page 107)
nimo migo sa tulo
ka semina. Kutod
lng me diri
karong petsa The client is trying
Enero 6, 2010 to interact with the
migo og mao na student nurse.”
nga adlaw ang sa
atong
The nurse should
culmination.’ seek clarification
53
throughout
interactions with
help the nurse to
avoid making
assumptions that
The student nurse understanding have
“Ok lng man is starting in
maam, sayo ko establishing to articulate thoughts,
feelings, and ideas
nakatulog” rapport to the
more clearly.
client. (Videbeck, Sheila;
Psychiatric-Mental
“Kamusta man
imong tulog edition; page 108)
kaganina migo?”
Encouraging
asks the client to
consider people and
The client
responds to the so encourages the
student nurse
her own appraisal
question. rather than to accept
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 107)
“Ok lng man
Giving information.
maam”
The Student nurse facts increases his or
her knowledge about
“Unya Migo starts seeking
a topic or lets the
kamusta man information from client know what to
imong adlaw the client.
functioning as a
karon?” resource person.
Giving information
54
Mental Health
Nursing; fourth
edition; page 107)
The client The nurse should
seek clarification
responds to the
throughout
student nurse interactions with
“O maam”. question.
help the nurse to
avoid making
assumptions that
understanding have
feelings, and ideas
more clearly.
“Migo kame man
(Videbeck, Sheila;
imong mga The student nurse Psychiatric-Mental
student nurse is still establishing
edition; page 108)
karon kong naa rapport to the
Encouraging
kay kailangan client.
naa lang me diri asks the client to
consider people and
ha para
mutabang sa her own values. Doing
so encourages the
imoha kong
kailangan na me Client fully her own appraisal
nimo”. accepted the offer
“Vincent R. presented by the (Videbeck, Sheila;
Psychiatric-Mental
Moran maam, student Nurse.
taga Dacoville edition; page 107)
ko maam akong
edad kay 48.” Offering self. The
nurse can offer his or
her presence, interest,
and desire to
55
understand. If is
important that this
The student nurse
offer is unconditional,
“Migo unsa gane still seeking that is, the client does
not have to respond
imong tinuod nga information to the
verbally to get the
pangalan? Taga client. nurse’s attention.
(Videbeck, Sheila;
asa pud ka
Psychiatric-Mental
migo? Pila na Health Nursing; fourth
edition; page 108)
pud gane imong
edad migo? Accepting. An
accepting response
“Silence”
indicates the nurse
has heard and
The patient replied indicate agreement
the student nurse
Facial expression,
questions in tone of voice, and so
forth also must
complete details.
meaning. (Videbeck,
Mental Health
Nursing; fourth
edition; page 107)
The student nurse
The nurse should
“Migo unsa man allowing the client seek clarification
throughout
imong gusto to take the
interactions with
istoryahan nato initiative in clients. Doing so can
help the nurse to
karon? introducing a
avoid making
topic. assumptions that
understanding have
“Silence”
feelings, and ideas
The client using a more clearly.
56
therapeutic (Videbeck, Sheila;
Psychiatric-Mental
communication in
a silent way. edition; page 108)
Giving information.
her knowledge about
a topic or lets the
client know what to
“Migo nganong functioning as a
resource person.
ako man
Giving information
magbuot ikaw The student nurse also build trust with
diay?” validating the
“Naa lang clients answer. Mental Health
gamay nga Nursing; fourth
problema edition; page 107)
maam”
Broad Opening. Broad

Openings make
explicit that the client
has the lead in the
interaction. For the
client who is hesitant
about talking, broad
The client using a openings may
stimulate him or her
therapeutic
take the imitative.
communication in (Videbeck, Sheila;
Psychiatric-Mental
a silent way.
edition; page 107)

encourages the client
“Migo nganong that it is interested
and expectant.
naa man ka diri?
Silence gives the
“Gusto ka “Wala man client time to organize
57
istoryahan nato maam” Student nurse thoughts, direct the
na migo?” seeks more
information by are most important.
Much nonverbal
exploring past
experiences of the during silence, and
client.
aware of the client
and his or her own
nonverbal behavior.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 109)
The client is
partially
The nurse should
“Unsa mana cooperative and seek clarification
throughout
imong gamay with hesitation
interactions with
nga problem considering the clients. Doing so can
help the nurse to
amigo?” people and events
“O maam avoid making
muapil ko” in light of his past assumptions that
understanding have
experiences.
feelings, and ideas
The student nurse more clearly.
(Videbeck, Sheila;
tries to validate
Psychiatric-Mental
the clients answer. Health Nursing; fourth
edition; page 108)

encourages the client
and expectant.
Silence gives the
58
are most important.
“Nalipay ko Much nonverbal
The client is
man kay behavior takes place
‘Migo muapil ta nalingaw pud answering during silence, and
ko ganina”. the nurse needs to be
sa mga activities respond to the
aware of the client
karon ha?” question of the and his or her own
nonverbal behavior.
student nurse.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 109)
Suggesting
collaboration. The
The student nurse the client can identify
encourages the
others, grow
“Sige maam client to emotionally, and
ugma na pud, improve the ability to
participate the
bye-bye pud form satisfactory
maam”. activities during relationships. The
nurse offers to do
the program.
“Unya migo unsa for, the client.
(Videbeck, Sheila;
man imong gibati
Psychiatric-Mental
sa atong mga Health Nursing; fourth
edition; page 109)
gipangbuhat
ganina?’ The patient replied Suggesting
collaboration. The
to the student
nurse actively. relationship in which
others, grow
emotionally, and
form satisfactory
relationships. The
nurse offers to do
59
The student nurse for, the client.
(Videbeck, Sheila;
“Migo ugma na encourages the
Psychiatric-Mental
pud ha, ing ani patients to Health Nursing; fourth
edition; page 109)
gihapon nga verbalize her
oras. Mao feelings about the Exploring. When
clients deal with topics
gihapon to ang activity done.
superficially, exploring
atong mga can help them
examine the issue
pagabuhaton.
mere fully. Any
Bye-bye migi”. problem or concern
can be better
understood if explored
in depth. If the client
expresses an
The client
unwillingness to
verbalizes his explore a subject,
however, the nurse
Feelings towards
must respect his or
the activity given. her wishes.
(Videbeck, Sheila;
Psychiatric-Mental
The student nurse Health Nursing;
fourth edition; page
doing the
107)
termination phase Giving information.
and giving the
information for the her knowledge about
a topic or lets the
next day activity.
client know what to
functioning as a
resource person.
Giving information
The patient replies Sheila; Psychiatric-
Mental Health
the student nurse
Nursing; fourth
directly. edition; page 107)
Suggesting
60
collaboration. The
others, grow
emotionally, and
form satisfactory
relationships. The
nurse offers to do
for, the client.
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 109)
Accepting. An
accepting response
indicates the nurse
has heard and
indicate agreement
Facial expression,
forth also must
meaning. (Videbeck,
Mental Health
Nursing; fourth
edition; page 107)
Encouraging
asks the client to
consider people and
so encourages the
her own appraisal
61
(Videbeck, Sheila;
Psychiatric-Mental
edition; page 107)
Alogia. Tendency to
speak very little or to
convey little
subdtance of
meaning. (Videbeck,
Mental Health
Nursing; fourth
edition; page 269)
Giving information.
her knowledge about
a topic or lets the
client know what to
functioning as a
resource person.
Giving information
Mental Health
Nursing; fourth
edition; page 107
Accepting. An
accepting response
indicates the nurse
has heard and
indicate agreement
Facial expression,
62
forth also must
meaning. (Videbeck,
Mental Health
Nursing; fourth
edition; page 107)
B. Progress notes and other observations on the succeeding interaction.
V. PSYCHODYNAMICS
According to Manfreda and Krampitz, predisposing causes are

those conditions, which make the individual susceptible to the effect of the
later, precipitating cause, and thus more likely to develop psychosis. It is
generally believed that no human being can escape completely all
predispositions to mental disorders. While precipitating causes of mental
disorders are considered by many investigators to be more dynamic,
motivating and damaging causes of mental illness. If it is possible to identify
the physical etiologic factors through laboratory examinations and specific
test, the psychic and emotional precipitating factors are not easily identified or
understood.
A. Tabular Presentation
63
Factors Present Rationale
A.Predisposing
Factors
a. Hereditary According to Biologic factor (Hereditary)
Mr. Vin’s Dick and Bevrit formed that 50 % to
younger 60% of variation in causes of
brother, there alcoholism was the result of genetics,
are alcoholics with the remainder caused by
in their father’s environmental influences.
side. (Videbeck, Shiela, Psychiatric Mental
Health Nursing p. 372, 4th ed.)
In addition to genetic links to
alcoholism, family dynamics are
thought to play apart. Children of
alcoholics are four times as likely to
develop alcoholism schuckit (2005)
compared with the general
population period. Some theorists
believe that inconsistency in the
parents behavior, poor role
modeling, and lack of nurturing pave
the way for the child to adapt as
similar style adaptive coping, stormy
relationships, and substance abuse.
(Videbeck, Shiela, Psychiatric Mental
Health Nursing p. 372 4th ed.)
b. Age Mr. Vin started According to Manfreda and Krampitz,

using there are three periods in life when
64
marijuana at persons appear to be constitutionally
the age of 15 vulnerable to mental disorders:
yrs. old and adolescence, the menopause, and
used injectable the senile periods. We are much
drugs at the aware that during these periods the
age of 22. body undergoes very definite
physiological changes. Combined
with stress and strain of everyday
living and its inevitable problems,
change may prove vastly
overwhelming for some persons.
(Psychiatric Nursing, 10th Edition
p.11)
65
c. Sex The client is Age in general, younger

male. experimenters use substances that
carry less social disapproval such as
alcohol and drugs, whereas older
people use drugs such as cocaine
and opioids that are more costly and
rate higher disapproval.
Maximum recommendations are
one standard drink per day(12oz. of
bear, 5 oz. of wine or 1.5 ounce of
distilled 80% proof spirits) for adult
women and person older than
65years not to exceed 7 drinks per
week and 2 drinks per day for adult
men not to exceed 14 drinks per
week. Risky or binge drinking is
identified as intake of more than 4
drinks per drinking episode per
women and 5 drinks per men, not
necessarily exceeding the weekly
maximum of 14 drinks recommended
by the NIAAA.
(Reference: Neushotz, L. and
Fitzpatrick, J.)
66
d.Social and Mr. Vin had According to Manfreda and Krampitz,

Environmental many friends the mores and customs of one’s
who culture may become problematic,
influenced particularly if a person migrates to a
him to drink different environment and becomes
alcoholic involved in the assimilation process.
drinks and Very important environmental social
use drugs. factors are the feelings which exist in
relationships between family
members. A child who feels
emotionally insecure and unwanted is
potentially the victim of psychiatric
disorder in later life. The child who is
over-protected and unable to
emancipate himself from parental
control may become predisposed to
later mental disorder.
(Psychiatric Nursing, 10th Edition p.11)
Cultural factors, special attitudes,
peer behaviors, laws, cost and
availability all influence initial and
continued use of substances(Jaffe
and Anthony,2005), thus,
environment and social customs can
influence a person’s use of
substances.
67
B.Precipitating
Factors
a. Trauma At the age of According to Manfreda and Krampitz,

14 y/o Mr. Vin sometimes a few or several months
was already following the date of injury,
involved in pronounced changes in an
gang wars and individual’s personality and behavior
experienced are noted.
being hit at the (Psychiatric Nursing, 10th Edition p.13)
head with a
cue ball.
b. Intoxicants At the age of According to Manfreda and Krampitz,

14 y/o Mr. Vin narcotics, alcohol, bromides,
started barbiturates and Benzedrine, when
drinking taken in large amounts over a long
alcoholic period of time, many accumulate in
drinks and he the body and cause by the individual
was 15 y/o to manifest psychiatric symptoms.
when he used Most investigators believe, however
marijuana and that persons who take these drugs
injectables already endowed with a predisposing
drugs. sociopathic or neurotic personality
structure. (Psychiatric Nursing, 10th
Edition p.13)
Alcohol is a central neurons system
depressant that is absorbed rapidly
68
into the bloodstream. Initially, the
effects are relaxation and loss of
inhibitions. With intoxication, there is
slurred speech, unsteady gait, lack of
coordination and impaired attention,
concentration, memory and
judgment. Some people become
aggressions or display inappropriate
sexual behavior when intoxicated.
The person who is intoxicated may
experience black out.
Marijuana begins to act less than 1
minute after inhalation. Peak effect
usually occurs in 20 to 30 minutes
and last at least 2 to 3 hours. Users
report a high feeling seminar to that
with alcohol, lowered inhibitions,
relaxation, euphoria and increased
appetite. Symptom of intoxication
include impaired judgment and short
term memory, and distortions of time
and perception.
c. Lifestyle Mr. Vin is an A rare binge will probably not cause

early morning permanent memory problems, but
alcoholic. habitually abusing alcohol can cause
real damage. In fact, short-term
69
memory loss is one of the hallmarks
of alcoholism. Alcohol destroys brain
tissue and interferes with the process
of absorbing information so that it
never enters long-term memory.
Prolonged alcohol abuse causes
permanent damage to the memory
system. Short-term memory loss is
often the first indicator of alcohol-
related neurological damage. This
type of memory loss means a person
has difficulty remembering new
information, so the learning process
takes longer. It also reduces a
person's higher-level thinking (the
ability to think in abstract terms).
Excessive drinking changes the
underlying brain chemistry that
controls ability and skills. People who
habitually drink too much may also
experience blackouts -- periods of
amnesia that occur when the amount
of alcohol consumed prevents the
formation of memories in the brain. If
untreated, chronic alcoholics may
develop a confused state of thinking
that can lead to severe amnesia and
disorientation.
(Reference: Richard C. Mohs, Ph.D.)
B. Schematic Presentation
70
During this age, children begin to develop a sense of pride in their
accomplishments. They initiate projects, see through completion and feel
good about what they have achieved. Teachers at this time play a role in the
development of child. If children are encouraged and for their initiative they
begin to feel confident in their ability to achieve goals. If they are discouraged
by parents or teachers, then the child begins to feel inferior, doubting his own.
Abilities and therefore may not reach his potential.
School Age (5-12 yrs old)

Industry vs Inferiority
Mother Father
 financially supports family
 pampers need of patient whenever present
 give rewards to the patient in his
accomplishments
Pampered
patient
His elder
sister is the Engage
Although his with
busy at work one who
assist him in patient in
he still have school
time to his
children in
regards to their
education
71
Praise to Father
patient in his
achievement
Praise to Give rewards to

Give love
patient in his the patient in his
and support
achievement accomplishments
Became an honor
student
Patient had
discovered and
develops his own
capabilities
Industry
Adolescence ( 9- 18 yrs old)

Identity vs role confusion
During adolescence, the transition from childhood to adulthood is most

important. children are becoming more independent, and begin to look at the
future and terms of career, relationship, families, housing, etc. During this
period, they explore possibilities and begin to form their own identity upon the
outcome of their explorations. This sense of who they are can be hindered,
with results in a sense of confusion. (I don’t know what I want to be when I
grow up”) about themselves and their role in the world.
Mother Father Sibling Peers
72
Give love Temporary Doesn’t like Influence in
to the caregiver his attitudes using marijuana
patient - drinking
and alcohol
pampered - smoking
too much - cutting
classes
He was Support Don’t want

sent to children in to play with
Sulu with their needs the patient
his father because of
being
stubborn
Patient had develop

role confusion
Young Adult (18 – 30 yrs old)

Intimacy vs Isolation
Occurring in young adulthood, we begin to share ourselves more

intimately with others. To explore relationships leading toward longer term
commitments with someone other than a family member. Successful
completion can lead to comfortable relationship and a sense of commitment,
safety and care within a relationship. Avoiding intimacy, fearing, commitment
and relationships can lead to isolation, loneliness and sometimes depression.
Mother Father Siblings Peers
Give love Give Give love and He had a

Let the Give patient
to patient support to
patient what
Give he
the 73 care for girlfriend
the family
play with wants
family their
financially patient once but not
his friends basic needs
serious
Pampered Continue
patient with his
vices
Age 27 became
violent
Always stayed with

his peers or
neighbors
Never had a serious

relationship of the
opposite sex
Isolation
74
Middle Adulthood ( 41 -60 yrs old)
Generativity vs Stagnation
Generativity derives from the word generation, as in parents and children, and
specifically the unconditional giving that characterizes positive parental love
and care for their offspring. Erikson acknowledged that this stage also
extends to other productive activities. Work and creativity for relationship but
given his focus on childhood development and probably the influence of
Freudian theory, Erikson’s analysis at this stage was strongly oriented
towards parenting . Generativity, potentially extends beyond once own
children, and also future generation which gives the mode ultimately a very
modern globally responsible perspective.
Stagnation is and extension of intimacy which turned in the form of self-
interest and self- absorption. It’s the disposition that requirements feeling of
selfishness, self indulgence, greed, lack of interest in young people and future
generation and wider world.
Stagnation and or self-absorption result from not having an outlook of
opportunity for contributing to the good or growth of children and others
potentially to the wider world.
Father Siblings Peers
- Pampered Let the Companion in

the patient
patient decide drinking
- Give the what he alcohol,
patients
wants smoking,
what he
wants
75
No work at all
Always stayed with his

friends
Patient became violent as

manifest by:
- Ideas of reference
- - Homicidal
- Auditory
halllucination
Admitted on January 7, 2010

NDRC
76
VI. LABORATORY EXAMINATION
Actual Nursing
Type of Test Indication Normal Values Implication
result responsibility
Refer to NOD
0-17 10/ul Normal for any
unusualities
WBC
Refer to NOD
0-3 1/HPF Normal for any
unusualities
Refer to NOD
unusualities
RBC
Refer to NOD
unusualities
Refer to NOD
Urinalysis unusualities
Epithelial Cells
U/A Refer to NOD
unusualities
Refer to NOD
unusualities
CAST
Refer to NOD
unusualities
Refer to NOD
unusualities
Bacteria
Refer to NOD
unusualities
Color - Straw Yellow

Character - Cloudy
Reaction - 6.0
Specific gravity - 1.025
Albumin - Negative
Sugar - Negative
77
VII.DIAGNOSIS
A. Psychotic Disorders
Common Characteristics:
The major symptom of these disorders is psychosis, or delusions and

hallucinations. Delusions are false beliefs that significantly hinder a person's
ability to function. For example, believing that people are trying to hurt you
when there is no evidence of this, or believing that you are somebody else,
such as Jesus Christ or Cleopatra. Hallucinations are false perceptions.
They can be visual (seeing things that aren't there), auditory (hearing),
olfactory (smelling), tactile (feeling sensations on your skin that aren't really
there, such as the feeling of bugs crawling on you), or taste.
Categories:
a. Schizophrenia (Paranoid, Disorganized, Catatonic, Undifferentiated, and
Residual)
b. Schizophreniform Disorder
c. Schizoaffective Disorder
d. Delusional Disorder
e. Brief Psychotic Disorder
f. Shared Psychotic Disorder
78
Schizophrenia, Paranoid Type
Positive or Hard Symptoms: Negative or Soft Symptoms:
Ambivalence Alogia √
Associative looseness Anhedonia
Delusions (Persecutory or Apathy
Grandiose; occasionally
excessive religiosity)
Echopraxia Blunted Affect √
Flight of Ideas Flat affect
Hallucinations √ Lack of volition √
Ideas of Reference Other Symptoms:
Perseveration Hostility √
Aggressive behavior
TOTAL = 5 / 16 x 100 PERCENTAGE = 31.25%
Schizophrenia, Disorganized Type

Delusions Apathy
Flight of Ideas Grossly Inappropriate or Flat
affect
Perseveration Incoherence
Extremely Disorganized
Behavior
TOTAL = 4 / 16 x 100 PERCENTAGE = 25%
Schizophrenia, Catatonic Type

Ambivalence Alogia or mutism √
Delusions Apathy
Echolalia Catatonia or Marked
Psychomotor Disturbance
79
(either motionless or
excessive motor activity)
Flight of Ideas Flat affect
Perseveration Waxy flexibility or stupor
Extreme Negativism
Peculiarities of voluntary
movement
Schizophrenia, Undifferentiated Type

(Mixed Schizophrenic Forms)
Flight of Ideas Catatonia
Hallucinations √ Flat affect
Ideas of Reference Lack of volition √
Perseveration
Other Symptoms:
80
Hostility √ Waxy flexibility or stupor
Aggressive behavior Extreme Negativism
Incoherence Peculiarities of voluntary
movement
Extremely Disorganized
Behavior
Schizophrenia, Residual Type

(Characterized by one of the following, though not a current episode)
Ambivalence Alogia
Echopraxia Blunted Affect
Hallucinations Flat affect
Ideas of Reference Lack of volition
Perseveration
Other Symptoms:
Hostility Waxy flexibility or stupor
Aggressive behavior Extreme Negativism
Incoherence Peculiarities of voluntary
movement
Extremely Disorganized Social Withdrawal
Behavior
TOTAL = PERCENTAGE =
81
Schizophreniform (less than 6 months of the following symptoms)
Ambivalence Alogia
Delusions Apathy
Perseveration
Schizoaffective (Psychotic Disorder + Mood Disorder)

Psychotic Disorder Symptom Mood Disorder Symptoms
Positive or Hard Symptoms:
Ambivalence
Associative looseness
Delusions
Echopraxia
Flight of Ideas
Hallucinations
Ideas of Reference
Perseveration
Negative or Soft Symptoms:
Alogia
Anhedonia
Apathy
Blunted Affect
Catatonia
Flat affect
Lack of volition
82
Delusional Disorder
One or more non-bizarre or believable delusions
Brief Psychotic (sudden onset of at least one of the following which last
from 1 day to 1 month)
Ambivalence Alogia
Delusions Apathy
Perseveration
Shared Psychotic Disorder

Delusions such as in delusional disorder which are similar in content to
those of an individual who already has an established delusion.
B. Mood Disorders
Common Characteristics:
The disorders in this category include those where the primary symptom is a
disturbance in mood. In other words, inappropriate, exaggerated, or limited
range of feelings. Everybody gets down sometimes, and everybody
83
experiences a sense of excitement and emotional pleasure. To be diagnosed
with a mood disorder, your feelings must be to the extreme. In other words,
crying, and/or feeling depressed, suicidal frequently. Or, the opposite
extreme, having excessive energy where sleep is not needed for days at a
time and during this time the decision making process in significantly
hindered.
Categories:
a. Major Depressive Disorder
b. Bipolar Disorder (Type I, Type II and Mixed Type)
Major Depressive Disorder Symptoms

Tiredness An hedonism
Change in sleep pattern Depressed mood
Unintentional weight change of Agitation or psychomotor
5% or more in a month retardation
Worthlessness or guilt Hopelessness, helplessness,
inappropriate to the and/or suicidal ideation
situation(possibly delusional)
Typical Mania Symptoms

Tiredness An hedonism
Change in sleep pattern Depressed mood
Unintentional weight change of Agitation or psychomotor
5% or more in a month retardation
Worthlessness or guilt Hopelessness, helplessness,
inappropriate to the and/or suicidal ideation
situation(possibly delusional)
84
VIII. MEDICAL MANAGEMENT
85
X.PROGNOSIS and RECOMMENDATIONS
A. Onset of Illness: 1
In the year 1981, when Mr. Vin was still 27 yrs. old patient manifested
onset of illness. According to his younger brother, he is naturally hot
tempered but it got worst with his visual and auditory hallucination due to long
term use of alcohol and drugs. The patient was observed talking and laughing
by himself.
86
Substance induced psychosis results from polysubstance abuse or abuse
of more than one substance. It is generally manifested during long term use
of substance/s and withdrawal of use.
B. Duration of Illness
When Mr. Vin’s was still 27 yrs. old, the signs and symptoms of Substance
Induced Psychosis were observed and until now he is still manifesting
evidence signs and symptoms of Substance Induced Psychosis Mr. Vin was
first admitted at DMH(1981-1990), Taguig Rehabilitation Center(1992-2001),
St. Elizabeth(2003) and Dela Rosa Psychiatric Facility(2005) and recently at
New Day Recovery Center(Jan. 7, 2010).
Poor outcomes have been associated with an earlier age at onset, longer
periods of substance use, and the co-existence of a major psychiatric illness.
(Psychiatric Mental Health Nursing by Sheila L. Vide beck p. 371)
C. Predisposing/ Precipitating Factors: 1

The factors affecting Mr. Vin performance has been tabulated.
Predisposing factors include the age, environmental and social factors and
previous attacks. While the precipitating factors, include trauma, intoxicants
and Lifestyle. (Psychiatric Nursing by: Manfreda & Krampitz 10th ed.)
D. Mood and Affect: 2

During the nurse-patient interaction, Mr. Vin was asked some questions
and he answered it appropriated. A happy mood has been observed, but he
maintains a blunted affect all throughout the interaction.
Clients may be pleasant and seemingly happy, appearing unaffected by
the situation, especially if they are still in denial about the substance use.
.(Psychiatric Mental Health Nursing by Sheila L. Vide beck p. 383)
87
E. Attitude and willingness to take medication and treatment: 2
Clients who are substance abuse generally describe some crisis that
precipitated entry into treatment, such as physical problems or development
of withdrawal symptoms while being treated for another condition. Usually,
other people such as an employer threatening a loss of job or a spouse or
partner threatening loss of relationship are involved in a client’s decision to
seek treatment. Rarely do clients decide to seek treatment independently with
no outside influence.
F. Any Depressive Features: 3

Clients have low self esteem, which they may express directly. They do
not feel adequate to cope with life an stress without the substance and often
are uncomfortable around others when not using the substance. They often
have difficulty identifying and expressing true feelings, in the past, they have
preferred to escape feelings and to avoid any personal pain or difficulty with
the help of the substance. Hence, they feel depressed. .(Psychiatric Mental
Health Nursing by Sheila L. Vide beck p. 383)
G. Family Support: 2
Treatment and support groups are available to address the issues of
family members. Clients and family also need information about support
groups, their purpose, and their locations in the community.
.(Psychiatric Mental Health Nursing by Sheila L. Vide beck p. 384)
88
89
III. BIBLIOGRAPHY
Textbooks:
Basic Concepts Of Psychiatric--Mental Health Nursing. 6th ed. Shives, Louise
Rebraca.Philadelphia : Lippincott Williams & Wilkins, c2005.
Lippincott's Manual of Psychiatric Nursing Care Plans. 7th ed. Schultz, Judith
M.
and Videbeck, Sheila L. Philadelphia : Lippincott Williams & Wilkins,
c2005..
Psychiatric-Mental Health Nursing. 4th ed.Videbeck, Sheila L.; illustrations by
Cathy J. Miller. Philadelphia : Lippincott Williams & Wilkins, c2008.
Psychiatric Nursing: A Textbook and a Reviewer. 2nd ed. Evangelista-Sia,
Maria
Loreto J. Quezon City : RMSIA Publishing, c2008.
Psychiatric Nursing: Contemporary Practice.3rd ed. Boyd, Mary Ann.
Philadelphia
Lippincott Williams & Wilkins, c2005.
Website:
http://www.psychologynet.org/dsm.html
http://allpsych.com/disorders/d
Substance abuse (Psychotic Disorder + Mood Disorder)

Psychotic Disorder Symptom Mood Disorder Symptoms
Positive or Hard Symptoms:
90
Ambivalence
Associative looseness
Delusions
Echopraxia
Flight of Ideas
Hallucinations
Ideas of Reference
Perseveration
Negative or Soft Symptoms:
Alogia
Anhedonia
Apathy
Blunted Affect
Catatonia
Flat affect
Lack of volition
91

JR and A Manu

Caricato da

Informazioni sul documento

Descrizione originale:

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

JR and A Manu

Caricato da

Copyright:

Formati disponibili

A CASE STUDY OF

SUBSTANCE- INDUCED PSYCHOSIS

In Partial Fulfillment of the Requirements

Presented to the level III Clinical Instructors

CHAPTER III ANAMNESIS…………………………………..…………...5

CHAPTER VII DIAGNOSIS………………………………………………..42

Those aspects of clinical nursing care that involve interpersonal

A substance-induced psychotic disorder is sub-typed or categorized

Substance abuse problems are serious medical and public health

Apparent understanding of present illness of patient: The father verbalized,

Other Characteristics and Attitude of the Informant: The informant is friendly

Apparent understanding of present illness of patient: During the interview, he

Apparent understanding of the present illness of the patient: As verbalized by

Name: Raffy Aron

Apparent understanding of the present illness of the patient: The informant

Apparent understanding of the present illness of the patient: “Kana si Vinz

Apparent understanding of the present illness of the patient: “Maglakaw-lakaw

According to Mr. Vin’s father, their family has no known history of

The mother of Mr.Vin, as described by the father is so kind, caring

However, this method of disciplining has changed over time

Patient Name: Mr. Vin

Personal and Social History:

Pre-school - Informant cannot recall.

Adolescent – Patient is an honor student, good in declamation, good

History of present Illness- would hurt (“Gibunalan ang amahan ug

Patient’s words = “Gidala man ko nila sa rehab.”

Date in year Hospital / Duration Age of Patient

2001 – After patient was discharged on Taguig Rehabilitation and brought

IV. COURSE IN THE HOSPITAL

2. Activity (√) Normoactive ( ) Hyperactive, Restlessness

3. Facial Expression: (√) Appropriate ( ) Inappropriate

A. MOOD: (√) Euthymic ( ) Depression ( ) Euphoric

B. AFFECT: ( ) Appropriate ( ) Inappropriate

E. SUICIDAL POTENTIAL ( ) Present (√) Absent

F. HOMICIDAL POTENTIAL ( ) Present (√) Absent

IV. THOUGHT CONTENT

The client does not report anything that he sees/hears/smells/feels/tastes

D. DIURNALVARIATION: Client is sometimes hyperactive especially during

therapy and when he was asked to dance, and sometimes during

therapies he felt drowsy.

E. ATTENTION SPAN: (/) Good ( ) Fair

VII. GENERAL SENSORIUM & INTELLECTUAL STATUS

mag-igsuon migo?.” Client: “kinamanghuran man ko.”

RECENT (√) Unimpaired ( ) Impaired

ganiha migo?” Client: “ pinakbet man to maam.”

IMMEDIATE (√) Unimpaired ( ) Impaired

he was asked to spell the word FLOWER backwards.

C.CALCULATION: Progressive Subtraction of 7’s from 100

E. ABSTRACT THINKING ABILITY

F. JUDGEMENT AND REASONING: ( √) Unimpaired ( ) Impaired

IX. SUMMARY OF MENTAL STATUS EXAMINATION

DAVAO DOCTORS COLLEGE

II. STREAM OF TALK

C. ACCESSIBILITY ( ) Good (√) Fair ( ) Self-Absorbed

III. EMOTIONAL STATE AND REACTION

A. MOOD: (√) Euthymic ( ) Depression ( ) Euphoric

B. AFFECT: (√) Appropriate ( ) Inappropriate

C. DEPERSONALIZATION & DEREALIZATION

E. SUICIDAL POTENTIAL ( ) Present (√) Absent

F. HOMICIDAL POTENTIAL ( ) Present (√) Absent

IV. THOUGHT CONTENT

D. DIURNALVARIATION: The usual day to day activities (from morning to night)