BULACAN STATE UNIVERSITY

Mojon, City of Malolos, Bulacan COLLEGE OF NURSING

A Case Study of a 32 years old Male Client with a Diagnosis of Undifferentiated Schizophrenia

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ACKNOWLEDGEMENT
The group wishes to express their deepest gratitude and warmest appreciation to the following people, who, in any way gave us the possibility making this case study a success: First of all, to the Almighty God, who never cease in loving us and for the continued guidance and protection. To the groups clinical instructor, Mrs. Maria Ongleo, RN, Mrs. Leila Calma, RN, Mrs. Edna Anez, RN and Mr. Clark Ian Francisco, RN for their guidance and support in the duration of the study and during the psychiatric nursing exposure , whose help, stimulating suggestions and encouragement helped us in all the time of making this case study. 3/20/13

The group also wishes to acknowledge the invaluable assistance and cooperation of the staff of the Mariveles Mental Hospital (MMH),especially those who are in the acute crisis intervention service (ACIS) for allowing us to conduct this study, for essential assistance in reviewing the patient files and giving us the opportunity to care for the mentally-ill patients. Special appreciation is extended to the client subjected for this study and other informants for their selfless cooperation, time and entrusting personal information needed for this study. To our parents who have always been very understanding and supportive both financially and emotionally. And lastly, to our dear pan elist for sharing their time and giving us 3/20/13 additional knowledge which are not just found

This is the case of Mr. R.F., 32 years old male client that was admitted at Mariveles Mental hospital last March 6, 2013 and was diagnosed with undifferentiated schizophrenia. The patient was admitted at the Acute Crisis Intervention Service ( ACIS ) due to the complaints of the informant that the client harms other people, stabbed his uncle, has poor sleep, refuses to take medications and is irritable.
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INTRODUCTION

One of the most positive areas of schizophrenia research today is in the area of identification of early risk factors for development of schizophrenia, and prevention of schizophrenia in those people who are predisposed to the disease. (source:NeuropsychiatryReview) .
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are 5 subtypes of There schizophrenia naming; paranoid, disorganized, catatonic, undifferentiated, and residual. Paranoid type is characterized by persecutory or grandiose delusions, hallucinations and occasionally excessive religiosity hostility and aggressive behaviour. Disorganized type is characterized by inappropriate or flat affect, disorganized speech and disorganized behaviour.
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The catatonic is characterized by marked psychomotor disturbance, either motionless or excessive motor activity. Motor immobility may be manifested by waxy flexibility or stupor. Excessive motor activity is apparently purposeless and not influenced by external stimuli. Other features include extreme negativism, echolalia, echopraxia or even mutism.
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The residual is characterized by the absence of prominent delusions, hallucinations, disorganized speech and grossly disorganized or catatonic behavior. Our client was classified and diagnosed as schizophrenia, undifferentiated type. Which means, that she demonstrated mixed schizophrenic symptoms of others but not enough of them to define its particular type.
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Schizophrenia undifferentiated is the type of schizophrenia wherein characteristic symptoms (delusions. Hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms) are present, but criteria for paranoid, catatonic, or disorganized subtypes are not met.

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According to American Accreditation HealthCare Commission risk factors of schizophrenia are the following:

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AGE Schizophrenia can occur at any age, but it tends to first develop (or at least become evident) between adolescence and young adulthood. Schizophrenia in children is likely to be severe. Although the risk of schizophrenia declines with age, its incidence has been known to peak in those who are about 45 years old, and again in people who are in their mid60s (mostly women). Late-onset schizophrenia that develops in the 40s is most likely to be the paranoid subtype with fewer negative symptoms or learning impairment. Such patients usually have functioned at a near-normal level until structural deficits in the brain break down.

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GENDER Although schizophrenia affects both men and women, there are some differences:Men tend to develop schizophrenia between the ages of 15 - 24. Paranoid schizophrenia may be more common in men, and symptoms tend to be more severe.The onset in women is usually slightly later, between ages 25 - 34, and the symptoms tend to be less severe. The earlier a girl starts menstruation, the longer she is protected against schizophrenia. Schizophrenia is more severe during a woman's menstrual cycle when estrogen levels are low. Such findings and other evidence suggest that estrogen may have nerve-protecting properties. For example, the higher the estrogen levels in female patients with schizophrenia, the better their mental functions.
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INTELLIGENCE People with schizophrenia span the full range of intelligence. In fact, one study reported that a higher than expected number of people who develop schizophrenia had been intellectually gifted children. Research suggests, however, that a decline in IQ scores during childhood may be a sign of potential psychotic symptoms in adults.

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CULTURAL AND GEOGRAPHIC FACTORS No cultural or geographic group is immune from schizophrenia, although the course of the disease seems to be more severe in developed countries. However, the content of delusions may vary depending on a person's culture. According to one study, European patients were more apt to have delusions of poisoning or religious guilt while in Japan the delusions were most often related to being slandered.
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SOCIOECONOMIC FACTORS Schizophrenia occurs twice as often in unmarried and divorced people as in married or widowed individuals. Furthermore, people with schizophrenia are eight times more likely to be in the lowest socioeconomic groups. However, these findings are likely to be a result of schizophrenia rather than a cause. Nevertheless, low income and poverty increases the risk for delayed diagnosis and treatment, and such delays could lead to more severe disease in patients with fewer resources
.

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FAMINE AND MALNUTRITION Prenatal malnutrition may also play a role in the development of schizophrenia. Some studies have found that people who are born during times of famine are more than twice as likely to develop schizophrenia as those born during years of adequate food. The association between famine and schizophrenia illustrates how environmental and biologic factors are connected. For example, scientists think that malnourished mothers may not get enough folate in their diet. Folate is a micronutrient important for genetic processes. Folate deficiencies may cause genetic mutations in the developing fetus that can lead to schizophrenia.
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OTHER FACTORS ASSOCIATED WITH SCHIZOPHRENIA Being Left- or Mixed-Handed. The rate of left-handedness or mixed-handedness is significantly higher among patients with schizophrenia than the general population. This suggests that some neurologic pattern that may be responsible for each. (A large minority of the population is non-right handed, and very few of these people develop schizophrenia.)
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Obsessive-Compulsive Disorder. Obsessive compulsive disorder (OCD) affects a significant number of schizophrenic patients. OCD is an anxiety disorder marked by obsessions (recurrent or persistent mental images, thoughts, or ideas) that may result in compulsive behaviors, repetitive, rigid, and self-prescribed routines that are intended to prevent the manifestation of the obsession. Some doctors believe the behaviors exhibited in the disorder may actually be protective in people with schizophrenia in early stages.
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Behavioral and Motor Problems in Childhood. Children who later develop schizophrenia often suffer from the following certain problems, including excessive shyness or minor early physical and motor-control problems. Such problems are so common, however, that their presence without any other risk factors is no cause for concern
.

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Fathers Age. According to some studies, the older a father is when a child is born, the greater the risk is for schizophrenia in his offspring, perhaps because of a greater chance of genetic mutations in the sperm that can be passed on. In one study, children of fathers who were 50 years old or more faced a three-fold risk for schizophrenia compared to children of fathers who were 25 or younger.
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Epilepsy. A family history of epilepsy increases the chance for developing schizophrenia or similar psychosis. Scientists think that epilepsy and schizophrenia may share similar genetic or environmental factors. (www.urac.org).

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Schizophrenia is not a terribly common disease but it can be a serious and chronic one.
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Schizophrenia Ranks among the top 10 causes of disability in developed countries worldwide (source: The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank, Harvard University Press, 1996. http://www.who.int/msa/mnh/ems/dal ys/intro.htm )
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Schizophrenia is a severe form of mental illness affecting about 7 per thousand of the adult population, mostly in the age group 15-35 years. Though the incidence is low (3-10,000), the prevalence is high due to chronicity (www.hon.ch).

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Schizophrenia is a treatable disorder, treatment being more effective in its initial stages (www.hon.ch). More than 50% of persons with schizophrenia are not receiving appropriate care (www.hon.ch). 90% of people with untreated schizophrenia are in developing countries (www.hon.ch).
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Worldwide about 1 percent of the population is diagnosed with schizophrenia. About 1.5 million people will be diagnosed with schizophrenia this year around the world. (mentalhelp.net).
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Ninety-five percent (95%) suffer a lifetime; thirty-three percent (33%) of all homeless Americans suffer from schizophrenia; fifty percent (50%) experience serious side effects from medications; and ten percent (10%) kill themselves (Keltner, 2007).
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According to study done 697,543 out of 86,241,697 of Filipinos or approximately 0.8% are suffering from schizophrenia (cureresearch.com). There are 697,543 cases of schizophrenia in the Philippines, 75% are males and the rest are females. And 51 million people worldwide suffer from schizophrenia in which males have the most number of percent. This statistics shows that males have the greater risk to develop psychiatric disorder such as schizophrenia because of their lifestyle and keeping their emotions.
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Here in Mariveles Mental Hospital the total numbers of in patients are 491and according to the record section the most prevalent case is Schizophrenia.

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We have chosen this case for the reason that we want to gain more knowledge about the disorder which is undifferentiated schizophrenia and also to enhance the knowledge we had learn from Psychiatric Nursing in relation to its application in actual setting.

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objectives
General

Objectives:

This case presentation aims to identify and determine general health problems and needs of patient with Undifferentiated Schizophrenia. This also intends to present an extensive and comprehensive case study of our chosen client that would present an inclusive discussion of Undifferentiated Schizophrenia to yield important information and gain additional knowledge which can be utilize on the future.
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objectives
Student-Centered
After

the case presentation, the students will be able to: and discuss various theories of etiology of Undifferentiated Schizophrenia data using the nursing process in the care of client with Undifferentiated Schizophrenia
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Knowledge
Define

Analyze

objectives
Skills
Present

relevant and valid data that were gathered in an organized manner. appropriate interventions such as health teaching to client with Undifferentiated Schizophrenia, giving special considerations to the chief complaint of the client related to his condition. effective therapeutic communication skills to the client. teaching to client, families and
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Implement

Utilize

Provide

objectives
Attitude
Establish

therapeutic communication and rapport with the client for effective nursepatient interactions all throughout the care providing process. own emotions while in the actual field of duty.

Manuever

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