SCHIZOPHRENIA: NURSING CASE STUDY
INTRODUCTION
This is a case study describing the assessments that would be carried out on the patient as per the particulars given in the brief. It also describes the diagnostic inferences and suggested treatments.
In this case, there appears to be a medical problem as well as certain concerns of psychiatric nature. Hence, both types of evaluations would be recommended in order to enable a clear diagnosis.
PATIENT’S DETAILS
Name: Marilyn
Age: 22 years
Gender: Female
Profession: Student (final year at university)
Complaints: Burning sensation during urination, fever, pain during sexual intercourse, fatigue, irritability, low mood, sadness, auditory hallucinations over the past year, and the recent loss of interest in hobbies like music.
Duration: Burning sensation for the past week.
Physical examination: BMI: 24; Blood Pressure: Slightly elevated; Body temperature: Slight fever.
Medical history: Alcohol and cannabis use from the age of 10 years to date. Continued regular recreational smoking of cannabis. At present, daily consumption of alcohol.
Mental health history: The patient has not previously undergone a psychiatric evaluation. Describes hearing voices in her head. The voices were pleasant at first, but they are now disturbing and cause her stress. Denies suicidal ideation. Describes paranoid tendencies.
DIAGNOSIS
The urinary symptoms clearly indicate a bacterial urinary tract infection. This has been confirmed by urine culture. The patient is sexually active, hence which is a potential pathway for acquiring the infection. Alternatively, UTI is often caused by excessive consumption of alcohol,(Ronald, 2003) and this patient admits to a long history of alcohol and cannabis use. Her blood pressure is slightly elevated and blood investigations indicate mild hyperglycemia which could be an early indicator of diabetes. She is definitely overweight. All of these signs support the diagnosis of alcohol abuse. Hence, it is quite likely that UTI is an outcome of alcohol consumption. It is possible that the urinary tract infection is unrelated to the patient’s psychiatric symptoms.
However, substance abuse over the long term has also been connected to auditory hallucinations and psychiatric disorders. The patient’s symptoms, taken together, make a strong case for schizophrenia. For one, she has recently been withdrawing from social contact and spending a lot of time alone. She describes losing interest in activities that were formerly of great interest to her. Additionally, her participation at university has also been impacted. This might be a sign of a drop in her ability to focus. Impairment in concentration and social withdrawal are typical signs of schizophrenia. Her recent episodes of paranoia also support this finding. Imaging tests were undertaken to identify indicators such as enlargement of ventricles. The findings were positive for schizophrenia. (Lawrie et al, 1988)
THEORIES OF CAUSATION
The etiology of schizophrenia is not well understood. Research into this area is ongoing and at present, it suggests that the illness arises out of a complex interplay between genetic, environmental, and lifestyle factors. In this patient’s case, there is no documented family history of the condition. However, she is known to be struggling with substance addiction and this is clearly identified as a known trigger for schizophrenia in medical literature and clinical practice. Both substance abuse and by extension, schizophrenia, are known to be exacerbated by stress. (Falloon et al, 1982) The patient is in the final year of university and this may be a factor for elevated stress.
The relationship between marijuana use and schizophrenia continues to be the subject of research. Some studies indicate that the drug increases the likelihood of psychosis while others negate this idea. Cannabis can certainly have a therapeutic effect but when regular use begins in childhood or during adolescence, there are greater chances of a lasting detrimental impact on cognitive development and socialisation. (Arseneault et al, 2002) This may explain the patient’s recent tendency to remain withdrawn and isolated. Early initiation of substance abuse may indicate the probability of emotional trauma or other forms of childhood abuse. Such abuse could also form the basis for psychosis in various forms, including auditory hallucinations and paranoia. This would need to be looked into in greater detail.
The final diagnosis is that the patient appears to be in the early stages of schizophrenia. This may have been triggered by substance abuse.
TREATMENT PLAN
Schizophrenia is a chronic illness and although it is not curable, it is certainly possible to manage it effectively in such a way that the patient is able to continue living a full life. On the other hand, alcohol and marijuana addiction is certainly curable.
The Schizophrenia care plan for Marilyn would most likely involve multiple pathways. First, in order to treat medical symptoms such as the urinary tract infection, she will be given antibiotics. For best results, she must continue on the course until completion even if the symptoms are relieved well before completion of the course. In order to prevent the recurrence of the UTI and to avoid further complications arising out of alcohol and cannabis abuse, she will have to be enrolled in a rehabilitation programme to gradually wean her off these substances. This will have to be a lifelong commitment to stay clean and avoid relapses.
Treatment for schizophrenia itself will involve antipsychotic, anti-depressant, and anti-anxiety medications. Depending on her response the specific drugs and dosages will be varied. This will help to relieve her auditory hallucinations, stress, and paranoia. It may be helpful to ease withdrawal symptoms during addiction rehabilitation. It is highly recommended for the patient undergo psychosocial therapy. With the help of this holistic therapy, we expect that the patient will regain her interest in socialisation and hobbies. She will be able to normalise thought patterns and actively avoid negative ones. For best results, it is recommended that her family fully participate in this process and provide Marilyn with the support she needs.
REFERENCE LIST
Arseneault, L., Cannon, M., Poulton, R., Murray, R., Caspi, A. and Moffitt, T.E., 2002. Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. Bmj, 325(7374), pp.1212-1213.
Falloon, I.R., Boyd, J.L., McGill, C.W., Razani, J., Moss, H.B. and Gilderman, A.M., 1982. Family management in the prevention of exacerbations of schizophrenia: a controlled study. New England Journal of Medicine, 306(24), pp.1437-1440.
Lawrie, S.M. and Abukmeil, S.S., 1998. Brain abnormality in schizophrenia. A systematic and quantitative review of volumetric magnetic resonance imaging studies. The British Journal of Psychiatry, 172(2), pp.110-120.
Ronald, A., 2003. The etiology of urinary tract infection: traditional and emerging pathogens. Disease-a-Month, 49(2), pp.71-82.
