Nursing Case Study - Mental Health Nursing

This article discusses the complex aetiology, signs and symptoms of schizophrenia and the health promotion and recovery options available. It also includes a nursing case study on mental health nursing.

Running head: Mental Health Nursing
Nursing Case Study
-Mental Health Nursing
Name of the Student
Name of the University
Author Note

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Introduction to Schizophrenia:
Schizophrenia can be understood as a chronic form of mental health disorder that
affects how an individual behaves, thinks or feels. Schizophrenic patients often seem distant
or disconnected with reality, and even though it is not a common disorder, the effects can be
very debilitating (Nimh.nih.gov 2018). Individuals suffering from Schizophrenia might often
experience auditory hallucinations (‘hearing voices’), and develop paranoia (thinking
someone is trying to hurt them). It can also affect their communication, emotions and thought
process, and also reduce their ability to take care of themselves or to retain their jobs
(Medlineplus.gov 2018).
Aetiology:
Schizophrenia affects about 1% of the global population. Till date the exact cause(s)
of schizophrenia or schizoid disorders have not been fully identified, however studies do
show that such conditions can develop through a complex interaction between environmental,
genetic physical and psychological factors. It might be possible that some people to be more
prone to develop this condition, where certain events can trigger an episode of psychosis
(nhs.uk 2018; Cunningham and Peters 2014). Tsoi, Hunter and Woodruff (2008) pointed out
those genetic factors can play a crucial role in the aetiology of schizophrenia. This is justified
by the fact that early brain development pattern of the brain and its neurotransmitter receptor
system is highly regulated by genetic codes, and that environmental stress and ‘expressed
emotion’ can cause an onset of the disorder. Other environmental factors that can also lead to
the development of this disorder include exposure to viruses, malnutrition before birth, birth
complications and psychosocial factors (Nimh.nih.gov 2018). Difference in brain chemistry
and structures, involving the neurotransmitters dopamine and glutamate is also being linked
with schizophrenia, while other studies shows such dysfunction can also occur during the

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development of the brain during puberty, caused by genetic and environmental factors
(Steiner et al. 2015).
Signs and Symptoms:
Onset of schizophrenia can occur between the ages of 16 to 30 years, but can also
occur in children in rare cases. The symptoms caused due to schizophrenia can be classified
into two categories: positive symptoms (like delusions or hallucinations that can alter
thought processing, behaviour and cause detachment from reality) and negative symptoms
(that can lead to withdrawal, disruptions to normal emotions and lack of function).
Hallucinations can include seeing, hearing, feeling smelling or tasting something that does
not exist out of the mind, and auditory hallucination (hearing voices) is the most common
among them. The voices heard in these episodes of hallucination generally describe events or
activities, discuss the thoughts or behaviour of the individual, instruct on specific actions, and
also engage in active communication. The voices can also seem to come from different
sources. Delusional symptoms include having a false or wrong conviction about something,
based on an unrealistic or mistaken idea. This can severely affect the behaviour of the person.
The episodes of hallucination can also lead to paranoid delusions (feeling that someone is,
or attempting to watch, follow or even chase or persecute them). Though Disorders can also
occur in schizophrenia that can affect their though process and cognition, leading to
confusion. Though disorders can also reduce the ability to concentrate or communicate, and
subsequently make the person more erratic and disorganized, and cause mood swings. The
negative symptoms can cause a loss of motivation to care for themselves, and severity affect
the memory, attention span, and can also cause depression and withdrawal and reduce
cognitive and executive functioning as well as coherence (nimh.nih.gov 2018; nhs.uk
2018).

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Relation to patient’s condition:
The patient, Mr X (name withheld to maintain confidentiality), a 21 year old male
have already exhibited a reclusive behaviour, quit his job, showed inappropriate
suspiciousness and stopped answering the door when his friends came. He even expressed
suspicion that he was being used for experimentations on thought control by the government
(delusional thought), where electrodes were being placed in his brain to receive specific
signals. He was further assured of this when he heard the neighbour’s dog bark in the middle
of the night, and he started receiving ‘coded messages’ and ‘covert signals’ from the radio all
the time (hallucinations and paranoia). However, the patient did not show any signs of mood
swings or dysfunction, his speech was understandable and was coherent, and did not exhibit
any loss of disturbance in motor functions. The auditory hallucinations, reclusive behaviour,
paranoid delusions and suspicions point out towards many of the ‘positive’ schizophrenic
symptoms. Negative symptoms seem to be limited to the reclusive behaviour of the patient,
and could potentially get aggravated over time if not treated.
Health Promotion and Recovery Options:
Since the aetiology of this disorder is unclear, treatment options are aimed to reduce
or remove the symptoms of the disease, and can involve antipsychotics, psychosocial
treatment, coordinated specialty care (CSC) (Nimh.nih.gov 2018). The psychosocial
treatment can further include several aspects like family education, illness management,
Cognitive Behaviour and substance abuse (nimh.nih.gov 2018). O’Brien (2018) pointed out
that social Therapy (CBT), rehabilitation, self help and advocacy groups, and
interventions for addiction stigmatization have affected the health promotion needs for
individuals with schizophrenia and their families, ignoring the need for symptom
stabilization, prevention of relapse, and support to the caregivers. A sense of guilt, fear, grief

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or isolation felt by the family members or caregivers also renders them less proactive and
capable of providing proper care. Moore et al. (2015) suggests that equity of access to all
levels of healthcare like acute care, long term care and management, preventative medicine
and health promotion can reduce the mortality risk due to schizophrenia. Carney, Bradshaw
and Yung (2015) also added that intervention strategies should be investigated for individuals
identified at risk for developing psychosis, and prevention of cardio metabolic risk factors in
such individuals should be considered. Additionally, increasing physical activity, reduce
sedentary lifestyle, and encouraging cessation of smoking can help to alleviate or even
prevent the effects of schizophrenia. The importance of physical activity has also been
highlighted by many other authors (Vancampfort et al. 2015; Stubbs et al. 2016; Rosenbaum,
Tiedemann and Ward 2014; Stubbs et al. 2017)
Conclusion:
Schizophrenia and schizoid disorders have a complex aetiology, involving several
causative factors in a complicated interplay. Genetic propensity, combined with
environmental triggers can cause an early onset in susceptible individuals. Since the specific
causes of schizophrenia are not well understood, treatment and management of this disorder
aims to reduce or remedy the effects of the disorder on the individual, and health promotions
are aimed to eliminate the risks that can trigger an onset of the disorder or promote recovery
of affected individuals.

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References:
Carney, R., Bradshaw, T. and Yung, A. (2015). Physical health promotion in people with
schizophrenia: why we should consider the ultra high-risk state. Acta Psychiatrica
Scandinavica, 133(2), pp.166-167.
Cunningham, C. and Peters, K. (2014). Aetiology of Schizophrenia and Implications for
Nursing Practice: A Literature Review. Issues in Mental Health Nursing, [online] 35(10),
pp.732-738. Available at:
http://www.tandfonline.com/doi/full/10.3109/01612840.2014.908441 [Accessed 7 Feb.
2018].
Medlineplus.gov (2018). Schizophrenia: MedlinePlus. [online] Medlineplus.gov. Available
at: https://medlineplus.gov/schizophrenia.html [Accessed 7 Feb. 2018].
Moore, S., Shiers, D., Daly, B., Mitchell, A. and Gaughran, F. (2015). Promoting physical
health for people with schizophrenia by reducing disparities in medical and dental care. Acta
Psychiatrica Scandinavica, 132(2), pp.109-121.
nhs.uk (2018). Causes. [online] nhs.uk. Available at:
https://www.nhs.uk/conditions/schizophrenia/causes/ [Accessed 7 Feb. 2018].
nimh.nih.gov (2018). NIMH » Psychotherapies. [online] Nimh.nih.gov. Available at:
https://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml [Accessed 7 Feb. 2018].
Nimh.nih.gov (2018). NIMH » Schizophrenia. [online] Nimh.nih.gov. Available at:
https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml [Accessed 7 Feb. 2018].

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Nimh.nih.gov (2018). NIMH » Schizophrenia. [online] Nimh.nih.gov. Available at:
https://www.nimh.nih.gov/health/publications/schizophrenia-basics/index.shtml [Accessed 7
Feb. 2018].
O'Brien, S. (2018). Health promotion and schizophrenia: the year 2000 and beyond. -
PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at:
https://www.ncbi.nlm.nih.gov/pubmed/9429351 [Accessed 7 Feb. 2018].
Rosenbaum, S., Tiedemann, A. and Ward, P.B., 2014. Meta-Analysis Physical Activity
Interventions for People With Mental Illness: A Systematic Review and Meta-
Analysis. Journal of Clinical Psychiatry, 75(0), pp.1-11.
Steiner, J., Schiltz, K., Bernstein, H.G. and Bogerts, B., 2015. Antineuronal antibodies
against neurotransmitter receptors and synaptic proteins in schizophrenia: current knowledge
and clinical implications. CNS drugs, 29(3), pp.197-206.
Stubbs, B., Chen, L.J., Chung, M.S. and Ku, P.W., 2017. Physical activity ameliorates the
association between sedentary behavior and cardiometabolic risk among inpatients with
schizophrenia: A comparison versus controls using accelerometry. Comprehensive
psychiatry, 74, pp.144-150.
Stubbs, B., Firth, J., Berry, A., Schuch, F.B., Rosenbaum, S., Gaughran, F., Veronesse, N.,
Williams, J., Craig, T., Yung, A.R. and Vancampfort, D., 2016. How much physical activity
do people with schizophrenia engage in? A systematic review, comparative meta-analysis and
meta-regression. Schizophrenia research, 176(2), pp.431-440.
Tsoi, D., Hunter, M. and Woodruff, P. (2008). History, aetiology, and symptomatology of
schizophrenia. Psychiatry, 7(10), pp.404-409.

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Vancampfort, D., De Hert, M., Stubbs, B., Ward, P.B., Rosenbaum, S., Soundy, A. and
Probst, M., 2015. Negative symptoms are associated with lower autonomous motivation
towards physical activity in people with schizophrenia. Comprehensive Psychiatry, 56,
pp.128-132.