Case Scenario:
Schizophrenia Scenario:
You are working on an inpatient psychiatric unit and need to do an initial assessment of R.B., who has just been admitted. He has a diagnosis of schizophrenia, paranoid type. He is 22 years old and has been attending the local university and living at home with his parents.
He has always been a good student and has been active socially. Last semester his grades began declining and he became very withdrawn.
He spends most of his time alone in his room. His grooming has deteriorated; he can go days without bathing. For several weeks before admission, he insisted on keeping all of the blinds and curtains in the house closed. He refuses to join family gatherings and games. For the past 2 days he has refused to eat, saying, "They have contaminated the food." As you approach R.B., you note that he appears to be carrying on a conversation with someone, but there is no one there.
When you talk to him, he looks around and answers in a whisper but gives you little information. He states, "They are watching me and told me not to cooperate."
1. Explain what a negative symptom of schizophrenia is and identify at least three negative symptoms of schizophrenia that R.B. might be experiencing.
2. Explain what a positive symptom of schizophrenia is and identify at least two positive symptoms of schizophrenia that R.B. might be experiencing.
3. Define each of the following types of delusional thinking:
a. Thought broadcasting
b. Ideas of reference
c. Thought insertion
d. Persecution
e. Grandeur
f. Somatic delusions
4. What symptoms indicate that R.B. has paranoid schizophrenia?
5. Why is it important to know R.B.'s history before he is diagnosed with schizophrenia?
6. What diagnostic screenings are important in evaluating R.B.? Want Online Help?
7. What are the most important initial interventions in treating R.B.?
8. Which class of antipsychotic medications is considered first-line therapy for schizophrenia?
9. K.B. will need to be monitored closely. How will this be done?
10. What types of psychosocial treatments may be used to treat R.B.'s schizophrenia?
Case Study Progress:
R.B. is started on olanzapine (Zyprexa). You inform R.B. and his family about the common side effects of the atypical antipsychotics.
11. What are the common side effects of atypical antipsychotics such as olanzapine (Zyprexa)? Select all that apply
a. Tardive dyskinesiab. Drowsiness
c. Dry mouth
d. Palpitations
e. Nausea
f. Weight gain
As you go in to give R.B. his medication, he speaks to you in fragmented sentences. "Is that a bird? The little flowers jump up and down. What says the moon?" Before you can say anything, he asks,
"Do you see that bird over my bed? She is telling me not to leave this room. If I move she will swoop down and try to peck at my eyes. Be careful!
12. Is he having a delusion or a hallucination? Explain your answer.
13. Which responses by the nurse are appropriate? Select all that apply.
a. "I don't see a bird over your head, but I can understand how that would be upsetting to you."
b. "There is no bird over your bed."
c. "Tell me more about what you are seeing."
d. "The voice you are hearing is part of your illness. It can't hurt you."
e. "I'll come back to talk to you when you are settled down."
After 2 weeks of inpatient therapy, K.B. is discharged back to his parents' home and is enrolled in a day treatment program. He and his parents attend family therapy sessions twice a month. He hopes to move to a halfway house in the community