I.

INTRODUCTION

Doubt is to certainty as neurosis is to psychosis. The neurotic is in doubt and has fears about persons and things; the psychotic has convictions and makes claims about them. In short, the neurotic has problems, the psychotic has solutions. - Thomas Szasz Health is very critical aspect in everyones life, having good health enables us to work efficiently and finish our tasks with ease. However, it is not only that our physical health be maintained in good terms. We should also consider our mental health. Ever heard of stress? Sometimes, we get this from working so hard and not even having the time to rest because we feel like our bodies could still go on or rather this is brought about by specific events that causes us to feel stressed, and for some reason, some people cannot cope up with this which leads to psychiatric disorders. 1. Current Trends Cannabis Use Precedes the Onset of Psychotic Symptoms in Young People, Study Finds (March 3, 2011) Cannabis use is somehow linked to increased risk for mental illness; however it is not yet clear whether the link between cannabis and psychosis is causal. So, a team of researchers led by Professor Jim van Os from Maastricht University in the Netherlands, set out to investigate the association between cannabis use and the incidence and persistence of psychotic symptoms. The study took place in Germany and involved 1,923 adolescents and young adults aged 14 to 24 years. They found out that cannabis use almost doubled the risk of later incident psychotic symptoms and also in those with cannabis use at the start of the study, continued use of cannabis over the study period increased the risk of persistent psychotic symptoms. These results "help to clarify the temporal association between cannabis use and psychotic experiences," say the authors. In addition, cannabis use was confirmed as an environmental risk factor for persistence of psychotic experiences." (http://www.sciencedaily.com/releases/2011/03/110301184056.htm) Statistics

2. Objectives STUDENT-NURSE CENTERED OBJECTIVES General Objectives: After the completion of the study, the student shall have:

Acquired and applied classroom theories and principles into the actual situation. Achieved knowledge about the past and present disease condition of the patient. Identify and differentiate risks for psychosis. Performed a comprehensive assessment of patients condition. Enumerated the different signs and symptoms of psychosis. Obtained the rationale of the nursing management of the patients condition. Be updated with the latest trends and in the treatment of psychosis.

Specific Objectives: During the course of study, the student shall have: Established an atmosphere of ease and trust that will conduct the patient freely and fully cooperate in every nurse-patient interaction. Discussed the history of patients past and present illness, development and family health. Discussed the Psychopathology basis of the patients manifestations. Listed each treatment and rationalized them and indicated patients reaction to each treatment. Analyzed and formulated Psychiatric Nursing Care Plans that will individualize and prioritize the problems of the patient. PATIENT-CENTERED OBJECTIVES General objectives: During the course of the study, the patient shall have: Acquired knowledge on how to take care of him. Gained understanding and demonstrated compliance on the treatment rendered by the health care team to manage the condition. Specific objectives: During the course of the study, the patient shall have: Built a trusting relationship with the researchers as well as the other members of the health care team. Received the best possible nursing care, leading to a feeling of security, comfort, and good prognosis of the condition. Demonstrated compliance on self-care. II. NURSING ASSESSMENT 1. Profile This is a case of Joe, 18 years old, male, a natural born Filipino. The student nurses have analyzed his developmental age during the course of care for the patient. He is already at the genital stage of Freuds Developmental Stage based on our assessment as he is observed to be aware with things of sexual in nature. He is also in Concrete Operational stage of Jean Piagets Cognitive Stages of Development as we have observed that he still has concrete thinking when asked to explain his insights and Industry versus Inferiority of Erik Ericksons Psychosocial Development as he is seen to avoid talking to anyone besides the nurses and his lack of confidence is prominent. We have also noted that he is a Roman Catholic but has stopped being religious since he the time he got separated form his mother. He is admitted on December 2, 2008, allegedly picked up by the Barangay Captain of San Fabian because he was vagrant. He was initially kept in Barangay Jail for a week and then

eventually referred to the DSWD of Sto. Domingo, Nueva Ecija. He refused to talk so he was brought to Marivels Mental Hospital for evaluation and management. He was diagnosed of Unspecified Psychosis. 2. History They are six in the family; he said he had good relationship with each and every one of them till he decided to go away from home with his cousin. According to him, he worked as a pin boy, planted rice and onions at San Fabian. He only finished up to Grade 2 because he hated his teacher when he was a child. He is single and never had a girlfriend before. Upon assessment, the student nurses have noted that he spends most of the money he earns on cigarettes and alcohol, they also found out the he used marijuana or cannabis before he is admitted into the hospital. 3. General Assessment and Motor Behavior Initially, the student nurses have observed him to be neat to himself. He said that he takes a bath everyday at 4am in the morning. He walks straight but most of the time he is looking downwards, he looks at the student nurses when speaking to them. He has been observed to have uncontrolled muscle movement such as rapid eye blinking, lip smacking, tongue protrusion and pill rolling tremors. He also has thought blocking as he sometimes stops abruptly in the middle of a conversation and suddenly resumes. 4. Mood and Affect He shows a neutral facial expression most of the time, but he smiles when he feels happy which indicates an appropriate affect. 5. Thought Process and Content He has a fixed belief that a mirror will break if he looks at it; he is capable of imparting to the student nurses his ideas clearly. He doesnt have any plans of self harm and never attempted suicide. 6. Sensorium and Intellectual Processes He is well aware of the time and day when asked, however, he sometimes get confused when asked about the month and year. He sometimes has difficulty remembering recent and remote memories, specifically names of people. 7. Abnormal Sensory Experiences or Misperceptions He said that he see mirrors breaking whenever he looks at them, he has difficulty concentrating when there is food or a lot of people around him. He also lacks abstract thinking as evidenced by literally interpreting his drawings or frankly answering the student nurses questions about how he understood a quotation. 8. Judgment and Insight He interprets the environment inside the hospital as not that good since he always sees other patient fighting. In terms of judgment, he always avoids getting into issues by not bothering to do something about a problem so as not to end up being hurt.

9. Self Concept He views himself as a good person, a brave one and someone who has a very beautiful body. He is cooperative at times and very quiet when he doesnt feel like talking. 10. Roles and Relationships

He doesnt have many roles in his stay at the hospital, he told the student nurses that he mostly spends his time in the hospital eating and sleeping. He has a friend inside whom he named Jeric who happens to be another patient in the ward. 11. Physiologic and Self Care Considerations He is very fond of eating as the student nurses have observed that he is very strict with time for eating. He also has a good sleeping pattern as he told the student nurses that he has a specific time for getting into bed and waking up. The student nurses also have noted that he has hemorrhoids and cellulitis near the anus and a history of acquiring herpes simplex. He his also compliant with his medications and is able to perform his ADLs with minimum assistance. 12. Psycho - Pathology (Client Centered) A. Schematic Diagram Information enters the brain Primary sensory areas Overactivity of dopamine function In the mesolimbic pathway Abnormal function in frontal and temporal area of the brain Sensory deprivation Hallucinations delusions

Loss of grip from reality Psychosis Anti psychotic drugs Low level of dopamine Pseudo Parkinsonism Uncontrolled muscle movement Pill rolling tremors rapid eye blinking lip smacking tongue protrusion

B. Synthesis of the Disease Definition of the Disease Psychosis means an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are described as psychotic. Psychosis is given to the more severe forms of psychiatric disorder, during which hallucinations and delusions and impaired insight may occur. People experiencing psychosis may report hallucinations or delusional beliefs, and may exhibit personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out the daily life activities. Predisposing Factors (Non - Modifiable) GENDER males are more at risk because of their lifestyle. Precipitating Factors (Modifiable) ALCOHOLISM prolonged abuse of alcohol may cause mental illness. DRUGS - use of cannabis or marijuana is linked with acquiring psychotic disorders Signs and Symptoms HALLUCINATIONS he said that he can see mirrors break whenever he looks at them. DELUSIONS he has a fixed belief that a mirror will break if he looks at it. THOUGHT BLOCKING he sometimes stops abruptly in the middle of a conversation then resumes. PLANNING List of Nursing Problems 1. 2. 3. 4. 5.

IMPLEMENTATION 1. Medical Management Date Ordered/Discontinued December 2, 2008/January 27, 2011 Route/Frequency of Administration/Dosage Oral 5mg OD General Action/Functional Classification/Mechanism of Action Typical Neuroleptic/Antipsychotic it has an antagonistic effect to dopamine Clients Response to the medication Patients behaviour is controlled however, he began manifesting side effects such as uncontrolled muscle movements Patients mood is stabilized. He also experiences motor coordination impairment

Name of Drug Haldol (Haloperidol)

Indication For treatment of acute psychotic states and control of behaviour

Carbamazepine Tegretol

December 2, 2008

10g

Anticonvulsant/Mood Stabilizing Agent

For controlling the patients mood

Biperiden - Akineton

December 2, 2008/January 27, 2011

1mg

Anti-Parkinsonian Agent

Used to improve Parkinsonian signs and symptoms related to antipsychotic drug therapy.

Improved patients abnormal gait

2. Nursing Management Day 1: Assessed patients demographic data, general condition, thought and intellectual processes, orientation about time, place and people, family background, tested memory, reason for admission, significant events before admission and noted abnormal mannerisms. We also gave him activities such as exercise, community singing and gardening. Day 2: Assessed patients past medical history, abnormal sensory experience such as hallucinations, measured abstract thinking and decision making ability. We also gave him music and art therapy and evaluated them after the activity. Day 3: Assessed patients personal view of self, personal qualities and attributes, current roles and significant relationships. We also administered remotivational therapy in the form of a puppet show. Day 4: Thought patient of how to handle certain stressful situations and presented facts about his false beliefs. We also let them watch a role play we prepared. FINDINGS CONCLUSION Based on the findings of the study, the following conclusions were drawn: Cannabis use is linked with acquiring psychotic disorders. Anti psychotic drugs may cause Pseudo parkinsonism. Biperidin can be used to counteract the anti psychotic drug therapy side effects. Differentiated psychosis from neurosis respectively. Overactivity of dopamine in the brain which causes abnormal function in the frontal and temporal area that brought the patients hallucinations.

RECOMMENDATION After doing this case study, the nurse-researchers finally came up with some recommendations for the patient regarding the disease. We nurses should help our patients distinguish what is real from not. We should guide them and always present the reality to them to be able to give them the opportunity to improve their decision making skills. Maintaining a schedule that contains adequate time for rest and sleep and proper nutrition should be considered. Always prioritized other safety first before the patients safety if he gets violent.

The study can be recommended for the following persons: To the physicians. They can acquire base line knowledge about the condition of the patient. They can help with the prognosis of the patient. They can perform appropriate interventions and therapy for the betterment of the patient. To the nurses. Acquiring this information can equip the nurse to render proper nursing intervention for the prognosis of the patient.

To the clinical instructors and nursing students. This study will be helpful to increase awareness regarding several conditions and that they can give appropriate health teachings to the people for the prevention of the occurrence of such condition. LEARNING DERIVED I have learned from the study that we conducted about Psychosis that once we lost grip of reality, it is irreversible. Itll be hard for the patient to improve his functioning as the disease is progressive in nature. Therefore, I can say that prevention is the best way for us to avoid the development of psychotic disorder. Since the factors that associated with the condition we can modify are mainly focused on lifestyle. Then, perhaps lifestyle modification is a choice to be considered. I suggest marijuana smoking cessation, because this factor greatly contributes to developing psychosis as it affects our brain which eventually leads to synaptic gaps and probably psychotic manifestations. Alcohol also shouldnt be abused though it is not only a cause of psychosis but also a manifestation that indicates depression. Through this Case study, I am now able to impart knowledge not only to my family but to other people as well about what should we do to preserve our mental health. BIBLIOGRAPHY Videbeck, Sheila (2011) Psychiatric Mental Health Nursing 5th Edition U.S.A.: Lippincott Williams & Wilkins http://www.wrongdiagnosis.com/p/psychosis/causes.htm http://en.wikipedia.org/wiki/Psychosis http://www.sciencedaily.com/releases/2011/03/110301184056.htm