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Paranoid Schizophrenia: A Clinical Case Study
Milcah Prasad
University of Maryland, Baltimore

Introduction
Schizophrenia is a complex mental illness that is characterized by having psychotic symptoms such as delusions, hallucinations, disconnect with reality, and illogical thinking patterns for at least one month and having a major impact in the lives of the individuals, their family and friends (American Psychiatric Association, 2000). According to the statistics, “1 in 100 people develop schizophrenia. In the United States, 2- 3 million people have the illness” (Mueser & Gingerich, 2006). The purpose of this case study is to demonstrate an in-depth understanding of schizophrenia and to consider various evidenced based treatment options in psychiatric nursing.

Brief Description of the Client
DO is a 36 year old African-American woman who was admitted on February 1, 2011, to the Psychiatric Unit of Howard County General Hospital. She was brought to the hospital involuntarily by her mother through the emergency department. The reason for the current psychiatric hospitalization is non-compliance to medications, a potential risk of safety for self and others, and delusional thinking. She denies having any mental illness and therefore she flushes her medications down the toilet. DO stopped complying with her medication regimen while she was pregnant with her baby because she believed that the medication would harm the growing fetus. Two months after she delivered her baby, she took the baby and locked the baby in a room without feeding her child. Her mother began to notice that the symptoms were getting worse and brought DO to the hospital in desperation.

DO believes that Usher, a famous R&B/Pop singer, is her fiancé and that he is planning their wedding. She also believes that he is her high school sweetheart, dedicated a song for her, made an announcement on the radio confessing his love for her, and bought her a nice house in Baltimore. She mentioned that both Usher and God told her that she is pregnant again with twins and is very excited about the upcoming wedding and addition of new born babies in the near future – indicating visual and auditory distortions. She denies hearing voices and has no history of substance abuse. She is currently in the hospital with a diagnosis of paranoid schizophrenia. She has persecutory delusions in believing that her mother and sister want to harm her and take her baby away from her. She also reports that her mother makes unhealthy foods to harm her and is cautious before eating.

My first interaction with the client was in the day room, of Howard County General Hospital, during occupational group therapy where she was interacting with other patients and the occupational therapist. My first impression of her was that she is talkative and aggressive. At the end of the group meeting, I introduced myself as a nursing student and offered to assist her filling out the menu. She responded with a smile and asked for assistance in filling out the menu. Afterwards, we sat on the sofa for an interview to which she responded attentively. I observed that she was wearing regular street clothes, looked alert, relaxed, and felt comfortable talking openly. My questions were regarding the reason for her visit, and she openly expressed all her concerns and struggles. DO was very pleasant to talk to and interacted with other fellow students as well. My interview with her was very short, since she had to attend a meeting with her doctor, but I spoke with her briefly each time I went to the hospital. DO and I held a therapeutic relationship. I followed many therapeutic techniques, like listening, giving respecting, and supporting the patient, throughout our encounter.

DO currently lives with her mother and sister in a single family home, and has large extended family in New York. She has never been married but has a daughter who is 4 months old. She is currently...
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