case study

Topics: Psychosis, Schizophrenia, Bipolar disorder Pages: 6 (1700 words) Published: March 13, 2014
Client profile:
Johannah is a 34-year-old female. Born in the Netherlands, she married an American and came to this country when she was 25 years old. About a year later, Johannah began a series of admissions to psychiatric facilities. She was diagnosed with major depression and later with schizoaffective disorder. About a month ago, Johannah stopped keeping outpatient appointments, stopped taking her medications, stopped bathing, and stopped eating, but was sleeping all the time. Johannes mood symptoms suddenly became less noticeable, and she began wandering her yard after dark, saying the neighbors were in trees. Johannah began to carry a gun to protect itself against the neighbors, who she thought were out to kill her. When she started to fire the gun into the trees, her husband got a court order to have Johannah committed for treatment.

Case study:
Two deputies, one male and one female, and her husband have brought Johannah to the hospital to be admitted. The nurse does an assessment on Johannah and discovers Johannah has been on risperdone (Risperdal) liquid, valproic acid (Depakote), and venlafaxine (Effexor XR). The psychiatrist orders these medications to be continued. At first the nurse is unable to get Johannah to sign consent forms to take her medication, but after a few days, she does sign the forms. By this time, her pregnancy test has come back negative, and she is started back on her usual medication. The nurse finds Johannah to be somewhat tangential with loose associations. When the nurse assigns Johannah to attend a medication class, she refuses. When asked to interpret a proverb, she refuses. Johannah begins to talk about her food being poisoned and being” King” of the hospital. She claims to have subjects to take care of the food and those who try to poison it. Johannah tells the nurse that she has been hospitalized eight times previously on another mental health unit. The nurse sends a signed release of information form to the designated facility requesting copies of Johannes latest psychosocial assessment, treatment plan, and discharge summary. The requested information reveals that Johannes discharge diagnoses at the facility was schizoaffective disorder, bipolar type. After three weeks on medication, Johannah no longer seems to have hallucinations and delusions. The psychiatrist is ready to discharge Johannah, but her Depakote level comes back low. A nurse discovers Johannah to be cheeking her morning dose and sometimes her evening dose of Depakote and has been putting the medication in a pair of shoes. Johannah Hansen nurse and envelope with $200 and the words “Thank- you nurse” written on the outside. About this time the nurse notices that Johannah has suddenly become hyperverbal, hyperactive, intrusive, and sexually suggestive to peers and staff.

Questions

*What is schizoaffective disorder ? What are the diagnostic criteria?

According to NAMI, schizoaffective disorder resembles both schizophrenia and a serious mood (affective) disorder. The person who has this disorder will experience delusions, hallucinations, other symptoms that are characteristic of schizophrenia and significant disturbances in their mood (Duckworth, K. & Freedman, J. L., 2012). The diagnostic criteria for this disorder are outlined in the DMS-IV-TR. According to this, “people who experience more than two weeks of psychotic symptoms in the absence of severe mood disturbances – and then have symptoms of ither depression or bipolar disorder – may have schizoaffective disorder” (Duckworth, K. & Freedman, J. L., 2012). This disorder is thought to be a mix between bipolar disorder and schizophrenia.

*Do Johannah symptoms match those of schizoaffective disorder, and if so, how?

The symptoms that Johannah has that match those of schizoaffective disorder are the following: depressive symptoms including disturbed sleep and depressed mood; manic symptoms including increased energy, decreased sleep, hyperverbal,...
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