1

Introduction

This Care Study looks at a client currently admitted to ward five (5) at the Bellevue

Hospital. We shall refer to him as *S.F. He was admitted on the seventh (7th) of

October 2008 (and diagnosed with schizophrenia) after he was brought in by mental

health officers with a history of exposing and denuding himself on the compounds

of a school on which he worked as the caretaker.

This Care study will also look at the nursing and medical management of Mr. *S.F.

as well as all the related therapies, these include; group therapy, one to one therapy,

pharmacotherapy, and occupational therapy.

A profile of the clients community, his outcome/prognosis as well as his familys

involvement in his care will also be looked at.

_________________________________________________________________
*Initials used to protect privacy, used interchangeably with A.F.
2
 3

Purpose of this study

This Care Study is being done in partial fulfilment of the course Post Basic

Psychiatric Nursing. Its intent is to provide this student with the requisite skill and

knowledge to manage the client with the above named diagnosis as well as others

with similar mental health challenges.

 4

Literature Review

Schizophrenia is a severe mental illness that usually strikes between the ages of

seventeen (17) and twenty five (25) years of age (Ignatavicius, 2004). It is one of

the large groups of severe mental disorders typified by gross distortion of reality,

disturbance in language and breakdown of thought processes, perceptions and

emotions. Delusions and hallucinations are usual as are apathy, confusion,

incontinence, and strange behaviour. No single cause is known but genetic factors,

chemical imbalance, structural brain abnormalities, and stressful events are probably

important (Frisch, Frisch, 2006; Ignatavicius, 2004).

TheDSM-1V-TR list five subtypes: (1) Paranoid - this is where theres presence of

hallucination and delusional thinking, but fairly organized speech and behaviour;

may show some range in affect. (2) Disorganized - theres dominant manifestations

of disorganized speech and behaviour, with flat or inappropriate affect; may also

have hallucinations and delusions. (3) Catatonic theres the presence of bizarre

motor activity, either excessive and purposeless or immobilized as if in a stupor;

may be mute or show incoherent speech. (4) Undifferentiated theres the presence

of two or more of the following signs and symptoms, but theres no marked feature

as in the previously named subtypes: hallucinations, delusions, disorganized

speech/behaviour and flattening of the affect. (5) Residual behaviours do not

manifest obvious hallucinations, delusions, or disorganization, but theres an

alteration in the range of affect and thought patterns (Black 2005).

 5

In all cases, theres a profound deficit in an individuals ability to think and to

communicate.

Signs and symptoms are generally classified as either positive or negative symptoms

or both. Positive signs and symptoms include the following: auditory/visual

hallucinations, delusions, disorganized thinking and speech, which is obvious, signs

of psychosis. Negative signs and symptoms include: blunted affect, avoidance of

social contact, lack of attention to hygiene, and a decrease in speech, these are all

lack of usual emotional/social responses.

The cause of schizophrenia is unknown, but several theories have been

propagated, among these are: The genetic, psychoanalytic, organic, and

neurotransmitter theories.

The Genetic view posits, that for the general population the chance of an individual

becoming schizophrenic is 1%, while the individual with two parents stands a 40-

50% chance of becoming ill with the condition, other family relations is also a risk

factor. Of all the genetic permutations, studies have shown that monozygous twins

stand the greatest chance of being affected with schizophrenia. (Frisch 2006).

The Psychoanalytic view states, that childhood situations, such as, temper tantrums

and unresolved aggression might ultimately lead to psychosis. Another view posits,

that inadequate maternal nurturance in early infancy could lead to psychosis.

Further psychoanalytical research has evaluated a wide range of developmental,

environmental and psychological factors, but those studies have not proved to be

very definitive (Frisch, 2006).

 6

The Organic theory, suggests that there is something physically and structurally

wrong with the brain of the schizophrenic individual. Studies done have shown

(with the CT scanner) that there is an abnormality in the structure of the ventricles

of the brain of male clients. Despite this finding, it is not clear that ventricular

abnormality is the cause of schizophrenia; however, it has been shown that

ventricular enlargement may occur in the schizophrenic client and may lead to

cerebral atrophy. Studies have also shown that the hippocampus in the brain is larger

in the schizophrenic client (Delisi, 2000).

It must be noted that while these findings are speculative, they could result in the

view that schizophrenia is a neurologic degenerative disease.

The Neurotransmitter theory states that, brain chemicals, particularly dopamine are

the major culprit. Dopamine is produced in the brain and serves as a signalling

molecule or neurotransmitter, an excess or hyperactivity could be the cause of

schizophrenia. Drugs effective in the control of positive symptoms in schizophrenia

all seem to have a dopamine blocking action, that is, these drugs seem to work

because they reduce the effect of the individuals own dopamine on his brain. It

should be noted that while dopamine is speculated to be the major cause of

schizophrenia, other neurotransmitters such as GABA, and the neuropeptides

cholecystokinin and somatostatin are also decreased (Freedman, 2003).

Positive manifestations of schizophrenia is usually managed by both typical

(Chlorpromazine, Haloperidol) and atypical (Risperidone, Clozapine) psychotropic

medications, but the negative manifestations are managed better by atypical

 7

medications and supportive therapy (Black 2005). Antipsychotics have been in use

since the 1950s, and several classes have evolved over time in an effort to reduce

unpleasant side effects brought about by the older antipsychotics (For example

Chlorpromazine) (Frisch, Frisch 2006). These antipsychotic are usually required to

be taken over a lifetime to control the manifestations of schizophrenia, with

medication some client report an absence of hallucinations, but for others internal

voices become an unpleasant permanent experience (Black 2005).

A major concern for most clients is the presence of side effects related to sedation

and abnormal movements. Antipsychotics particularly, typicals, affect dopamine

receptors and result in side effects known as extrapyramidal syndrome (EPS). Some

of these side effects are: stiffness, tremors of the arms and legs, extreme

restlessness with subjective discomfort, drooling and acute muscle spasm of the

face, neck and tongue. These side effects are usually short termed and can be

reversed with an anticholinergic (Benztropine) (Frisch, 2006).

However, it should be noted that there is a long term side effect called tardive

dyskinesia, which manifests itself with the following: involuntary movements of the

tongue, face, hands or legs and occurs after long term antipsychotic use, usually it is

irreversible. Treatment options include, changing the current medication to a less

potent one or to one of the atypicals (these have a better side effect profile).

Neuroleptic malignant syndrome (NMS) is a rare, but serious, life threatening side

effect that occurs from long-term use of antipsychotics, this manifest it self in the
 8

following ways: extreme muscle rigidity, hyperpyrexia, diaphoresis, high blood

pressure and extreme fluctuation in conscious levels.

Treatment options include: supportive therapy, to decrease temperature and keeping

the client cool as well as monitoring vital signs and stopping the medication

immediately (Black, 2005).

Treatment options for impaired functioning include long term supportive therapy

and psycho rehabilitation. Social withdrawal and lack of interest in school or work

often signal the onset of the illness and may persist throughout treatment. For the

schizophrenic client there is a need for development and maintenance of maximal

functioning, individual counselling and support, psycho education and organized

rehabilitation and family therapy.

The client experiencing schizophrenia has many remissions and exacerbations,

exacerbations are compounded by medication non-compliance, denial of illness, and

stressful life events, these will usually result in multiple admissions over a life time.

With consistent support of family and community resources, many clients can

progress toward higher levels of independence. (Black, 2005) (Frisch, 2006)

9
 10

Patients profile

Name: S.F.

Age: 31yrs.

Gender: Male

Religion: Church of God

Marital Status: Single

Medical Diagnosis: Schizophrenia

Address: Mount Airy District Saint Thomas

Next of Kin: Aunt, E.A.

Occupation: worked as a caretaker and welder, currently unemployed

Height: Approximately 6ft.

Weight: - 1781bs

History of present Illness

Chief Complaint: According to docket and patient, he was brought to Bellevue

hospital on the seventh (7th) of October 2008 by mental health officers, after they

were called to say that he was on the compound of the Ardene preparatory school

masturbating and denuding him in public view of the students.

History of present complaint: Client was picked up on the compound of the Ardene

preparatory school on the seventh (7) of October 2008 at approximately 4:55pm.

Mental health officers reported that Reverend Mr. Angling called them to lodge the
 11

complaint; he (Mr. Angling) stated that the clients parent had died about (4) four

years ago.

Prior to her death, mother had worked as caretaker at the same school; after she

died he took their position. He lived in a home next door which belonged to his

mother, but he burned it down in 2006, because he felt that that someone had

bugged it, subsequently, he went to live on the school compound in early 2008.

About 3/52 ago he began to neglect his personal hygiene, becoming quite smellier

and dirty, 2/52 he stated that, he started to hear voices in his head telling him to do

various things, including throwing things at people and approximately 1/52 he

began to denude himself as well as masturbate in front of all the school children.

Parents and community members became quite concerned about the behaviour;

subsequently he was brought to Emergency Room, Bellevue hospital, where he was

admitted on the seventh (7) of October 2008.

On examination: Young adult male sitting on chair, relatively calm and cooperative.

Temperature-97.7, Pulse rate-84 beats per minutes, Respiratory rate-20 breaths per

minutes. Mucus membrane: pink, anicteric, acyanotic.

DSM IV Classification

Axis I- R/O Psychotic disorder, Substance disorder, Depressive disorder, later

diagnosed as Schizophrenia.

Axis II- Nil

Axis III- Nil

Axis IV- Currently unemployed and has very little social support

Social/ developmental/Family History

 12

Client grew up with mother and father in a home that had all the physical amenities,

such as electricity, piped water and adequate garbage disposal system. Mother had

two (2) children, him and a younger female sibling, who is one year, his junior, she

currently resides in England, but they are not in touch right now. According to

client, home was a relatively happy place most of the time, with few squabbles

between his sibling and himself.

Past Medical History

Nil Significant

Past Surgical History

Nil Significant

Psychosexual History

Has no children and is currently not in any relationship, however, he said that he

had about three relationships in the past, but they did not last very long because he

was not working most of the time. His last relationship, which broke up about three

years ago lasted for about six months and ended due to frequent quarrels, especially

as it related to finances.

Family History of Psychiatry

Two paternal cousins are mentally ill, but has never been admitted formally

Past Psychiatric History

Client has never been treated for a psychiatric condition before.

 13

Educational History

Attended three primary schools, but he could not remember their names or why he

had to be moving from school to school. He looked a bit sad as he reflected on the

fact that he did not do his common entrance exams. Clients docket stated that he

attended Pembroke Hall, Ardene day and Extension as well as the Saint Josephs

high schools however; he stated that he only attended the Saint Josephs High

school where he sat 5 CXCs, and was successful in two, namely Accounts and

Principle of Business. When client was spoken to again, he confirmed the high

schools as stated in docket.

Employment History

Worked as a welder for six years in Vineyard Town and as a caretaker for the

Ardene Preparatory School at 59 Hope Road. He went on to say that the last time

he worked as a welder was three years ago. He left because business became very

slow.

Forensic History

Client was arrested for eight years, but cannot remember much about the incident
 14

Description of clients community

Hope Road is one of the sub communities in the community located in Barbican in

the parish of Saint Andrew. It is described as being moderately populated and is

border by Halfway Tree to the left, and Liguanea to the right. It is one of the more

affluent communities in Jamaica, and features mainly middle to upper class

individuals. It has all the physical amenities such as light, water and sewer system

an adequate garbage disposal and telephone system as well as fine roads.

Some of the facilities available in that community include:

Entertainment center (Ronald Williams, Police Officers Club)

Shops, Variety stores, Supermarkets, Shopping centers (Thank God its

Friday, Baskin Robins, Devon House)

Playing ground (Police Officers Club)

Schools (including Basic, Primary and high)

Churches (Seven Day Adventist, Pocomania, Faith of Light ,Church of God)

The nearest Hospital is the Andrew Memorial Hospital (Private)

The nearest Police Station are the Police Officers Club and Matildas corner

Post Office is located in the shopping centre.

 15

The people in the community of Hope Road are largely from middle to (lower)

upper class socio-economic background. However, there are a few working class

individuals that include skilled workers who, work on construction sites and in the

public and private sectors. (These include professionals). Others are self employed

which range from the vending of food to the keeping of shops and supermarkets.

The individuals of Hope Road are described as co-operative and friendly.

Crime is not as widespread and publicized as in the rest of the country, although

they do occur, one significant example is the robbing of a nearby supermarket, twice

within a month.
16
 17

On admission at the emergency Room, Young, tall, slimly built gentleman, sat very

quietly and calmly in chair, was cooperative and spoke mainly rationally. He was

able to indicate that the house that he lived in got burned down, and that he denuded

himself because he wanted to take a bath, and not because he wanted to expose

himself to the children or anybody.

Stated that he eats and sleeps very well, smokes cigarettes and smoked cocaine in

the past. He also admitted to hearing voices in his head telling to do various things,

however, he did not elaborate.

He was seen by doctor *O.B. and admitted to K3 ward on the following

medications: Risperidol 4mg, PO, BD; Chlorpromazine 100mg PO, Nocte and

Benztropine 5mg, PO, BD.

 18

___________________________________________________________________

* Name withheld to secure privacy.

 19

Medical Management

The doctors at Bellevue hospital are currently treating *A.F. with the following:

Medication Frequency Mechanism of Side effects Nursing

action Responsibilities
Risperidol 4mg b/d (Twice Binds to Little or no side Monitor vital

daily) dopamine effects, but signs. Monitor

receptors to causes some and assess for

decrease CNS, GI, skin, orthostatic

psychotic respiratory side hypotension.

symptoms effects. Assess for motor

and cognitive

impairment.
Cogentin 5mg b/d (Twice Decrease the Sedation, Monitor for

daily) anticholinergi drowsiness, muscle weakness,

c and palpitation, input and output,

Dopaminergic Paralytic Ileus. advise to report in

side effects urination or

 20

infrequent

voiding, monitor

for signs of

Paralytic Ileus.
Chlorpromazin Nocte Blockade of EPS, NMS, Monitor vital

e 100mg. post synoptic hypotension, signs before and

Fluphenazine Monthly dopamine Sedation for after admin.,

Decanoate 1cc receptor. Chlorpromazin NMS, sedative

e antiemetic and

visual effects

(Chlorpromazine)

This treatment is consistent with the works of Worrel, Marken, Beckman, and

Ruehter (2000) and Freedman (2003), who posits that schizophrenia, may be treated

with typical and atypical antipsychotics as well as an anticholinergic to combat the

side effects caused by the typical antipsychotics

Physical Status Examination

Done: on the 10. 07.2009

General appearance: Client appeared alert, conscious and calm, sat by himself and

seemed preoccupied with his own thoughts. Had no obvious signs of pulmonary or

painful discomfort. Well nourished and appropriately dressed for setting, age, gender

time of day and for season. Hair was well kempt and feet shod, however, posture was

somewhat slouched and eye contact, intermittent.

Vital signs: T 37 deg. C; P-88bpm; R-20bpm; B/P-120/70

 21

Growth (weight and height): Weight 178lbs.

Height 6ft. 2 inches

Skin (hair, nails): Skin colour was quite uniformed, no patches seen; same was

smooth, moist with good skin turgor. No skin lesion or abrasions noted, warm to the

touch. Hair was kempt and clean with adequate distribution, quantity, texture and

colour. Nails were a bit long and dirty, same firmly attached to nail beds. Capillary

refill of nails occurred in less than three seconds.

Lymph nodes: None felt

Head: Normal, proportional to body size, skull contour smooth, no sign of trauma

swelling, tenderness, nodules or lesions was seen.

Neck: Symmetrical, skin intact, had no visible signs of abnormal pulsation, masses,

swelling or venous distention. Thyroid gland non palpable, client was able to move

neck through the entire range of motion, had no difficulty when swallowing. Trachea

remained in midline position.

Eyes: Symmetrical, no lacrimal drainage or swelling was noted. Equal distance

apart, outer cantus in line with the ears. Pupils were equally round, had no tenderness

on palpation, mucus membrane pink and moist.

Ears: Non tender touch, warm on palpation. No signs of hyper/hypo pigmentation,

in line with the eyes, no signs of drainage nor swelling, no ceruman was seen on
 22

inspection.
Nose: Colour uniformed, no signs of nasal drainage or discharge seen, no lesions or

evidence of flaring. The sinus area was non tender on palpation and had no sign of

swelling.
Mouth and Throat: Lips were symmetrical, no swelling, same were moist, gum and

mucus membranes were pink and moist, and no lesions were seen. Teeth were in line,

no evidence of dental carries were noted. Tongue was pink and clean, no sign of

swelling or lesions observed.

Lungs: Chest expansion equal bilaterally, no abnormality was noted to chest wall,

same was non- tender to touch. No flaring observed from the nares, breath sounds

normal and vesicular. Client had no signs of respiratory distress/discomfort.

Heart: Heart sounds were normal, S1 and S2 heard on auscultation. No obvious

signs of cardiac distress detected, capillary refill was within three seconds.

Chest/Thorax: Normal bilaterally, two nipples present, no hyper/hypo pigmentation

or any other abnormality observed.

Abdomen/Gastrointestinal: Abdomen soft, flat and non-tender when touched, no

signs of lumps bulges or masses felt or observed. Normal bowel sounds heard on

auscultation, no obvious signs of abnormality were detected.

Genitourinary: Made no complaint about genitalia, stated that he passed urine on a

regular basis, No abnormality observed.

Back and Extremities: Both sides were symmetrical, with uniformity in colour,

spinal cord straight, no signs of scoliosis, hypnosis or lordosis observed. Arms and

legs appeared to be of equal size, no deformities noted, however had very mild

intermittent tremors of the hands. Range of motion, colour and sensation present in

all four extremities.

 23

Neuromuscular: Reflex was good, range of motion to all four limbs good, although

client appears sluggish at times, with intermittent tremors of the hands. Voiced no

complaints of pain or tenderness on examination.

Laboratory Test: Test for cocaine, marijuana and opoids was done, same was

positive for cocaine.

Mental status examination

Appearance: Clean and well put together, dressing appropriate for setting,

age, climate and time of the day. Hair quite kempt and feet shod.

Mood: Euthymic

Affect: blunted/restricted (negative symptom)

Speech: Low toned, clear and mainly rational

Though form/process: No abnormalities detected

Thought content: No delusions, paranoid ideations, however, expressed

decreased self worth, as he feels that he has not maximized his full potential.

Perception: Admitted to auditory hallucinations, (positive symptom) stated

that he has heard voices speaking in his head from time to time, sometimes

the voices tells him to throw things at staff as well as fellow patients.

Orientation: Fully oriented in all spheres, time, place and person

Behaviour: Very cooperative, answer questions asked,

Abstract/Cognition: Intact; was able to explain the idiomatic expressions,

One, one coco full basket and Every tub must stand on its own bottom.
 24

Memory: Recent, and remote memory are intact, he could recall events in

his early childhood and could state currents events, such as the prime

ministers of the recent past and the present.

Judgement: This is very good, when asked what he would do if he was

locked in a room burning, he replied, that he would shout for help or try to

break the window pane.

Insight: Client knows that something is wrong with him, but stated that he is

not sure, but suggested that maybe something is wrong with his mind and

could have resulted from his financial and social situation.

Summary of the care of A.F.

Week One: 29.06. - 05.07.09

Mr. *A.F. was met sitting quietly beside his bed by himself, when approached he

was quite reluctant to talk however, after I introduced myself and what I intended to

do, he became more receptive and was quite willing to share his situation with me.

*A.F. does not socialize much with the other clients, he generally takes his morning

baths then sits by himself and wait for medication and breakfast to be served, at

other times he may sit in the group sessions if he so inclined, then he comes back

inside where he sits until its time for the afternoon meal and baths.

He said that most times when he is sitting by himself he hears a voice speaking in

his head, this voice tells him many things, including throwing water on the staff and

his fellow clients.

 25

Mr. *A.F. was encouraged to speak to at least one person each day, to attend and

participate in the group therapy sessions, to assist in doing minimal ward chores, to

watch television, to take his medications, and to try and not listen to the voices. In

addition to these the client would, be engaged in a one to one conversation each day

with yours truly.

So far the client has been very complaint with all the measures/therapies identified.

He has sat in the group meetings for all the days so far and has actively participated;

he has tried to speak to client N.T. who sleeps beside him.

The other aspect of his care such as hygienic needs, are done very early in the

morning and in the afternoon, these the client usually accomplish by himself

without any supervision.

Week Two: 06.07.2009-10.07.2009

Client received locked in seclusion room on the 06.07.2009. He reportedly threw

water at staff the previous day. When questioned why he threw the water, he gave

no response but a blank stare.

Mr. *A.F. was nursed in the seclusion room on a request made by the nurses from

the doctor. The intent of this method was to provide behaviour modification for the

client and to provide protection for him (from other patients, who wanted to beat

him for the incident) for the other clients and staff. He was reviewed by the ward
 26

doctor and a decision is yet to be made concerning a change in his current medical

management.

Client was allowed out of seclusion room each morning under close supervision for

baths, meals, medication, and group therapy as well as one to one interaction with

yours truly.

On Friday client stated that he felt bad that he threw water at the staff, and that he

would try very hard not to listen to the voice when it tells him to do things. (See

nursing care plan for interventions).

Client was briefly educated about his condition, reason for taking medication, the

possible side effects and what he should do if and when they occur.

Familys attitude towards client

*A.F. father is reportedly living in Portmore, but cannot be located at this time, he

has not visited client since he has been admitted in hospital. Client has a sister who

resides in United States, but they are not in contact with each other. There is an aunt

*A.E. who also lives in Greater Portmore, she has visited *A.F. once, but stated that

she is unable to accommodate him as there are three other persons who are mentally

challenged living with her.

In terms of family support, there is no one to assist *A.F. should he be discharged

from the hospital; however, he stated that is just a small challenge he can over

come.
 27

Communitys attitude/involvement towards client

Community was always receptive of client, but when he started to denude himself in

front of the children, they became quite upset and intolerant of him and demanded

that he should be treated. It should be noted that the church is quite willing to take

him back as long as his condition improves. (So says Pastor Angling, the church

pastor at 59 Hope Road).

Clients outlook for the future/prognosis

*A.F. has a very positive outlook for the future, he stated that the wants to go back

to school and finish up his education so that he could provide for him, he also wants

to continue working as a welder. He stated he knows that he will have challenges,

but those can be overcome.

Prognosis: Client will be able to live a functional life as long as he takes his

medication, is gainfully employed, (his job at the church was given to someone else,

prior to his admission), keeps his appointments at the clinic/health centre and stop

the use of hard drugs.

_________________________________________________________________

*Initial used to protect privacy, A.F. used interchangeably with S.F.

 28

With
 ASSESSMENT DIAGNOSIS PATIENTS INTERVENTIONS

1. Client stated that he 1. Altered sensory OBJECTIVES 1. Establish one to one,

29
heard voices telling him perception (auditory) 1. Client will for therapeutic

to do things, including related to disturbed report/exhibit a decrease in relationship.

throwing water at thought process auditory hallucination Medicate with Risperdol

people. secondary to an following nursing and and Chlorpromazine to

2. Client stated that he imbalance in collaborative intervention decrease psychotic
felt that he did not neurotransmitter. throughout the next two symptoms.
achieve as much as he weeks. Do not validate
could have, feels sad at hallucination, to allow
times. client to realize that they
3. Client sits by himself are not real.
most of the times, does
Allow client to take part
not initiate conversation
in ward chores, to take
with fellow clients or
mind from off the
staff.
hallucinations.

2. Risk for violence, 2. Client will not cause 2.

directed against others any injury to other clients Keep client under close

related to auditory or staff throughout the next observation to prevent him

hallucinations. two weeks of from harming others.

hospitalization, following Keep harmful objects from

nursing and other out of the reach of client

interventions. (example knife) to prevent

harm to others.

Keep client in seclusion

room, for behaviour

modification and from

harming others and others

from harming him.

30
 31

Recommendations

Schizophrenia can be a debilitating disease with disordered thoughts, delusions and

hallucinations, which can be a frightful experience for the client as well as their

significant other/s. However, with proper management, clients can lead a functional

and near normal life.

For the client in this care study, I would like to recommend the following:

1. Social investigation and follow up - Mr. *A.F. would benefit from having his

familys support, but as it stands now, he cannot tell where his father is, he

has no link with his sister who is abroad and his aunt does not visit. Family

participation is important when it comes on to the management of psychotic

clients. In addition multiple studies have shown that this type of therapy

along with drug treatment significantly reduce the frequency of relapses

(Schizophrenia Discussion Group, 2004; Huxley, Rendall and Sederer2000).

2. Rehabilitation This would include vocational goals and social skills; this

would help to increase clients skills and knowledge as well as reduce his

rate of relapse. These skills include: one to one, psychotherapy, group and

family and occupational therapies, community programmes, all these have

proven to be the most effective psychosocial measures. These provide

elements of practicality and would provide *A.F with the entire problem

solving of every day challenges, socialization, building of self-esteem,

vocational activities and specific goal orientation.

 32

3. Follow up from mental health officers- Mr. *A.F. Would benefit from

frequent follow by mental health officers, as this would prevent him from

becoming reinstitutionalized when he is discharged.

4. Medication compliance and follow education- It is recommended that Mr.

*A.F. be educated on his condition and told the reason why he has to take

medication. He should also be told about the prognosis of disease, the

therapeutic effects as well as the adverse side effects of the medications as

well as what he should do when he experiences the adverse effects. Client

should also be instructed to take medication as prescribed, to return for

follow up on the date specified on card, he should also be told about drug

interactions (for example drugs interacts negatively with marijuana, so he

should not smoke while taking medication).

These were just some of the recommendations that I feel would greatly assist Mr.

*A.F. and others with the challenge of schizophrenia.

__________________________________________________________________

*Initial used to secure privacy

 33

Conclusion

The objective of this care study was to look at a client suffering from schizophrenia,

(Mr. A.F.) the causes of schizophrenia and the prognosis and treatment for the

disease. This presenter can safely conclude that the objectives for doing this study

was clearly met, now understands some aspects of schizophrenia and its

management and is now better able to care for others with a similar diagnosis.