Download PBL-Max and Adam Smith

Max Smith
Action Point 1: Describe the prodromal phase and how this impacts on a client’s recovery.
The prodromal phase of schizophrenia usually develops during adolescent years and is the
precursors of schizophrenia. There are four main aspects that have been researched that is
related to Max illness.
1. Social functioning
There is a noticeable impairment in the areas of work, communication, relationships and
self care for Max. There is lack in social interactions, general loss of interest and
irritability.
2. Organisational functioning
Max’s thoughts, cognition and perceptions are disorganized.
3. Intellectual functioning
There is evidence with a decline in academic performance. Max gets very forgetful, he
cannot forget and has short attention span. He has bizarre beliefs/hallucinations for
example ability to mind-read-claiming that he has been followed by the devil.
4. Physical activity
There is decline in Max’s physical activity and lack of motivation. He is spending more
time alone.
IF Max is left untreated with the present symptoms:
 The symptoms can accelerate.
 It will pose mental, physical and emotional risk to himself and his loved ones.
 It will prevent Max from fulfilling his dreams, career and normal life.
 His cognitive abilities may deteriorate further during this time and this can cause an
additional barrier to educating Max about his illness.
 It can prevent him from performing his normal activities of daily living due to his own
due to his hallucinations and beliefs.
 Delaying intervention will mean that Max’s recovery is hindered until his condition is
treated and managed.
Action Point 2: Outline for Max’s parents, the criteria for a person to be under the Mental
Healh Act and the family.
Mental Health Act Admission criteria: for Max’s parents
That the patient must be mentally ill where an abnormal state of mind poses a serious risk to the
safety of self or others.
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Under section 8a of the Mental Health Act an application first needs to be made by a
member of the public eg. GP accompanied with a medical certificate(section 8b)
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Max would then undergo a further assessment examination by a ‘responsible clinician’
appointed under the Mental Health Act (section 9) eg. Psychiatrist. Max can apply to the
District Court judge to have his condition reviewed; however, if the clinician decides that
Max fits the criteria to be treated under a ‘compulsory treatment order’, this can occur
either within an inpatient setting or under supervision in the community for a further 5
days (section 11).
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Section 12 and 14 can be applied for, for a further 14 day assessment and application for
compulsory treatment order (s29 or s30).
Give the family an overview of how antipsychotic/anxiolytic medications are used in the
management of psychosis.
Antipsychotic medications will help reduce Max’s symptoms of psychosis. These
medications can only be prescribed by a qualified doctor and has the knowledge in mental
disorders. The dose and type of antipsychotic is individualized per patient as symptoms vary.
Anxiolytic medications, or antianxiety medications, are minor sedatives prescribed to treat
anxiety disorders that may be related to physical or psychological symptoms of psychosis,
which hinders normal functioning.
As with most medications, there may be some adverse effects such as dry mouth, headache
and constipation. The nurse and doctor will advise of these effects and any precautions that
must be taken while on the meds.
Max’s parents also ask you about the interview taking place in the other room. Describe
your response.
I would respond and reassure that Max is in a safe and appropriate environment. The team is
trying their best to give Max and his family all the best and safe support. I would
acknowledge their frustration and concerns. I have to be assertive and firm and in response I
that this is the best time for Max to be treated and it is best to get thorough results from him
in order to make a care plan that is safe, appropriate and includes the care of the family and
other network supporters. I would ensure that I maintain Max’s rights to privacy and
confidentiality, unless Max gives informed consent to disclose his personal information.
Action Point 3: Describe what needs to be undertaken for a holistic assessment of Max in a
first assessment interview.
Comprehensive Psychiatric Assessment (CMDHB)
1. Date and Time of Admission
2. Patient’s Personal Information
3. Reason for referral to the Service
4. History of present illness/problems
5. Previous Psychiatric History
6. Medical History
7. Family History
8. Drug and Alcohol Use History
9. Mental State Examination:
10. Appearance
11. General behavior and attitude
12. Speech and Language
13. Thought Form/Content
 Mood
 Affect
 Perception
 Orientation & Cognition
 Insight
 Judgement
14 Risk Plan & Risk Management Goals
In addition
 Providing a safe environment for the assessment to take place, ensuring safety
precautions are taken e.g. Awareness for patient violence, mindfulness of available
escape routes, de escalation techniques, that other staff are aware of your location etc.
 Gaining consent from Max
 Giving patient the right to freely talk about his condition.
 Documentation, keeping every information legible and confidential.
 Ensuring that the family is informed and included in all care plans for Max.
Adam Smith
Action Point 1: What information are you going to pass on to Agnes?(regarding
schizophrenia)
Schizophrenia is a thought disorder that includes psychotic symptoms such as, thinking disorder
which sometimes is out of touch at times, hallucination and paranoia. It is a disorder
distinguished by mainly disturbance in perception (hallucination), thought (eg loose association),
reality testing (delusion), feeling (flat or inappropriate effect), behavior (catatonia/ careless
behavior), attention (inability to concentrate), motivation (can not initiate in goal- directed
activities) and psychosocial functioning. This is caused by an imbalance of chemicals in the
brain and is characterized by their deteriorating personality.
There are 2 types of schizophrenia which are:
1.
Positive or type 1 is a result of sub cortical dopaminergic process or too much dopamine
affecting the cortical areas. Signs and symptoms are paranoia, hallucination, delusions,
lack of social skills and communications.
2.
Negative or type 2 is a result of hypo dopamine which leads to lack of affect, energy,
communication, labile, blunted and limited to look after himself.
Short term stay
When a client is in a short term stay inpatient he / she is there for an assessment to monitor their
behavior. Hence saying that ensures that the patient and their family’s safety is first priority of
the assessment. This is done to protect he / she and their families are protected from further
harm.
Long term stay
It is to help and assist the client to maintain their recovery and well being so that there will be no
relapses by monitoring their blood results, trail of treatments (medications) and stabilizing clients
from symptoms. Their presentation will determine how long they will stay in hospital and this
will be viewed by the psychiatrist, doctors, nurses and Mental Health Act.
The relationship of schizophrenia to substance abuse is significant. Due to impairments in insight
and judgment, people with schizophrenia may be less able to judge and control the temptations
and resulting difficulties associated with drug or alcohol abuse.
In addition, it is not uncommon for people suffering from this disorder to try to "self-medicate"
their otherwise debilitating symptoms with mind-altering drugs. The abuse of such substances,
most commonly nicotine, alcohol, cocaine and marijuana, impedes treatment and recovery.
Therefore alcohol is not the cause of schizophrenia but it heightens psychosis and the signs and
symptoms of schizophrenia
Reference:
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Elder, R., Evans, K., & Nizette, D. (2009). Psychiatric and mental health nursing (2nd ed.). Australia: Mosby
Elsevier.
http://www.livestrong.com/article/79052-prodromal-schizophrenia-symptoms/
http://www.uv.es/jcruiz/artic/IQ-Comprhensive%20Psychiatry.pdf
http://www.healthcentral.com/schizophrenia/c/76/3075/early-phase/
http://www.schizophreniaguidelines.co.uk/schizophrenia/index2.php
http://www.healthpoint.co.nz/default,41195.sm
http://www.moh.govt.nz/moh.nsf/Files/mha99/$file/mha99.pdf
http://www.tepou.co.nz/page/739-outcome-measures+additional-outcome-measures
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CMDHB website