PSYCH 209 - Schizophrenia Jeremy Brown is a 30-year-old Caucasian male. UNFOLDING Clinical Reasoning Case Study.

PSYCH 209 - Schizophrenia Jeremy Brown is a 30-year-old Caucasian male. UNFOLDING Clinical Reasoning Case Study.

Kendall Harrison

Schizophrenia Case Study

Carrington College

Mental Health Clinical

Rosalyne Reynolds

July 10, 2020

© 2018 Keith Rischer/www.KeithRN.com

UNFOLDING Clinical Reasoning Case Study

History of Present Problem:

Jeremy Brown is a 30-year-old Caucasian male who was brought to the emergency department (ED) by the

police after being involved in an altercation at work. Jeremy was at work today, and he threw a large piece of

metal at a coworker and began yelling, “Stop following me, I know what you have been up to!” Because

Jeremy was very agitated and upset, and the police were called.

Since arriving in the ED, he has been agitated, displaying rapid pressured speech and repeating the

phrases he hears the police and others in the ED said. Jeremy reported that he recently stopped taking his

risperidone and citalopram because he believed his coworkers have been breaking into his house and

poisoning his medications. Jeremy’s manager reports that he was diagnosed with schizophrenia five years

ago.

Personal/Social History:

Jeremy graduated from college with a 4.0 GPA and was in his first year at law school when he

experienced the first episode of acute mental illness and was diagnosed with schizophrenia. He had to drop

out of law school at age 24 and never finished. Jeremy lives at home with his mother and father and

recently broke up with his girlfriend.

Jeremy likes his job at the foundry but feels he is a disappointment because both of his sisters are

lawyers, as is his father. Jeremy has no close friends and only a few acquaintances. Jeremy’s mental health

had been stable up until the last three months. He has been feeling more paranoid the past three months and

experienced a dramatic increase in symptoms when he stopped taking all of his medications one month ago.

What data from the histories are RELEVANT and have clinical significance to the nurse?

RELEVANT Data from Present Clinical Significance:

© 2018 Keith Rischer/www.KeithRN.com

Problem:

o Patient threw a large metal object at

coworker

o yelled “stop following me, I know

what you’ve been up to.”

o Signs of rapid pressured speech and

repeating phrases

o Stopped taking medication because

he believes coworkers are trying to

poison him

o High emotion which means patient should be monitored to

make certain that further escalation is avoided.

o Paranoia is a positive symptom of schizophrenia (Halter,

2014, pg. 197)

o Pressured speech as well as echolalia are both symptoms of

someone presenting with a severe and mental illness such as

schizophrenia (Professor Reynolds, 2020).

o Patient is experiencing paranoia and persecutory delusions

which are symptoms of an exacerbated schizophrenic episode

related to lack of taking medication.

RELEVANT Data from Social History: Clinical Significance:

o Recently ended relationship with

girlfriend

o diagnosed with schizophrenia 5

years ago

o Feels he has disappointed his family

because he wasn’t able to complete

college

o Has no close friends and only a few

o Changes in relationship can trigger an increase in symptoms

or relapse in patients with schizophrenia.

o Patient is experiencing acute phase of schizophrenia and

Diagnosis of schizophrenia explains patient’s behavior and

symptoms.

o Feelings of disappointment may lead to depression and

anxiety, which have the ability to increase schizophrenic

symptoms

o All persons require socialization, someone with

schizophrenia or other mental illnesses are at risk for

© 2018 Keith Rischer/www.KeithRN.com

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