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A Case Study on
SCHIZOPHRENIA PARANOID
Submitted to:
Ms. Melba Irene Gabuya, R.N.
Clinical Instructor
Sumitted by:
Glaiza Ayop
Lev Jasper A. Blanco
Kara Marise Cortez
Arriane Noelle Gamalinda
Lovely Ann Lim
Lord Jacob Nique
Kim Ryan Renejane
Regine Saso
Angelie Tan
Kevin Tipon
Charrae Zarragosa
BSN-3D
August 7, 2010
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TABLE OF CONTENTS
Acknowledgement
Introduction
Objectives (General& Specific)
Patient’s Data
Genogram
Health History
Personal History
Anamnesis
Theories of Development
Etiology
Symptomatology
Psychodynamics
Mental Status Exam
Multi Axial Diagnosis
Definition of Complete Diagnosis
Differential Diagnosis
Anatomy and Physiology
Doctor’s Order
Drug Study
Nursing Care plan and Nursing Theories
Medical Management
Prognosis
Recommendations
Significance of the Study
Conclusion
References
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ACKNOWLEDGEMENT
The group wishes to express their gratitude and appreciation to the people who supported
the group in their works and helped in the success of this case study.
First of all, the group would like to thank the almighty God who gave the group
protection at all times.
To the group’s clinical instructor, Ms. Melba Gabuya, R.N. for her patience, guidance
and knowledge that she imparted to the group throughout the whole duration of the group’s
psychiatric exposure. To Mrs. Anabel Bauzon, R.N., Ms. Magnolia Jadulang, R.N., M.N., and
Mr. Richard Cheng, R.N., for their guidance and precence during the psychiatric exposure. To
Mrs. Nancy Bargamento, R.N., M.N., for imparting her knowledge and preparing the whole class
in our lectures on Psychiatric Nursing concept before the actual psychiatric exposure.
The group would also like to thank the staff of Davao Mental Hospital, for the usage of
the facilities and allowing us to read our client’s latest and previous charts.
To the Lim family, the group is grateful for providing lodging and sustenance during the
production of this group project.
To the patient, for his cooperation and expressing his feelings and insights in relation to
his illness during the interview that the group conducted.
To our patient’s father, for the time he allotted in giving all the necessary information
needed to complete this study.
To our families and friends, thank you for the support and encouragement you have given
to the group, without all of you, this report would not be a success.
To the group members, thank you for your unwavering effort and unadulterated
dedication for the commencement and completion of this project.
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INTRODUCTION
Schizophrenia is a serious mental illness characterized by a disintegration of the process
of thinking and of emotional responsiveness It most commonly manifests as auditory
hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with
significant social or occupational dysfunction. Onset of symptoms typically occurs in young
adulthood, with around 1.5% lifetime prevalence of the population affected. Diagnosis is based
on the patient's self-reported experiences and observed behaviour. No laboratory test for
schizophrenia currently exists.
Schizophrenia Ranks among the top 10 causes of disability in developed countries
worldwide (World Health Organization, www.who.int) Schizophrenia is a disease that typically
begins in early adulthood; between the ages of 15 and 25. Men tend to get develop schizophrenia
slightly earlier than women; whereas most males become ill between 16 and 25 years old, most
females develop symptoms several years later, and the incidence in women is noticeably higher
in women after age 30. The average age of onset is 18 in men and 25 in women. Schizophrenia
onset is quite rare for people under 10 years of age, or over 40 years of age (schizophrenia.com).
Approximately 1 percent of people develop schizophrenia at some time during their lives.
Experts estimate that about 1.8 million people in the United States have schizophrenia. The
prevalence of schizophrenia is the same regardless of sex, race, and culture.
In the Philippines, the prevalence of schizophrenia is thought to be about 1% of the
population. About 90% of patient in treatments is between 18-55 years old. (www.doh.gov)
The group 2 of BSN-3D was given the opportunity to have a psychiatric exposure at the
Davao Mental Hospital last July 26 until August 6, 2010. Within these dates the group was
assigned to have the case of Kida which was diagnosed with schizophrenia paranoid. After the
group’s initial research about his case we found out that he had several recurrent admissions at
the institution. With this data the group ought to seek the factors that influenced his condition.
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OBJECTIVES
The group formulated one general objective which serves as the main goal of the case
study and a number of specific objectives which may lead to the completion of the study.
General Objective:
The group will be able to apply and relate the knowledge and skills gained from the
nursing concept of Psychiatric Nursing to achieve a comprehensive and intensive learning
experience on a case study.
Specific Objectives:
a. Choose a client to be the subject of the case study related to Mental Illness
b. Establish rapport and good therapeutic relationship with the client and the family
members to gain their trust and to attain relevant information in the process
c. Gather necessary data through interview with the client and family members which will
serve as the baseline data for the case study
d. Trace the genogram of the client to be able to identify occurrence of the present condition
of the client
e. Know the past and present health history of the client and the family which will help in
determining the factors that caused the condition of the client
f. Present the anamnesis by thorough gathering of the client’s pertinent data, selected
informants, and familial history taking.
g. Determine if the client followed or achieved the theories of development by Eric Erikson,
Robert Havighurst, Sigmund Freud and Jean Piaget
h. Trace the psychodynamic of the final diagnosis including the etiology, symptomatology,
the predisposing and precipitating factors
i. Assess the client’s mental status thoroughly during the orientation and termination phase
as well as the Multi-Axial diagnosis
j. Interpret and analyze nurse-patient interactions taken through effective use of therapeutic
communication
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k. Give at least 3 definition of the complete diagnosis of the client
l. Arise with a differential diagnosis in relation to the client’s maladaptive behaviors.
m. Discuss the human anatomy and physiology of the organs involve in the client’s
condition
n. Present a doctor’s order with rationalization.
o. Present diagnostic exams true to the condition of the client in order to know what
complications the client had undergone as well as its clinical interpretation
p. Review the drugs taken by the client including its classification, mechanism of action,
indications, contraindications, drug interactions, side effects and adverse effects and
nursing management of each medication that have been prescribed to the client
q. Formulate at least 10 nursing care plans for the management and implementation of the
different interventions for the client
r. Arise to a prognosis
s. Make recommendations
t. Provide the significance of the study
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PATIENT’S DATA
Name : Kida
Age : 36 years old
Address : Purok 1B, Hilltop Bajada
Birthday : October 6, 1974
Birth Place : Makilala, Cotabato
Gender : Male
Ordinal Rank : 2nd child
Civil Status : Single
Nationality : Filipino
Religion : Roman Catholic
Educational Attainment : Secondary Level Undergraduate
Occupation : Unemployed
Source of Information : Client, Father, Cousin and neighbors
Father Mother
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Name: Amakida Name: Inakida
Age: 64 years old Age: 59 years old
Occupation: Service Driver Occupation: Midwife
Educ. Attainment: College Level Educ. Attainment: College Level
Medical Data
Date of Admission : March 23, 2010
Admitting Physician : Al Raymond Tupas, M.D.
Diagnosis : Schizophrenia Paranoid
Institution : Davao Mental Hospital
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HEALTH HISTORY
Past Health History
Kida was a shy type of child. He’s not fond of playing games with his siblings. During
his elementary years, specifically in grade 6, he engaged in premarital sex. The lady he had made
love with became pregnant. His parents did not know about it. When he was already in
secondary level he engaged in gangsters. Due to the influence of these gangsters, his studies
were affected. He used illegal drugs, specifically Marijuana. Aside from using drugs he also
became alcoholic. His vices became chronic which led to a conflict in the family. Because of this
behavior it became a problem in the family. Such behavior became a problem because Kida can
no longer perform basic household chores.
Present Health History
Kida has been admitted for several times in the same institution. His last admission was
last March 23, 2010 and was discharged July 20, 2010. At home Kida didn’t take his medicine
two days prior to the incident when he hurt a 5 year old child. One day he became irritable and
hostile which led to his admission.
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PERSONAL HISTORY
Pre-natal
Amakida said that his wife carried herself well and didn’t experience any bumps, falls
and other accidents during pregnancy. His wife had her prenatal check-ups every month. His
wife never experienced any sickness during her pregnancy to Kida. His wife didn’t have any
problems experienced during her pregnancy with Kida and according to Amakida, his wife had
normal pregnancy. His wife is very careful regarding to her pregnancy. The mother took
vitamins and supplements every day. His wife eats nutritious foods during her pregnancy.
Birth
According to Amakida, Inakida experienced a complete nine months of pregnancy. On
October 6, 1974 in Makilala, North Cotabato, Inakida gave birth to Kida in the hospital through
normal delivery without difficulty and no instrumental sequels. Attended by a doctor.
Infancy and Childhood Characteristics
Kida is breastfed for only 3 months after birth because his mother needs to go back to
work and after 3 months, they mix fed him. The feeding pattern during infancy is not normal
because he had different feeding patterns. He was taken care by a “Yaya” and sometimes by his
Lola.
According to Amakida, Kida and his mother cuddles and hugs him always when she
breastfeeds him. Kida completed the immunization.
His first tooth came out when he was 1 year old. He started talking at age 1 and also
walking at the same age. The toilet training started when he was 2 years old and it was mostly
done by the mother and she was not strict in it. He does it independently but with a mother’s
guidance.
According to Amakida, Kida thumb sucks. He have fever for 2-3 days.
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Psychosexual History
He got circumcised at the age of 10 and he started to become aware about sex is when he
was 15 years old and at that age he also started to masturbate. He reads porn magazines and
watches pornography. The age when his voiced lowered in pitch is when he is 18 years old.
Play Life
According to his father, he’s a silent type of person, he’s not talkative. The games he
mostly plays are basketball and “takyan”. He would play only in their yard together with his
siblings and cousins. And he has few playmates, both boys and girls, because he has difficulty
establishing rapport to other children. According to the father, when playing, he was a follower.
When he was in Grade school, he does not leave school to play but when he was in High
school he leaves school to play.
School History
He started schooling at the age of 4 years old and he left school during his 2 nd year in
College at the age of 18 years old. He only completed his 1 st year college and he stopped during
his 2nd year in college.
During Pre-school and Elementary, he studied in Jizon Elementary School but when his
family transferred to Fatima Street, Guerrero, he continued his High School there. According to
his father, Kida adjusted easily in school and in the community when they transferred.
When he was in Elementary and in High school, he was focused in school, he does not
skip classes and his performance in school is fair. He doesn’t have many friends, he is not
talkative and he is shy. His favorite subject is Home Economics.
During Elementary and High School, his grades were normal. Most of it were at 80 + but
in College, his grades were just enough to pass the subject.
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Religious and Social Adaptability
Kida has few selected friends, both male and female, and most of them are the same with
his age. He is a shy boy but when he became a teen, he joined a Gang and learned vices like
smoking Marijuana and drinking alcohol.
His family goes to church but is not that religious.
Occupational History
Patient wasn’t able to experience employment. Unemployed.
Marital History
Kida is not married. However, he did have relationships with the opposite sex. When
Kida was 20 years old, he had his first girlfriend. And after that according to his father, they live
for one month and decided to separate after his girlfriend got pregnant.
Onset of Present Illness
According to the father, there are many reasons why he was readmitted. Two weeks prior
to admission, he had positive late insomnia and he was noted to be violent to himself and started
to harm other people. Furthermore, he also hit his youngest sister without any apparent reasons,
thus Kida was restrained by his parents. This last incident prompted the father to seek for
hospitalization.
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ANAMNESIS
INFORMANTS
1.) Name: Amakida
Age: 64
Civil Status: Married
Address: Hilltop Bajada
Relationship to patient: Father
Length of time known to patient: Since birth
Apparent understanding of present illness of patient:
While Kida was still in college, his father started to suspect that he’s using illegal
drugs. He observed the changes of Kida’s behavior such as destroying their bathroom,
burning his clothes for no reasons, and stealing things that he doesn’t own and then sell them.
After they noticed the changes of Kida’s behavior, they decided to bring Kida to the San
Pedro Hospital to have a check-up. The result shows that he’s positive in using illegal drugs,
so the family finally has confirmed that he was under the use of illegal drugs. The doctor just
prescribed him a medicine. He doesn’t take his medications religiously, so Kida’s behavior
worsened.
Other characteristics and attitude of informant:
The informant was very accommodating and cooperative. He’s open in discussing about
Ronaldo’s mental illness. He shows concern on his son’s condition. He’s willing to answer
the questions that we asked.
2.) Name: Cuzkida
Age: 35
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Address: 170 Fatima Street Guerero
Relationship to patient: 1st Cousin
Length of time known to patient: 30 years
Apparent understanding of present illness of patient:
Cuzkida said that Kida is a quiet person and not very open in saying what he feels.
Kida don’t like to be asked with many questions. Kida’s family started to live with them in
Fatima Guerero when he was still in elementary. During high school he started to drink
alcoholic beverages and smoke cigarette. She said that kida’s illness only started during when
he was at college. He would still asked money to his grandparents, even though his parents
have already given him the money for the tuition fee. If his parents don’t give money, he
would sell his clothes. She mentioned that he might be influenced by his group of friends in
college on using drugs.
Other characteristics and attitude of informant:
The informant was accommodating and kind to us. She was very responsive
in the conversation, and willing to tell the group everything that she knows about
the patient. She has shared to us much information about kida.
3.) Name: Girkida
Age: 38 years old
Address: Fatima Street Guerrero
Relationship to patient: Girlfriend
Length of time known to patient: 18 years
Apparent understanding of present illness of patient:
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Girkida and Kida met during college. Both of them have the same set of friends and she
admitted that she has also tried using illegal drugs. They got lived in together for 1 month
only, and then she decided to part ways with him. So, Kida went back to his family in
Bajada. He didn’t know that she was already pregnant with his baby, until they heard about it
and his family searched for her. Almost 10 years after, he saw his child. As what she knows
about Kida is that he’s a quiet, good person, and an obsessive compulsive type of person. He
never talks to her about his problems; he only kept it to himself. According to her, Kida’s
group of friends was the main reason why he got addicted, because of their influenced to him
to take illegal drugs.
Other characteristics and attitude of informant:
The informant was warm and welcoming to us. She was responsive and willing to answer our
questions.
4.) Name: Anakida
Age: 15 years old
Address: Fatima Guerrero
Relationship to patient: Kida’s son
Length of time known to patient: 5 years
Apparent understanding of present illness of patient:
According to Anakida, he first met his father at the age of 10. They only see each other
during weekdays. As what he knew also, his father was influenced by his friends in using
drugs.
Other characteristics and attitude of informant:
He’s uncomfortable talking about his father’s condition, but somehow he was able to give
us some information that we need. He quiet anxious when he had talked to us.
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FAMILY HISTORY
Maternal and Paternal Grand Lineages
According to the reports, there’s no history of mental illness in both sides of parents.
Both on the maternal line and paternal line, no illness were reported to run in the family.
Aside from Kida’s mother, his grandmother on mother’s side also took care of him since
birth until he was 12 years old. When his mother is busy on her work, his grandmother is the
one who takes care of him.
Father
Amakida is now 64 years old. he works as a driver on Department of health According to the
informants, amakida is good father to his children and he does everything he can to provide
the needs of his family. He scold his children whenever they do something wrong, because
he just want them to learn from their own mistakes. He believes that as a father he must give
financial support to his family and security to his family. He thinks that he must also be a
good role model to his children. Although he wasn’t able to finish his studies, he still does
his best to give his family a good life. He only has the vices of drinking alcoholic beverages
and smoking, occasionally.
Mother
According to Kida’s father, his wife loves her children very much and she’s very supportive
to him and his children. She works as a midwife at the Makilala to supplement her family’s
needs. Whenever she’s on duty and his husband is on work, she would leave her children to
her mother or to a “yaya”. She disciplines her children in a typical Filipino way. Her
relationship with his husband is good, but they don’t see each other that much because both
are busy in their works.
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Siblings
The family is composed of four siblings; Brokida 1 being the eldest, followed by Kida,
then Brokida 3, and lastly Siskida as the youngest. Kida was close to all of his brothers and
sister, but much more closer with his sister, the youngest.
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THEORIES OF DEVELOPMENT
ERIK ERICKSON’S PSYCHOSOCIAL DEVELOPMENT THEORY
Erik Erickson’s developmental theory divides the human life cycle into eight distinct
psychosocial stages, each with its own conflicts to be resolved, significant relationships, and
favorable outcomes. Conflicts that are not resolved in a timely fashion cause difficulties and may
be rewarding therapy
* INFANCY (0 -1 ½ years old) – TRUST vs. MISTRUST
During the first year of life, an infant depends on the parents for all their physiologic and
psychological needs. Fulfillment of these needs is required for the infant to develop a basic sense
of trust. Parents can enhance this sense of trust by responding consistently to an infant’s needs,
providing a predictable environment in which routines are established and being sensitive to the
infants needs and meeting these needs skillfully and promptly.
TRUST
In Kida’s case he was breastfed for the first 3 months of life and bottle-fed after because
the mother needs to go back to work. Her mother is a midwife and is usually not at home. The
maternal-infant bonding was met only on the first 3 months of life. Her mother is a midwife, so
she wasn’t able to take care much of her children because of too much work. Also her father
wasn’t available all the time because of work and so he wasn’t able to take care of Kida all the
time. When his mother and father are not at home, his nanny and grandmother takes care of him.
They fed him and give attention and care to the child. As a conclusion, the task was met in this
stage which created mistrust to the infant.
* TODDLER (1 1.2 – 3 years old) – AUTONOMY vs. SHAME and DOUBT
Toddler begin to develop their sense of autonomy by asserting themselves with the
frequent use of the word “no”. They are often frustrated by restraints to their behavior and
between ages 1 and 3 may have temper tantrums. Parents need to have a great deal of patience
coupled with an understanding of the importance of this developmental milestone. Caregivers
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need to give the child some measures of control and at the same time be consistent in setting
limits so that the child learns the results of misbehavior.
AUTONOMY
In Kida’s case, he was able to meet the task because he was able to learn and explore
more of his surroundings because of her mother giving measures of control and at the same time
being consistent in setting limits to the child so we can say that he had met autonomy.
The patient started talking when he was 1 year old and started walking on that age as
well. The patient was toilet trained when he was 2 years old. Toilet training was mostly
implemented by his mother, and she is not strict in it. Kida does it independently but with
mother’s guidance. The child was able to master this kind of task in this stage, since he
developed the sense of autonomy which he was able to handle things of his own.
* PRESCHOOLER (4 and 5 years old) - INITIATIVE vs. GUILT
During this stage, the child learns to take initiative and get ready for leadership and goal
achievement roles.
If adults encourage and support children’s efforts, while also helping them make realistic and
proper choices, children develop initiative- independence in planning and undertaking activities.
But if, adults discouraged the search of independent activities, children develop guilt about
their needs and desire.
GUILT
According to his father, he’s a silent type of person, he’s not talkative. He would play only in
their yard together with his siblings and cousins. And he has few playmates because he has
difficulty establishing rapport to other children. According to the father, when playing, he was a
follower. The child developed guilt.
* SCHOOL AGE (6 -12 years old) – INDUSTRY vs. INFERIORITY
At this time, children begin to create and develop a sense of competence and
perseverance. School age children are motivated by activities that provide as sense of worth.
They concentrate on mastering skills that will help them function in the adult world. If children
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have been successful in previous stage, they are motivated to be industrious and to cooperate
with others toward a common goal.
INDUSTRY
He entered elementary at the age of 6yrs.old. During his school age, Kida is fine. He
studies well and got average grades. He has no back subjects. He has met the expectations of his
parents from him, which is to do well in his studies.
* ADOLESCENCE (12 - 20 years old) – IDENTITY vs. ROLE CONFUSION
During this stage, Adolescents help one another through this identity crisis by forming
cliques and a separate young culture. Adolescents are usually concerned about their body, their
appearance and their physical abilities. New sense of identity on self is established, commitment
to career planning, sense of having a place in society, establishing relationship with opposite
sex, fidelity to friends, developments of personal values, testing out adult roles and mature
sexuality is achieved.
ROLE CONFUSION
Kida studied in Our Lady of Fatima during high school. According to his neighbor, which
is his classmate as well, he joined a gang during high school. He started drinking and smoking
because of peer pressure. Also, he started using marijuana, he’s cutting his class and because of
his vices he always got low grades. He studied college in MATS and stopped on his second year
for the reason that he prefers going out with his friends than going to school. His parents already
doubt that Kida started using marijuana because of behavioral changes and going home late at
night. At the age of 20, he was admitted to the Drug Detention Rehabilitation Center (DDRC)
because his father couldn’t control kida anymore. He is already violent and steals their things to
sell it in order to have money to buy marijuana. He developed role confusion.
YOUNG ADULTHOOD (20-30 years old) INTIMACY VS. ISOLATION
Trust is essential to establish intimate relationship. Intimacy involves mutual
compassion, commitment and acceptance.
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Once people have established their identities, they are ready to make long-term commitments to
others. They become capable of forming intimate, reciprocal relationships and willingly make
the sacrifices and compromises that such relationships require. If people cannot form these
intimate relationships--a sense of isolation may result.
INTIMACY
He had his first girlfriend at the age of 20. Their relationship did not last long but they had a
child. He had intimate relationship with his friends who are also drug addicts and are usually
with them most of the time. Kida developed intimacy because he was able to form intimate
relationship with friends.
MID-ADULTHOOD: (30-65 years old) GENERATIVITY VS. STAGNATION
Generativity is occurred when adults gained enough self-sufficiency and motivity to be
able to guide the next generation. Self absorption and caring for one is signs of stagnation.
During middle age the primary developmental task is one of contributing to society and helping
to guide future generations. When a person makes a contribution during this period, perhaps by
raising a family or working toward the betterment of society, a sense of generativity ,a sense of
productivity and accomplishment results. In contrast, a person who is self-centered and unable
or unwilling to help society move forward develops a feeling of stagnation- dissatisfaction with
the relative lack of productivity.
A person in this stage should have time for companionship and recreation. He also knows his
responsibilities and knows that he is accountable of whatever actions he takes.
STAGNATION
The patient is not so productive due to his illness. He’s being dependent to his family.
The little money he earned out of the stolen things he sold is being wasted for buying what is
being prohibited for him to be used, like marijuana and cigarettes that contributes in worsening
his illness. He doesn’t support his child that’s why he wastes his money for his own wants. He’s
not helping the country to move forward since he had violated the Republic Act 6425 or the
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Dangerous Drug Act of 1972, Article III, Sec. 8 which is regarding the usage of the prohibited
drugs.
SIGMUND FREUD’S PSYCHOSEXUAL THEORY
Oral Stage (0 to 18 months)
During the first stage of Sigmund Freud theory, the mouth is the major source of
gratification, exploration and source of pleasure and satisfaction. During this stage, the child
believes that his mouth is the source of pleasure because it is where he feeds and in turn brings
comfort, security and happiness to him. The major source of pleasure comes from sucking,
eating, biting, and chewing. If ever the child will not accomplish this pleasure then fixation can
happen.
In Kida’s case, his mother was able to supply him with regular Breast milk until 3months
of life with proper duration and in time interval. After 3months, Kida was mixed fed because her
mother is not at home all the time. Thumb sucking was evident. If his mother is not at home, her
grandma and nanny take care of him. If ever Kida cries, they immediately fed him to supply his
needs. The parent and the guardian were able to meet the pleasure site of the infant which is the
mouth. Oral stage is achieved.
Anal Stage (18 months to 4 years old)
The second stage of psychosexual development is the anal stage which occurs from 18
months of the child up to 4 years; in this stage, the child begins to control his muscles from
urination and defecation. The child explores his control on his body parts by either holding on
or letting go of his bodily waste. Toilet training is crucial in this stage. If the training is too
rigid, then the child may develop retentive personality in the future on which he becomes too
rigid, obsessive orderly and stringent. On the other hand, if the parent is to loose on toilet
training on which the child does not receive reward punishment at the right time then the child
may develop expulsive personality on which the child’s future becomes disordered, destructive
and careless.
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According to his father, they are not strict in Kida’s toilet training. They let Kida do it
independently but his mother guide him. He was able to handle things of his own. Therefore,
anal stage is achieved.
Phallic Stage (3 to 7 years old)
In this stage, the center of pleasure comes from the child’s genitals. The child now starts
to know gender differences and becomes aware of his genitals. The child starts to touch and
explore his body parts and it is in this stage that the child’s curiosity arises on masturbation.
Oedipus complex appears on boys on which they have feelings of intimate sexual possessiveness
for the mothers and Electra complex arises on the girls on which they also want to possess
intimate sexual possessiveness to their father. The child develops fear of punishment by the
parent of the same sex, guilt, and sexual identity. The child conflict is resolved when the child
identifies with the parent of the same sex.
Fixation occurs when he is unable to identify with the parent of the same sex and the
child may exhibit reckless, resolute, self-assumed, narcissistic behavior in the future.
Kida did complete the tasks identified in this stage. At this stage, he was able to learn
that a boy is for a girl, and a girl is for a boy. According to his father, he saw Kida holding his
penis while drinking milk and when taking a bath.
Latency Stage (7 to 12 years old)
In this stage, the child does not have any center of pleasure; the child uses most of his
energy to gain new skills in social relationships and knowledge. It is in this stage; the child
becomes more focused in dealing with friends and focuses on his academic performance. It is in
this stage the child masters the sense of industry.
He started to go to school by this time; he had gained few friends and few playmates. He got
good grades and performing well in school. The child achieved this stage.
Genital Stage (12 years up to 20 years old)
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During this stage the genitals again becomes the pleasure zone of the child. It is in this
stage that the child builds a sexual relationship with the opposite sex. There will come a time
that the child will now try to engage in sexual intercourse. The individual gains gratification
from his or her own body. During this stage, the individual develops satisfying sexual and
emotional relationships with members of the opposite sex.
In Kida’s case he was able to experience attraction to the opposite sex. And He
experienced sexual intercourse at the age of 20.
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
The Theory of Cognitive Development, one of the most historically influential theories was
developed by Jean Piaget, a Swiss Philosopher (1896–1980). His genetic epistemological theory
provided many central concepts in the field of developmental psychology and concerned the
growth of intelligence meant the ability to more accurately represent the world and perform
logical operations on representations of concepts grounded in interactions with the world. The
theory concerns the emergence and construction of schemata — schemes of how one perceives
the world — in "developmental stages", times when children are acquiring new ways of mentally
representing information. The theory is considered "constructivist", meaning that, unlike nativist
theories (which describe cognitive development as the unfolding of innate knowledge and
abilities) or empiricist theories (which describe cognitive development as the gradual acquisition
of knowledge through experience), it asserts that we construct our cognitive abilities through
self-motivated action in the world.
1. The Sensorimotor Period (birth to 2 years)
During this time, Piaget said that a child's cognitive system is limited to motor reflexes at birth,
but the child builds on these reflexes to develop more sophisticated procedures. They learn to
generalize their activities to a wider range of situations and coordinate them into increasingly
lengthy chains of behaviour.
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The father of Kida remembered that they noticed that Ronaldo responds to different reflexes
when he was a baby. He would move his body when both his parents touch him. He would grasp
things when handed to him. Breastfeeding and bottle feeding are the food provided by his mother
during her birth. When giving the bottle, the infant grasp it as a response of his hungriness.
2. Pre Operational Thought (2 to 6 or 7 years)
At this age, according to Piaget, children acquire representational skills in the areas mental
imagery, and especially language. They are very self-oriented, and have an egocentric view; that
is, preoperational children can use these representational skills only to view the world from their
own perspective.
Kida was a silent son and brother. He wasn’t that expressive towards his feelings because
he was not that open to everyone.
3. Concrete Operations (6/7 to 11/12)
A opposed to Preoperational children, children in the concrete operations stage are able to take
another's point of view and take into account more than one perspective simultaneously. They
can also represent transformations as well as static situations. Although they can understand
concrete problems, Piaget would argue that they cannot yet perform on abstract problems, and
that they do not consider all of the logically possible outcomes.
According to his father, Kida is a very organized person. His room and things are well
arranged. But when he started taking marijuana, his father noticed that Kida is disorganized and
breaks the things inside their house.
4. Formal Operations (11/12 to adult)
Children who attain the formal operation stage are capable of thinking logically and abstractly.
They can also reason theoretically. Piaget considered this the ultimate stage of development, and
stated that although the children would still have to revise their knowledge base, their way of
thinking was as powerful as it would get.
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The characteristics of this stage are:
• The person is capable of deductive and hypothetical reasoning.
• The logical quality of the adolescent's thought is when children are more likely to solve
problems in a trial-and-error fashion.
• During this stage the young adult is able to understand such things as love, "shades of gray",
logical proofs and values.
• During this stage the young adult begins to entertain possibilities for the future and is
fascinated with what they can be.
When asked, “Kung makakita ka ug pitaka na punog kwarta, unsaon man nimo ang pitaka, iuli o
gastuhon ang kwarta?”; he then replied “Iuli nako, kay basig kailangan sa tag-iya ang kwarta.”
He was able to draw conclusion from the given situation available.
ROBERT HAVIGHURST’S DEVELOPMENTAL TASKS
1. INFANCY AND EARLY CHILDHOOD (0-6yrs old)
*Learning to walk. * Learning to crawl. * Learning to take solid food. * Learning to
talk. * Learning to control the elimination of body wastes. * Learning sex differences
and sexual modesty. * Getting ready to read. * Forming concepts and learning language
to describe social and physical reality.
According to his Father, Kida was able to walk at the age of 1 year and able to eat solid
foods at the age of 7months. Makes gurgling sounds when left alone and when playing. He was
toilet trained and was able to control the elimination of body wastes. According to his father,
Kida is able to distinguish right from wrong.
2. MIDDLE CHILDHOOD (6yrs old-12 yrs old)
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*Learning physical skills necessary for ordinary games
*Achieving personal independence
* Developing fundamental skills reading, writing, and calculating:
* Achieving personal independence: To become an autonomous person, able to make plans
and to act in the present and immediate future independently of one's parents and other
adults. The young child has become physically independent of his parents but remains
emotionally dependent on them.
He was able to develop fundamental skills such as reading, writing and calculating. He was able
to learn physical skills necessary for ordinary games: such skills as throwing and catching,
kicking, and handling simple tools. Achieving personal independence: The young child has
become physically independent of his parents but remains emotionally dependent on them.
3. ADOLESCENCE (12yrs old -18yrs old)
• Achieving new and more mature relations with age mates of both sexes. * Achieving a
masculine or feminine social role. * Accepting one’s physique and using the body
effectively. * Achieving emotional independence of parents and other adults. * Preparing
for marriage and family life. * Acquiring a set of values and an ethical system as a guide
to behavior. * Desiring and achieving socially responsible behavior.* Selecting an
occupation.
He was able to learn a socially approved adult masculine social role. He enrolled BS-MT
during college but stopped on his second year. He achieved new and more mature relations with
age mates of both sexes. He was able to use his body effectively.
4. EARLY ADULTHOOD (18yrs old-30 yrs old)
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*Selecting a mate. * Learning to live with a partner. * Starting family. * Rearing
children. * Managing home. * Getting started in occupation. * Taking on civic
responsibility. * Finding a congenial social group.
Kida had a live in partner at the age of 20. Their relationship did not last long and
they had one child. He has no occupation. He did not take responsibility to his own child.
5. MIDDLE AGE (30 yrs old- 60 yrs old)
* Assisting teenage children to become responsible and happy adults. * Achieving adult
social and civic responsibility. * Reaching and maintaining satisfactory performance in
one’s occupational career. * Developing adult leisure time activities. * Relating oneself to
one’s spouse as a person. * To accept and adjust to the physiological changes of middle
age. * Adjusting to aging parents.
In the middle years, from about thirty to about fifty-five, men and women reach
the peak of their influence upon society, and at the same time the society makes its
maximum demands upon them for social and civic responsibility. It is the period of life
to which they have looked forward during their adolescence and early adulthood. And
the time passes so quickly during these full and active middle years that most people
arrive at the end of middle age and the beginning of later maturity with surprise and a
sense of having finished the journey while they were still preparing to commence it.
According to his father, Kida is not productive due to his illness. He’s being
dependent to his family. He has no job and spends most of his time with his friends that
are drug addicts. He doesn’t support his child that’s why he wastes his money for his own
wants. “Wala na xay pulos ” as verbalized by his father.
.
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MENTAL STATUS EXAMINATION
Initial
Name: KIDA Diagnosis: Schizophrenia Paranoid type
Age: 36 years old Physician: Al Raymond Tupas M.D.
Ward: Crisis Intervention Unit Date of Examination: July 31, 2010
A. General description
1. Appearance: During our interview at the Crises intervention unit in Davao Mental
Hospital we observed that our client has a small body type, poorly groomed wearing
old clothing. He has short hair and dirty nails in both feet and hands and open wounds
due to insect bites on his left foot. He seemed to be healthy. No signs of anxiety
noted.
2. Behavior and psychomotor activity: The client is ambulatory. No mannerisms, tics
and spasms noted.
3. Speech: He can to talk with ease. No impairment in verbal communication noted such
as stuttering, echolalia and mumbling of words were noted.
4. Attitude toward examiner: The client was cooperative throughout the whole
interview.
B. Moods, feelings, and affect
1. Mood: Client has a euthymic mood or in the normal range of mood. No mood swing
and signs of irritability were noted.
2. Affect: Client has an appropriate affect. Client is not in the state of agitation, tension,
or panic.
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C. Perceptual Disturbance
No signs of illusions were noted during the whole duration of the interview. Client
claims that he was experiencing auditory hallucinations instructing him to do superfluous
actions such as burning his own clothes.
D. Thought Process
1. Stream of thought: Client speaks spontaneously with some loosening of associations
at some points during the interview. No circumstantiality, tangentiality, clang
associations, and blocking were noted.
2. Content of thought: Client claims that he was experiencing delusion of persecution.
Client always tuck the linens of his bed indicating signs of obsessive compulsion. No
suicidal ideation was noted.
E. Sensorium and Cognition
1. Consciousness: Client was alert throughout the whole duration of the interview.
2. Orientation: Client was asked “kung lunes gahapon miyerkules ugma, unsa adlaw
karon?” Client was able to answer “martes” indicating orientation to time. Client was
also oriented to the place that he is at the Mental Hospital. Client was able to identify
and name the examiners.
3. Memory: Client was able to recall significant events of his life even during his
childhood. He was able to remember his episodic admission at the institution for the
last 15 years.
4. Information and Intelligence: Client was able to reach 2 nd Year College of formal
education.
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5. Concentration: Client was given simple mathematical tasks like subtracting 5 from 50
and keeps subtracting 5.
F. Judgment
Patient said he knows his behavior why he was admitted. He also knows that his behavior
would cause harm to other people that is why he would stop doing it, he will also not use
things that will bring harm to other people.
G. Insight
Client was able to manifest intellectual insight. Client is aware that he is ill and that it
was a consequence of his actions in his past. Client understands his status but he does not
apply his knowledge to future experiences such as taking his medications conscientiously
upon his discharge.
H. Reliability
We can fairly say that his statements are realistic enough. He is able to report to
each questions are more likely to be accurate. He expresses his feelings and concerns
honestly to the examiners.
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Final
Name: KIDÀ Diagnosis: Schizophrenia Paranoid type
Age: 36 years old Physician: Al Raymond Tupas M.D.
Place of Interview: Hilltop Bajada, Davao City Date of Examination: August 5, 2010
A. General description
1. Appearance: During our latest home visit at their own house we observed that Client
has a small body type, groomed well wearing his old blue clothes. He still has short
hair and his nails are now trimmed well in both feet and hands. He seemed to be
healthy. He also seemed to look young for his age. Still no signs of anxiety noted.
2. Behavior and psychomotor activity: The client is ambulatory. No mannerisms, tics
and spasms noted. No echopraxia and retarded motor activity were noted. No signs of
agitation noted.
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3. Speech: He can to talk with ease and spontaneously. No impairment in verbal
communication noted such as stuttering, echolalia and mumbling of words were
noted.
4. Attitude toward examiner: Client was cooperative throughout the whole duration of
the interview.
B. Moods, feelings, and affect
1. Mood: The patient was able to maintain a normal mood all through the home visit. He
was responding well to the conversation and his mood was appropriate for the
discussion.
2. Affect: Client has an appropriate affect. His ideas are with harmony with his sppech.
Client is not in the state of agitation, tension, or panic.
C. Perceptual Disturbance
No signs of illusions were noted during the whole duration of the interview. During the
whole visit client stated that he longer experiences hallucinations after he was discharged.
D. Thought Process
1. Stream of thought: Client speaks spontaneously during the interview. No
circumstantiality, tangentiality, clang associations, and blocking were noted.
2. Content of thought: No delusions or false beliefs were noted. No suicidal and
homicidal ideation was noted.
E. Sensorium and Cognition
1. Consciousness: Client was alert throughout the whole duration of the interview.
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2. Orientation: Client was asked the same question during our interview at the Davao
Mental Hospital about his orientation to time, place, and person and he was able
answer all question correctly.
3. Memory: Client was able to recall recent events that happened at the Davao Mental
Hospital and the day he was discharged.
4. Information and Intelligence: Client was able to reach 2 nd Year College of formal
education.
5. Concentration The patient was given again given mathematical equations. Still, he
was able to answer all of them correctly and quickly.
F. Judgment
Client was given a situation to evaluate him. He was asked with “kung ginaaway
og ginasunlog-sunlog sa mga bata diri tungkol sa imo pamilya unsa imu buhaton? He was
able to answer awayon pud nako oi.
G. Insight
The client still has the same understanding about his illness. He also insists that
his vices especially smoking and drinking Coke, which the doctor prohibited, will not
do any harm to him and will not do any effect on his illness. With these statements,
we can say that he has a poor insight.
H. Reliability
We can fairly say that his statements are true to his emotions. His actions and
statements reflect to his feelings and emotions.
MULTIAXIAL DIAGNOSIS
