This document describes the case of a 37-year-old man presenting with psychotic symptoms including delusions of poisoning, morbid jealousy, and unpredictable behavior. He has a history of schizophrenia and was non-compliant with medications. On admission, he was refusing food and water due to delusional beliefs. He was started on antipsychotic medications and monitored closely in the psychiatric ward. The specialist diagnosed him with schizophrenia exacerbated by borderline personality traits and medication non-adherence. Nurses focused on safety, monitoring for acute psychotic episodes, and establishing trust to effectively care for the patient.

2. RELAPSE SCHIZOPHRENIA-DEFINITIONS
• SCHIZOPHRENIA IS DEFINED AS A FUNCTIONAL PSYCHOSIS CHARACTERIZED BY DISTURBANCES IN
THINKING, EMOTION, VOLITION, AND PERCEPTION.
• A DELUSION IS A FALSE BELIEF HELD WITH STRONG CONVICTION.

3. RELAPSE SCHIZOPHRENIA-INTRODUCTION
• THIS CASE STUDY ILLUSTRATES THE COMPLEXITY OF DIAGNOSIS IN A PERSON WITH A FIRST
PRESENTATION OF PSYCHOTIC SYMPTOMS ,UNPREDICTABLE BEHAVIOUR, MORBID JEALOUSY AND SOME
BORDERLINE PERSONALITY DISORDER.

4. RELAPSE SCHIZOPHRENIA-CASE
PRESENTATION
• 37 YEAR OLD MAN WITH A HISTORY OF DEPRESSION, DELUSIONS , MORBID JEALOUSY, & BORDERLINE
PERSONALITY TRAIT.
• WHEN THE PATIENT WAS 29 YEARS OLD , HE WAS DIAGNOSED & SUFFERING FROM SCHIZOPHRENIA AND
MORBID JEALOUSY.
• ON ADMISSION HE WAS ORIENTED AND ALERT AND WILLINGNESS TO GET ADMITTED.
• FATHER OF THE PATIENT REPORTED TO CASUALTY OFFICER , THAT HE IS HAD NOT EATEN AND DRINKING
WATER FOR PAST ONE WEEK.

5. RELAPSE SCHIZOPHRENIA-CASE
PRESENTATION
• PATENTS IS BELIEVING THAT FOOD AND WATER IS POISONED.
• HE THINKS THAT HIS PARENTS AND SIBLINGS ARE CONSPIRING AGAINST HIM TO CAUSE HIM HARM.
• HE HAS EUPHORIC MOODS AND RACING THOUGHTS.
• HE WAS RESTLESS AND AVOIDING EYE CONTACTS.

6. RELAPSE SCHIZOPHRENIA -DEMOGRAPHY
• MR JOHN SMITH IS A 37 YEARS OLD MAN.
• HE IS OF ASIAN ORIGIN.
• A DIVORCEE
• WORKS A HANDY MAN IN A FIVE-STAR HOTEL IN THE SOUTH OF THE COUNTRY
• HAS 2 CHILDREN : A SON & A DAUGHTER
• CURRENTLY STAYING WITH PARENTS .

7. RELAPSE SCHIZOPHRENIA – MODE OF
REFERRAL
• MR JOHN SMITH WAS FOLLOWING SCHIZOPHRENIA TREATMENT IN THE OUTPATIENT DEPARTMENT OF
MAHEBOURG HOSPITAL.
• HE WAS BROUGHT TO BROWN SEQUARD MENTAL HEALTH CARE CENTRE BY FATHER & POLICE.
• HE WAS HAVING A BIZARRE AND UNPREDICTABLE BEHAVIOUR.
• HE FREQUENTLY VISIT THE NEAREST POLICE STATION FOR NO VALID REASON.

8. RELAPSE SCHIZOPHRENIA –OBJECTIVE
DATA
• AXILLARY TEMPERATURE 36.6 DEGREE CELSIUS.
• BLOOD PRESSURE 120/80 MMHG
• HEART RATE 72BPM
• OXYGEN SATURATION 99%
• PATIENT IS ALERT, ORIENTED TO TIME AND PLACE.
• DENIES CONSUMING ALCOHOL AND DRUGS.
• SMOKES A PACKET OF CIGARETTE DAILY.
• NO KNOWN ALLERGIES TO FOOD AND MEDICATION.
• NO PREDISPOSING FACTORS IDENTIFY LEADING TO PRONENESS TO DEVELOP NON COMMUNICABLE OR MENTAL ILLNESS.

9. RELAPSE SCHIZOPHRENIA-HISTORY OF
PRESENT COMPLAINT
• PATIENTS WAS KEEPING OFFENSIVE WEAPONS WITH HIM.
• FREQUENTLY VISIT POLICE STATION FOR NO REASON.
• COMPLAINING OF INSOMNIA & AUDITORY HALLUCINATONS
• FALSE BELIEFS THAT FOOD AND WATER IS POISONED
• FOLLOWING SCHIZOPHRENIA TREATMENT
• HISTORY OF POOR COMPLIANCE TO MEDICATION.

10. RELAPSE SCHIZOPHRENIA-HISTORY OF
PRESENT COMPLAINT
• JOHN HAS A LEAST TEN HOSPITALISATIONS FOR EXACERBATIONS OF SCHIZOPHRENIA,
• WAS REPORTED TO HAVE ATTEMPTED SUICIDE BY HANGING HIMSELF TO THE CEILING FAN OF THE LIVING
ROOM.
• ADMIT TO BE TAKING MEDICATION BUT DENIES TO BE MENTALLY SICKED.
• DESCRIBES SERIOUS SIDE EFFECT TO MEDICATION SUCH AS TREMORS, FATIGUE,SLEEPINESS

11. RELAPSE SCHIZOPHRENIA –FORENSIC
HISTORY
• HAVE NOT COMMITTED ANY CRIME
• HAVE NOT BE SENTENCED TO JAILED OR CONTRAVENTION.
• NOT CONVICTED OR TO BE CONVICTED TO COURT.

12. RELAPSE SCHIZOPHRENIA –SUBSTANCE
ABUSE HISTORY
• DENIES TAKING DRUGS OR ALCOHOL.
• HE SMOKES A PACKET OF CIGARETTE DAILY.
• FOR EXPERIMENTATION PURPOSES AND UNDER PEER PRESSURE HAD ADMITTED TO US TO HAVE TRY TO
CONSUME ALCOHOL AND DRUGS.

13. RELAPSE SCHIZOPHRENIA –FAMILY
PSYCHIATRIC HISTORY
• NO PARENTS OR SIBLINGS IS DIAGNOSED AND SUFFERING ANY MENTAL ILLNESS.
• PATIENT HAD A PARENTAL GRANDMOTHER WHO HAS SUFFERED FROM PARANOID SCHIZOPHRENIA.
• THE GRANDMOTHER WAS A LONG STAY PATIENT AT BROWN SEQUARD MENTAL HEALTH CARE CENTRE.

14. RELAPSE SCHIZOPHRENIA- MEDICAL
HISTORY
• THE PATIENTS IS NOT SUFFERING ANY AILMENTS APART FROM SCHIZOPHRENIA.
• NO KNOWN MEDICAL ALLERGIES.
• NO SURGERY DONE.
• MEDICATION USED:- TAB OZITAS 10MG NOCTE, TAB LARGACTIL 75MG NOCTE FOR PSYCHIATRIC ISSUES.
• TREATING SPECIALIST: DR JACK SPARROW

15. RELAPSE SCHIZOPHRENIA –CURRENT
NEUROVEGETATIVE SIGNS AND SYMPTOMS
• POSITIVE SYMPTOMS :-HALLUCINATIONS , DELUSIONS AND PARANOIA
• NEGATIVE SYMPTOMS : LOSS OF MOTIVATION , APATHY, ASOCIAL BEHAVIOUR, LOSS OF AFFECT AND POOR
USE OF SPEECH AND LANGUAGE
• COGNITIVE SYMPTOMS :-IMPAIREDWORKING MEMORY, DISSOCIATED THOUGHT PROCESSES AND
IMPAIRED EXECUTIVE FUNCTION

16. RELAPSE SCHIZOPHRENIA-PAST-
PSYCHIATRY DISORDER
• MR JOHN SMITH WAS TRANSFERRED FROM JAWARHAL NEHRU HOSPITAL TO BROWN SEQUARD HEALTH CARE CENTRE ON
23/04/2010.
• HE WAS IN ACUTE PHASE OF PSYCHOTIC DISORDERS.
• BELIEVING THAT HIS WIFE IS HAVING AN AFFAIR.
• PROVISIONALLY DIAGNOSED AND SUFFERING FROM PARANOIA AND DELUSION
• TREATING SPECIALIST AT THE MENTAL HEALTH CARE CENTRE DIAGNOSED AN ACUTE PHASE OF MORBID JEALOUSY WITH
INTENSE PSYCHOTIC EPISODES.
• WAS PUT ON A RANGE OF MEDICATION SUCH AS TAB LAROXYL 10MG MANE, TAB XANAX 0.25MG NOCTE AND VITAMIN B-
COMPLEX ONCE DAILY.

17. RELAPSE SCHIZOPHRENIA – PAST
PSYCHIATRY HISTORY
• ON THE 12TH NOVEMBER 2012, BROUGHT AGAIN TO THE MENTAL HEALTH CARE CENTRE.
• WIFE REPORTED THAT HE IS HEARING VOICES AND LEAVING HOME AT VERY ODD HOURS.
• WAS DIAGNOSED TO BE SUFFERING FROM SCHIZOPHRENIA
• PUT UNDER MEDICATION SUCH AS OLANZAPINE 150MG NOCTE.
• ON THE 22TH DECEMBER 2014 , HIS SCHIZOPHRENIA RELAPSE DUE TO POOR MEDICATION COMPLIANCE.

18. RELAPSE SCHIZOPHRENIA- MENTAL STATE
EXAMINATION BY PSYCHOLOGIST
• FAIR COMPLEXION MUSCULAR MAN
• APPEARS TO BE YOUNGER THAN HIS AGE
• HAS TATTOOS DRAWN ON BOTH ARMS
• APPEARS TO BE WELL GROOMED
• BIT RESTLESS AND WANTS TO GO HOME
• CURLED INTO A CORNER AND AVOIDED EYE CONTACT
• RAPPORT DIFFICULT TO ESTABLISH
• ANSWER WAS NOT COHERENT, RELEVANT AND GOAL DIRECTED
• TALKATIVE AND PARANOID TOWARD FATHER.
• MOOD APPEAR TO BE DEPRESSED AND ANXIOUS

19. RELAPSE SCHIZOPHRENIA-MENTAL STATE
EXAMINATION BY RMO
• MENTAL STATE WAS REASSESSED TO TEST EFFECTIVENESS OF TREATMENT.
• PATIENT IS CALMED AND COOPERATIVE.
• ANSWER QUESTION WITH GREAT COHESIVENESS AND USE OF LOGIC
• SEEMS TO BE A BIT SUSPICIOUS
• REFRAINING FROM REVEALING SOME FACTS
• NO DELUSIONAL SYMPTOMS PERCEIVED

20. RELAPSE SCHIZOPHRENIA-MENTAL STATE
EXAMINATION BY PSYCHIATRIST• .
• PATIENT WAS IRRITABLE.
• POSITIVE MENTAL ATTITUDE INCREASED DURING PROBING, BY SHOWING SIGN OF DELUSION OF
GRANDIOSE & RELIGIOSITY.
• ARGUMENTATIVE
• DENIAL TO TAKE ORAL DRUGS.
• CALM WHEN NOT QUESTIONED
• APPEARS TO BE UNPREDICTABLE WITH SOME CHARACTERISTICS OF A PSYCHOPATH.

21. RELAPSE SCHIZOPHRENIA-COGNITION
• VOCABULARY IS CONSISTENT TO LEVEL OF EDUCATION.
• CALCULATIONS;- WAS ABLE TO CALCULATE SIMPLE ADDITION , SUBTRACTION, DIVISION &
SUBTRACTION.
• ABSTRACTIONS :-WAS ABLE TO INTERPRET PROVERB AND SIMILARITIES IN AN ABSTRACT FASHION.
• CONSTRUCTIONAL ABILITY:- WAS ABLE TO COPY A THREE DIMENSIONAL FIGURE ACCURATELY.

22. RELAPSE SCHIZOPHRENIA- SOCIAL
HISTORY
• OLDEST OF TWO SONS.
• DUE TO SOCIOECONOMIC ISSUES HAS LIVED WITH GRANDMOTHER FAR AWAY FROM PARENTS & BROTHER.
• STUDIED TILL STANDARD 6
• OFTEN RECEIVE VISIT OF PARENTS.
• ORIENTED TOWARD PREVOCATIONAL FIELD AFTER STANDARD 6.
• HE BECAME A BARBER
• LATER ON HE HAS WORKED IN AN INDUSTRY
• HE MET HIS WIFE THEIR AND HAD TWO CHILDREN.
• WIFE WAS A BIT INTROVERT HAVE LITTLE CONTACT BESIDES HER FUNDAMENTALIST CHURCH
• LATER ON HIS WIFE LEFT HIM , BECAUSE HE WAS MENTALLY ILL. & NOT WANTING TO BEAR HIS RESPONSIBILITY ,& FREQUENT MOOD SWING.

23. RELAPSE SCHIZOPHRENIA –INTERVIEW
• WAS CARRIED OUT IN A CLOSED ROOM
• OPEN ENDED AND CLOSED ENDED QUESTION WAS USED TO INTERVIEW PATIENT.
• RAPPORT WAS DIFFICULT TO ESTABLISH BECAUSE HE GETS IRRITATED EASILY.
• WAS MADE AT EASE BY DIVERSIONAL THERAPY.
• HE WAS ANXIOUS AND INDULGE IN DEEP THOUGHTS FROM TIME TO TIME.
• STILL BELIEVING THAT FOOD AND WATER IS POISONED
• NOT AWARE TO BE MENTALLY ILL
• ANSWERS WAS INCOHERENT, SCATTERED IDEAS , NO USE OF LOGIC WITH INDULGENCE TOWARD RELIGIOSITY
• COMMUNICATION WAS VERY ARGUMENTATIVE AND HE SEEMS TO BE HIDING FACTS.
• PERSONAL HISTORY WAS VERY PARADOX AND SEEM ALIKE THAT SOMEONE IS READING A FAIRY TALE.

24. RELAPSE SCHIZOPHRENIA- PREMORBID
PERSONALITY
• FEATURES OF A BORDERLINE PERSONALITY DISORDER.
• DESCRIBED AS HAVING AN IMPULSIVE & SELF DESTRUCTIVE DISORDER WITH INTENSE EMOTIONAL SWINGS AND UNPREDICTABLE DISORDER.
• FEARED TO BE ABANDONED BY FAMILY
• HAS A IMMENSE ANGER BURIED INSIDE WITHIN HIMSELF.
• UNCLEAR OR UNSTABLE SELF IMAGE OF HIMSELF
• CHRONIC FEELING OF EMPTINESS
• UNSTABLE RELATIONSHIP WITH FAMILY SOMETIMES CONFLICTUAL OR ARGUMENTATIVE.
• IS NOT VIOLENT AND HAVE NOT RECUR TO VIOLENCE TO SORT OUT PROBLEMS.

25. RELAPSE SCHIZOPHRENIA-PHYSICAL
EXAMINATION
• HEIGHT 1M68, WEIGHT 68KG, TEMPERATURE 36.6 DEGREE CELSIUS. RESPIRATION RATE 16
• BLOOD PRESSURE 110/62MMHG PULSE 82BPM
• APPEARANCE: MUSCULAR TALL MAN, FAIR COMPLEXION, NEATLY DRESSED & WELL GROOMED
• SKIN: SOFT DRY SKIN
• EYES :- VISUAL ACUITY 6/6
• ENT :- HEARING GROSSLY INTACT
• MOUTH: DENTITION SLIGHTLY INTACT
• NECK :- FULL RANGE MOTION
• ABDOMEN: NO SCARS, BOWELS SOUND NORMAL

26. RELAPSE SCHIZOPHRENIA-PROGNOSIS
/DIAGNOSIS & DIFFERENTIAL DIAGNOSIS
• SPECIALIST DIAGNOSIS :- PSYCHOPATHY SCHIZOPHRENIA
• PROVISIONAL DIAGNOSIS: PARANOIA, DELUSION, MORBID JEALOUSY, ACUTE PSYCHOTIC EPISODE
• EARLY DIAGNOSIS BY SPECIALIST: PARANOID SCHIZOPHRENIA
• TYPE OF DELUSION: GRANDIOSE, RELIGIOSITY, PERSECUTION
• PERSONALITY :- BORDERLINE PERSONALITY DISORDER
• CHARACTERISTIC TRAITS: UNPREDICTABLE , HIDING FACTS

27. RELAPSE SCHIZOPHRENIA-TREATMENT BY
SPECIALIST• PATIENT IS ADMITTED IN ACUTE MALE PSYCHIATRIC WARD
• MONITOR VITAL SIGNS
• SENT BLOOD AND OTHER SPECIMEN FOR ANALYSIS EXAMPLE FBC, U&E , S. CREATININE AND BLOOD GLUCOSE
• BEHAVIOUR OF PATIENT TO BE CONTINUOUSLY MONITORED & ACCOUNTED IN A NURSING REPORT.
• ENSURE SAFETY OF PATIENT BY ALLOWING CLOSE NURSING SUPERVISION
• ADVISE NURSING STAFF TO RESTRICT ACCESS TO POTENTIALLY HARMFUL OBJECT
• OBSERVE PATIENT IN PHASE OF ACUTE PSYCHOTIC EPISODE
• RESTRAINED PATIENT IF HE IS HYPERACTIVE
• ADMINISTER DRUGS AS SCHEDULED
• INFORMED RMO ON CALL IF CASE OF ANY ABNORMALITIES

28. RELAPSE SCHIZOPHRENIA-
PHARMACOLOGICAL MANAGEMENT
• THE MEDICATION USED IN THIS CONTEXT WAS:
• TAB OLANZAPINE 10MG NOCTE : TO RESTORE THE BALANCES OF SUBSTANCES IN THE BRAIN
• TAB LARGACTIL 75MG NOCTE : TO RELIEVE RESTLESSNESS
• INJECTION MODECATE 25MG/ML : TO REDUCE LEVEL OF DOPAMINE IN THE BRAIN
• TAB PHERNERGAN 25MG NOCTE: IT IS USED AS SEDATIVE & INDUCES SLEEP
• CAP POTHIADEM 50MG NOCTE: TRICYCLIC ANTIDEPRESSANT & USED TO TREAT DEPRESSION

29. RELAPSE SCHIZOPHRENIA – NURSING
DIAGNOSIS• SCHIZOPHRENIC PATIENT MAY BECOME ACUTELY ILL.
• THEY MAY GET ACUTE EXACERBATIONS DURING THE LONG TERM COURSE OF THEIR ILLNESS
• ACUTE EXCITEMENTS ARE MOST COMMON IN PARANOID TYPES.
• THE MAIN NURSING CONCERN IS CONTROLLING HIS IMPULSIVE DISORDER
• HE WILL BE VERBALLY ABUSIVE TO STAFF
• IT IS DIFFICULT TO COMMUNICATE WITH PATIENT WHO IS PSYCHOTIC
• BUT PROGRESSIVELY NURSE SHOULD GATHER INFORMATION ON THOUGHT.
• THESE DATA IS USEFUL ,TO THE NURSE WHO CAN ESTABLISH SOME DEGREE OF TRUST WITH THE PATIENT

30. RELAPSE SCHIZOPHRENIA – NURSING CARE
PLAN
• APPROPRIATE NUTRITION
• TAKING CARE OF PERSONAL HYGIENE
• IMPROVE HIS COMMUNICATION AND SOCIAL CONTACTS.
• PREVENT INSTITUTIONAL NEUROSIS , PATIENT IS GIVEN TASK AT WARD LEVEL
• MEDICATION AND THERAPEUTIC GROUP MEETINGS IS DONE TO FULFIL PSYCHOSOCIAL NEEDS OF PATIENT TO
PREVENT RELAPSE.
• ENSURE SAFETY OF PATIENT, IN ORDER TO PREVENT PHYSICAL INJURY
• ENSURE THAT THE SPIRITUAL NEEDS OF PATIENT IS MET
• A DISCHARGE PLAN IS ASSESSED FOR CONTINUING OF CARE AT COMMUNITY LEVEL.

31. RELAPSE SCHIZOPHRENIA- NURSING
PROCESS
• THE NURSE SHOULD UNDERSTAND THE GENERAL MANAGEMENT OF SCHIZOPHRENIA.
• SCHIZOPHRENIA IS A LONG TERM ILLNESS, HENCE , THE MAINTENANCE OF LONG TERM TREATMENT.
• TOTAL CURE IS NOT POSSIBLE IN THIS CONTEXT.
• AIM OF THE NURSING ASSESSMENT & CARE PLAN SHOULD AIM IS TO GIVE AN IMPROVEMENT & CONCISE
REGULAR, APPROPRIATE TREATMENT TO CLIENT.
• THE AIM OF THE NURSING PROCESS IS TO PREVENT RELAPSE OF PATIENT HEALTH TO DISEASE CONDITION.
• ALLOWING THE CLIENT TO FEEL THAT HE IS NOT REJECTED , THUS PROMOTING REMISSION.

32. RELAPSE SCHIZOPHRENIA -REHABILITATION
• PATIENT IS REFERRED TO THE OUTPATIENT DEPARTMENT NEAREST TO LOCALITY.
• ONCE EVERY MONTH THE PATIENT WILL BE REQUIRED TO ATTEND HIS NEAREST LOCALITY COMMUNITY
HEALTH CARE CENTRE FOR INJECTION OF MODECATE 25 MG/ML.
• PATIENT IS PLACED ON LONG TERM MEDICATION SUCH AS TAB OLANZAPINE. TAB LARGACTIL.
• COUNSELLING, PSYCHOTHERAPY AND FAMILY THERAPY ARE DONE TO ALLOW SMOOTH REINSERTION TO
SOCIETY.
• DESPITE HIS MENTAL ILLNESS PATIENT IS MANAGEABLE IN DRUG AND ALLOW TO LEAD AN ACTIVE &
PRODUCTIVE LIFESTYLE.

33. RELAPSE SCHIZOPHRENIA –
DISCUSSION/REHABILITATION
• IT IS CRYSTAL CLEAR EVIDENCE THAT PEOPLE WITH ONGOING MENTAL ILLNESS THE QUALITY OF THEIR
RELATIONSHIP WITH FAMILY & SOCIETY RELATES TO THEIR ABILITY TO MAINTAIN WELLNESS IN THE THE
COMMUNITY.
• IT IS PROVED THAT FOR SCHIZOPHRENIC PATIENT THAT COMPLIANCE TO MEDICATION IS IMPORTANT.
• 37 YEARS OLD PATIENT WITH A HISTORY OF RELAPSE SCHIZOPHRENIA, APPEARS TO HAVE IMPACTED HIS
LIFE IN NUMEROUS WAYS.
• HOPEFULLY THE SERVICE HAS CHANGED TO BE CUSTOMER FOCUSED & ALLOW REINSERTION TO SOCIETY.
• NOWADAYS PATIENT WITH SCHIZOPHRENIA CAN LEAD A NEAR TO NORMAL & ACTIVE LIFESTYLE.