Schizophrenia Case Study
She was transferred to a medical floor, where she was treated with warfarin and coumadin until her INR levels reached a normal range of 2. 4. She has since been transferred back to the inpatient psychiatry service for continued treatment of her psychosis. She has been treated for bipolar, anxiety and OCD. She has history of attending marriage counseling with her husband. M. has a history of chronic back pain that caused her to take leave from her job as a librarian. She has been unemployed for two years.
Her pain was initially treated with opiod painkillers, which she later became addicted to. She attended rehab in 2008 and completed detox from opioid painkillers. She attributes her recent exacerbation of anxiety to an increase in her back pain. The current episode of paranoia and delusions that caused her to seek treatment on 9/11 is new for her. Nursing Focus My overall impression was that she seemed anxious, apprehensive and highly fearful. The immediate priorities for her nursing care are environmental/physical safety nutrition/fluid intake, and psychosis symptom anagement. Once these are stabilized, we can move into working at acknowledging and normalizing her fear as well as identifying how she can develop new effective coping strategies. Epidemiology According to the WHO World Health Report 2007 depression is very common and considered one of the oldest clinical mood disorders responsible for morbidity worldwide. Approximately 20. 9 million American adults aged 18 or over experience depression at some point in their lifetime. Major Depression is the leading cause of disability in the United States for ages 15-44 (WHO, 2007. It affects men women and children worldwide, while crossing all cultural and socioeconomic groups. Men are at lower lifetime risk for experiencing a major depression, 7-12% compared to women, 20-30% (Stuart, 2012, p. 291). Pathophysiology Depression is caused by multifaceted exchange between biology, psychological and sociological factors. A few different models define this dynamic. The biopsychosocial model explains depression through the interplay of biological, psychological and social factors which combine and together are responsible for causing depression.
The stress model specifies that some people have preexisting genetic vulnerability, or tendency, towards depression that is activated by stressful life events. The Monamine Hypothesis suggests that depressed people have overproduction of the enzyme MAO-A which causes lower levels of monoamines (Porth 1371). Most agree that brain chemistry plays a significant role in depression as evidenced by neurological changes seen on the brains of depressed people. PET and MRI scans have shown a reduction in gray matter and decreased activity in the prefrontal cortex (Porth 1371).