June 20, 2014

Undifferentiated Schizophrenia Case Study Psychology


The advantage of case study is the tremendous amount of detail it provides. It may also be the only way to get detailed information about a patient. The following is a case study of patient affected by schizophrenia. This will help Psychology and psychiatry students to prepare cases. This is just for reference only so look at the format.

Undifferentiated Schizophrenia Case Study



A person with undifferentiated schizophrenia meets the usual criteria for schizophrenia including delusions, hallucinations and disordered thoughts and bizarre behaviours but does not clearly fit into one of the other types of schizophrenia because of a mixed-symptom picture.
People in the acute, early schizophrenic episodes breakdowns frequently exhibits undifferentiated schizophrenia symptoms as do those whose clinical picture may change enough over time to warrant a change in diagnosis from a specific sub type to the undifferentiated sub type. The criteria’s for undifferentiated schizophrenia was named, described and classified in the American psychiatric association’s diagnostic manual –IV-TR. Symptoms of schizophrenia that do not meet criteria for the paranoid, disorganised and catatonic types.

SOCIO DEMOGHRAPHIC DATA


    Name                                         : D.K
     Age                                            : 36 years
    Sex                                              : Female
    Occupation                                 : Housewife
    Socio-economic-status              : Middle class
    Marital status                             : Married
   Education                                     : Degree passed


INFORMANTS

         The informant was the patient himself as well as the social workers and nurses. The information is reliable and adequate.

COMPLAINTS AND THEIR DURATION

  Reduced self-esteem and self-confidence        : 8 years
      Suicidal thought                                             :   5 years
      Disturbed sleep                                              : 4 years
      Hearing noises                                     :      2 years

HISTORY OF PRESENT ILLNESS

      Mode of onset     : Sub acute (few days to few weeks)
      Course of illness: Fluctuating
      Precipitating factor: Psychological in nature such as love failure and related quarrels in the family
Associated disturbances: Lack of sleep, loss of appetite and weight.

PAST HISTORY

There was no significant past physical illness.


Family History

     (Family genogram will come here)

- DEAD MALE, FEMALE                    
- AFFECTED MALE, FEMALE

- UNAFFECTED MALE, FEMALE

- INDEX PATIENT

PERSONAL HISTORY

Birth and early development

           Mother’s health during pregnancy time was normal with full term normal delivery. Birth cry was present, birth weight and skin colour was normal. She was born from non-consanguineous union.

Behaviour during childhood

           Frequent fights with siblings

Physical illness during childhood

       There is no clear evidence of physical illness during childhood.

Educational history

The relationship between teachers and peers was good.  She was interested in extracurricular activities and has average scholastic performance.

Occupation

1997- Receptionist in dental clinic
2005- Sales woman in a saree shop  

Menstrual history

     No significant information.

Marital history

     The client is married and the husband used to beat her after drinking alcohol.

Sexual History

High levels of anxiety related to sexual fantasies/ practises.

Use and abuse of alcohol, drugs

      None

PREMORBID PERSONALITY


Attitude to others in social, family and sexual relationships.

Inability to trust others, anxious, dominant and suspiciousness. But she is very attached to her children.

Attitude toward self

Critical, self-conscious, pessimistic attitude toward present and future slightly shows narcissism.

Moral and religious attitude

     Moral and religious attitude is good. But after the illness started she used to visit temples every week

Mood

   Anxious, irritable, over expression of feelings anxiety.

Fantasy life

Day dreaming

Reaction pattern to stress

      Decreased ability to tolerate frustration, losses, and anxiety.

Habit

   Watching movies.


MENTAL STATUS EXAMINATION

General appearance and behaviour

  The patient appeared hygienic and cooperative. She has orientations with surroundings. She avoided eye contact.

Psycho-motor activity

     Psycho-motor activity is increased.

Talk

   Spontaneous. Her talk was irrelevant.

Thought

       Stream: There was flight of ideas.
       Form: Intact
       Possession: Nil
       Content: Auditory hallucination.

Mood

   Subjective explanation of emotion, anxious and tensed.

Perception

     The patient feels restless.

Cognitive functions
Attention and concentration: Intact
Memory: Good Immediate memory, recent memory and long term memory
General information: Average general awareness.
Intelligence:She has average level of intelligence.
Judgement: Intact

    Personal: The patient has the awareness of his illness and also need for treatment.
    Social    : Poor
    Test       : Her test judgement is intact.
     Insight: Presence of insight

Summary

    Ms. D.K is 42 years old married female, graduate, from middle class socio economic rural background with no significant past or family history of alcoholism of husband with nil personal history of illness. Pre morbidly well adjusted. Presented with sub-acute onset, fluctuating course illness of 8 years duration precipitated by love failure and related psychological causes characterised by decreased sleep, suicidal thoughts, and diminished appetite. Mental status examination revealed auditory hallucinations, irritable mood with intact judgement with presence of insight.


  Provisional diagnosis

      Undifferentiated schizophrenia

Management

Psycho social therapy
Cognitive therapy
Interpersonal therapy
Behavioural therapy
Family therapy
Pharmacotherapy

Sources:

Detailed model of Case work in Social Work

Model Of Case History On Intellectual Disability In NIMHANS, Banglore Model

Example format of a Case study of patients with Paranoid Schizophrenia