Mental Health Case Study: Schizoaffective Disorder 1

Rebecca Platt

Youngstown State University

March 24, 2018

Theresa Peck

NURS 4842 L
Mental Health Case Study: Schizoaffective Disorder 2

Abstract

The case study that follows is on a 34-year-old female patient who was admitted with a

primary psychiatric diagnosis of schizoaffective disorder, along with bipolar disorder,

depression, and homicidal ideation. Objective data was collected by using the patient’s chart that

provided notes from date of admission, treatments, and medications, and by interviewing and

observing the patient during the day of care. Precipitating stressors and behaviors that led up to

the patient’s reason for admission, an analysis of influences that impact the patient, an evaluation

of patient outcomes related to care provided or the patient, a summary of plans for discharge, and

a list of prioritized NANDA nursing diagnoses are provided throughout the case study.
Mental Health Case Study: Schizoaffective Disorder 3

Objective Data

A 34-year-old female patient with schizoaffective disorder was admitted on March 9,

2018 involuntarily. The police were called to her house by her stepmother who she seemingly

was fighting with and she had threatened to shoot and kill her mother. The patient believed that

she was being raped and that someone was putting blood in her milk. She had also stated at that

time that she had a feeling that something was wrong with her family, found out that her uncle

had passed away, and two days later after that her cousin passed away.

On the morning of March 20, 2018 I was able to interview and observe the patient during

free time and during group therapy sessions. The patient was calm, cooperative, friendly and

very talkative during her interview with me. Her cognition was displaying a flight of ideas

approach with talking rapidly and changing thoughts quite frequently throughout the interview.

The patient also was displaying both grandiose delusions and persecutory illusions. She included

a couple of famous people that are involved in her life, such as Barrack & Michelle Obama,

while talking with me and was also continuously looking around not making good eye contact

while speaking. Patient stated in her interview that the reason for her being here is because she

was going to hurt herself. She also said that she doesn’t feel like herself in the morning and her

vagina hurts because she feels as if someone is raping her in the middle of the night. Her DSM

Axis I is schizoaffective disorder. The patient has been previously hospitalized multiple times in

the past and was pink slipped by the police in 2015.

Summarize

Schizoaffective disorder is manifested by schizophrenic behaviors, with symptoms

associated with depression and mania (Mary C. Townsend, 2015, pp.429). As stated by

Townsend, “the client may appear depressed, with psychomotor retardation and suicidal ideation,

or their symptoms may appear to include euphoria, grandiosity, and hyperactivity.” In order to

diagnose schizoaffective disorder, there has to be a presence of hallucinations/delusions that

occur in the patient for at least two weeks in the absence of a major mood disorder (APA, 2013).

Schizoaffective disorder is divided into two different types based on the type of mood episode

the patient presents with: bipolar or depressed. Symptoms for this include: delusions,

hallucinations, disorganized speech and grossly disorganized or catatonic behavior. The mood

disorder may include episodes that meet diagnostic criteria for a depressive episode (including

depressed mood), manic episode, or a mixed episode (Abrams, Rojas, Arciniegas, 2008). The

patient that is being discussed about in this case study has both depression and bipolar along with

schizophrenia which would mean that they have a mix of the two mood disorders. Abrams,

Rojas and Arciniegas believed that “persons with schizoaffective disorder (also schizophrenia

and psychotic mood disorders) often experience dysfunction in other neurobehavioral domains of

function” (2008).

It is known that approximately one third of patients with schizoaffective disorder was

diagnosed between the ages of twenty-five and thirty-five, one third diagnosed prior to the age of

twenty-five (the mean age of onset for schizophrenia), and one third diagnosed after the age of

thirty-five (the mean age of onset for bipolar disorder) (Abrams, Rojas, Arciniegas, 2008).

Abrams, Rojas, and Arciniegas also specified “the DSM-IV-TR states without reference that

schizoaffective disorder most likely occurs more often in women than it does men” (2008).
Mental Health Case Study: Schizoaffective Disorder 5

People who are diagnosed as having schizoaffective disorder often times have a later onset of

illness than people who are diagnosed with schizophrenia and are more likely to be female than

male (Castle, 2012). As stated by Andersen & Black, “the prognosis for schizoaffective disorder

is generally better than that for other schizophrenic disorders but worse than that for mood

disorders alone (2011). “In DSM-5, Schizoaffective Disorder is a lifetime diagnosis that

associates from the time of onset of the psychosis up to the current episode the patient is

exhibiting, rather than only defining a single episode with co-morbid psychotic and mood

syndromes,” (Malaspina, Owen, Heckers, Tandon, Bustillo, Schultz, Barch, Gaebel, Gur,

Tsuang, Os, and Carpenter, 2013).

Identify

The patient seems to have a difficult relationship with their mother at home, which is

what brought her to the hospital. From reviewing her chart upon her admission, it was said that

she had threated to shoot her mother. During my interview with this patient, she had told me that

she was living with her mother prior to coming to the hospital and talks with her while she is

being hospitalized currently. Patient stated that she has a good relationship with her mother.

After the patient was finished with her breakfast, I decided to interview her again for a second

time and during this time she had told me that her mother says she is not going to therapy and

that her mother is “sleeping” with the men that she is dating.

Along with stressors that precipitated her current hospitalization, there are also a

numerous amount of behaviors that she displayed upon her reason for admission. She seems to

be having grandiose and persecutory delusions. She had mentioned to me that she does not feel

like herself first thing in the morning when she wakes up and believes that someone is raping her
Mental Health Case Study: Schizoaffective Disorder 6

in the middle of the night. She also seemed to be very paranoid during our interview because she

would consistently look around while talking with me, not making good eye contact, and would

begin to whisper as soon as other patients, nurses or doctors would walk by us. During the

interview she had told me that she believes the patients staying on the same unit were telling the

nurses and staff to make her stay and that was her reason for not getting discharged sooner.

After I would ask her a question or bring up a topic she would answer it appropriately but then

would go way off top with a flight of ideas approach. Casually in the middle of the conversation,

she stated that her parents had found her in a desert in the Middle East after their plane crashed

there and then she had to go to Africa to live for a couple months. She then continued to tell me

that Africa had sued America for what had happened, and then America sued Africa to get her to

come back to America. From there she lived with Michelle and Barrack Obama in Chicago for

approximately two months and they are still a huge part of her life now.

Discuss

This patient has been hospitalized multiple times in the past and was pink-slipped by the

police in 2015. She is diagnosed with schizoaffective disorder and also has a history of bipolar

disorder, depression, homicidal ideation, psychosis, anxiety and seizures. There didn’t seem to

be any family history in her chart, and when I asked her about her family during her interview

she only seemed to have her mother who is in her life right now. She never mentioned about

having a father or any siblings. The patient is unemployed and said during her interview that she

is currently dating three different men. She also stated that she wants to get married to one of the

men and is “playing the Bachelorette” trying to narrow down to dating only one of them in the

end. When asked about her living situation, she said that she was living with her mother prior to
Mental Health Case Study: Schizoaffective Disorder 7

coming to the hospital, but now is waiting on her apartment to get refurnished, which is why she

has not been discharged yet. She did state during her interview that staying in the hospital has

been helpful and is helping her situation.

Describe

During their day of care while I was on the floor from 0700 until 1300, we all gathered

report from our patients first thing in the morning so that way we could get an overview of the

patients’ progress and how their depression and anxiety levels are ranked on a scale from 0-10.

After the patient was finished eating her breakfast, I interviewed her on how she has been feeling

lately, if her mood has been changing frequently, what coping strategies she uses and if they are

helping with her current situation, and asking if she has any support from family/friends. It is

important that all the patients on the unit attend group therapy sessions to help relieve any stress

from their current illness and to help with possible coping strategies they haven’t thought of

before. During this time, the nurses are able to evaluate whether the patient is or isn’t attending

group session, if they are actively participating, and if they are improving throughout their stay.

While I was observing my patient during the two group therapy sessions in the morning, I

noticed that she is actively participating and pays attention closely to directions and to the person

who is leading the sessions.

The patient also mentioned that they go to a counselor outside of the hospital and enjoys

talking to them. When I asked her if attending group therapy sessions here have helped them,

she stated that they are definitely helping and she really enjoys attending them. I also asked the

patient what types of coping strategies they like to use to help them and she mentioned that she
Mental Health Case Study: Schizoaffective Disorder 8

enjoys coloring adult coloring books, meditating and praying to God helps her relieve stress, and

loves to listen to Gospel music.

Analyze

This patient is an African-American female in her thirties. During the interview with this

patient, she stated that she is religious and that she meditates and prays to God everyday to help

her relieve stress. She says that she has three daughters; one is eleven-years-old, another is

twelve-years-old, and the last is thirteen-years-old. She claims that her current father who she

does not speak too much about adopted her when she was five months old. She also mentioned

that she was the only child growing up without any siblings. The patient does not have any

cultural influences that seem to impact her.

Evaluate

The patient has a history of seizures so it is important that she is placed on seizure

precautions protocol while being hospitalized. Upon admission to the unit, this patient wanted to

harm herself so they are placed on self-harm precautions and evaluated daily. One patient

outcome that was related to her care was that she has not harmed herself or others, which was

met. The environment on the unit was free from any sharp objects, or materials that could be

used for physical hurt and/or harm. Another outcome related to her day of care was that she

would recognize distortions of reality, which was not met. This was not met because of her

grandiose delusions she was displaying during her interview. The patient does indeed perform

self-care activities independently, was dressed neatly and appropriately so that was outcome was

met. The outcome that she demonstrates the ability to trust others was not met because she was
Mental Health Case Study: Schizoaffective Disorder 9

very paranoid during our interview process. She kept reassuring me that the other patients on the

unit were telling the nurses to make her stay.

Summarize

The patient explained to me that they feel they are ready to get discharged and ready to

go home. She also stated that she doesn’t understand why they are still keeping her and thinks

that the other patients on the unit are telling the nurses that she must stay. When discussing

about this matter, her mood seemed to be more upset and calm rather than angry and frustrated.

When asked about where she would go after being discharged she mentioned to me earlier that

she would be going to Riverbend but that there wasn’t a bed available. Later on in the interview

she stated that she had gotten an apartment by herself and was just waiting on it to get

“refurnished” before getting discharged. After reviewing her chart in the computer, she received

an Aristada intramuscular injection on March 11, 2018, which is used for long-term compliance

for schizophrenia, bipolar, and depression. It is to be given every 30 days and it helps with

patients who are non-compliant with their medications. She is also on Depakote and her valproic

acid level was extremely low on March 9, 2018 but on March 19, 2018 it is within normal range

so she has the “okay” to be discharged pending the physicians assessment and evaluation for her

later on in the day.

Prioritized list

1. Risk for self-injury related to bipolar disorder as evidenced by previous attempts of self

harm

2. Disturbed thought processes related to schizophrenia as evidenced by behaviors that

indicate the presence of delusional thinking

3. Disturbed sensory perception related to schizophrenia as evidenced by inappropriate

responses while communicating and disordered thought sequencing

4. Impaired verbal communication related to schizophrenia as evidenced by loose

association of ideas and poor eye contact

List

 Low self-esteem

 Disturbed sleep pattern

 Risk for social isolation

 Impaired social interaction

 Interrupted family process

 Defensive coping

 Impaired home maintenance

 Ineffective health maintenance

 Fear
Mental Health Case Study: Schizoaffective Disorder 11

Conclusion

I felt that this was a very good patient to do this case study on. She was able to provide a

wide variety of information, was calm and cooperative, and loved to communicate with others.

Unfortunately it seems as though this patient is non-compliant with her medications and does not

have the family support at home that is needed to help her. Hopefully the long-term compliant

medications will help her long-term, and she continues to see her counselor outside of the

hospital to help with her medication regime and support with her mental illness. She is a very

friendly and talkative person so I suggested to her that she should talk to others and make new

friends to help her as a coping technique. Overall, I thought this was a great opportunity to learn

more about schizoaffective disorder and being able to understand the signs and symptoms

associated with this mental illness.

References

Abrams, D. (2008). Is schizoaffective disorder a distinct categorical diagnosis? A critical review

of the literature. Neuropsychiatric Disease and Treatment, 1089. doi:10.2147/ndt.s4120

Castle, D. J. (2012). Schizoaffective disorder. Advances in Psychiatric Treatment, 18(01), 32-33.

doi:10.1192/apt.bp.111.008987

Malaspina, D., Owen, M. J., Heckers, S., Tandon, R., Bustillo, J., Schultz, S., . . . Carpenter, W.

(2013). Schizoaffective Disorder in the DSM-5. Schizophrenia Research, 21-25.

doi:10.1016/j.schres.2013.04.026

Townsend, M (2009). Psychiatric mental health nursing: Concepts of care in evidence-based

practice (8th ed., pp.429). Philadelphia: F.A. Davis.