A Case Analysis on

DISSOCIATIVE IDENTITY DISORDER

In Partial Fulfillment of the Requirements in NCM 217 – RLE

MALADAPTIVE NURSING ROTATION

Submitted to:

Melinda Tantoy, RN, MAN

Clinical Instructor

Submitted by:

Acuna, Mutiara Honey B. Morales, John Manuel D.

Alingasa, Chester Jan J. Moreno, Angeline Nicole B.

Añana, Ma. Andrew Nicole M. Nermal, Alliza Nicole O.

Antojado, Bob Ryan B. Oconer, Cristianne Jane C.

Arbis, Abegail Anne M. Panuncio, Karen Kae B.

Bagaslao, Juan Carlos I H. Pasaol, Donald John B.

Ferraren, Van Robert B. Pascual, Joren John R.

Millama, Gracelyn Chen C. Ramirez, Joanna Patricia B.

Montebon, Khelvin Jun Q. Roque, Juzminn Berzelle

Torejas, Hillary Grace G.

BSN 3H & 3I – Group 2

March 14, 2023

TABLE OF CONTENT

I. Introduction
II. Objectives
III. Brief History of the Case/Personal Data/Clinical Data
IV. Course in the Hospital
A. Mental Status Examination
V. Psychodynamics
A. Risk Factors
B. Signs and Symptoms
VI. Differential DiagnosIs/Final Diagnosis
VII. Medical Management
A. Test
B. Therapies
C. Drug Study
VIII. Nursing Management
A. Nursing Theory
B. Nursing Care Plan
IX. Prognosis
X. Recommendation
XI. Appendices
A. Clustering of Cues using Gordon’s Functional Health Pattern
XII. Reference
I. Introduction

Psychiatric nursing is a clinical rotation that gives student nurses hands-on

training with a comprehensive approach to caring for people with mental or behavioral
disorders. Moreover, it focuses on therapeutic communication, interpersonal
relationships, and environmental factors that may impact mental health (Huizen, 2020).
Student nurses will learn to be therapeutic agents, provide physical care, communicate,
and socialize with residents to establish a safe and comfortable environment that may
encourage healing and rehabilitation.

Mental health is a condition of mental wellbeing that enables people to handle

life's stressors, recognize their talents, learn and work efficiently, and give back to their
communities. It is a crucial aspect of health and well-being that supports both our
individual and communal capacities for decision-making, interpersonal interaction, and
influencing the world in which we live (World Health Organization, 2022). In addition,
failure to thrive under the everyday stresses of life would lead to mental illness. Mental
illnesses are conditions of health that involve shifts in one's emotions, thinking, or
behavior and can manifest in various ways. Mental illnesses can be linked to a state of
distress as well as difficulties functioning in social, occupational, or familial contexts
(Parekh, 2018)

Globally, one in every eight people lives with a mental disorder. It is estimated
that mental disorders account for 14.3% of global mortality, or around 8 million deaths
annually. Mental illness affects more women worldwide (11.9%) than men (9.3%)
(SingleCare Team, 2023). In 2020, around 3.6 million Filipinos suffered from mental,
neurological, or drug abuse disorders (Department of Health, 2020). Davao City
Councilor Joselle Villafuerte stated in 2018 that there were rising concerns about
teenage suicide and depression in the city in 2017, which are types of mental illnesses,
with no recent statistical data available about mental illness in the city (Philippine News
Agency, 2018).

The nursing students explored R.P.'s case since he exhibited symptoms such as
amnesia and depersonalization. The events of R.P.'s life are essential to this
investigation. R.P. claims he is from the planet KPAX and came to Earth by a beam of
light. Considering that R.P. has shown amnesia and other symptoms that may be
associated with the mental illness, obtaining a firm grasp of this ailment and performing
more analysis is feasible.

Current facts about mental illness show that the number of people with it is rising.
This may be because more people are learning about it, and it is being diagnosed more
accurately. This can bring about several implications. For nursing education, this will
initiate more focus on learning the disorder, providing the professional and student nurse
with sufficient knowledge and skills about diagnosis and management since mental
illness is often misdiagnosed and requires multiple assessments. The study will benefit
nursing practice by involving advocacy for mental health and illness, further
strengthening organizational and management structures within nursing. In addition, the
study will also benefit nursing research by strengthening the foundations in theory,
management, and diagnosis concerning maladaptive nursing to create new analyses
based on evolving data and ensure that care and treatment will be consistent and
appropriate for clients with mental illness.

The nursing students have ardent hopes that this case analysis of the R.P.
condition will help them better understand how mental illness impacts a person's overall
ability to function. Furthermore, R.P.'s condition shows unusual and unique symptoms
that intrigue the student nurses about the causality and how the client progressed to his
present state. With this in mind, the study is needed to understand the plausible
underlying factors contributing to the client's mental illness.

II. Objectives

At the end of the psychiatric nursing rotation, the BSN-3H & I Group 2. will be
able to understand the factors that affect a client's health and general well-being,
especially in the case of R.P.. Also, to develop the knowledge and skills needed to
provide interventions and manage the condition by applying the concepts and theories
learned to provide the best care possible, which will help develop compassion and
empathy for the condition.

Specifically, the BSN - 3H & I Group 2 will be able to:

a. define mental health and mental illness;

b. state the statistical background of the case internationally, nationally, and locally;
c. explain the significance of the study to nursing education, practice, and research
d. indicate client’s biological, clinical, and brief history;
e. discuss the mental status examination;
f. identify psychodynamics of the disorder including the risk factors and the
symptomatology;
g. present 3 differential diagnosis of the disorder;
h. determine different managements such as tests, therapies, and drugs rendered
and applicable to the client;
i. relate 2 nursing theories ;
j. formulate 5 nursing care plans;
k. provide the prognosis of the case; and
l. present recommendations for the client.

III. Brief History of the Case/Personal Data

Personal Data

Patient R.P. is a 33-year-old, widowed man based in New Mexico. Both of

his parents’ names are unknown. His wife was called S.P. and his daughter was
called R.P.

Brief History
R. P. shows up unexpectedly at Grand Central Station in New York. Dr.
Powell is interested in his claim that he is from the remote planet K-PAX, and his
suspicion quickly turns to fascination. A group of well-known scientists has been
puzzled by patient R.P.'s in-depth understanding of the star system he calls
home. He was admitted to a mental hospital as a delusional patient, but because
of his persuasiveness, every patient in his ward is convinced that he is from
K-PAX. He promises to take one of them back to K-PAX with him and gives them
hope and a goal to strive for. After learning that many of his patients plan to leave
Earth on July 27, Dr. Powell confronts the patient, so he invites R.P. to their
house to eat and there while R.P pushes Natalie Daughter of Dr. Powell, in the
swing, the lawn sprinklers turn on, the sound of it suddenly makes R.P stiffen. He
looked around and was visibly shaken. Dr. Powell runs to R.P. with Dom and
Danny to bring R.P. down. Later on, Dr. Powell realizes the sound of lawn
sprinklers triggers R.P. because it is where he washes his hands, covered in
blood, after holding his dead wife and daughter.

On the other hand, according to Dr. Powell, this was an essential day in
the patient's life and a day on which he experienced severe psychological
trauma. Dr. Powell then decides to hypnotize patient R.P. using regression
therapy successfully. According to Dr. Powell, a man was presumed dead after
attempting suicide in 1996, the same year his wife and daughter were killed.
Patient R.P. was found catatonic under his bed on July 27, and one of the other
patients has disappeared. The other patients are unfamiliar with R.P as he is
taken from the room.

IV. Course in the Hospital

A. Mental Status Examination

Mental Status Examination

I. PRE-EXAMIN Mark Description/Verbatim Quotes

ATION

A. General
Appearance The client is a 33-year-old Hispanic Male. He appears
to be well-groomed. He wears sunglasses, dark
1. Grooming and ✓ flannel, a jacket, pants, and shoes.
Dressing

2. Hygiene

a. Note evidence ✓ The client's body odor nor halitosis was not
of body or mentioned.
breath odor
b. Condition of ✓ The skin is good, and the fingernails were
skin, well-trimmed and short.
fingernails
c. Disheveled The client could present himself hygienically with no
d. Untidy signs of disheveled or untidiness in his appearance.

3. Height and Weight

a. Perform
✓ The height and weight of the client were not discussed
accurate
or mentioned.
measurement
s

4. Level of Eye
contact

a. Intermittent
b. Occasional
and fleeting
c. Sustained and ✓ The client maintained good, sustained, and intense
intense eye contact when communicating with the health
d. No eye providers.
contact

5. Hair and color

texture

a. Is hair clean ✓ The hair is thin, black, and has alopecia.

and healthy
looking
b. Greasy,
matted,
tangled

6. Evidence of scars,
tattoos or other
distinguishing skin
marks

a. Note any ✓ The client has no traces of scars, tattoos, no

evidence of indentations, no lumps, no birthmarks, or rashes.
swelling or
bruises
b. Birthmarks
c. Rashes
7. Evaluation of ✓ The client’s appearance is appropriate for his
client’s appearance chronological age. There was no deterioration of
compared with appearance noted.
chronological age,
deterioration of
appearance, the
client needs to be
reminded

B. General Mobility

1. Posture ✓ The client stands and sits in an upright posture. There

were no abnormalities, no limping or shuffling.
a. Posture
b. Note if
standing upright,
rigid, or slumped over

Note for:

● Catatonia
● Catatonic
Stupor ✓ The client displays catatonic behavior after his alleged
● Catatonic return to the planet K-Pax.
rigidity
● Catatonic
posturing
● Waxy flexibility
● Catalepsy
● Cataplexy
● Gait patterns

2. Gait patterns There was no evidence of unusual gait patterns such

as limping, limited ROM, ataxia, or shuffling.
a. Any evidence
of limping
b. Limitation of
range of
motion
c. Ataxia
d. Shuffling

C. Motor Activity
Note for:

● Normoactivity ✓ The client displays an average level of activity. There

● Hyperactivity was no unusual behavior or unusual motor activity
● Psychomotor noted.
retardation
● Agitation
● Tremors
(hands, legs,
continuous, at
a specific
time)
● Tics
● Jerky or
spastic
movements
● Stereotypical
Movements
● Mannerisms
and Gestures
● Aggressivene
ss
● Echopraxia
● Bradykinesia
● Pacing and
Rocking
● Somnambulis
m
● Anchoring
● Anergia ✓ As the client’s condition deteriorated, it was observed
● Anhedonia that he experienced a significant loss of energy. He
● Regression was merely seated in his wheelchair and did not
● Compulsions move.

D. Behavior /
Nurse-Patient
Interaction

a. Cooperative ✓ The client shows cooperation during and throughout

b. Cooperative the interaction. He displays warm, friendly but guarded
(initially, all behavior.
throughout)
c. Uninterested/ ✓ The client is entirely apathetic when discussing
Apathetic relationships and family.
d. Friendly
e. Embarrassed
f. Seductive
g. Impulsive
h. Negativistic
i. Indifferent
j. Angry/hostile
k. Evasive ✓ When asked about specific topics, the client
l. Withdrawn sometimes evades giving clear, direct answers.
m. Warm
n. Distant
o. Guarded/Susp
icious
p. Dependent
q. Distracted

II. STREAM OF
TALK

A. Character

Note for:

● Slowness or
rapidity
● Intonation ✓ The client’s speech is monotonous.
● Volume
● Stuttering,
hoarseness,
slurring
● Spontaneous ✓ The client communicates without prompting and
● Blocking speaks spontaneously.
● Deliberate
● Pressured
● Aphasia

B. Organization of
Talk/Form of
Thought

● Relevant ✓ The client responds appropriately to the questions

● IrrelevantIncor posed by the physician or others..
rect
● Flight of Ideas
● Loose
association
● Circumstantial
ity
● Tangentiality The client has neologisms, he constantly insists that
● Neologism ✓ he came from a different planet called K-PAX, despite
● Concrete the fact that K-PAX never really existed.
Thinking
● Clang
Association
● Word Salad
● Perseveration
● Echolalia
● Mutism
● Bradylalia
● Poverty of
Speech
● Glossolalia
● Coprolalia
● Verbigeration
● Condensation

III. EMOTIONAL
STATE AND
REACTIONS

A. Mood

● Euthymic ✓ The client displays a euthymic mood. Based on

● Depression/de observation, the client shows emotions appropriate to
spairing the current situation or stimulus.
● Euphoria
● Elation
● Fearful
● Irritable
● Anxious
● Guilty
● Labile

B. Affect

● Congruence ✓ Based on observation, the client’s affect is congruent

with mood and appropriate to his mood.
● Constricted/Bl
unted
● Flat
● Appropriate ✓ The client has appropriate affect since the client’s
● Inappropriate emotion corresponds to the event's circumstances.

IV. THOUGHT
CONTROL /
POSSESS

Content of Thought

A. Delusions

● Persecutory
● Grandiose ✓ The client exhibits a Grandeur Delusion due to his
● Reference/Ide beliefs of coming from another planet and that he is
as of not a human being.
Reference
● Control/Influen
ce (Thought
Broadcasting,
Thought
Withdrawal,
Thought
Insertion)
● Somatic
● Nihilistic
● Erotomanic
● Jealous
● Religious

B. Suicidal
Thought/Ideati
on

● Attempt ✓ The client attempted suicide by drowning himself in

● Threat the river.
● Gestures

C. Obsessions
D. Magical
Thinking
E. Phobia
F. Poverty of
Content
Perceptual
Disturbances

1. Hallucinations

● Hypnagogic
● Hypnopompic
● Visual ✓ The client has visual hallucinations and claims to see
ultraviolet rays.
● Auditory ✓ The client experiences auditory hallucinations in which
● Tactile he believes he can comprehend and communicate
● Olfactory with the dog.
● Gustatory
● Trailing
Phenomenon
● Micropsia
● Macropsia

2. Illusions

● Visual
● Auditory
● Tactile
● Olfactory
● Gustatory

3. Depersonaliza ✓ The client has an obsession with the planet K-PAX,

tion from which he believed he originated.
Derealization

4. Preoccupation
Ruminations

5. Deja vu
Jamais vu

Impulse Control

Ability to control
impulses
a. Aggression
b. Hostility
c. Fear
d. Guilt ✓ The client controls his impulses by repressing his
e. Affection memory because of the trauma that is too severe to
f. Sexual be kept in conscious memory. Repression is a
feelings defense mechanism whereby a person unintentionally
pushes painful or traumatic memories and thoughts
away.

V.
NEUROVEGETATIVE
DYSFUNCTIONS

A. Sleep

● Normal ✓ There is no evidence that the client’s sleeping pattern

● Hypersomnia is disrupted.
● MNA
● EMA
● DFA
● Interrupted

B. Appetite

● Poor/Fair/Goo
d
● Polyphagia
● Voracious ✓ Based on observation, the client intends to display a
● Pica Voracious appetite because when eating, the client
● Binge Eating takes a big scoop of food and placed it into his plate.
● Coprophagia

C. Diurnal
Variation

D. Weight

E. Libido

VI. GENERAL
SENSORIUM AND
INTELLECTUAL
STATUS

A. Orientation ✓ The client is oriented when asked where he was, what

(place, time, the situation is, and who he is talking to.
person,
situation)
B. Memory

● Recent ✓ The client can remember recent events and also can
● Remote remember immediate memory since he remembers
● Immediate ✓ the details of the events from the past but he conveys
● Confabulation this in a third-person point of view
● Agnosia
● Apraxia .
● Amnesia ✓ The client is experiencing dissociative amnesia, this
can be characterized by an inability to recall
autobiological information due to the traumatic events
experienced. The client can not recall his true identity,
his past, and to what happened to his family.

C. Attention ✓ The attention span of the client is short since he can

Span be easily distracted and turn his attention to other
things.

D. General
Information

E. Abstract
Thinking
Ability

F. Judgement/Re
asoning

● Ability to solve
problems and
make
decisions,
make plans
for the future.

VII. INSIGHT

● Knowledge
about self,
limitations
● Awareness of
illness
● Adaptive/Mala ✓ The client’s maladaptive coping mechanism is
daptive use of repressing his memory. This is a defense mechanism
coping to unconsciously push away the painful or traumatic
mechanism memory.

VIII. SUMMARY OF
MSE

A. Disturbances
in:
( ) Presentation
( ✓ ) Stream of Flow of speech in which intonation, volume, and
Talk speech pressure were observed.
( ) Emotional State
and Reactions
( ✓ ) Thought Thought control/processes are characterized by
Control/Processes delusions, obsessions, and a suicide attempt.
( )
Neurovegetative
Dysfunctions

( ✓ ) General General sensorium and intelligence, with the patient

Sensorium and suffering from memory loss and general information
Intellectual Status about planet K-PAX.

( ✓ ) Insight The absence of self-awareness and illness

comprehension, as well as the presence of
repression, is a maladaptive coping mechanism.

B. Diagnostic Upon observation of the client, resident R.P. displays

Category dissociative fugue, amnesia, catatonic stupor,
(DSM-5: hallucination, delusional grandiosity, fragment of
Diagnostic Identity, depersonalization & derealization, and
and Statistical neologism. Wherein he has a temporary state where
Manual of his memory is lost. Overall, client R.P displays criteria
Mental for Dissociative Identity Disorder.
Disorders)

V. Psychodynamics
A. Risk Factors

PREDISPOSING FACTORS

RISK FACTORS PRESENCE JUSTIFICATION RATIONALE

Childhood ABSENT This risk factor is not In an Australian study

physical and present in the client's entitled Childhood
sexual abuse history because he did Sexual, Emotional, and
not experience physical Physical Abuse as
and mental abuse Predictors of Dissociation
during childhood. in Adulthood, It is stated
that the characteristics
that predict clinical levels
of dissociation in
adulthood are identified
using a person's
self-reported exposure to
childhood abuse, such as
physical and sexual
abuse. The findings show
that clinical levels of
dissociation and
dissociative disorders
occur in people who have
experienced childhood
abuse, such as sexual
abuse and experiences
that are potentially
life-threatening to a child,
an example is choking,
smothering, and physical
injury that will lead to
breaking bones or teeth,
or that compromise the
child's survival needs,
such as threatening to
abandon and depriving of
basic needs(Kate et al.,
2023)

Traumatizing PRESENT It has been present Dissociative disorders

experience(such since R.P. saw his wife typically develop because
as family loss and daughter being of traumatization.
due to killing) raped and killed by the Children who have
robber. After that, he experienced long-term
killed the robber and physical, sexual, or
washed his hands, after emotional abuse or, less
washing his hands, he frequently, those who live
attempted suicide by in frightening or unstable
jumping through the homes are more likely to
river and making develop the disorders.
himself drowned. (Mayo Clinic, 2022)

Family PRESENT It has been present The dynamics that predict

dynamics/relatio since R.P. 's father died clinical levels of
nship due to an accident, and dissociation in adulthood
his family died due to a were determined by
robbery and raped reviewing 310
inside his house that respondents'
caused the execution of retrospective accounts
his family. regarding the quality of
their relationships with
their caregivers during
their childhood.
Dissociative disorders
often develop in response
to traumatic experiences,
such as physical neglect
or exposure to violence. If
these experiences occur
within the family context,
they can significantly
impact a person's sense
of safety and trust in their
family members. (Kate et
al., 2023)

Stress of war ABSENT This risk factor is not Dissociative disorder may
and natural present in the client's be caused by stressful or
disasters history. It did not show traumatic events such as
that the clients war, natural disasters, or
experience stress due physical assaults(Gill et
to natural disasters and al., 2021). It can also
war. develop as a result of a
natural disaster or other
traumatic event, such as
combat. The disorder is a
way for people to
distance themselves from
or detach from
trauma(Cleveland Clinic,
2021).

PRECIPITATING FACTORS

Risk Factors Presence Justification Rationale

Medical illness ABSENT This risk factor is not Dissociative disorders

present in the client's and other cognitive
history because it is not problems are caused by
shown that the client physical causes such as
has had an existing head trauma or brain
medical illness. tumors. Because
dissociative disorders are
on the trauma spectrum,
many people who have
them may also have
trauma-related mental
health conditions such
anxiety and depression
(Better Health, 2023).

Comorbidity with ABSENT This risk factor is not In dissociative identity

mental disorder present in the client's disorder, similar
history. Because the symptoms can be seen in
client has not been mental illnesses such as
diagnosed with other obsessive-compulsive
mental illnesses in the disorder, panic disorder,
past, it is also not stated and post-traumatic stress
that the client is disorder. Certain
involved in substance substances, including
use and alcohol use. recreational drugs and
prescription medications,
have the potential to
mimic symptoms. When a
dissociative disorder
coexists with another
mental health problem,
such as depression, the
diagnosis may be more
hampered (Better Health,
2023).

Later-life PRESENT It was present in R.P. 's Dissociative disorders

retraumatization experience when he typically develop because
was in the doctor's of traumatization.
house, playing with the Persons who have
kids, and then suddenly experienced long-term
a kid opened the faucet, physical, sexual, or
which made R.P. recall emotional abuse or, less
the past traumatizing frequently, those who live
event that happened in in frightening or unstable
his life and made him homes are more likely to
retraumatize. develop the
disorders(Mayo Clinic,
2022). Many people who
have experienced abuse
may seek out or remain
in dangerous situations,
making them vulnerable
to retraumatization and
making them at risk for
Dissociative identity
disorder(Spiegel, 2022).

Peers ABSENT This risk factor is not Peer abuse can cause
present in the client's ongoing stress and
history. It did not show trauma, impacting a
that the client's mental child's ability to regulate
illness is affected by the emotions and cope with
peers that surround stress. This can make
him. them more vulnerable to
dissociation and other
dissociative symptoms.
Additionally, children who
lack positive social
relationships with peers
may be more likely to
experience a sense of
detachment or
disconnection from
others, which is a core
symptom of DID. Lack of
social support such as
peers may also
aggravate pre-existing
mental health problems
and can increase the
chance of being
vulnerable to
dissociation. (Kate et al.,
2023)

B. Signs and Symptoms

Signs and Present Justification Rationale

Symptoms

Catatonic Stupor PRESENT He was in a A person suffering from

wheelchair and did not trauma may have
move or make any catatonia. It was argued
emotion after the date that catatonia is
when he thought it was associated with fear and
time to go back (July alarm triggered by trauma.
27) to planet K-PAX. It has been linked to
animal defense against
tonic immobility in a
predatory environment.
(Ahmed et al., 2021)

Dissociative PRESENT Trauma is the source of

He claimed to be from
Fugue fugue. Individuals may
the planet K-Pax and
become disoriented and
was here (on Earth) to
realize they cannot
study planet Earth. He
remember who they are,
said that his memories
while some may develop a
from the past came
new personality and
from a friend of his
identity, moving
while under hypnosis.
somewhere new and
He was also unable to
beginning a new life. The
recall his own identity
brain's automatic reaction
or all of his memories
to distressing, traumatic,
due to the terrible
and painful memories and
incident that occurred
events results in
to him, in which he
forgetfulness. In these
saw his wife and
situations, a stressful
daughter murdered. incident or a buildup of a
large amount of stress
may cause the condition of
the fugue to occur (Bridges
to Recovery, n.d.)

Amnesia PRESENT He is experiencing

A person with a traumatic
generalized amnesia
history manifests amnesia
as he cannot recall his
as a subconscious
identity and history.
defense mechanism that
His wife and child were
helps them protect their
murdered in their own
emotional self from
house, and he killed
recognizing the full effects
the murderer
of some horrific or
afterward. He also
traumatic event by
forgot that he is R.P
allowing the mind to forget
and identifies himself
or remove itself from the
as R.P. from the planet
painful situation or
K-PAX. Furthermore,
memory. This category
he is unaware that he
includes a fugue
is experiencing
experience where the
amnesia.
client suddenly moves to a
new geographic location
with no memory of past
events and often the
assumption of a new
identity. (Videbeck, 2020)

Hallucination PRESENT The client claimed that An individual may

(visual and he was able to see experience hallucinations
auditory) ultraviolet light, which because of various
is not possible as the reasons. One of which is
visible portion of the because of past traumatic
electromagnetic experiences of a person.
spectrum has Trauma can cause
wavelengths ranging dissociation as a coping
from 380 to 700 technique for avoiding
nanometers. unpleasant memories,
Moreover, ultraviolet leading to hallucinations
light has a wavelength (Wright et al., 2020).
shorter than 380
nanometers. Thus, UV
light is not detectable
to the human eye.

Delusional PRESENT The client claimed that An individual may develop

grandiosity he was from a planet delusion because of
called K-PAX, and he traumatic events and
was sent to the planet stress. There are shreds of
Earth to study human evidence that traumatic
behavior. He displays events and stress may
a deep knowledge of cause a person to seek an
astrophysics and other explanation for their
scientific subjects and feelings, resulting in a
also believes that he delusion as a response
has the ability to (Cleveland Clinic, 2022).
understand and
communicate with
dogs.

Fragment of PRESENT The client believed When an individual suffers

identity that he was an traumatic events, their
extraterrestrial and not identity, emotions, and
the same person as personality experience a
the doctor was trying process of fragmentation.
to tell him (that he is This occurs when the body
R.P.). separates and organizes
the qualities and feelings
of the person, attempting
to keep some of them
buried until a safe
environment for
expression is available
(Rachel, 2020).

Depersonalizatio PRESENT The client claimed that Depersonalization and

n and he is not R.P. and that derealization are
derealization he doesn't have a experiences of
family when Dr. M.P. disconnection from one's
asked him. He also thoughts, self, body, and
claimed that he was surroundings. An individual
from another planet with depersonalization and
called K-pax and he derealization disorder
traveled on earth experiences severe
through “light”. trauma and stress, such as
the unexpected death of a
loved one or a close friend.
The person typically feels
disconnected from their
memories and cannot
remember them (Spiegel,
2021).

Neologism PRESENT The client has his own Neologisms are frequently
words that only he can associated with aphasia or
understand. schizophrenia since their
origins and meanings are
usually illogical and
incomprehensible (Gillette,
2022).

Voracious Eating PRESENT When Dr. M.P. invited An individual may develop
R.P. to their house, greediness for food as a
and as they were means of coping with the
about to eat, he unpleasant memories
scooped an enormous related to the traumatic
amount of salad and event (Braun et al, 2019).
smiled while doing it.

VI. Differential DiagnosIs/Final Diagnosis

I. Posttraumatic Stress Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth

Edition, Post-traumatic stress disorder (PTSD) is a distressing pattern of action shown
by an individual who has suffered, seen, or been exposed to a traumatic event, such as
a natural disaster, a war, or an assault. A person with PTSD was exposed to a traumatic
event that posed an actual or perceived risk of death or severe injury, to which they
responded with extreme fear, helplessness, or terror. The four subcategories of
symptoms in PTSD include re-experiencing the trauma through dreams or recurrent and
intrusive thoughts, avoidance, negative cognition or ideas, being on guard, or
hyperarousal. The person persistently re-experiences the trauma through memories,
dreams, flashbacks, or reactions to external cues about the event, avoiding stimuli
associated with the trauma. The victim feels a numbing of general responsiveness and
shows persistent signs of increased arousal, such as insomnia, hyperarousal or
hypervigilance, irritability, or angry outburstst. They report losing a sense of connection
and control over their life.

Duration

The symptoms occur 3 months or more after the trauma, which distinguishes
PTSD from acute stress disorder, which may have similar types of symptoms but lasts 3
days up to 1 month. The onset can be delayed for months or even years. Typically,
PTSD is chronic, though symptoms can fluctuate in intensity and severity, worsening
during stressful periods. Often, other life events can exacerbate PTSD symptoms
(Videbeck, 2020).

Criteria

Listed signs
Criteria Presen Justification Rationale
and
t
symptoms
of the client

A. Exposure to Doctor Mark Clients who survive a

Derealization actual or Powell trauma may have
threatened discovered survivor's guilt,
Depersonaliz death, that Prot is believing they "should
ation serious most likely have died with
injury, or R.P. R.P was everyone else." Clients
Dissociative sexual married and who have been
Amnesia violence in had a little traumatized report
one (or daughter. reliving the trauma,
more) of the Eventually, a often through
following recently nightmares or
ways: released flashbacks. Intrusive,
1. Directly convict broke persistent thoughts
✔
experiencing the into the about the trauma
traumatic event(s). client’s home interfere with the
2. Witnessing, in and raped client's ability to think
person, the Prot’'s wife about other things or
✔
event(s) as it before to focus on daily living.
occurred to others. murdering Some clients report
3. Learning that the both her wife hallucinations or
traumatic event(s) ✔ and her buzzing voices in their
occurred to a close daughter. heads. Self-destructive
family member or The client, thoughts, impulses,
close who just got and intermittent
friend. In cases of home, was suicidal ideation are
actual or able to take also common. Some
threatened death of the rapist and clients say they have
a family member or murdered fantasies in which they
friend, the event(s) him before take revenge on their
must have been drowning abusers.
violent or himself in the (Videbeck, 2020)
accidental. river.
4. Experiencing
repeated or
extreme exposure
to aversive details
of the traumatic
event(s) (e.g., first
responders
collecting human
remains: police
officers repeatedly
exposed to details
of child abuse).

B. Presence of Due to neurological

Dr. Powell
one (or changes in the brain,
invites R.P to
more) of the some people with
a picnic at his
following PTSD may engage in
house.
intrusion aggressive or other
During the
symptoms violent behavior as a
picnic, R.P
associated way to process their
communicate
with the trauma. People
s with the
traumatic frequently see that
dog, eats,
event(s), acting aggressively to
and learns
beginning protect themselves is
about Dr.
after the the safest reaction to
Powell's
traumatic extreme threats. Many
family, and
event(s) trauma survivors,
plays with the
occurred: particularly those who
kids until the
experienced trauma in
sprinkler
1. Recurrent, their early years, never
turns on by
involuntary, and ✔ learn any ways to cope
the kid and in
intrusive distressing with threats. When
which he
memories of the they are threatened,
starts to
traumatic event(s). they tend to become
panic.
trapped in their ways
Because of
2. Recurrent of reacting. They may
that he
distressing dreams be aggressive,
became
in which the content reacting without
aggressive
and/or affect of the thinking (VA, 2022).
by pulling the
dream are
child away
related to the
from the
traumatic event(s).
water and
insisting not
3. Dissociative
go there.
reactions (e.g.,
Later on, it
flashbacks) in
which the individual was revealed
✔
feels or acts as if that he
the traumatic attempted
event(s) were suicide by
recurring. (Such jumping into
reactions may the river,
occur on a which caused
continuum, him to be
with the most terrified of
extreme expression water.
being a complete Therefore,
loss of awareness the client
of present acted
surroundings.) dissociative
reactions
4. Intense or because of
prolonged traumatic
psychological events.
distress at
exposure to internal
or external cues
that symbolize or
resemble an aspect ✔
of the traumatic
event(s).

5. Marked
physiological
reactions to internal
or external cues
that symbolize or
re-
semble an aspect
of the traumatic
event(s).
✔
Note: Criterion A4
does not apply to
exposure through
electronic media,
television,
movies, or pictures,
unless this
exposure is work
related.

C. Persistent The client is According to the

avoidance brought to Diagnostic and
of stimuli the Statistical Manual of
associated Psychiatric Mental Disorders, Fifth
with the Institute, Edition, The person
traumatic where Doctor who remembers the
event(s), Mark Powell trauma repeatedly
beginning begins to through memories,
after the diagnose him nightmares,
traumatic as psychotic. flashbacks, or
event(s) Nevertheless responses to external
occurred, as , due to his signs about the
evidenced avoidance of incident, and hence
by one or stimuli avoids stimuli
both of the related with connected with the
following: his previous trauma. This might
traumatic result in avoidance
1. Avoidance of or experiences, behavior, or the
efforts to avoid R.P’s attempt to avoid any
distressing unwavering places, people, or
memories, ✔ ability to events that may trigger
thoughts, or deliver logical memories of the
feelings about answers to trauma.
or closely questions
associated with the about himself
traumatic event(s). remains
unsolved.
2. Avoidance of or
efforts to avoid
external reminders
(people, places, ✔
conversations,
activities, objects,
situations) that
arouse distressing
memories,
thoughts, or
feelings about or
closely associated
with the traumatic
event(s).
D. Negative We noticed
When trauma
alterations that the client
overwhelms a person's
in cognitions had lost his
ability to cope with a
and mood memory
situation, the traumatic
associated during his
event's memories may
with the interview with
not fully integrate with
traumatic Dr. Powell.
their awareness. While
event(s), His inability
memories fade
beginning or to recall an
gradually over time,
worsening important
flashbacks of trauma
after the aspect of the
may seem hyperreal
traumatic traumatic
for people suffering
event(s) events, which
from PTSD. People
occurred, as is typical of
with dissociative
evidenced dissociative
disorders have the
by two (or amnesia, is
essential feature of a
more) of the visible since
disruption in the
following: he cannot
usually integrated
remember
functions of
1. Inability to his real
consciousness,
remember an name. He
memory, identity, or
important aspect of claims to
environmental
the traumatic have no wife
perception. This often
event(s) (typically or child, no
✔ interferes with the
due to dis- family at all,
person’s relationships,
dissociative because
ability to function in
amnesia and not to there is no
daily life, and ability to
other factors such family in K-
cope with the realities
as head injury, PAX. Poor
of the abusive or
alcohol, or drugs). judgment is
traumatic event. This
evident since
disturbance varies
2. Persistent and he is unable
greatly in intensity in
exaggerated to plan for his
different people, and
negative beliefs or future
the onset may be
expectations about because his
sudden or gradual,
oneself, others, thinking is far
transient, or chronic.
or the world (e.g., “I from reality.
Dissociative symptoms
am bad,” “No one He can only
are also seen in clients
can be trusted,” think about
with PTSD (Rtcher,
‘The world is going to K-
2018).
completely PAX.
dangerous,” “My
whole nervous
system is
permanently
ruined”).

3. Persistent,
distorted cognitions
about the cause or
consequences of
the traumatic
event(s) that lead
the individual to
blame
himself/herself or
others.

4. Persistent
negative emotional
state (e.g., fear,
horror, anger, guilt,
or shame).

5. Markedly
diminished interest
or participation in
significant activities.

6. Feelings of
detachment or
estrangement from ✔

others.

7. Persistent
inability to
experience positive
emotions (e.g., ✔
inability to
experience
happiness,
satisfaction, or
loving feelings).

E. Marked
The client The person
alterations
has not been persistently
in arousal
and ✘ showing any re-experiences the
reactivity signs of trauma through
associated difficulty in memories, dreams,
with the sleeping as flashbacks, or
traumatic well as reactions to external
event(s), problems in cues about the event
beginning or concentration and therefore avoids
worsening and was also stimuli associated with
after the not showing the trauma. The victim
traumatic any irritable feels a numbing of
event(s) behavior. The general
occurred, as client only responsiveness and
evidenced had a straight shows persistent signs
by two (or face and of increased arousal
more) of the didn't show such as insomnia,
following: any facial hyperarousal or
reaction in hypervigilance,
1. Irritable behavior terms of irritability, or angry
and angry outbursts being happy outbursts.
(with little or no or any angry (Videbeck,2020)
provocation) outburst.
typically ex-
pressed as verbal
or physical
aggression toward
people or objects.

2. Reckless or
self-destructive
behavior.

3. Hypervigilance.

4. Exaggerated
startle response.

5. Problems with
concentration.

6. Sleep
disturbance (e.g.,
difficulty falling or
staying asleep or
restless sleep).
F. Duration of Based on the The difference
the patient’s between PTSD and
disturbance ✘
duration of acute stress disorder,
(Criteria B,
C, D, and E) disturbance which may have
is more than criteria B, C, similar types of
1 month.
D, is present symptoms but lasts 3
while criteria days to 1 month, is
E is absent that PTSD symptoms
making it not appear 3 months or
evident. more after the
traumatic experience,
months or even years
may pass before the
symptoms appear.
Although symptoms of
PTSD can vary in
degree and severity
and are worse during
stressful times, they
are often persistent in
nature. Such life
experiences can make
PTSD symptoms
worse (Videbeck,
2020).

G. The ✔ The According to Mann

disturbance unfortunate and Marwaha (2022).
causes
event that Posttraumatic Stress
clinically
significant transpired in Disorder significantly
distress or R.P.'s life had impairs social, and
impairment
a significant occupational.
in social,
occupationa impact on his Consequently, PTSD
l, or other occupation, can result in clinical
important
leaving him impairments in
areas of
functioning. unemployed important areas of
and roaming functioning.
on the
streets.
H. The ✘ The client’s Acute stress disorder
disturbance mental illness and post-traumatic
is not was not due
stress disorder are
attributable to the
to the influence of diagnoses that include
physiologica substances, some of the problems
l effects of a alcohol nor
individuals have after
substance any medical
(e.g., conditions. experiencing a
medication, Hence, it stressful event
alcohol) or developed
(PTSD). Dissociative
another after the
medical client experiences (such as
condition. experienced sensations of unreality
a traumatic or detachment),
event.
intrusive thoughts and
pictures, efforts to
block out memories of
the traumatic
experiences, and
anxiety that may
develop a month after
the occurrence are all
described by ASD.
The diagnosis of
PTSD is used to
identify these events
when they endure for
more than a month.
Abuse of substances
impairs a person's
ability to focus, be
productive at work and
in life in general, have
a good night's sleep,
and deal with painful
memories and outside
stressors. Abuse of
substances can
exacerbate emotional
numbness, social
isolation, impatience
and rage, despair, and
the sense that one
must be on alert
(hypervigilance)
(International Society
for Traumatic Stress
Studies, n.d).

II. SCHIZOPHRENIA

Schizophrenia is a gradual but continuous and severe mental condition that

affects all parts of a person's life. According to Videbeck (2020), schizophrenia creates
distortions in thinking, perceptions, emotion, movement, and behavior. This mental
disorder cannot be defined as a single illness but rather, as a syndrome or as a disease
process with many different varieties and symptoms. Moreover, the symptoms are
divided into two major categories: positive and hard symptoms/signs, which include fixed
false beliefs that have no basis in reality (delusions), false sensory perceptions or
perceptual experiences that do not exist in reality (hallucinations), fragmented or poorly
related thoughts and ideas (associative looseness), continuous flow of verbalization that
jumps rapidly from one topic to another (flight of ideas), grossly disorganized thinking,
speech, and behavior; and the negative or soft symptoms/signs that include blunted, and
flat affect, anhedonia or the feeling of no joy or pleasure from any circumstances, lack of
drive to act or accomplish tasks (avolition), along with immobility or catatonia. The
diagnosis consists of identifying a group of signs and symptoms related to impaired
occupational or social functioning.

Duration

The onset may be abrupt or insidious, but most clients slowly and gradually
develop signs and symptoms. The diagnosis of schizophrenia, according to Videbeck
(2020), is usually made when the person begins to display more actively positive
symptoms of delusions, hallucinations, and disordered thinking (psychosis). An episode
of schizophrenia may persist for days, weeks, or even months (in exceptional situations).
While some people only experience one or two episodes of schizophrenia in their lives,
others experience several intermittent episodes.

The Diagnostic and Statistical Manual of Disorders, Fifth Edition, Text Revision of
the American Psychiatric Association noted that the characteristic symptoms of
schizophrenia involve a range of cognitive, behavioral, and emotional dysfunction, but no
single symptom is pathognomonic of the disorder. The duration of schizophrenia is
determined by any symptoms or underlying factors that persist for six (6) months; Two or
more symptoms, such as hallucinations, delusions, incomprehensible speech, and
extremely disorganized or catatonic behavior, must also be present and persist for at
least one (1) month. Furthermore, schizophrenic episodes or psychosis has classified
into three stages: (1) Prodromal phase which the patient shows signs of delusion or
distorted perception and indicates that psychosis may occur soon; (2) Acute phase
where the disorder begins to affect regular life activities as the periods of hallucinations,
delusions, and other mental condition sets in; (3) Recovery phase where the patient will
be able to recover from the condition and slowly revert to normalcy. Hence, in this case
analysis, symptoms were already evident during the presentation of the client in the
Psychiatric Hospital.

Criteria

Listed Criteria Pr Justification Rationale

signs and e
symptoms s
of the e
client nt

- Catatonic A. Two (or more) Delusions are

Stupor of the following, characterized by an
each present for unshakeable belief in
- Dissocia-
a significant things that are not true, and
tive Fugue
portion of time this belief is frequently

- Amnesia during a 1 maintained despite

-month period (or opposing evidence. Not all
- less if delusions are created
Hallucina- successfully equal. Non-bizarre beliefs
tion treated). that may possibly exist in
actual life may be involved.
- At least one of
Others could seem
Delusional these must be The client has
strange, imaginative, or
Grandiosit (1), (2), or (3): been having
impossible. The nature of
y delusions
1. Delusions the delusional symptoms
because he
- Fragment may be crucial in the
✔ believes he is an
of Identity diagnosis. Consequently,
extraterrestrial
grandiose delusions are
from the planet
- Deperso regarded as firmly held
K-PAX. Also, a
nality & erroneous ideas about
delusion of
Derealizatio having an exaggerated
grandiosity was
n value, power, or a unique
observed as he
identity that are sustained
-Neologis manifested
the undeniable evidence to
m delusional
the contrary. It has long
fantasies of power
been assumed that
and knowledge.
irregularities in
These were
inference—the process of
evident when the
forming beliefs via
client believed
experience—are the cause
that he could heal
of delusions. Some
everyone in the
individuals with
facility and was
schizophrenia show social
knowledgeable
cognition deficits, including
about
deficits in the ability to infer
astrophysics the intentions of other
which he used to people and may attend to
explain about a and then interpret irrelevant
certain planet events or stimuli as
which he called meaningful, perhaps
his home. leading to the generation of
explanatory delusions
(Baker et al., 2019)

Auditory Hallucinations are noises

✔
hallucinations or feelings that are
2. Hallucinations
were observed as perceived as real even if
the client they exist only in the mind.
converse with the Although hallucinations can

dog and assumes affect any of the five

that the client senses, auditory

understands the hallucinations (such as

dog. Furthermore, hearing voices or other

both auditory and sounds) are the most

visual prevalent in schizophrenia.

hallucinations They frequently arise when

were seen a distressed individual

particularly when misinterprets his own inner

he hears familiar self-talk as emanating from
voices and sees somewhere else. In

things when he neurobiology, patients with

stood near the schizophrenia have

water sprinkler defective regulation of

which also thalamocortical gamma

triggered him to activity by external sensory

become histrionic. information, allowing
attentional processes to
predominate in the
absence of sensory input
which may result in
hallucinations.
Schizophrenia can make it
3. Disorganized The client’s difficult to concentrate and
✔
speech (e.g., speech, retain a stream of thought,
frequent particularly his which might affect how a
derailment or articulation, and person speaks. Individuals
incoherence) pronunciation was may react to questions with

not affected by his unconnected answers,

mental illness. begin sentences with one

However, the topic and conclude with
client spoke of a another, speak
K-Paxian incoherently, or utter
language which nonsensical things.
was composed of According to Musa et al.
incomprehensible (2022), shallow cortical
words. attractors may cause
thinking disorders
(particularly tangentiality
and derailment) by
lowering the threshold for
switching between attractor
states.

Catatonia is distinguished
4. Grossly
Physiological by a significant
disorganized or
✔ immobility is psychomotor disruption,
catatonic
present as he which may include lower
behavior.
showed motor activity, less

unresponsiveness involvement during an

to different stimuli interview or physical

thus, completely examination, or excessive

lacks verbal and and unusual motor activity.
motor responses During the most severe
after being found stages of catatonia, the

unconscious on individual may require

July 27 which close supervision in order

where he to avoid self-harm or

assumes to go injuring others.

back to his home, Malnutrition, fatigue,

K-Pax. hyperpyrexia, and

self-inflicted injuries are all
possible hazards (5thed.;
DSM–5; American
Psychiatric Association,
2013, p. 119). On the other
hand, catatonia is thought
to be induced in part by the
dysregulation of specific
neurotransmitters.
Gamma-aminobutyric acid
is the most researched
neurotransmitter in the
context of catatonia
(GABA). Other
neurotransmitter disorders,
such as dopamine and
glutamate, have been
linked to catatonia, as well
(Bence, 2021).

Negative symptoms are

common in the prodromal
The client
5. Negative and residual phases and
conveyed
symptoms (i.e., can be severe. Individuals
X emotions as he
diminished who had been socially
talked eloquently
emotional active may become
to everyone in the
expression or withdrawn from previous
facility.
avolition). routines. Such behaviors
are often the first sign of a
disorder (5thed.; DSM–5;
American Psychiatric
Association, 2013, p. 101).

B. For a ✔ Because of a
Videbeck (2019) mentioned
significant tragic experience
that positron emission
portion of the in the past, the
tomography studies
time since the client had formed
suggest that glucose
onset of the a different view of
metabolism and oxygen
disturbance, life, which is why
are diminished in the
level of he believed he
frontal cortical areas of the
functioning in was an alien from
brain. The research
one or more the planet K-PAX.
regularly demonstrates
major areas, He desired to be
decreased brain volume
such as work, free of the past's
and altered brain function
interpersonal influence and
in the frontal and temporal
relations, or transformation of
lobes of people who have
self-care, is him into someone
schizophrenia. This
markedly below he is not.
pathology is related to the
the level
positive indicators of
achieved prior to
schizophrenia (temporal
the onset (or
lobe), such as psychosis,
when the onset
and the negative signs of
is in childhood or
schizophrenia (frontal
adolescence,
lobe), such as lack of
there is failure to
volition or motivation and
achieve
expected level of anhedonia. Intrauterine
interpersonal, effects such as poor
academic, or nutrition, smoking, alcohol,
occupational and other drugs, and stress
functioning). are also being investigated
as potential causes of the
brain pathology seen in
individuals with
schizophrenia.

✔
C. Continuous Due to a lack of Certain symptoms of the
signs of the information on the disruption must be present
disturbance time period for at least 6 months.
persist for at covered it was Prodromal symptoms
least 6 months. unable to tell if the frequently precede the
This 6-month client had been active phase, and residual
period must exhibiting symptoms, defined by
include at least 1 symptoms for at moderate or subthreshold
month of least six months. hallucinations or delusions,
symptoms (or However, there may follow (DSM-5;
less if was a scene in American Psychiatric
successfully which the Association, p.101, 2013).
treated) that psychiatrist
meet Criterion A suspects the
(i.e., client may have
active-phase experienced a
symptoms) and traumatic event
may include five years ago,
periods of but it is unclear
prodromal or when the
residual symptoms first
symptoms. appeared
During these because they
prodromal or were already
residual periods, present when he
the signs of the entered the
disturbance may mental health
be manifested by institution.
only negative
symptoms or by
two or more
symptoms listed
in Criterion A
present in an
attenuated form
(e.g., odd beliefs,
unusual
perceptual
experiences).

✔ The presence of mood

[Link] All throughout, the
symptoms distinguishes
disorder and client only
schizoaffective disorder
depressive or manifested a
from schizophrenia. A
bipolar disorder labile mood
person with schizoaffective
with psychotic during hypnosis
disorder is likely to have
features have and when the
severe mood symptoms
been ruled out client’s auditory
but the symptoms may
because either and visual
come and go, unlike
hallucinations
schizophrenia which comes
were triggered by
persistently (Preda, 2022).
1) no major the water
Furthermore, in
depressive or sprinkler.
schizophrenia, mood
manic episodes symptoms and full mood
At the first
have occurred
hypnosis session, episodes are frequent and
concurrently with
the client showed may occur concurrently
the active-phase
discomfort and his with active-phase
symptoms,
body became symptomatology. A

fidgety as the schizophrenia diagnosis,

hypnosis as opposed to a psychotic

or continued. Thus, mood disorder, requires the

in the succeeding presence of delusions or
sessions of hallucinations in the

2) if mood hypnosis, the absence of mood episodes

episodes have client manifested (DSM-5; American

occurred during discomfort, and Psychiatric Association,

aggressiveness p.109, 2013).

active-phase
symptoms, they and was crying as

have been he vividly saw the

present for a events which

minority of the triggered him to

total duration of his current state.

the active and However, when

residual periods the client wakes

of the illness. up from hypnosis,

he goes back to
being calm
demeanor and
was clueless of
what behavior he
elicited earlier.

E. The ✔
The client’s Rates of comorbidity with
disturbance is
mental illness was substance-related
not attributable
not due to the disorders are high in
to the
influence of schizophrenia. The drug/
physiological
substances nor medication-induced
effects of a
any medical psychotic condition begins
substance (e.g.,
conditions. with the substance
a drug of abuse,
Hence, it suspected of causing
a medication) or
developed after hallucinations or delusions.
another medical
the client (DSM-5; American
condition.
experienced a Psychiatric Association, p.
traumatic event. 98, 2013).

F. If there is a X
The fundamental
history of autism
symptoms of schizophrenia
spectrum
remain the same in
disorder or a
children, although
communication
diagnosis is more
disorder of
challenging. Delusions and
childhood onset,
hallucinations in children
the additional
may be less detailed than
diagnosis of
in adults, and visual
schizophrenia is
hallucinations are more
made only if
prevalent and should be
prominent
separated from normal
delusions or
imaginative play.
hallucinations, in
Disorganized speech and
addition to the
behavior (e.g., attention
other required
deficit/hyperactivity
symptoms of
disorder) are common in
schizophrenia,
many childhood conditions.
are also present
These symptoms should
for at least 1
not be linked to
month (or less if
schizophrenia without
successfully
taking into account the
treated).
more prevalent childhood
disorders. Childhood-onset
situations are similar to
poor-outcome adult cases
in terms of gradual onset
and prominent negative
symptoms. Children who
later obtain a schizophrenia
diagnosis are more likely to
have experienced
nonspecific
emotional-behavioral
problems
emotional-behavioral
problems and
psychopathology,
intellectual and language
alterations, and subtle
motor delays (DSM-5;
American Psychiatric
Association, p. 102 - 103,
2013).

III. DISSOCIATIVE IDENTITY DISORDER

Dissociative Identity Disorder, commonly known as Multiple Personality Disorder,

is characterized by two or more distinct personality states or a sense of possession
(DSM-5; American Psychiatric Association, p. 292 - 293, 2013). This disorder constantly
exerts power over the person's behavior by switching to alternate identities, that can be
identified by two clusters of symptoms, like sudden changes or discontinuities in the
sense of agency, sense of self and, as well as recurrent dissociative amnesia.
Individuals with this disorder may report being at the beach, at work, in a nightclub, or
somewhere at home (e.g., in the closet, on a bed or sofa, in the corner) without memory
of how they got there, a condition known as dissociative fugue. The inability to recall
important personal data, the inability to recall something experienced, the failure to recall
their name, or the difficulty recognizing their wife, children, or close friends are all
symptoms of dissociative identity disorder. DSM-5, American Psychiatric Association, p.
293, 2013.)

Furthermore, individuals with dissociative identity disorder frequently have

comorbid depression, and they frequently conceal or are not fully aware of disruptions in
consciousness, amnesia, and other symptoms of dissociation. Dissociative flashbacks
occur when a person with DID experiences sensory reliving of a previous event, event as
if it were happening now, or complete loss of contact with or disorientation from current
reality during the flashback, followed by amnesia for the content of the flashback. As it is
believed to be a complex psychological condition brought on by various factors,
including traumatic experiences. In these cases, a person may dissociate the recent
memories of the location, circumstances, or feelings about the traumatic event, mentally
escaping
Lastly, Females with dissociative identity disorder predominate in adult clinics
but not in pediatric clinics. Adult males with dissociative identity disorder may deny their
symptoms and trauma histories, resulting in a higher rate of false negative diagnosis.
Females with dissociative identity disorder are more likely to present with acute
symptoms; these include flashbacks, amnesia, fugue, hallucinations, and self-mutilation
are examples of dissociative states. Males are more likely than females to engage in
criminal or violent behavior; common triggers of acute dissociative states among males
include combat, prison conditions, and physical or sexual [Link] fear and pain that
negatively affects a person's ability to connect with reality. (DSM-5; American Psychiatric
Association, p. 295, 2013)

Duration
It takes time to make a diagnosis of dissociative identity disorder. Individuals with
dissociative disorders are estimated to have spent seven years in the mental health
system before receiving an accurate diagnosis. This is common because the symptoms
that lead to a person seeking treatment for a dissociative disorder are very similar to
those of many other psychiatric diagnoses. (WebMD, 2022)

Criteria

Listed signs Criteria P Justification Rationale

and re
symptoms of s
the client e
nt

[Link] of ✔ The client believed Dissociative Identity

- Dissocia-
identity he was from another Disorder is a mental
tive Fugue
characterized by planet, he constantly health condition in

- Amnesia two or more insists that he came which two or more

distinct from a different identities coexist with
- Deperso personality planet called K-PAX, distinct people within
nalization states, which despite the fact that one individual. These
may be K-PAX never really distinct individuals or
described in existed and was sent personalities are also
some cultures as to the planet Earth to referred to as alters.
an experience of study human An alter is a
possession. The behavior. There is completely different
disruption in also a change in his person who has a
identity involves personal experience completely different
marked and perception due personality than the
discontinuity in to his claim that he is original person.
sense of self and not a human but Dissociative identity
sense of agency, rather a visitor from disorder: (Horchner,
accompanied by another planet. n.d.) Each alter's
related personality is unique
alterations in and distinct from the
affect, behavior, others; it is a complex
consciousness, unit with memories,
memory, behavioral patterns,
perception, and social
cognition, and/or relationships that
sensory-motor govern how a person
functioning. behaves when that
These signs and personality is
symptoms may dominant.
be observed by
others or
reported by the
individual.

B. Recurrent ✔ Mr. R.P. is in Dissociation is a

gaps in the recall repression as he is subconscious defense
of everyday not able to recall any mechanism that allows
events, and of his personal a person to forget or
important information or even remove himself or
personal the traumatic events herself from a painful
information, and/ that happened. situation or memory to
or traumatic protect his or her
events that are emotional self from
inconsistent with recognizing the full
ordinary effects of the horrific or
forgetting. traumatic event.
Swaim, E. (2022)

C. The ✔ We noticed that the Dissociative disorders

symptoms cause client had lost his are distinguished by
clinically memory throughout disrupting typically
significant the interview with Dr. integrated functions
distress or Powell. As a result, such as
impairment in he has impaired consciousness,
social, thinking because he memory, identity, or
occupational, or cannot recall his real environmental
other important name, where he has perception. This will
areas of lived, and he claims frequently disrupt the
functioning to have no wife or individual's
child, nor family at relationships, ability to
all. Poor judgment is function in daily life,
evident because he and ability to cope with
is unable to plan for the realities of the
his future because abusive or traumatic
his thinking is far event.
from reality, and his
only option is to
return to the K-Pax
planet because he
has an obsession
with the planet's
K-PAX, from which
he believed he
originated.

D. The X The client insisted According to DSM-5;

disturbance is on arriving on Earth American Psychiatric
not a normal part via "light travel," he Association, the
of a broadly demonstrated disturbance must be
accepted cultural derealization. viewed as an ordinary
or religious Furthermore, he component of cultural
practice. stated that he is from or religious practice.
planet K-PAX. He Possession from this
also claims that he is disorder differs from
not a human being culturally accepted
because he has no possession states
wife, or children, and since it is involuntary,
is completely distressing,
apathetic when unmanageable, and
discussing frequently recurring or
relationships and continuous. Involves
family. conflict between the
individual and his or
her surrounding family,
social, or work milieu;
and usually manifests
at times and in places
that violate the social
rules of the culture or
religion majority of
possession around the
world is normal and
usually part of spiritual
practice.

E. The ✔ There was no history Substance abuse

symptoms are of physiological does not cause
not attributable effects of substance dissociative identity
to the from the client, such disorder. Dissociative
physiological as blackout or identity disorder
effects of a chaotic behavior develops from a
substance (e.g., during alcohol traumatic event rather
blackouts or intoxication, and no than from substance
chaotic behavior medical condition abuse. It can also
during alcohol was noted that could include issues with
intoxication) or have resulted in him one's sense of self,
another medical having delusions and memory, feelings,
condition since he does not actions, and/or
(e.g., complex drink alcohol. perception. Substance
partial seizures). abuse is prevalent
among individuals with
dissociative identity
disorder, however, it
doesn't usually appear
before the disorder
develops (Gonzales,
2022)

VII. Medical Management

A. Test

Test Purpose Results Nursing

Responsibilities

CBC The red blood cells, Normal Result: [Link] the

white blood cells, procedure and
and platelets that purpose of the
Hematocrit normal
make up your blood laboratory test.
range:
are counted during
a complete blood ● Male: 40 - Rationale: To
count (CBC). ( 55% achieve full
Ratini, 2022) cooperation with
the patient.
The CBC is a
Platelet Count
helpful, affordable [Link] the
normal range:
test for general necessary
health screening ● Adult: equipment and
and for keeping 150,000 - supply
track of side effects 400,000/mL
in people taking Rationale: To
White blood cell
psychiatric reduce
(WBC) normal
medication. range: unnecessary time
( Jacobson, 2020) being wasted and
● Adult:
will be used
5,000-10,0
efficiently.
00/mL

[Link] a consent
form, if required.

Rationale: To gain
understanding that
the patient will fully
volunteer the
procedure.

4. Ensure standard
precautions or
sterile technique.

Rationale: To
reduce risk of
infection towards
the site and ensure
the safety of the
patient.

5. Provide
emotional support
to the patient and
monitor the
patient’s response
during the
procedure.

Rationale: Provide
support towards the
patient since taking
the CBC would
inflict pain and
acknowledge the
patient’s reaction
and feedback.

6. Ensuring the
correct labelling,
storage, and
transportation of the
specimen.

Rationale: To
refrain from any
errors and ensure
proper results of the
patient.

7. Differentiate the
former and current
result of the test.

Rationale: Gain
baseline
information if
there’s any
significant changes
regarding the
patient.

8. Report the result

to the health team.

Rationale: Ensure
the patient’s safety
from manifesting
further health
threatening results.

9. Observe side
effects of the
patient and report
for unusualities.

Rationale: To avoid
any unusualities
from manifesting
after the procedure.

Drug Test This is done largely Result for drug test 1. Do not
to screen persons through urinalysis: provide
systematically or food, fluid,
randomly for Negative activity, or
indications of usage medication
of one or more restrictions
potentially addictive unless by
substances since medical
all drugs have side direction.
effects, but the Rationale: since
intensity and consuming a lot of
breadth of their water before a test
influence vary from may result in a
minor to severe, positive dilute but
such as damage to will not result in a
mental health, can negative dilute.
alter the brain and
can possibly cause 2. Instruct the
death. Moreover, patient to
there are a variety void directly
of ways to test for into a clean,
drug substance in dry
the body, the most container.
common one is Rationale: So that
through urinalysis it will not
(O'Malley & contaminate the
O'Malley, 2022). urine that can alter
the result of the
test.

3. Cover all
specimens
tightly, label
properly and
send
immediately
to the
laboratory.
Rationale: to
assure accurate
sample
identification and
close the cover
tightly to prevent it
from getting
contaminated.
4. Observe
standard
precautions
when
handling
urine
specimens.
Rationale: To avoid
contamination of
the specimen or
deterioration of
urine constituents.

EEG It uses electrodes Normal Result: 1. Review the

attached to the patient's
scalp to record the The most clinical
electrical activity of commonly studied record.
the brain and waveforms include Rationale: to find
displays variations delta (0.5 to 4Hz); patient harm
in brain activity that theta (4 to 7Hz); instances,
may help with the alpha (8 to 12Hz); guarantee quality
diagnosis of many sigma (12 to 16Hz) improvement, and
brain illnesses, and beta (13 to so increase patient
particularly epilepsy 30Hz). safety. For the
and other seizure handling of medical
disorders (Mayo claims, accurate
Clinic, 2022). assessment of
pertinent medical
information is also
crucial.

2. Approach
and identify
the patient.
Rationale:
Because patient
identification errors
can result in failure
to treat a serious
disease or illness,
medical treatment
for incorrect
diagnostic lab
results, and
procedures being
performed on the
wrong patient.

3. Explain to
the patient
events that
will occur
during and
after the
procedure.
Rationale: this
makes the patient
aware of any
potential risks so
that we could gain
the patient’s
cooperation, while
also providing
reassurance.

4. Withhold
Antiseizure
agents,
depressants
medications,
tranquilizers
, and
stimulants
like caffeine,
chocolate,
tea, etc. for
24 to 48
hours before
an EEG
Rationale: since it
alters the EEG
wave patterns or
mask the abnormal
wave patterns of
seizure disorders.
5. Encourage
the client to
have regular
meal before
the EEG
Rationale: To avoid
alteration of blood
glucose level. Low
blood sugar can
cause changes in
the brain wave
patterns and
change the EEG
result.

6. Assist the
patient to
wash the
hair before
and after the
test.
Rationale:
Because hair
products can make
it harder for the
sticky patches that
hold the electrodes
to adhere to your
scalp.

EKG Electrocardiogram Normal Result: 1. Verify the

or known as EKG or Heart rate: 60 - physician’s
ECG is a diagnostic 100 bpm order
tool that records the PR interval: 0.12 Rationale: Since
electrical activity of -0.20 sec EKG procedure is a
the patient’s heart QRS Interval: 0.06 dependent nursing
through small - 0.10 sec intervention. Hence,
electrode patches QT interval: less needing a
that are attached to than half of the physician’s order
the skin of the R-R interval
patient's chest, ST segment: 0.08 2. Explain the
arms, and legs. sec procedure to
Moreover, this is a the patient
test that is Rationale: To
commonly used to promote
detect signs of heart understanding and
disease (Begum, cooperation with
2023). the patient

3. Remove all
the jewelry
and other
metallic
accessories
Rationale: Metal
can affect the
accuracy of the
result.

4. Clean the
skin and clip
area where
the
electrode
will be
placed.
Rationale: To
ensure adherence
and reduce
discomfort on
removal

5. Record and
document
test findings
Rationale: For
documentation
purposes

MRI A magnetic Normal result: 1. Explain the

resonance imaging purpose of
scan or also known the test to
as an MRI is a the patient.
painless procedure Rationale: To
used to produce promote
clear images of the cooperation and
formation and understanding of
- Normal
structure of the the patient
structure of
head – mainly the
brain. Furthermore, the brain 2. Tell the
MRI scans use - No signs of patient to
radio waves to print inflammatio resume his
and produce these n and normal diet
very clear images. bleeding. and
Also, MRI is activities.
commonly used to Rationale: Since
diagnose tumors, MRI does not need
hemorrhages, to restrict food and
aneurysm, and etc. fluid for it does not
(Cleveland Clinic, affect the test.
2022).
3. Instruct the
patient to
get rid of
any jewelry,
hairpins, or
watches that
are made of
metal.
Rationale: Metal
can affect the result
of MRI.

4. Assess if
the patient
is
claustropho
bic.
Rationale: With
MRI, the patient will
be placed in a
capsule-like
machine, which
may trigger
claustrophobic
patients. If this is
the case, the
patient can be
sedated.

5. Monitor for
orthostatic
hypotension
Rationale: When a
patient undergoes
MRI scan test, he
or she needs to lie
down for a period of
time, making the
patient prone to
orthostatic
hypotension.

HEALTH The need to Results:

ASSESSMENT comprehend what is Patient P.R
causing a patient's manifested signs Explain the purpose
discomfort requires of Amnesia and of the Assessment
an examination. Delusion persisted.
Instead of a Rationale: In order
neurological for the patient to be
disorder, patients fully aware of the
may have a medical assessment that
issue that affects will be held.
their mental health.
A patient could also Encourage patient
suffer from both a cooperation
physical and a
mental ailment. Rationale: To
Hence, doing an maximize the time
assessment of the procedure
examines the and early diagnosis
patient's physical will be provided.
and psychological
health in general. ( Ask for consent
Northern Kentucky while doing a
University, 2022) procedure.

Rationale: To
preserve the
confidence of the
patient while
cooperating.

Promoting client’s
safety.

Rationale: During
the assessment,
proper safety
should be
observed, in a way
to assess the
patient efficiently.

Teach effective
communication
skills.

Rationale: If the
patient isn’t not able
to fully
communicate
verbally, the student
nurse is able to
teach the client with
non-verbal gestures
and action.

.
Show gratitude
client’s participation

Rationale: To
appreciate the effort
of the patient with
the assessment.

B. Therapies

THERAPY PURPOSE EFFECTS ON PATIENT

Hospitalization Hospitalization might be Patient P.R. was first seen

the first step or therapy to at the train station and was
be used in psychiatric almost falsely accused of
patients. It is because being a thief by a police
when a person exhibits officer, making that
psychiatric symptoms for situation for P.R. an
the first time, that person encounter with a first
may need to be responder. Resulting in him
hospitalized so that he or being checked and
she can be mentally hospitalized because of the
assessed, closely way he talks to the police
monitored and accurately officer. He was sent to
diagnosed. Moreover, Bellevue hospital to be
hospitalization may be an admitted for almost a
option when the person month. During his stay at
decides that it is the best the hospital, several tests
decision for themselves, or were performed on him.
because of a family However, they all tested
member, physician, or a normal. Additionally,
result of an encounter with delusions and amnesia
a first responder such as were observed, which is
paramedics, police officer, why they administered
and etc. (Serani, 2019). Thorazine. Unfortunately,
thorazine had no effect on
him, resulting in him being
sent to the psychiatric
facility.

Hypnotherapy Hypnotherapy is a therapy In the case of patient R.P.

used by changing the state he has been exposed to
of awareness through hypnotherapy for a total of
intense concentration, three sessions. Throughout
deep focus, and increased those three sessions,
relaxation. Moreover, patient R.P has been
Hypnotherapy is also responding well to it. He
known as hypnosis and was able to talk about his
should be performed with a “friend” who needed his
health care provider who is help, which was basically
certified to perform such him. Moreover, the
therapy with the use of psychiatrist was able to
verbal repetition and explore the patient’s
mental images. Also, feelings and emotions
hypnotherapy is since hypnotherapy made
considered to significantly P.R. in a trance-like state,
aid in psychotherapy, allowing R.P.’s to respond
wherein the hypnotic state appropriately to the
of the patient allows the psychiatrist. Furthermore,
trained health care hypnotherapy has proved
provider to explore to be very effective on P.R.
feelings, emotions, and because it helped
memories that might be determine his real identity,
hidden deep from the his forgotten memories,
conscious mind (Bhandari, and trauma that was buried
2021). deep within his mind.

Psychotherapy a. Psychoanalysis and Patient R.P had three

psychodynamic sessions of Psychotherapy
therapies- attempts together with his therapist
to lessen symptoms to know what are the
and distress by causes of client’s trauma
assisting individuals and the possible cause of
with severe his current mental state.
psychiatric This therapy helped R.P in
disorders in developing
understanding and problem-solving abilities,
changing intricate, increasing his confidence,
ingrained, and and being more self-aware.
frequently This also improves his
unconscious feelings and actions
emotional and because the client had the
relationship issues. opportunity to express his
(Ablett-Tate, 2018) emotions and opinions
b. Behavior therapy- which was the involvement
This type of of both the client and his
treatment aims to therapist.
recognize and
assist in changing
potentially harmful
or unhealthy
behaviors. It is
predicated on the
notion that all
behaviors are
taught and that they
are modifiable.
(Gotter & Burford,
2022)
c. Cognitive
Behavioral therapy-
It is a sort of
psychotherapy
treatment that
teaches people
how to recognize
and modify
damaging or
unpleasant thinking
patterns that
influence their
behavior and
emotions. (Cherry,
2022)
d. Humanistic
therapy- It is a
mental health
strategy
emphasizing the
significance of
authenticity to live
the most satisfying
life possible.
Because it is built
on the idea that
everyone has their
own unique way of
looking at the
world, it also
includes the
fundamental
concept that
individuals are
capable of making
best decisions for
themselves. This
point of view may
influence your
choices and
actions. (Raypole,
2019)
e. Integrative or
holistic therapy-
This therapy treats
the mind, body, and
spirit to assist
health and healing,
with the goal of
improving
well-being, lowering
stress, and helping
to decrease trauma
responses (Mayer,
2022).

Psychopharmacology Psychopharmacotherapy Most schizophrenia

therapy provides a purpose for patients can have their
therapeutic monitoring; psychotic symptoms
especially for a psychiatric reduced by
patient who produces psychopharmacological
significant mental illness; therapy, although 20% of
drugs such as them are still susceptible to
antidepressants, mood the antipsychotic effects of
stabilizers, lithium neuroleptic therapy and
valproate, carbamazepine, continue to experience
and other drugs that are hallucinations and
well suited to support the delusions. Unfortunately,
psychiatric patient. drugs don't have any
(Schoretsanitis et al., 2020) significant positive effects
towards the patient P.R as
he was resistant to the
antipsychotic effects.

C. Drugs

GENERIC NAME Haloperidol LA and Peridol

BRAND NAME Haldol, Haldol decanoate and Serenace

DRUG CLASSIFICATION conventional antipsychotics

MODE OF ACTION The active mechanism of Haldol is to

block postsynaptic dopamine (D2)
receptors in the mesolimbic system of the
THbrain which decreases the level of
dopamine. (Medscape, 2022).
AVAILABILITY ● Intramuscular: 2 to 5 mg
haloperidol every 4 to 8 hours.
● Oral: 0.5 to 2 mg for 2 to 3 times a
day. It should not exceed 30 mg
daily in case of severe cases.

INDICATION, DOSAGE & ROUTE

a. Schizophrenia
● PO Moderate disease,
0.5-2 mg q8-12hr initially
● Severe disease, 3-5 mg
q8-12hr initially; not to
exceed 30 mg/day

b. Tourette Syndrome
● PO 0.5-2 mg q8-12hr
initially
● if severe symptoms
necessitate increased
dosage, titrate upward to
3-5 mg PO q8-12hr

c. Psychosis
● PO For moderate
symptomatology: 0.5 to 2
mg 2 to 3 times a day. Up
to 30 mg/day may be
necessary in some
resistant cases.
● IM can be given as a 2 to 5
mg dose every 4 to 8
hours. The maximum
intramuscular dose is 20
mg/day.

CONTRAINDICATIONS Haloperidol is contraindicated if there is

documented:

● Hypersensitivity to the drug

● Patients with Parkinson disease
● Dementia with Lewy body
● Comatose patients, in any
condition with a severely
depressed central nervous system
(CNS).
SIDE EFFECTS ● Difficulty with speaking or
swallowing
● Inability to move the eyes
● Loss of balance control
● Mask-like face
● Muscle spasms, especially of the
neck and back
● Restlessness or need to keep
moving (severe)
● Shuffling walk
● Stiffness of the arms and legs
● Trembling and shaking of the
fingers and hands
● Twisting movements of the body
● Weakness of the arms and legs

ADVERSE EFFECTS ● ECG changes - (QT prolongation)

● Photosensitivity reaction
● Generalized pruritus
● Diarrhea, gastrointestinal distress
● Blood dyscrasia
● Ejaculatory problems
● Seizure
● Cholestatic jaundice
● Priapism or prolonged erection of
the penis

DRUG INTERACTIONS DRUG-DRUG

● Blood pressure lowering
medication (Methyldopa): can
increase the risk of side effects
caused by certain antipsychotic
and other drugs (relating to motor
control) and other central nervous
system effects.
● The combined use of lithium:
has been shown to cause
encephalopathy, extrapyramidal
symptoms, coma and other
neurological problems.

DRUG-LIFESTYLE
● Alcohol or Narcotics: The
actions and side effects of these
drugs such as sedation and
respiratory depression will be
enhanced.

NURSING RESPONSIBILITIES ● Monitor for therapeutic

effectiveness.
Rationale: Because of long half-life,
therapeutic effects are slow to develop in
early therapy or when established dosing
regimen is changed.

● Monitor patient's mental status

daily.
Rationale: can aid in differentiating
between mood disorders, thought
disorders, and cognitive impairment if it
gets worse or improving.

● Monitor for neuroleptic malignant

syndrome (NMS), especially in
those with hypertension or taking
lithium.
Rationale: Because NMS symptoms
might emerge quickly following the start of
therapy or after taking neuroleptic
(antipsychotic) medication for months or
years. If NMS is detected, stop taking the
medicine immediately.

● Monitor for extrapyramidal

(neuromuscular) reactions or side
effects caused by certain
antipsychotic and other drugs that
occur frequently during the first
few days of treatment.
Rationale: When antipsychotics block D2
receptors, dopamine is no longer
available to suppress acetylcholine
release within the nigrostriatal pathway.
This leads to acetylcholine overactivity in
the basal ganglia, which manifests as
EPS. (Lee, 2021)

● Monitor for exacerbation of seizure

activity.
Rationale: To be aware of a client's
seizure frequency, type, and potential
effects. The health care provider can
better diagnose the patient with the use of
this information.

● Instruct the client to avoid use of

alcohol during therapy.
Rationale: Can affect gastrointestinal
blood flow and drug absorption by making
medicines more gastrically soluble, which
can also change a treatment's
effectiveness.

● Discuss oral hygiene with health

care provider
Rationale: Because dry mouth may
promote dental problems so drinking
adequate fluids is encouraged.

● Advice the client to avoid

overexposure to sun or sun lamp
and use a sunscreen
Rationale: Since drugs can cause a
photosensitivity reaction.

● Observe patients closely for rapid

mood shift to depression when
haloperidol is used to control
mania or cyclic disorders.
Rationale: Since Depression may
represent a drug adverse effect or
reversion from a manic state.
Generic Name Chlorpromazine

Brand Name Thorazine

Drug Classification Antipsychotic drug

Mode of Action
By inhibiting D2 receptors in the
mesolimbic pathway postsynaptically, it
exerts an antipsychotic effect. The
blocking of D2 receptors in the
nigrostriatal pathway is what causes the
extrapyramidal side effects.

Indication, Suggested Dose, Route

Psychotic Disorders, Agitation:
Adult: PO 25–100 mg t.i.d. or q.i.d., may
need up to 1000 mg/d. IM/IV 25–50 mg
up to 600 mg q4–6h

Nausea and Vomiting

Adult: PO 10–25 mg q4–6h prn. PR
50–100 mg q6–8h IM/IV 25–50 mg q3–4h
prn

Intractable Hiccups
Adult: PO/IM/IV 25–50 mg t.i.d. or q.i.d.

Schizophrenia:
The patient is initially started on 25 to 75
mg/day orally twice daily and maintained
at 200 mg/day for the treatment of
schizophrenia. The maximum daily oral
dosage is 800 mg. If administered
intravenously or intramuscularly, the dose
is begun at 25 mg and increased as
needed to 25 to 50 mg after 1 to 4 hours.
300 to 800 mg per day is the typical dose.

Nausea and vomiting:

The dosage of chlorpromazine can range
from 10
25 mg taken orally each four to six hours
as needed. if administered
intramuscularly or the dosage of an
intravenous injection might vary every 4
to 6 hours, between 25 and 50 mg, as
needed.
Persistent Singultus:
administering chlorpromazine 25 to 50 mg
every 6 to 8 hours, orally. Has a hiccup
persistent even after receiving 2 to 3 oral
treatments days, chlorpromazine is
administered as a injected intramuscularly
or intravenously.

Anxiety:
before surgery, Chlorpromazine dosages
might vary. 12.5 to 25 mg orally and 25 to
50 mg intramuscularly administered over
2–3 hours .prior to surgery.

Contraindications
Chlorpromaxine should not be given if the
patient is having:

● phenothiazines allergy or
hypersensitivity, Due to the
possibility of experiencing severe
hypotension,
● The medication should be used
with caution in patients on
antihypertensive drugs.
● It shouldn't be given along with
medications that depress the
central nervous system or to
people who have uncontrolled
seizures.
● For the treatment of psychosis
associated with dementia, the
medication is not approved.
Levodopa and cabergoline are two
drugs that operate as dopamine
agonists, and their therapeutic
efficacy may be impacted by
chlorpromazine's D2 receptor
blocking action.
● The combination of
chlorpromazine and
selective-serotonin reuptake
inhibitors like citalopram and
escitalopram is not advised.

Side Effects ● Anticholinergic effects

● Sedation
● Weight gain
● Erectile dysfunction
● Oligomenorrhea or amenorrhea
● Drowsiness
● Hypotensive

Adverse Effect ● Akathisia

● Dystonia
● Muscle stiffness
● Neuroleptic malignant syndrome
● Parkinsonism
● Tardive dyskinesia
● Seizure
● Priapism
● Cholestatic jaundice

Drug Interactions
Drug:
● Alcohol: produces significant
impairment of the physical action.
● CNS DEPRESSANTS: increase
CNS depression;
● ANTACIDS: produces impared
absorption.
● ANTIDIARRHEALS: decrease
absorption—space administration
2 h before or after administration
of chlorpromazine;
● phenobarbital: increases
metabolism of phenothiazine;
● GENERAL ANESTHETICS:
increase excitation and
hypotension; antagonizes
antihypertensive action of
guanethidine;
phenylpropanolamine poses
possibility of sudden death;
● TRICYCLIC
ANTIDEPRESSANTS: intensify
hypotensive and anticholinergic
effects;
● ANTICONVULSANTS: decrease
seizure threshold—may need to
increase anticonvulsant dose.
● Herbal: Kava-kava increased
risk and severity of dystonic
reaction.

Nursing Responsibilities [Link] the baseline BP before

administering..

Rationale: In order to monitor if there's

low-blood pressure occurring and avoid
cardiovascular related problems.

2. Educate client on drug will be

administered.

Rationale: to promote understanding and

compliance.

3. Drugs should be administered with

caution.

Rationale:The adverse effects of

antipsychotic medications range from
relatively minor tolerability issues to a
life-threatening occurrence.
4. Provide safety measures

Rationale:To prevent injury, since this

drug can produce drowsiness and
dizziness.

5. Make arrangements to dispense the

smallest amount of medication possible.

Rationale: To reduce the risk of overdose

and abuse,

6. If there is Gastrointestinal pain, give

the medication with food or milk.

Rationale: If the GI is irritated by the

drug, eating a meal before administering
could lessen and delay the absorption of
the drug.

7. Ensure early diagnosis of negative

effects and appropriate therapies, keep
track of your weight, CBC, and ECG.

Rationale:Rationale: Weight will

significantly increase while taking this
drug, and rapid weight gain can affect the
daily life of the patient. Additionally, CBC
can indicate if there’s Leukopenia and
agranulocytosis; these are life-threatening
side effects of antipsychotics, ECG
should also be monitored to avoid
cardiovascular problems such as
hypotension.

8. Provide health teachings.

Rationale: Encourage patients to be

aware of what to avoid while taking the
medicine.

9. Observe patient after administering the

drug from time to time.

Rationale: In order to avoid any

unusualities accumulating after taking the
drug.

GENERIC NAME: ● Alprazolam

BRAND NAME: ● Xanax

● Apo-alpraz
● Alprazolam Intensol
● Niravam
● Novo-Alparazol

CLASSIFICATION: ● Pharmacological class: Benzodiazepine

● Therapeutic class: Anxiolytic, Antipanic

MODE OF ACTION: ● It is a benzodiazepine drug that binds to Gamma

Aminobutyric Acid (GABA) receptors throughout the
CNS, which increases and enhances its effects.
Moreover, GABA is known to inhibit excitatory
stimulation. Hence, if it is amplified by the said
medication, it would produce a sedative, muscle
relaxant, and anticonvulsant effect.

AVAILABILITY: ● Oral Solution: 1 mg/ml

● Tablets (Immediate-release): 0.25mg, 0.5mg, 1mg,
2mg
● Tablets (Extended-release): 0.5mg, 1mg, 2mg, 3mg
● Tablets (Orally disintegrating): 0.25mg, 0.5mg, 1mg,
2mg

INDICATION, DOSAGE ● Anxiety Disorder

& ROUTE: ○ Adults
■ PO (Immediate-Release, oral
solution, ODT): Initially, 0.25 to 0.5
mg t.i.d. Maximum, 4 mg daily in
divided doses.

● Panic Disorder
○ Adults
■ PO (Immediate-Release, oral
solution, ODT): Initially, 0.5 mg t.i.d.
May increase at intervals of 3-4 days
in increments of no more than 1 mg/
day. Maximum of 10 mg/day
■ PO (Extended-Release): Initially, 0.5
to 1 mg O.D. Increase by no more
than 1 mg/day every 3-4 days.
Maximum daily dose of 10 mg.

CONTRAINDICATIONS
● Hypersensitivity to Xanax or other benzodiazepines
:
● Patients with acute angle-closure glaucoma
● Labor and delivery
● Pregnancy and breastfeeding

Precautions

● Patients with hepatic disease

● Patients with severe pulmonary disease
● Elderly patients
● Patients with history of substance abuse/addiction

SIDE EFFECTS: ● Frequent (41%-20%): Light-headedness,

drowsiness, Ataxia. Occasional (15%-5%): Blurred
vision, constipation, diarrhea, dry mouth, headache,
nausea. Rare (4% or less): Behavioral problem
such as anger, impaired memory; paradoxical
reactions (insomnia, nervousness, irritability)

ADVERSE EFFECTS:
● CNS: Hallucinations, confusion, lack of coordination,
memory loss, seizure
● CV: Hypotension
● EENT: Yellowing of the eyes
● HEPATIC: Hepatic failure
● SKIN: severe skin rash, Stevens-Johnson
Syndrome
DRUG DRUG-DRUG
INTERACTIONS: ● Amiodarone, cyclosporine, diltiazem,
ergotamine, isoniazid, macrolide antibiotics
(clarithromycin, erythromycin), nicardipine,
nifedipine, paroxetine, sertraline: Possible
alteration in alprazolam plasma levels antacids:
altered alprazolam absorption rate
● Anticonvulsants; antidepressants;
antihistamines; other benzodiazepines, CNS
depressants, and psychotropics: Increases CNS
depressant effects
● Carbamazepine: Decreases plasma level of
alprazolam and potentially decreases its
effectiveness
● Cimetidine, fluoxetine, oral contraceptives,
propoxyphene: Decreased alprazolam elimination
and increased effects
● Hydantoins (phenytoin): May decrease effects of
alprazolam and increase hydantoin levels. Monitor
patient closely
● Methadone: May significantly increase risk of
respiratory depression. Use together cautiously.

DRUG-HERBS
● Kava and valerian root: may increase sedation
effect
● St. John’s wort: May decrease effectiveness of the
drug

DRUG-FOOD
● Grapefruit Juice: May increase level of drug and its
effect

DRUG-LIFESTYLE
● Alcohol: May cause additive CNS effects
● Smoking: May decrease effectiveness of the drug

NURSING ● Read the label, expiration date, and dosage of

RESPONSIBILITIES: Alprazolam drug carefully.
Rationale: To avoid errors that may endanger the patients’
health status.

● Prepare Flumazenil on the side.

Rationale: Flumazenil is used to treat Xanax toxicity and
preparing it on the side makes it very convenient to have
access with the antidote and help prevent life threatening
effects of Xanax toxicity.

● Make sure the patient is in a secure and relaxed

position before administering the drug.
Rationale: Since Xanax is known to have a sedative effect,
making patients prone to fall and trauma.

● Monitor vital signs of the patient, especially the

respiratory and cardiac function.
Rationale: In order to determine if the patient is responding
well with the medicine and to determine if the patient is
manifesting any adverse reactions.

● Monitor hepatic functions in patients on long-term

therapy.
Rationale: Xanax is known to increase ALT or
transaminase, a type of liver enzyme, in which elevated
levels of ALT indicate liver damage.

● Monitor for signs of adverse reactions such

hallucination, rashes, and problems with
coordination.
Rationale: If adverse reactions are identified and caught
immediately, we can prevent further worsening of the
situation.

● Encourage patient to avoid OTC medication without

physicians’ approval
Rationale: Because many OTC contain similar
components which may cause overdose and toxicity.

● Advise the patient to avoid activities that require

alertness
Rationale: Since Xanax is known to have a sedative effect,
which makes them sleepy. Hence, activities such as driving
should be avoided.

● Warn the patient to avoid drinking and smoking

when taking the drug.
Rationale: Alcohol increases the risk of Xanax overdose
symptoms and may cause additive CNS effects. On the
other hand, smoking decreases the effectiveness of the
drug.
● Inform the patient to not stop taking the drug
immediately and slowly decrease the drug dose until
none are taken.
Rationale: Immediately stopping to take the drugs may
lead to withdrawal symptoms. Hence, when planning to
stop taking drugs, start by decreasing the dose little by little.

VIII. Nursing Management

A. Nursing Theory

HILDEGARD PEPLAU
Interpersonal Relations Theory

Hildegard Peplau's Interpersonal Relations Theory is a nursing theory that

emphasizes the importance of establishing a therapeutic relationship between two
individuals, with the goal of achieving mutual understanding and facilitating healing. The
theory suggests that people possess an inherent desire to connect with others and that
successful communication and cooperation can fulfill this need. When people develop a
bond built on empathy, regard, and confidence, they can collaborate towards identifying
and accomplishing common objectives.

We see the importance of interpersonal relationships in the character of R.P. who

is struggling with mental health issues. The people around him, including his psychiatrist
and fellow patients, recognize the value of connection and support in helping him heal.
Their ability to communicate effectively and show empathy towards Prot demonstrates
the principles of Peplau's theory in action. It showcases the transformative power of
human connection and highlights the need for individuals to establish meaningful
relationships in order to achieve their goals and maintain their well-being.

Peplau's theory also highlights the importance of understanding the unique

needs and perspectives of the individual with whom one is interacting. By recognizing
and respecting individual differences, individuals can create a connection based on
mutual respect and understanding. This is particularly important in situations where
individuals may have different experiences, beliefs, or cultural backgrounds. By
acknowledging and valuing these differences, individuals can establish a connection that
promotes healing and growth, creating a space where people feel understood,
supported, and valued (Gonzalo, 2021).

Ida Jean Orlando

Deliberative Nursing Process Theory

Ida Jean Orlando's Deliberative Nursing Process Theory is a nursing theory that
emphasizes the importance of understanding and addressing the unique needs and
concerns of the individual patient. According to this theory, nurses should focus on the
patient's individual experiences, feelings, and responses to their environment in order to
provide individualized care. The theory also highlights the importance of the
nurse-patient relationship and effective communication in promoting healing and growth.

We see the importance of understanding and addressing the unique needs of the
character R.P., who is struggling with mental health issues. The characters in the movie
recognize the importance of providing individualized care that is tailored to R.P.’s needs
and concerns. Through effective communication and empathy, they work to create a safe
and supportive environment that fosters R.P's healing and growth.

Furthermore, the Deliberative Nursing Process Theory emphasizes the

importance of ongoing assessment and evaluation in nursing practice. This includes a
continuous cycle of observation, analysis, and reflection, in order to identify areas of
concern and make necessary adjustments to the care plan. We see this process in
action as the characters monitor R.P’s progress and adjust their approach accordingly.
By engaging in ongoing assessment and evaluation, the characters are able to provide
the best possible care for R.P. promoting his healing and growth (Gonzalo, 2019).
B. Nursing Care Plan

DATE/ CUES NEED NURSING DIAGNOSIS PATIENT INTERVENTION IMPLEME EVALUATION

TIME OUTCOME NTATION

March Subjective: S Disturbed personal identity After 1 week of 1. Establish trust and rapport with the client. 1 March 16, 2023
09, ● “I am E related to past traumatic nursing R: It is essential that the client trusts you @ 3:00 pm
2023 from L experience as evidenced intervention the in order for the client to provide their
@ Planet F by memory loss and patient will be complete cooperation and make any “GOAL
8:00 KPAX”, - delusion. able to: necessary alterations. PARTIALLY MET”
am ● “We P
don't E Domain 6 Class 1 a. Develop 2. Promote clients safety (e.g. close 2 After 1 week of
have R Diagnosis Code 00121 trust to the supervision). nursing
family in C nurse R: It is important to reassure the client intervention the
KPAX”, E R: A traumatic experience b. Respond that he is safe and secure by being patient was able
P can affect a person's to available to them; the client may to:
T emotions, body, and mind. reality-bas experience dissociative behaviors, which
Objective: I These emotions are ed may be quite frightening for them. Short term
● Amnesi O common and typically pass interaction a. Developed
a N within a few weeks. 3. Facilitate identification of stressful 3 trust to the
● Grandio Humans react differently to situations. nurse
se P bad situations. In the R: In order to establish an efficient client
delusion A absence of visual signs, care and problem-solving strategy, it is
T individuals may exhibit vital to determine the stressor that led
T extreme emotional the client to experience excessive
E responses. Shock and anxiety.
R denial frequently shield
N oneself from the emotional 4. Have the patient write his name Abegail Anne M.
repercussions of an periodically; keep this record for comparison 4 Arbis, St. N
occurrence. Individuals and report differences. Reorient to
going through an identity time/place, as needed.
disturbance most likely R: Reorientation is an essential action
have contradictory views that should be taken in order to minimize
and behaviors, and they the amount of function loss and enhance
may also tend to over the potential for improvement.
identify with groups or roles
rather than with their 5. Let the client enumerate methods for 5
identity. coping (e.g. trying new hobby, making daily
or weekly plan and listen to relaxing music )
R: Asking for information with the client
Reference: about the ways in which they have
Pedneault, K. (2022, previously overcome stress and listening
November 14). Why Many to their responses. This is to determine if
People With BPD Lack a the strategy was adaptive or maladaptive
Strong Sense of Self. in nature.
Verywell Mind. Retrieved
March 12, 2023, from 6. Maintain a pleasant and quiet 6
[Link] environment and approach the patient in a
om/borderline-personality-d slow and calm manner.
isorder-identity-issues-4254 R: In the event that the patient is
88 shocked or overstimulated, they may
react with behaviors that are nervous or
violent.

7. Reduce provocative stimuli, negative 7

criticism, arguments, and confrontations.
R: This is done so as not to elicit the
fight-or-flight reactions.

8. Recognize and support the patient’s 8

accomplishments (projects completed,
responsibilities fulfilled, or interactions
initiated).
R: Acknowledging the patient's
successes helps reduce the patient's
anxiety and the need for them to rely on
delusions as a source of self-esteem.

9. Encourage the patient to verbalize true 9

feelings by applying therapeutic
communication.
R: The patient may find it easier to come
to terms with long-standing difficulties
that have not been addressed if they are
able to verbalize their thoughts.

[Link] patient to engage in

reality-based activities to distract them from 10
their delusions.
R: When a patient's thoughts are focused
on reality based tasks, he is free deluded
thoughts and may help direct attention
outwardly.

Date/ Cues Need Nursing Diagnosis Patient Outcome Nursing Intervention Impleme Evaluation
Time ntation

M Subjective cues: C Disturbed thought Within 2 weeks of 1. Provide safety measures to the 1 March 09 , 2023
A “I am from the planet O process related to past nursing client such as removing harmful @ 3pm
R of KPAX.” as G disturbing events as intervention the objects.
C verbalized by the N evidenced by grandiose patient will be able R: It is necessary to consider the “Goal Partially
H client. I delusions, visual to: safety of the patient to avoid Met”
T hallucinations, and accidents.
09 I derealization. Short term:
Objective cues: V ● Establish 2. Maintain a pleasant and relaxed 2 After 2 week of
2 ● Grandiose E Rationale: rapport with the atmosphere and approach the nursing
0 delusions / One of the most nurse patient in a calm manner. intervention the
2 ● Visual P important aspects of ● Communicate R: The patient may respond with client was able to:
3 hallucinations E someone's overall health clearly anxious or aggressive behaviors if
● Repression R is their psychological, ● Sharing past startled or overstimulated. Short term:
@8am ● Derealization C emotional, and social experiences ● Establish
E well-being. It affects a 3. Be consistent with the client; 3 rapport with
P person's feelings, Long term: demonstrate that you embrace the nurse
T thoughts, and behaviors ● Maintain reality him for who he is while still
I and has an effect on how ● Learn coping establishing and upholding ● Communicate
O they connect with management boundaries for certain actions. clearly
N people, handle stress, and activities R: The client may test limits of the ● Sharing past
and come up with therapeutic relationship. Problems experiences
P decisions. Adult trauma with acceptance, trust, or authority
A can lead to psychosis, often occur with posttraumatic
T and post-traumatic stress behavior.
T disorder can also
E manifest with psychotic 4. Encourage the patient to discuss 4
R symptoms such visual his past experiences.
N hallucinations and R: Sharing the experience may help
related affect-congruent the client in recognizing the reality
delusions. Trauma could of what has occurred as well as in
have an impact on the identifying and resolving any
client’s mind, and body, associated emotions.
including how they think,
feel, and behave. Later 5. Use the techniques of consensual Angeline Nicole
on, this will become a validation and seeking 5 [Link], St.N
problem to the patient, clarification when communication
such as experiencing reflects alteration in thinking.
delusion, hallucination, R: These methods make clear the
depersonalization and so patient's perception of himself in
on, which leads to the eyes of others.
deeper personal
concerns. 6. Reorient the patient to time,
place, and person, as needed.
R: To maintain orientation is a sign 6
Reference: of deterioration.
Wagner, M. (2022,
September 15). 7. Consistently present reality with
Mental Health the client and do not argue with 7
Nursing the absurd thinking. Avoid being
Diagnosis & Care unclear or evasive with the client.
Plan. R: Patients with delusions are
NurseTogether. delicate with regards to others and
Retrieved March they can also instantly identify
12, 2023, from insincerity.
[Link]
[Link]/me 8. Avoid pressuring the client to do
ntal-health-nursin activities and communications. 8
g-diagnosis-care- R: The patient may feel threatened
plan/ and may withdraw to communicate.

9. Avoid flooding the data with the

‌
patient with relation to their past 9
experience
R: Patients who are exposed to
painful information from which the
amnesia is providing protection
may decompensate even further
into a psychotic state.

10. Enable the client to learn any

coping management and 10
activities, such as bibliotherapy,
dance therapy, occupational
therapy, music therapy, art
therapy, etc.
R: Due to the patient's terrible
experience could caused the loss
of or decline in sense of assurance
and safety. 11

11. Encourage the patient to join

resocialization programs or
organizations.
R: This is to maximize level of
function.

Date/ Cues Need Nursing Diagnosis Patient Nursing Intervention Impleme Evaluation
Time Outcome ntation

Subjective: S 1. Render close patient supervision by 1 March 12 , 2023

Self directed violence as Within 3 days of
M ● “He is trying to A sustaining observation or awareness of @ 8 A.M
evidence by history of nursing
A kill himself.” F the patient at all times.
suicide intervention
R verbalized by E Rationale: Suicide could be act “Goal Partially
patient will
C the client T impulsively and without much Met”
participate in
H Y developing a forewarning. Close observation is After 3 days of
Rationale:
/ plan of action to essential. nursing
A significant risk factor for
P address current intervention the
subsequent suicide
9, R issues and [Link] a secure environment 2 Client uses
attempts among people is
2 Objective: O verbalize . Drugs and weapons ought to be taken adaptive coping
having previously
0 ● Visual T impulse control. away by the nurse. techniques when
attempted suicide.
2 hallucinations E Rationale: Taking away potentially suicidal thoughts
As the cause or trauma
3 ● Denial C dangerous items stops the patient from surface.
that motivated the ideation
● History of T acting on impulsive self-destructive
and behavior leading up to
suicide attempt I impulses.
the first attempt is
@ ● Trying to drown O
frequently not addressed
himself N [Link] the patient from making choices 3
or appropriately
8 under extreme stress.
addressed, survivors of
A.M Rationale: The ability of patients to
the first attempt may also
identify mood changes that point to
experience these issues
impulsivity issues or a worsening
resolved.
depressive state.

Reference:
[Link] grounding. Using strategies and a 4
● Harmer, B., Lee,
reality-based approach, you can assist a
S., Duong, T. vi, &
client who is dissociating or experiencing
Saadabadi, A.
flashbacks.
(2020, December
Rationale: The client is reminded using
23). Europe PMC.
grounding techniques that he is safe, an Pasaol,Donald
[Link]. adult, and in the moment. John B. St.N
Retrieved March It's crucial to acknowledge the client's
13, 2023, from feelings as they are going through these
[Link] experiences.
org/article/nbk/nbk
565877 5. Provide regular possibilities for 5
conversation about emotions
Rationale: Hostile, aggressive
Communication encompasses
unpleasant emotions

[Link] the client to participate in 6

activities such as therapy sessions included
in the planned structure of activities.
Rationale: To distract the client from
suicidal thoughts
Date/ Cues Need Nursing Diagnosis Patient Outcome Nursing Intervention Impleme Evaluation
Time ntation

M Subjective: C Post-trauma syndrome Within 2 weeks of Use a calm and reassuring approach when 1 MARCH 23, 2023
A “I am from the planet O related to the death of nursing interacting with the patient. @ 8AM
R K-PAX”, as G his wife and daughter as intervention, the R: This can help to reduce anxiety and
C verbalized by the N evidenced by patient will be able agitation, which may exacerbate altered GOAL PARTIALLY
H patient. I dissociative fugue, to talk about sensory experiences. Patients with altered MET
T amnesia, hallucination, grief-related sensory experiences may feel overwhelmed
9, Objective: I and delusional feelings and by their environment, leading to feelings of After 2 weeks of
● Dissociative V grandiosity express feelings anxiety or agitation. By using a calm and nursing intervention,
2 fugue E directly and openly reassuring approach, the nurse can help to the patient was able
0 ● Amnesia / R: Long after the in nondestructive reduce these feelings and promote a sense to talk about
2 ● Delusional P traumatic event has way. of calm. grief-related feelings,
3 grandiosity E passed, PTSD and express feelings
● Visual R individuals are plagued Be consistent with the patient; convey 2 directly and openly
@ hallucination: C by vivid, unsettling acceptance of him as a person while setting but in a quite
8 ultraviolet E thoughts and feelings and maintaining limits regarding behavior. destructive way.
A rays P relating to their R: The patient may test limits of the
M ● Auditory T experience. Flashbacks therapeutic relationship. Problems with
hallucination: I or nightmares may acceptance, trust, or authority often occur
able to O cause them to relive the with post traumatic behavior.
communicate N incident, they may
with the dog experience sadness, Administer medications as prescribed by the 3
fear, or rage, and they physician, such as antipsychotics or
may feel distant or anxiolytics, to help manage symptoms of
estranged from other altered sensory experiences.
people. Individuals who R: Medications can help to reduce the Alliza Nicole O.

suffer from PTSD may severity of symptoms associated with Nermal, St. N

avoid places or persons traumatic experiences, such as hallucinations

that make them think of or delusions. By administering medications
the terrible experience. as prescribed, the nurse can help to manage
these symptoms and promote the patient's
Reference: overall well-being.
American Psychiatric
Association. (2022). Provide a quiet and dimly lit environment, as 4
Trauma and Stressor excessive stimulation can increase the
Related Disorders. In severity of altered sensory experiences.
Diagnostic and R: Sensory overload can exacerbate
Statistical Manual of symptoms of altered sensory experiences,
Mental Disorders (5th making it difficult for the patient to focus and
ed., text rev.). engage with their environment. By providing
a quiet and dimly lit environment, the nurse
can help to reduce sensory overload and
promote a sense of calm.
Encourage the patient to engage in calming 5
activities such as deep breathing, guided
imagery, or progressive muscle relaxation.
R: These activities can help to promote
relaxation and reduce stress, which may
contribute to altered sensory experiences. By
calming activities, the patient can learn to
manage their symptoms and promote a
sense of calm.

Limit restraints or seclusion, as these 6

measures can increase the patient's distress
and exacerbate altered sensory experiences.
R: Restraints or seclusion can be traumatic
for patients, leading to feelings of fear or
anxiety. These measures can exacerbate
symptoms of altered sensory experiences,
making it difficult for the patient to engage
with their environment. By limiting the use of
these measures, the nurse can promote the
patient's sense of safety and well-being.

Assist the patient in recognizing triggers. 7

R: Try to reduce delusional behavior by
identifying triggers, such as high stress or
worry, and learning how to cope with these
sensations.

Assist the patient with distraction through 8

listening to music, journaling, or sketching.
R: The patient can avoid hallucinations by
listening to music, journaling, or sketching. It
can also be beneficial to remind the patient
that while suffering a hallucination, they
should exclaim loudly, "go away! " or "leave
me alone!" in order to acquire control.

Encourage the patient to talk about his 9

experience.
R: Retelling the experience can help the
patient identify the reality of what has
happened and help identify and work through
related feelings.

Encourage the patient to identify 10

relationships, social or recreational situations
that have been positive in the past.
R: The patient may have withdrawn from
social relationships and interest in
recreational activities are common following
trauma.

Date/ Cues Need Nursing Diagnosis Patient Outcome Nursing Intervention Implem Evaluation
Time entation

M Subjective: C Impaired Memory After 2 weeks of Assess the patient's current level of 1 March 23, 2023
A “Home is K-Pax, it’s O related to altered nursing intervention, cognitive function and identify areas of @8am
R about 2,000 of light G perception of reality and the client will be able memory impairment. Use cognitive
C years away” N delusional thinking as to demonstrate assessments such as the Mini-Mental Goal Partially Met
H I evidenced by the client’s improved memory State Examination (MMSE) to evaluate
9, Objective: T inability to recall their function by recalling the patient's memory and cognitive After 2 weeks of
2 ● Amnesia I personal history significant personal functioning nursing intervention,
0 ● Altered V events from the past R: Assessment is a crucial step in the client was able to
2 perception of E R: Individuals with developing a care plan that is recall some
3 reality / psychotic disorders, individualized to the patient's needs. By significant personal
@ ● Neologism P such as schizophrenia assessing the patient's cognitive function, events from the past
8 ● Grandiose E often have difficulties we can identify the specific areas of
A Delusion R with working memory memory impairment and tailor
M ● Depersonaliz C and episodic memory interventions to address these deficits.
ation E due to the impact of
P delusions and Provide a structured and consistent 2
T hallucinations on environment for the patient to reduce
Bagaslao, Juan
I cognitive functioning. confusion and enhance memory.
Carlos, St. N
O Delusional thinking can R: A structured and consistent
N lead to distortions in environment can help to reduce
memory, as individuals confusion and improve memory function.
may have difficulty Familiar routines and surroundings can
distinguishing between also help the patient feel more secure
their own beliefs and and reduce anxiety.
actual events. The
resulting memory Implement memory aids to help the 3
deficits can impact daily patient recall important information
functioning, as well as R: Memory aids can help the patient
contribute to further compensate for memory deficits and
cognitive and emotional improve recall. By using written or visual
difficulties (Bora et al., cues, the patient may be better able to
2018; Lee et al., 2020). retrieve important information that they
may have difficulty remembering.

Encourage the patient to engage in 4

cognitive activities such as puzzles,
games, and reading to promote memory
function.
R: Engaging in cognitive activities can
help to stimulate the brain and promote
memory function. It may also provide a
sense of accomplishment and boost the
patient's self-esteem.

Educate the client on the difference 5

between reality and delusion
R: Help the client understand the
difference between what is real and what
is not. Use examples and encourage the
client to ask questions and clarify their
understanding.

Encourage the patient to participate in 6

cognitive-behavioral therapy to help
address the underlying delusional
thinking and altered perception of reality.
R: Cognitive-behavioral therapy can help
to address the patient's delusional
thinking and improve their overall
cognitive functioning. It may also help to
reduce anxiety and promote a more
positive outlook.

Monitor for delusional thinking 7

R: Observe the client for signs of
delusional thinking, such as unusual
beliefs, suspicion, paranoia, and
hallucinations. Promptly report any
concerning behaviors to the healthcare
provider.
IX. Prognosis

SCORE:
CRITERIA ( 1 ) - POOR JUSTIFICATION RATIONALE
( 2 ) - FAIR
( 3 ) - GOOD

[Link] of 1 Client R.P was Dissociation is a natural

illness scored 1 on the reflex mechanism that can
onset of illness, be beneficial when trying to
since the onset of deal with trauma. However,
his symptoms the repetition of traumatic
started when he events and the resulting
witnessed his wife dissociation results in
and daughter had dissociative identity disorder.
been killed and (Patel & Pharm, 2022)
made an attempt
on suicide by the
river when he was
around the age of
20-25 which put
him at longer
traumatic
experience.

[Link] 1 The duration of Patients may spend up to 5

Of illness illness, patient R.P to 12.5 years in treatment
was scored 1. before being diagnosed with
since his symptoms a dissociative identity
have been present disorder. Most people will
for almost five manage the disorder for the
years, having rest of their lives. But a
delusion and combination of treatments
amnesia and other can help reduce symptoms.
recurring (Mitra & Jain, 2022)
symptoms. Before
being diagnosed
with dissociative
identity disorder.
[Link] 1 Client R.P was The patient experienced life
ng Factor/ scored 1 in this trauma as a result of these
Predisposin aspect, most of the memories. Dissociation is a
g Factor precipitating and psychological condition in
predisposing which a person loses touch
factors of the with their thoughts, feelings,
disorder is present memories, or sense of self.
in his case, People who have been
especially about his subjected to severe or
Life traumas. developmental trauma may
have learned to detach
themselves from distress in
order to survive. At times,
dissociation can be very
pervasive and symptomatic
of a mental disorder, such as
dissociative identity disorder.
(Department of Health &
Human Services, 2023)

4. Premorbid NONE
Personality

5. Mood and 3 The client R.P. is The client may appear

affect given a rate of 3, scared, agitated, or hostile,
Since the first depending on his or her
meeting with the experience. During a
client, his mood flashback, the client will
has been euthymic frequently act terrified,
while his affect has sobbing, scream, hiding, or
been constricted fleeing. When a client is
and flat; he does dissociating, they may speak
not smile; however, in a different voice or appear
as the sessions vacant on the outside. The
progressed, he client may claim to be
became more open enraged, to be dead inside,
and appropriate or to be unable to identify
emotions and tones any feelings or emotions.
were shown every (Videbeck & Miller, 2019)
time he will share
something and
remember some
flashbacks. He
smiles more
frequently, and he
approaches and
greets more people
around him. It was
visible that his
mood and affect
improved day by
day.

6. 3 Client R.P is given Maintaining the medication

Willingness a rate of 3, in terms regimen is vital to a
of the of willingness of successful outcome for
patient to taking drug clients with DID. Failure to
take medication his take prescribed medications
medication history showed that on time is a frequent cause
or treatment he has no problem of psychotic symptoms and
in taking them, no hospitalization recurrence.
history of refusal Clients who adhere to and
but the given benefit from an antipsychotic
medication didn’t treatment regimen may have
have any effects on very normal lives only with
him that is why the occasional relapse.
they discontinued it Those who do not respond
and move on, On well to antipsychotic agents
the other hand may face a lifetime of
during the dealing with delusional ideas
treatment and hallucinations, negative
especially the signs, and marked
psychotherapy impairment (Videbeck &
helps a lot. Miller, 2019) Most DID
Through those treatment plans emphasize
sessions it showed talk therapy aka
the willingness of psychotherapy. Talk therapy
patient R.P to can help you understand
participate in the why you dissociate as well
said treatments or as provide you with coping
therapy. strategies. (Lebow, 2021)
7. Any 1 Client R.P. was Catatonia is a state of mind
depressive scored 1, as the wherein the person becomes
features time his friend unresponsive to the
named “Prot'' his environment, which can
other personality occur to patients with a
left, Dr. P finds the psychotic disorder such as
patient lying on the DID. (Videbeck & Miller,
floor in his room in 2019).
a catatonic state.
The other patient
did not recognize
him as he was
wheeled out of the
room, and the
patient's disorder
worsened over time

8. Family 2 Client R.P is given Family can provide a feeling

Support a rate of 2. As a of safety, support, and love
result of the deaths that is often missing in the
of his wife and lives of clients with a
daughter, he lacks dissociative identity disorder.
strong family For many clients, family
support throughout represents a source of
the progression of normalcy and stability in an
his condition. Dr. P, otherwise chaotic world.
on the other hand, Although family members
has expressed are not always a positive
genuine concern resource in mental health,
and support for his they are most often an
condition. By doing essential part of recovery.
everything possible Health care professionals
to learn about the cannot totally replace family
patient's medical members. (Videbeck &
history. As a result, Miller, 2019).
he'll implement a
treatment plan to
assist patient R.P.
His mental health
situation must be
stabilized. Dr. Pl is
still by his side at
the end of the film,
taking and caring
for him even
though the patient
has gone catatonic.

X. Recommendation

For Individual:

It is important to advise the client to seek professional mental help. The main
form of treatment for dissociative disorders is psychotherapy. Talk therapy, counseling, or
psychosocial therapy are other terms for this type of treatment, which includes
discussing your disorder and associated problems with a mental health expert. Look for
a therapist who has specialized training or expertise working with traumatized
individuals. The therapist will try to identify the root of the illness and develop new coping
mechanisms for difficult situations. Over time, the therapist could support the client in
talking more openly about the patient's trauma.

For Family:

The family of DID patients will benefit much from primary care. The nurse will
shorten the time between starting and finishing care for the patient, family, and symptom
relief and the start of therapy, reducing anxiety and improving the patient's capacity to
resume their regular lives. The parents or relatives must have a deep knowledge about
this condition so that they can help their patient to cope and provide the necessary care
to an individual who has this kind of illness. They can also help the patient on how to
deal with problems that can affect their well being. This can benefit both of them since
the parents or relatives are aware about this disorder to give the appropriate care, and
this can lead to a good mental health for the patient. The client may have flashbacks and
dissociative symptoms in response to specific triggers caused by the client's family.
Knowing the client's triggers, the family can assist these triggers in avoiding them or
being more prepared to cope with dissociative symptoms when they occur. The family
can also offer support with grounding activities. The family members can help determine
what would work best for the client and encourage them to keep using these methods
that they find helpful for the client's coping mechanism.

For Community

Individuals who suffer from mental diseases feel rejected in their communities.
Many people experience discrimination worldwide, which is why understanding it can aid
in lowering the level of negativity in society by enabling community members to alter
their judgments of people with disabilities and mental disorders. The ability to rely on
others in the community when suffering from dissociative identity disorder (DID) is crucial
to overcoming the condition. There are several ways in which dissociative identity
disorder might feel like a burden. You need to manage your "outer shell," or the parts
that most people engage with, in addition to the many conversations in your head.
Although talking about the client's life with DID is not required, it might help develop the
support of the community you need. More significantly, the client might realize that their
family members are not the only sources of support; the client's community can also help
the client with their condition. It is essential to increase public understanding of
dissociative identity and inform others about this disorder. By doing this, discrimination,
intimidation, and misunderstandings regarding the illness will be lessened while
awareness of it will grow since the government has programs for people with disorders,
such as the Mental Health Program and Community based Mental Health Program. On
the other hand, individuals who have DID will lead an everyday existence while their
relatives, family, and friends may assist them in addressing their issues as symptoms
start to appear.

XI. Appendices
A. Clustering of Cues using Gordon's Functional Health Pattern

Gordon's Cues Nursing Diagnosis Priority

FHP

Health
Perception/
Health
Management

Nutritional/
Metabolic

Elimination

Activity/ ● Catatonic Stupor

Exercise

Cognitive-Pe ● Amnesia ● Disturbed thought High

rception
● “Home is K-Pax, process related to past Priority
Pattern
it’s about 2,000 disturbing events as
of light years evidenced by grandiose
away” delusions, visual
● Grandiose hallucinations, and
delusion derealization. Mediu
● Hallucinations ● Post-trauma syndrome m
● Delusional related to the death of his Priority
thinking wife and daughter as
● Altered evidenced by dissociative
perception of fugue, amnesia,
reality hallucination, and Low
● Neologism delusional grandiosity Priority
● “I am from ● Risk for suicidal behavior
Planet KPAX” related to history of prior
● “We don't have suicide attempt.
family in KPAX”
● Visual
hallucination:
ultraviolet rays
● Auditory
hallucination:
able to
communicate
with the dog
● Dissociative
fugue
● Derealization
● Fragment of
Identity

Sleep rest

Self ● Depersonalizatio Disturbed personal identity High

Perception/
n related to past traumatic Priority
Self Concept
experience as evidenced by
memory loss and delusion.

Role
Relationship

Sexual
Reproductive

Coping/ ● Repression Impaired Memory related to Mediu

Stress
altered perception of reality and m
Tolerance
delusional thinking as evidenced Priority
by the client’s inability to recall
their personal history

Value-Belief

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