AMITY COLLEGE OF NURSING

CASE STUDY

ON

SCHIZOPHRENIA

Submitted To:

Dr. Poona Sharma

Associate Prof. ACON

Amity University, Haryana.

Submitted By:

Ms. Monica Banik

MSc. Nursing, 2nd Semester,

ACON, AUH.
CASE STUY
1
PROFILE OF THE PATIENT

 Name : Mrs. Niru sharma

 Husband name : Mr. Nikhil Sharma

 Age : 33 Yrs.

 Gender : Female

 Hospital no : 201814002

 DOA : 06/10/19

 Marital status : Married

 Education : Graduate

 Address : H.no 71 B, Sector-10, Gurgaon, Haryana, India

 Diagnosis : Paranoid Schizophrenia

 Source of referral : Not referred, direct admission

History of the illness

Informant details ;

 Relationship of the informant with the patient : Mother and Husband

 Reliability of the information : adequate and reliable
 Intelligence/observational consistency of individual : Normal
 Duration of Stay with Patient : 33 Yrs. & 5 Yrs. respectively
 Concern about the patient : Really concerned

Details of the illness :

 Onset : acute

 Total duration of illness : 6 months

 Course of illness : continuous

 Precipitating factor : Negatively influenced by the spiritual practices ( her condition

got worse after she started visiting Bhrammakumari spiritual center & stopped taking
medicine for a week)
  Reason For admission: muttering to self, decreased sleep, irritable mood , violent
and aggressive behavior, abusive, not cooperative with husband, treating her husband
like a brother, unmanageable at home.

Chief complaints

According to the patient:

 Pet se lahr ati h jaban tak

 Neend nhi aari 2 weeks
 Bhuk bhi kam kag rhi hai

According to the attendents:

 Muttering in self
 Abusive Language
 Removing all her cloths
 Treating her husband like a brother
 Irrelevant talks 6 months
 Increased appetite
 Talking to self

History of present illness

Patient was well adjusted to his personal, social, Psychological and occupational life for up-to
4 year (September 2019) after her marriage. After returning from her first spiritual visit from
Bhrammakumari she started behaving abruptly/abnormal. She starting treating her husband
like a brother and also started ignoring her own 3 years son. She became abusive in her
language.

PAST MEDICAL HISTORY: No history of any medical illness.

Past surgical history: No history of any surgery. Her baby was born with normal
vaginal delivery.

PAST PSYCHIATRIC ILLNESS : No history of any Psychiatric illness in past.

Family history :
  There is no history of any psychiatry illness in family
 No h/o TB, DM & Hypertension in her family

Father/ 65 yrs. Mother/ 58 yrs.

Brother/ 29 yrs

Nikhil/ 35 yrs.

Patient /33 yrs.

Nirnay 3 yrs.

Personal history:
Educational history: Niru started going to school at age of 4 and he never
missed or failed on academics years and she is educated up-to class graduate
and scored above 50% in class 12th

Occupational history: patient Niru started working privately in a small private

school in Gurgaon the age of 24 where her job was to teach small children in the
school and she has been working there until 3 and 1/2yrs back.

Infancy and childhood history:

Niru was been born with normal vaginal delivery. She has a normal happy life like other
normal kids. She was been loved by her parents and grandparents and by other family
members. She never faced any difficulties problems during her upbringing.

Middle Childhood:
No history available

SEXUAL HISTORY: patient achieved puberty at the age of 13yrs and his sexual knowledge
was adequate and mainly gathered from her friends. Patient had no committed relationship
and affairs prior to marriage and there is no history of sexual contact prior to marriage or
history of contact with FCSW

She had a loving and good sexual relationship with her husband.

Marital history: married

Substance abuse and use: Nil

Premorbid personality ;
 Attitude towards self : Good & normal
 Attitude towards others: don’t have good relationship with others
 Moral & Religious attitude: Have blind faith in god
 Mood: Mood alteration is there.

PHYSICAL EXAMINATON

 General examination
Cardiovascular system : s1, s2 normal, no murmur, NAD.
Respiratory system : Breath sounds B/L equal
No adventitious sounds, NAD
Neurological system : Cranial nerve functions are within
normal limit.
Bones and joints : NAD
Skin : some black rashes in face and cracking
of palms dehydrated skin.

GI system : disturbed bowel and urinary system

LAB INVESTIGATIONS

Hb : 10.6gm%
Platelet : 68 x 103mm3
TLC : 5400/mm3
Urea : 54mg/dl
 Creatinine : 0.4mg/dl

Na /k2 : 176/3.9

CXR : NAD
ECG : NAD

TREATMENT

 Tab amisculpride 50-100mg

 Tab amityptyline
 Tab fluoxetin 20 mg 20 days
MENTAL STATUS
EXAMINATION
  Date of MSE - 18/09/19
 Time of MSE - 11:00 am
 Place of Interview - activity room
OBJECTIVES;

 To do detailed mental health status of Mrs. Niru

 To record the data.
 To identify nursing needs of the patients.
 Plan and give nursing care based on priority.

 GENERAL APPEARANCE AND BEHAVIOUR:

 33 yrs. old female, moderately built, good nourished, well groomed & well kept,
come with her mother to interview room.
 Appearance: conscious, oriented, cooperative
 Rapport: Established and maintained throughout the interview
 Eye to eye contact made but not sustained for a long period.
 Dress and personal hygiene: well kept
 Appropriate to age, sex, time, place and weather.
 Gait: increased
 NO evidence of mannerisms, tics, waxy flexibility, obedience, posturization etc.
 He was having appropriate facial expression, gestures.

 TALK AND SPEECH

 He talk in a low pitch voice
 Language: Hindi
 Rate : normal
 Volume : slow
 Tone : normal variation
 Reaction time : normal
 Coherence/Relevance: Coherent & Relevant
 Inference:- Patient spoke in low voice with normal rate & spontaneity.
  MOOD AND AFFECT ;
 Objective : enthymic
 Subjective :aaj kaise hai aap
 Patient :thik hai.
 Range : full
 Reactivity : Immediate
 Mood – Mood is quite blunted

 THOUGHT
 a. Form: - goal directed and relevant.
 Some time show mutism
 b. Flow: - normal
 No evidence of flight of ideas, tangentiality, circumstentiality etc.

c. Content:-

QUESTION ; kya apme aisi koi baat hai jo apko dusro se alag karti hai ?

Answer: Nhi. Asa kch nhi hai

 PERCEPTION
Q. aapko kuch ajib sa dikhayi ya sunai deti hai, jo dusro ko sunai ya dikhayi nahi
deta hai ?

A. nhi bs mjhe gussa bhut ata hai

 HIGHER MENTAL FUNCTIONS

1. Alertness: consciousness-the patient is alert and conscious.

2. Orientation:

Place-

Q: Aap abhi kahan hain?

A: main abhi hospital main hun.

Time:

Q: Abhi kya time ho raha hai?

A: abhi 10 ya 11 bj rhe hai.

Person:

Q: Jo abhi aapke saath main hai wo kaun hai?

A: yeh mera ma hain.

 Inference:
Patient is oriented to time, place & person

 MEMORY

Immediate memory:

aap yeh cheezen repeat karenge

Q : table , fan , pen

Answer : table , fan, pen

Thodi der baad ,main aapko yeh things phir se mein puchungi toh aapko yaad se batana hoga

Answer: ok.

She has registered but not retained the things in her memory.

 ATTENTION AND CONCENTRATION ;

Digit span test:

7, 5 , 6 , 5,1

Aap yeh number repeat kariye:

Answer- 7 , 6 , 5, 1

Serial substraction:

Question: Aap 100 se 7 minus kro .

Answer: Abhi mra dimag kaam ni kr rha hai

RECENT MEMORY:

Question: Subeh breakfast m kya khaya?

Answer: bread and milk and daliya

REMOTE MEMORY:

Q: Aapka birthday kab hai.

A: 14 july

INFERENCE: Remote, Recent & Immediate memory intact.

 INTELLIGENCE
Level of formal education: Graduate

Calculation :

Q. agar aapke haathme rs.5/- hai aur aap pencil kharidne gaye ,dukaan me ek pencil ka daam
50 paise hai ,rs.5/- se aap kitna pencil kharid sakte ho ?

Answer: 3 pencils.

 GENERAL KNOWLEDGE
Q. India ka prime minister kaun h ?

Answer : modi ji .

Q. india ki capital kya h ?

Answer. delhi.

INFERENCE: intelligence is intact based on his formal education.

 ABSTRACT THINKING

Differences ;

Q: copy & book mein kya difference hai?

A: copy likhne ke kaam aati hai or book padne ke kaam aati hai .

Q: Pencil & pen mein kya fark hai?

A: Pencil se likhkr hum use mita skte h pen ko ni mita skte.

 Similarities :
Q: mango & apple main kya samanta hai?

A: Dono phal hai.

Q: Makhi & machar main kya samantha hai?

A: Dono udte hain.

 PROVERB EXPANSION
Q: nau do gyaraah hona ?

A: bhaag jana .
Q: jaise ko taisa ?

A: jo jaisa kare uske saath vaisa hi krna chahiye .

INFERENCE: ABTRACT THINKING IS INTACT.

 JUDGEMENT
Letter problem:

Q: Agar aapko koi letter raste me mil gaya to kya karenge?

A:. jiska hoga usko dunga .

fire problem:

Q: agar ekdum se yhan aag lag jaaye to aap kya karoge?

A: pani dalunga

INFERENCE: Judgement is intact.

Social judgment:

Is intact as evidence by his greeting when he met the interviewer and he also obeys rules and
regulations..

Personal judgement:

Q: Ghar jaker kya karenge?

A: kch nhi abi to aaram krunga

 INSIGHT
Q: aap yehape kyoun aaye hain?

A: gharwalo ne mra phone check kia to mjhe bhut gussa agya tha me fir behos ho gyee thi.

INFERENCE: PATIENT HAS PARTIAL INSIGHT.

Grade: 4/5

IX.ACTIVITIES OF DAILY LIVING

Niru gets up in the ward by 8am. After shower she would take her breakfast. After that she
would participate in recreational activities along with other patients. By 11.45am she would
finishes with his lunch, and then she take a nap for one hour. She goes to bed by 9pm.
NURSING DIAGNOSIS:

 Impaired verbal communication evidenced by Difficulty communicating thoughts

verbally. Difficulty in discerning and maintaining the usual communication pattern.

 Impaired social interaction

 Interrupted Family Process may be related to Situational crisis or transition.

NURSING MANAGEMENT:
1. SUBJECTIVE DATA- Patient says that, mra kisi se bat krne ka man ni krta h gussa ata
hai mjhe apne gharwalo pe bhut”.

OBJECTIVE DATA- Inappropriate verbalization

GOALS-patient will communicate her feeling with others.

DIAGNOSIS- Impaired verbal communication evidenced by Difficulty communicating

thoughts verbally. Difficulty in discerning and maintaining the usual communication pattern.

IMPLEMENTATION RATIONALE EVALUATION

Assess if incoherence in Establishing a baseline facilitates
speech is chronic or if it is the establishment of realistic
more sudden, as in an goals, the foundation for planning
exacerbation of symptoms. effective care
Keep environment calm, Keep anxiety from escalating and
quiet and as free of stimuli as increasing confusion and
possible hallucinations/delusions

Plan short, frequent periods Short periods are less stressful, Patient spends two to
with a client throughout the and periodic meetings give a
three 5-minute
day. client a chance to develop
familiarity and safety. sessions with nurse
sharing observations
in the environment
within 3 days.
Look for themes in what is Often client’s choice of words is
said, even though spoken symbolic of feelings.
words appear incoherent
(e.g., fearful, sadness, guilt).
When client is ready, Helping client to use tactics to Patient will learn one
introduce strategies that can lower anxiety can help enhance
or two diversionary
minimize anxiety and lower functional speech.
voices and “worrying” tactics that work for
thoughts, teach client to do him/her to
the following: decrease anxiety,
hence improving the
ability to think clearly
and speak more
Focus on meaningful
logically.
activities.

Learn to replace negative

thoughts with constructive
thoughts.

Learn to replace irrational

thoughts with rational
statements.

Perform deep breathing

exercise.

Read aloud to self.

Seek support from a staff,

family, or other supportive
people.

Use a calming visualization

or listen to music.

Use therapeutic techniques Even if the words are hard to

(clarifying feelings when understand, try getting to the
speech and thoughts are feelings behind them.
disorganized) to try to
understand client’s concerns.

2. SUBJECTIVE DATA- Patient says that, “ mera kisi se baat karne ka man nahi krta hai,
main bas room main rahna chahta hun”.
  OBJECTIVE DATA-Appears upset, agitated, or anxious when others come too
close in contact or try to engage him/her in an activity.

GOAL- Improve the social interaction.

 DIAGNOSIS- Impaired Social Interaction evidenced by appears upset, agitated, or

anxious when others come too close in contact or try to engage him/her in an
activity.

RATIONALE IMPLEMENTATION EVALUATION

Helps client to develop a Structure times each day to Patient uses appropriate social
sense of safety in a non- include planned times for brief
skills in interactions.
threatening environment. interactions and activities with
the client on one-on-one basis
Increase likelihood of Try to incorporate the strengths
clients participations and and interests the client had when
enjoyment.. not as impaired into the activities
planned.

Recognition and Remember to give

appreciation go a long way acknowledgment and recognition
to sustaining and increasing for positive steps client takes in
a specific behavior. increasing social skills and
appropriate interactions with
others.
Gradually the client learns As client progresses, provide the
to feel safe and competent client with graded activities
with increased social according to level of tolerance
demands. e.g., (1) simple games with one
“safe” person; (2) slowly add a
third person into “safe”.
Client continues to feel safe Eventually engage other clients Patient engage in one or two
and competent in a and significant others in social activities with minimal
graduated hierarchy of interactions and activities with encouragement from nurse or
interactions. the client (card games, ping family members.
pong, sing-a-songs, group
sharing activities) at client’s
level.
3. SUBJECTIVE DATA- Patient says that, meri gharwalo se ni banti hai..ye sab log apna
apna sochte hai

OBJECTIVE DATA-Changes in communication patterns,Changes in expression of conflict

in family.

GOAL- Improve the family relationship with patient

DIAGNOSIS- Interrupted Family Process may be related to Situational crisis or

transition as evidenced by Changes in communication patterns, Changes in expression
of conflict in family.

RATIONALE IMPLEMENTATION EVALUATION

Family might have Assess the family Family member are involving in
misconceptions and members’ current level of th care of patient..
misinformation knowledge about the
about schizophrenia and disease and medications
treatment, or no knowledge used to treat the disease.
at all. Teach client’s and
family’s level of
understanding and readiness
to learn
Family’s need must be Identify family’s ability to
addressed to stabilize family cope (e.g., experience of
unit. loss, caregiver burden,
needed supports).
Meet family members’ needs Provide information on
for information. disease and treatment
strategies at family’s level
of understanding.
To improve relation Involve family in care of
the patient
Nurses and staff can best Provide an opportunity for
intervene when they the family to discuss
understand the family’s feelings related to ill
experience and needs. family member and
identify their immediate
concerns.
HEALTH EDUCATION:
 Patient and his attendant educated about the disease conditions and its treatment,
complications and preventive measures at home.
 Patient is educated about control measure for aggressive behaviour i.e. - reverse
counting from 10 to 1, long breathing exercises.
 Family educated about to keep an observation on the patient behaviour if any
abnormal behaviour finds contact to the physician.
 Family and patient educated about the medications and its side effects.
 Teach for follow up routine.
 Teach for planning a whole day schedule activities.

CONCLUSION: As per requirement of the clinical area, I have chosen the case psychotic
disorder for clinical case study. After this case study I am able to under the case of my patient
and able to make an effective nursing care plan for patient to resolve his conflicts and
problems.
PROCESS
RCORDING
Objectives for patient
1. To establish rapport and therapeutic IPR
2. To socialize effectively
3. To ventilate his feelings
4. To identify the problems
5. To learn healthy coping mechanisms
6. To develop health life style
7. To learn regarding medications and its importance
8. To develop and maintain insight
9. To get back pre-morbid personality
10. To get prepared for discharge /termination of IPR

Objectives for the nurse

1. To develop adequate communication skill
2. To develop confidence in maintaining therapeutic relationship
3. To develop skill in acknowledging the problems of the patient
4. To assist the patient in dealing with his personal problems
5. To assist the patient in developing positive coping mechanisms
6. To procure skill in evaluating the pre-set objectives in order to assess the
effectiveness of therapeutic IPR
7. To judge self in dealing with anxiety, fear and sentiments while progressing through
the therapeutic IPR

 Interview 1

Name : Mrs. Niru Sharma

Age : 33 years

Gender : female

Hospital no : 1200123

Bed No : free bed

DOA : 18/09/19

Diagnosis : Paranoid Skizophrenia

Date : 18/09/19

Time : 11am
Specific objectives : to establish therapeutic IPR

Speaker Conversation Inference

Me Good morning Niru Checking social

Niru Good morning mam judgment.

Me Niru apko yaad hai meine kaha tha hm kuch baat krenge ?
Niru Ji mam mujhe yaad hai

Me To aap ready ho ? Checking her

Niru Haan pucho willingness to
participate in
Me Ap batayiye kahan pe baithenge ? interview
Niru Yahan chair pr theek h .

Me Aap kis din admit hue the ?

Niru Mein monday ko admit huyee.

Me Abhi aapke sath kaun hai? Promoting

Niru Abhi mere saath meriMa hain. independence

Me Aapka ghar pe kaun kaun hai?

Niru Main meri mummy , bhai aur choti bhai hai.
Starting with non-
Me Aap kya karte hai? threatening issues to
Niru Main job krta tha. Maine job chor di h . develop rapport

Me Kya aap jante hai ki aap admit kyu huye?

Niru (After a long pause)
Mujhe gussa bahut aata tha , ghar m tod fod krta tha.

Me Aapko kya lagta hai aapka treatment ho jayega?

Niru Ha ho jaayega .

Me Aapne theek kaha.dawia lene ke baad aap theek ho jaoge

.ab hm kal bat krte hain ki agar ghar par apko phir se
zyada gussa ata h to kya krna h . apki family and friends
 ke bare mbaat krenge . aap aur kuch boolna chaahate hai?
Niru Nahi
Thik hai , hm kal baat krte hain yahin par .

Me Thanks you Niru. Checking the insight

Niru Thank you mam.
Planning for the next
interview

Concluding the
interview

Summary

Mrs. Niru was very co-operative thorough out the interview. The objective of this interview
was to establish IPR with her. She is willing to continue with the interview.

Evaluation

I was able to establish therapeutic relationship with Niru.

Introspection

 I was able to conduct the interview confidently

 I did not find any problem during interview
 I was able to establish therapeutic relationship
Plan for the next interview

I planned to discuss about her family.

Interview 2
Date : 19/08/19

Time : 11am

Specific objectives : to talk about family members.

Speaker Conversation Inference

Me Good morning Niru Checking social judgment
Niru Good morning mam.

Me Niru apko yaad hai mein aap se baat krni the?

Niro Ji mam mujhe yaad hai
Checking her willingness to
Me To aap ready hai? participate in interview
Niru Ji mam

Me Aap batayiye kahan pe baithenge ?

Niru Yaha theek h.

Me Aapko yaad hoga kal hamne plan kiya tha ki Promoting independence in
aapki family ke bare mein aaj baat karenge? decision making
Niru Ji yaad hai

Me Aap log kitne bhai bahan hai?

Niru Meri choti bhai hai.

Me Ghar pe abhi kaun hai? Getting know about family

Niru Koi nahii members

Me Aur ghar pe sara kaam kaun krta hai?

Niru Meri maa aur behan .

Me Aap kya kaam karte hai?

Niru Main chote bachho ko padhti thi. Ahbi chod
diya .

Me So job pe kya kaam krte the?

Niru Bola na pdaha tit hi.

Me Aap mujhe kuch aur bolna chaahate ho? Exploring more about his
Niru Ji nahi . way of spending

Me Theek hai phir aaj ke liye hum interview

yahin pe khatam karte hai.kal hum aapki life
ke stress ke baare mein baat kareenge
Niru Theek hai
Me Thank you Niru Encouraging to work out
Niru Thank you mam. some new coping
mechanisms

Planning for tomorrow and

concluding today’s section

Summary

Mrs. Niru was very co-operative thorough out the interview. The objective of this interview
was to get to know about his family members.

Evaluation

I was able to establish therapeutic relationship and talk about her family members

Introspection

 I was able to conduct the interview confidently

 I did not find any problem during interview
 I could explore about his family members and their economic management.
Plan for the next interview

I planned to discuss about stress in her life and possible coping strategies.

Interview 3
Date : 20/09/19

Time : 11am

Specific objectives : to explore the daily stress and possible coping strategies
to deal with stress

Speaker Conversation Inference

Me Good Afternoon Niru Checking social judgment

Niru Good afternoon mam.

Me Niru apko yaad hai mein aap se baat karungi

Niru bola tha. Checking her willingness to
Me Ji mam bilkul mujhe yaad hai participate in interview
Niru
To aap ready hai?
Me Ji m ready hu .
Promoting independence in
Niru Aap batayiye kahan pe baithenge? decision making
Garden area m .
Giving broad opening
Me Aapko yaad hoga kal hamne plan kiya tha ki
Niru life ki day to day stess ke bare mein discuss
karenge.
Me Haan.

Niru To aap bataiye ki aap kahan pe life mein

stress mehasoos karte hai?
Me Meri job chali gyi h .ab shankar bhagwaan h
mujhe naukri denge. Exploring further

To apko aisa kyu lgta h ki apko Shankar

Niru bhakwan naukri denge ?

Me Mujhe gymnastic , marshall arts , gym sb

aata h .

Me Ye to bahut achi baat hai Niru aba j ke liye

itna h .hm kl baat krenge.
Thankyou Niru.

Niru Thank you mam. Apse baat krke bahut ach Concluding & planning for
alga. next interview.

Summary

Mrs. Niru was very co-operative thorough out the interview. The objective of this interview
was to explore stress in his day-to-day life and possible coping strategies.

Evaluation

I was able to establish therapeutic relationship and explore about possible coping strategies

Introspection
  I was able to conduct the interview confidently
 I did not find any problem during interview
 I was able to elicit his day–to-day stress and possible coping mechanisms
Plan for the next interview

I planned to discuss about his disease.

Interview 4

Date : 23/09/19

Time : 11am

Specific objectives : to discuss about the disease condition in order to

develop insight.

Speaker Conversation Inference

Me Good morning Niru Checking social

Niru Good morning mam (sitting comfortably on the bed) judgment

Aaj hum aapka beemari aur uske elaaj ke bare mein

Me baat karenge
Thik hai, bbat krte hai chalo. Introducing the topic
Niru
Aap bataeye ab kaisa lag rha hai?
Me Abhi mein better hun, gussa bhe nhe ata h ab to.
Niru

Apni bimaari ke bare mein aap kya jaante hai? Giving a broad
Me Mujhe gussa aata tha kaafi , ghar ka saaman todta tha opening
Niru m , aur kuch nhe jaanta.

Theek kaha aapne aur aapko kya lagta hai ye beemari

Me kaise theek hogi
Dawai leni hai lagaatar , aur lakshan chlae jaane ke
Niru baad bhi dawai continue karni hai.regular doctor se Exploring his
milna zaroori hai knowledge
Aapne theek kaha hai en baton ka hamesha dhyaan
Me rakhna hai.
Theek hai mam.
Niru
 Aaj ke liye etna kaphi hai agar aapko kuch poochna
Me hai to poochiye?
Nahi
Niru
Alright then hum phir Monday milenge aur us din
Me hum dawaai ke baare mein detail discussion karenge.
Niru Theek hai
Me Thank you Niru Exploring further
Niru Thank you mam.

Concluding and
planning for the next
interview

Summary

Mrs. Niru was very co-operative thorough out the interview. The objective of this interview
was to discuss about disease and to know his insight.

Evaluation

I was able to establish therapeutic relationship and discuss about disease condition

Introspection

 I was able to conduct the interview confidently

 I did not find any problem during interview
 I was able to discuss about his disease condition and explore his insight.
Plan for the next interview

I planned to discuss about medication in detail.

Interview 5

Date : 23/09/19

Time : 11am

Specific objectives : to discuss about medication and its side effects.

Speaker Conversation Inference

Me Good morning Niru Checking social
Niru Good morning mam judgement

Me To aaj ke discussion ka topic yaad hai?

Ji mam yaad hai aaj mujhe medicines ke bare jaanna
Niru hai Giving a broad
opening
Me Good aapko yaad hai.aap batao aap kya jaante hai
medicines ke bare mein.
Niru Mujhe ye pata hai ki mujhe medicinet de rhe hain meri
bimari ke liye jisse m theek ho jaunga.

Me Aur aap kaya jaante hai medicines ke baare mein.

Niru Mujhe inhe khaate rehna h , beech m nhe chorna h.
Getting known
Me Dawai lene ke kitne din baad aap thik huye? about her pre-
Niru 2- 3 weeks ke baad existing knowledge.

Me Ha sahi hai 2 haphte mein symptoms kam hone lagte

hai.Hamesha follow up mein rahni hai.
Niru Haan mam follow up m aata rhunga.
Me Aur aap jaante hai eska side effect kya hai?
Niru Maine jab se dawayi leni shuru ki hai tab se mera
wajan thoda bad gaya haii.doctor ne kaha ye es dawayi
ka side effect hai.aur to kuch mein nahi janta
Me Thik hai aap dawayi lene ke baad gaadi nahi chalana
Aur kuuch bhi taklif ho jo aapko lagta hai dawaayi ki
vajah se ho rahi hai to zaldi doctor se sallah leni
hai.par kabhi bhi dawaayi apne aap stop nahi karni hai.
Niru Theek hai Building the new
knowledge
Me Dawayi ke baare mein aap kuch aur poochna chahte
hai?
Niru Nahi

Me Aaj phir hum yehi pe discussion khatam karte hain.

Niru Thik hai
Encouraging to
Me Thank you Niru discuss
Niru Thank you mam.
Planning for next
 interview and
concluding

Summary

Mrs. Niru was very co-operative thorough out the interview. The objective of this interview
was to discuss about medication and its side effects

Evaluation

I was able to establish therapeutic relationship and discuss about medication and its side
effects

Introspection

 I was able to conduct the interview confidently

 I did not find any problem during interview
 I was able to discuss regarding medication and its side effects.
I was able to discuss regarding how to develop positive attitude towards life.

Total summary

I took total five interviews with Mrs. Niru. She was very co-operative and attentive
throughout the sessions. I could establish therapeutic rapport with him from the beginning.
She assured me that she would try to practice those points which we have discussed in the
interviews. She agreed to continue with the regular treatments and follow-up. I could
terminate the IPR successfully.

Interpersonal relationship

Pre-interaction phase
I had done self-evaluation and assessed my own abilities to deal with the patient’s problem.
Before establishing the IPR I got acquainted with my patient with the help of her mother,
treating team, records as well as from other clinical notes.

Orientation phase
Initially, I introduced myself to Mrs. Niru and told him regarding the plan for some sessions
which are to be held to discuss about various aspects of his problem in order to find solutions.
The objectives of the each session have to be mutually decided based on her perception of the
problem. I ensured her that everything will be kept confidential. I also informed about how
and when the IPR will be terminated.

Interaction phase
I could establish a rapport with Niru. We discussed his problems and tried to find out
practical solutions. We discussed about different aspects like positive attitude towards life,
healthy coping strategies, medication and its side effects etc. I gave some suggestions which
she felt as very useful and made me assure that she will try those in her life.

Termination phase
On 24th September I terminated IPR with Mrs. Niru. I also gave discharge counseling. I had
no problem in terminating the IPR. I informed her that I would be leaving the ward after my
posting.

Value of introspection
I have done self-evaluation after each interview that helped me to have some improvement in
the succeeding interviews. Before each interview I prepared myself with questions that
helped me to conduct the interview in a structured manner.

Learning experience
Conducting structured interview with the patient helped me to improve my communication
skill and confidence.

I could develop skill in planning interview and conducting and evaluating its progress.

I have also learned to develop trustworthy relationship and its importance.

Role of other team members in relation to patient care

All the members of female ward were very cooperative. Niru’s mother also encouraged her to
participate in interviews.

Review of objectives and evaluation of the objectives

1. The specific objective of my first interview was to establish therapeutic IPR. I could
achieve the objectives without any problem.
2. The specific objective of my second interview was to know about family members. I
could achieve the objectives without any problem.
3. Third interview was to find out the coping strategies to deal with his day-to-day
stress. I could achieve the objectives without any problem
4. Fourth interview was to discuss about disease condition in order to develop insight.
5. Fifth interview was to discuss about medication and its side effects. I could achieve
the objectives without any problem.
6. Seventh interview was to discuss about his future plan after discharge. I could achieve
the objectives without any problem.
7. Eighth interview was to terminate therapeutic IPR. I could achieve the objectives
without any problem.
 Pharmacotherapy-

Drugs Action
Tab diva OD 500mg 1-1- Mood stabilizer
1
Tab olimelt TDS 5mg 1- Antipsychotic
X-2
Tab colonotril 0.5 mg. Antipsychotic

Physical therapy : activities of daily-living.

Rationale : to make them active

Recreational therapy : like listening bhajan and watch TV etc.

Rationale : to divert their mind.

Occupational therapy : like making of paper bags, lining of papers and cutting

of crape papers for flower making etc.

Evaluation of patient’s condition at the time of termination of IPR and response of

patient to therapy

Mrs. Niru had excessive anger, delusion of grandeur, hyperactivity. But after 2 weeks of
starting medications he experienced fewer symptoms. In the interviews she discussed the
points which hurt her and we mutually developed coping strategies for those situations. Niru
assured me that she would try those whenever she experiences similar situation. Now she also
has positive attitude towards her life. When I terminated therapeutic IPR she was ready to go
back to his normal life.

Problems encountered: Nil