DOCTORS PROGNOSIS Patients attending physician, Dr.

Louie Lacso has rated Johnny with fair prognosis with a chance for improvement. Dr. Lacso explained that although Schizophrenia has no known cure, there are effective treatments that can reduce symptoms, decrease the likelihood that new episodes of psychosis will occur, shorten the duration of psychotic episodes, and in general, offer the majority of people suffering from schizophrenia the possibility of living more productive and satisfying lives. With the proper medications and supportive counselling, and psychotherapy, the ability of schizophrenic persons to live and function relatively well in society is excellent. The outlook for these patients is optimistic. In general, Dr. Lacso claimed that the expectancy for the relief from the illness patient has will be increased given that the he will religiously comply with his medications and psychotherapy and would submit himself in every follow- up checkups in the hospital. He added that the family is a great support system for Johnny, they should keep in mind to broaden their patience and understanding on his condition and they should never do things that would aggravate or trigger him to be violent and hostile with suicidal tendencies. If given that the family would give its full support on Johnny and would advise him to take his anti-psychotic medications regularly then progress from the illness would be evident in the near future because as he had already said, the only way to have relief from the symptoms of this illness is to comply with the medications and psychotherapy.

PROGNOSIS FROM THE MANUAL OF BASIC CONCEPTS OF MENTAL HEALTH AND PSYCHIATRIC NURSING BY MERCK During the first 5 years after onset of symptoms, functioning may deteriorate and social and work skills may decline, with progressive neglect of self-care. Negative symptoms may increase in severity, and cognitive functioning may decline. Thereafter, the level of disability tends to plateau. Some evidence suggests that severity of illness may lessen in later life, particularly among women. Spontaneous movement disorders may develop in patients who have severe negative symptoms and cognitive dysfunction, even when antipsychotics are not used. Prognosis varies depending on the subtype. Patients with paranoid schizophrenia tend to be less severely disabled and more responsive to available treatments. Patients with the deficit subtype are typically more disabled, have a poorer prognosis, and are more resistant to treatment. Schizophrenia can occur with other mental disorders. When associated with significant obsessive-compulsive symptoms), prognosis is particularly poor; with symptoms of borderline personality), prognosis is better. About 80% of people with schizophrenia experience one or more episodes of major depression at some time in their life. For the first year after diagnosis, prognosis is closely related to adherence to prescribed psychoactive drugs. Overall, one third of patients achieve significant and lasting improvement; one third improve somewhat but have intermittent relapses and residual disability; and one third are severely and permanently incapacitated. Only about 15% of all patients fully return to their pre-illness level of functioning. Factors associated with a good prognosis include: good premorbid functioning (eg, good student, strong work history), late and/or sudden onset of illness, family history of mood disorders other than schizophrenia, minimal cognitive impairment, few negative symptoms and paranoid or non-deficit subtype. On the other hand, the factors associated with a poor prognosis include: young age at onset, poor premorbid functioning, and family history of schizophrenia, isorganized or deficit subtype with many negative symptoms. In addition, men have poorer outcomes than women; women respond better to treatment with antipsychotics.

Substance abuse is a significant problem in up to 50% of patients with schizophrenia. Anecdotal evidence suggests that use of marijuana and other hallucinogens is highly disruptive for patients with schizophrenia and should be strongly discouraged. Comorbid substance abuse is a significant predictor of poor outcome and may lead to drug non adherence, repeated relapse, frequent rehospitalization, declining function, and loss of social support, including homelessness

PROGNOSIS GOOD FAIR POOR JUSTIFICATION Onset illness of the

Johnny first experienced the symptoms of schizophrenia when he was 22 years old when he was studying at Mountain View College.

Schizophrenia usually occurs in males aging 15-25 years old; basically younger age than that of the females. According to the staffs at their dormitory noticed that for how many weeks he was not going out of his room and he was not eating at the cafeteria. They noticed that his room was dark and silent as if theres no one inside the room. When the staff as well as the guards of the school tried to forcefully open his room, they saw Johnny sitting on the floor staring blankly at the wall and mumbling words that they could not understand. Since then

when people would start talking to him, they notice that he has illogical speech and flight of ideas. Then after a week, the schools admin decided to send Johnny back home. His family was devastated by his situation. Since then, they could not get an appropriate response from Johnny. Almost all of his answers to their questions were irrelevant. His mood also changed; he became irritable and would do harm to himself and to others. He had also his hallucinations and delusions. Most of the time, his elder brother and mother would notice him talking to himself. He would also keep saying that the policemen would catch him and they would kill him. And significantly, he had been suffering from

his illness for 7 years now.

Duration illness

of

The patient went to the Mindanao Center of Psychiatry and Behavioral Medicine and has been diagnosed with schizophrenia undifferentiated since 2006. On this year, the patient manifested the negative and positive symptoms of schizophrenia occurred, still his non-compliance to the

medications caused him to be admitted for seventeen times. Almost twice every year after he had been diagnosed, he again and again was admitted at the hospital. Recently, because he didnt comply with his medications, this prompted him to get easily angry with his mother causing him to be very violent and he even banged his mothers head on the houses wall.

Precipitating factors(General)

Intake of drugs, substances or chemicals which increase levels of dopamine is one of the precipitating factors. The patients brother noted also that the patient usually spends his money to buy alcohol. The proponents rated this area as poor since Johnny is drinking alcoholic drinks that cause increase in dopamine levels.

1. Alcohol

2. Emotional

Patient lacks emotional security with a disrupted family support system.

3. Poor Medical Compliance

Patient was not able to maintain medications due to lack of financial resources and unwillingness to comply with his medications.

6.

Lack

of

The patient was a scholar at their school because his parents cannot afford to provide for his studies in college. He worked in a farm and at the same time he was a student in order for him to continue his studies.

Educational Support

7.Socio-Economic Status

The

patients

familys

socio-economic

standing has exposed the patient to the hard realities of survival in life at such an early age.

8.

Unhealthy

Patient usually spends his time watching movies alone. He was not able to socialize with other people and he just prefers to stay at home to study or to watch the movies. The patients personality problem of not

Leisure Activity

9. Personality

being able to ventilate his true emotions and his inability to handle frustrations and disappointments in life has aggravated his condition

Mood and Affect

During the interview, Johnny has appropriate mood and affect therefore rating him with good prognosis.

Family Support

The family was a deteriorated and distorted support system for the patient. The father, who was supposed to stand by and provide for the basic needs of the family, unfortunately was already dead when the patients age was 18. The mother, who was supposedly the parent to nurture the emotional and psychological development of the children, was focused on providing their physical needs in order to survive. She didnt focus on caring for his children because she has to work as a

laundrywoman. The loss of parental supervision led the patient to explore of what the outside world could give him. The patient sought to assume role as a provider, as he wanted to help augment the family

income at such an early age. However, his eldest brother is very supportive of him. In fact, he would support the patient financially to sustain his medications and also if given the chance, he would talk to his brother and ask him on his condition.

Willingness

to

take medications and treatment

Johnny

was

brought

to

the

hospital

forcefully with the help of the policemen and 911 because he was having homicidal tendencies again. It was already his seventeenth time to be admitted at the CIU. In addition to that, he doesnt regularly submit himself properly to the medication and he is missing doses of his anti- psychotic drugs. The family may be supportive with his treatment and regimen; however, he is not listening to his family and doctors advice to stop alcohol and even drinking soft drinks. For a person to be treated he must not only take the drugs prescribed but also to stop things that are contraindicated for him for his treatment. Because of this, Johnny was rated with poor prognosis with the willingness to take the medication and treatment.

Depressive features

During the interview, the patient does not show any depressive features. He knew that something is wrong with him and he need medical attention. Even though he is aware that something is wrong with him, he is still not depressed with this fact. However, he had mentioned about his

heartache when a girl he loves back when he was in college left him and that he is depressed of the idea that he didnt finish and he did not fulfilled his dreams and goals in life. Not getting the things he wants make him depress and eventually he goes out of control and becomes hostile. In fact, the reason he had his homicidal tendency was because his mother didnt allow him to go to a barangays fiesta. He got very angry and depressed and banged his mothers head on the wall. Computation: Poor: (4*1) Fair: =4

(2*2) = 4

Good: (1*3) = 3 Total 4 2 1 Total: General Prognosis: 1-1.6 = POOR 11/7 = 1.6

1.7-2.3 = FAIR 2.4-3.0 = GOOD

Rationale for Poor Prognosis: Johnny has a poor prognosis therefore he has a very small chance, according to the calculation, of recovering from his illness. The onset of illness was 7 years ago. Although he was immediately brought to the hospital on the onset of his illness, still almost twice every year, he would still be admitted because he becomes violent, hostile and is suicidal. The duration of illness is quiet long since it was on the year 2006 that he was first diagnosed of Undifferentiated Schizophrenia and was admitted. This February 11, 2013, he was again admitted for the seventeenth time already because of his homicidal tendencies. He also abused substances like alcohol and soft drinks. Such substances are known to increase the levels of dopamine. With regards to his Emotional State, patient lacks emotional security with a disrupted family support system. Patient also was not able to maintain medications due to lack of financial resources and

willingness to comply with medications. And because his parents cannot provide for his education, patient became a scholar in college and would provide for himself including his studies. The patients family socio-economic standing has exposed the patient to the hard realities of survival in life at such an early age. The patient was fond of watching movies alone. He would not go out of their house and he would just watch his dvds. Patients personality problem of not being able to ventilate his true emotions and his inability to handle frustrations and disappointments in life has aggravated his condition.

Furthermore, during the interview, Johnny has appropriate mood and affect therefore rating him with good prognosis. Lastly, the patient does not show any depressive features during the interview. Even though he is aware that something is wrong with him, he is still not depressed with this fact. However, he had mentioned about his heartache when a girl he loves back when he was in college left him and that he is depressed of the idea that he didnt finish and he did not fulfilled his dreams and goals in life. Not getting the things he wants make him depress and eventually he goes out of control and becomes hostile. In fact, the reason he had his homicidal tendency was because his mother didnt allow him to go to a barangays fiesta. He got very angry and depressed and banged his mothers head on the wall.