Kendall Harrison
Schizophrenia Case Study
Carrington College
Mental Health Clinical
Rosalyne Reynolds
July 10, 2020
, UNFOLDING Clinical Reasoning Case Study
History of Present Problem:
Jeremy Brown is a 30-year-old Caucasian male who was brought to the emergency department (ED) by the
police after being involved in an altercation at work. Jeremy was at work today, and he threw a large piece
of metal at a coworker and began yelling, “Stop following me, I know what you have been up to!” Because
Jeremy was very agitated and upset, and the police were called.
Since arriving in the ED, he has been agitated, displaying rapid pressured speech and repeating the
phrases he hears the police and others in the ED said. Jeremy reported that he recently stopped taking his
risperidone and citalopram because he believed his coworkers have been breaking into his house and
poisoning his medications. Jeremy’s manager reports that he was diagnosed with schizophrenia five years
ago.
Personal/Social History:
Jeremy graduated from college with a 4.0 GPA and was in his first year at law school when he
experienced the first episode of acute mental illness and was diagnosed with schizophrenia. He had to drop
out of law school at age 24 and never finished. Jeremy lives at home with his mother and father and
recently broke up with his girlfriend.
Jeremy likes his job at the foundry but feels he is a disappointment because both of his sisters are
lawyers, as is his father. Jeremy has no close friends and only a few acquaintances. Jeremy’s mental health
had been stable up until the last three months. He has been feeling more paranoid the past three months and
experienced a dramatic increase in symptoms when he stopped taking all of his medications one month ago.
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
© 2018 Keith Rischer/www.KeithRN.com
, Problem:
o Patient threw a large metal object o High emotion which means patient should be monitored to
at coworker make certain that further escalation is avoided.
o yelled “stop following me, I know o Paranoia is a positive symptom of schizophrenia
what you’ve been up to.” (Halter, 2014, pg. 197)
o Signs of rapid pressured speech and o Pressured speech as well as echolalia are both symptoms of
repeating phrases someone presenting with a severe and mental illness such as
schizophrenia (Professor Reynolds, 2020).
o Stopped taking medication because
he believes coworkers are trying to o Patient is experiencing paranoia and persecutory delusions
poison him which are symptoms of an exacerbated schizophrenic episode
related to lack of taking medication.
RELEVANT Data from Social History: Clinical Significance:
o Recently ended relationship with o Changes in relationship can trigger an increase in symptoms
girlfriend or relapse in patients with schizophrenia.
o diagnosed with schizophrenia 5 o Patient is experiencing acute phase of schizophrenia and
years ago Diagnosis of schizophrenia explains patient’s behavior
and symptoms.
o Feels he has disappointed his family o Feelings of disappointment may lead to depression and
because he wasn’t able to complete anxiety, which have the ability to increase
college schizophrenic symptoms
o All persons require socialization, someone with
o Has no close friends and only a few schizophrenia or other mental illnesses are at risk for
© 2018 Keith Rischer/www.KeithRN.com
Schizophrenia Case Study
Carrington College
Mental Health Clinical
Rosalyne Reynolds
July 10, 2020
, UNFOLDING Clinical Reasoning Case Study
History of Present Problem:
Jeremy Brown is a 30-year-old Caucasian male who was brought to the emergency department (ED) by the
police after being involved in an altercation at work. Jeremy was at work today, and he threw a large piece
of metal at a coworker and began yelling, “Stop following me, I know what you have been up to!” Because
Jeremy was very agitated and upset, and the police were called.
Since arriving in the ED, he has been agitated, displaying rapid pressured speech and repeating the
phrases he hears the police and others in the ED said. Jeremy reported that he recently stopped taking his
risperidone and citalopram because he believed his coworkers have been breaking into his house and
poisoning his medications. Jeremy’s manager reports that he was diagnosed with schizophrenia five years
ago.
Personal/Social History:
Jeremy graduated from college with a 4.0 GPA and was in his first year at law school when he
experienced the first episode of acute mental illness and was diagnosed with schizophrenia. He had to drop
out of law school at age 24 and never finished. Jeremy lives at home with his mother and father and
recently broke up with his girlfriend.
Jeremy likes his job at the foundry but feels he is a disappointment because both of his sisters are
lawyers, as is his father. Jeremy has no close friends and only a few acquaintances. Jeremy’s mental health
had been stable up until the last three months. He has been feeling more paranoid the past three months and
experienced a dramatic increase in symptoms when he stopped taking all of his medications one month ago.
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Clinical Significance:
© 2018 Keith Rischer/www.KeithRN.com
, Problem:
o Patient threw a large metal object o High emotion which means patient should be monitored to
at coworker make certain that further escalation is avoided.
o yelled “stop following me, I know o Paranoia is a positive symptom of schizophrenia
what you’ve been up to.” (Halter, 2014, pg. 197)
o Signs of rapid pressured speech and o Pressured speech as well as echolalia are both symptoms of
repeating phrases someone presenting with a severe and mental illness such as
schizophrenia (Professor Reynolds, 2020).
o Stopped taking medication because
he believes coworkers are trying to o Patient is experiencing paranoia and persecutory delusions
poison him which are symptoms of an exacerbated schizophrenic episode
related to lack of taking medication.
RELEVANT Data from Social History: Clinical Significance:
o Recently ended relationship with o Changes in relationship can trigger an increase in symptoms
girlfriend or relapse in patients with schizophrenia.
o diagnosed with schizophrenia 5 o Patient is experiencing acute phase of schizophrenia and
years ago Diagnosis of schizophrenia explains patient’s behavior
and symptoms.
o Feels he has disappointed his family o Feelings of disappointment may lead to depression and
because he wasn’t able to complete anxiety, which have the ability to increase
college schizophrenic symptoms
o All persons require socialization, someone with
o Has no close friends and only a few schizophrenia or other mental illnesses are at risk for
© 2018 Keith Rischer/www.KeithRN.com
