CASE STUDY

1. Bio data of patient

 Name: Chamanjeet Singh s/o Ajit singh
 Age: 39 years
 Gender: Male
 Religion: Sikh
 Address: Moga
 Education: 10th
 Occupation: Unemployed
 Marital status: Unmarried
 Languages known: Punjabi
 Monthly income: 5000/-
 Date of Admission: 20/12/18
 CR: PFDGG2018035311 IP
 Consultant : Dr. Arvind Sharma
 Diagnosis: substance induced psychotic disorders(19.15)
 Reason for admission : Treatment and evaluation purpose
 Informant:
 Guardians
 Reliability of Informant: reliable
b. Significance/relevance to the concept:
Some substances are more likely to be associated with greater risk of psychosis, namely, cocaine,
amphetamines, cannabis and alcohol. The propensity to develop psychosis appears to be a
function of the severity of use and of dependence. Family loading for psychosis and personality
diatheses have important contributions. This area is significant with possibilities to explore the
biology of psychosis. Unfortunately, the research into neurobiological and genetic underpinnings
of substance-related psychoses has been sparse and has not yet generated a coherent theory of
psychosis.

c. B a c k g r o u n d k n o w l e d g e :

• Definition : Substance-induced psychotic disorder is a condition that causes symptoms like

hallucinations and delusions and that is triggered by misuse of drugs or alcohol. In most cases the
psychosis is short-term, but in rare cases, heavy and long-term use of a drug can cause psychosis
that lasts for months or years. Treatment for drug induced psychosis involves both immediate
treatment, including hospitalization, and long-term care, often in a residential setting and using
medications and behavioral therapies.
• Clinical manifestation:
People may experience:

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  Delusions. These are false beliefs that persist in the face of facts. For example, a person
may believe that someone is out to get them or that they have superpowers. Delusions
may be paranoid.
 Hallucinations. Hallucinations are seeing, hearing, or otherwise sensing things that are
not really there, but that the hallucinating person believes are real. For instance, this may
involve hearing voices and believing they are real.
 Disordered thinking. Psychosis may include disorganized, confused thinking, as well as
disturbing and persistent thoughts. This can cause someone to speak in a way that is
difficult to understand.
 Dissociation. Someone experiencing psychosis may feel detached from reality, from their
own body, and from their own sense of self. They may feel as if the world around them
isn’t real or that they are not connected to reality.
CAUSES:
The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

o Biology. substance-induced psychotic disorder may be a result of changes in your body's

own natural chemistry or brain functions.

o Genetics. substance-induced psychotic disorder may have a genetic component, but

specific genes have yet to be identified.

o Environment. Some environmental factors such as infections are suggested as a trigger

for substance-induced psychotic disorder , but more research is needed.

Prognosis
The prognosis of this condition is good, with most cases improving within a year of
diagnosis. The minority of cases will developing a long-term course of the illness,
fluctuating and persisting with time. When severe, the condition can last for many years,
and may be more resistant to treatment than less severe forms of the disease.

NURSE CENTERED

Objectives

Upon completion of the case study, participants should be able to:

1. Demonstrate transfer of knowledge of substance-induced psychotic disorder

pathophysiology, assessment, and treatment planning to a case situation.
2. Develop a multimodal treatment plan for a patient with substance-induced psychotic
disorder according to their prognosis.
3. Illustrate responsible therapy prescribing.
4. Understand complications of substance-induced psychotic disorder.

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 1. CHIEF COMPLAINTS:
According to records:
 Violent behaviour
 Substance use cannabis
 Putting face in urinal
 Putting hands in feces
 Difficult to interrupt X 6 weeks
 Disturbed sleep pattern
 Irritability
 Restlessness
 Pacing around
 Self care deficit
 Auditory hallucinations
2. HISTORY OF PRESENT ILLNESS:
 Duration : 6 weeks
 Mode of onset: insidious
 Course of illness: Continuous
 Predisposing factors : easy availability of dugs
 Aggravating factors : substance intake
3. PAST HEALTH HISTORY
 Medical history:
 No h/o hypertension, Diabetes mellitus , Asthma, or any other medical illness.
 No h/o neurological disorders
 No h/o convulsions
 No h/o unconsciousness
h/o HIV
 Surgical history: Not available
 Psychiatric history :
The father of patient is died 25 years ago . He was going to abroad for earning money .
but due to substance abuse deported to India back .
o Hospitalization : no history available
o Nature of treatment : no history available
o Improvement : no history available

4. FAMILY HISTORY
Sr. Members Relation with Education occupation Health status
no Patient
1 Sukhwinder Patient 10th Businessman Ill
singh

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2 Kuldeep kaur Wife Matric Housewife Good

3 Amandeep Son 3rd Student Good

singh

4 Jashandeep Daughter LKG Student Good

kaur

 Type of family : Nuclear

 Birth order : 1st in order
 Psychiatry history: No h/o mania and depression in the family
 h/o substance abuse in family
 Medical history: No significant history
 Surgical history: No significant history

Current housing conditions :

i. Home circumstances: lives in a gurudwara

ii. Per capita income : 2500 rs. per month
iii. Socioeconomic status : lower class
iv. Head of the family : mother
v. Current attitude of family members towards illness : lives alone in a gurudwara
away from mother
vi. Communication pattern in family : not satisfactory
vii. Cultural and religious view : Sikh religion
viii. Ethnicity : Punjabi
ix. Social support systems available : from guardians

FAMILY TREE

Father mother

Patient

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5. PERSONAL HISTORY
a) BIRTH & DEVELOPMENT
 Antenatal period:
o Any febrile illness : no history
o Physical illness : no history
o Medications / drugs use : no
o Trauma to abdomen : no
o Immunization : no history available
 Natal period:
o Birth : full term
o Wanted : yes
o Type of delivery : normal vaginal delivery
o Birth cry : immediate
o Birth defects : no
o Postnatal complications : no
b) CHILDHOOD HISTORY :
o Primary caregiver : mother
o Feeding : breast feed
o Age at weaning : 8 months
o Developmental milestones : normal
o Age and ease of toilet training : 2 years
o Behavioural and emotional problems :
i. Thumb sucking : NO
ii. Temper tantrums : YES
iii. Tics and head banging : YES
iv. Night terror : YES
v. Fears : YES
vi. Bed wetting : YES
vii. Nail biting : YES
viii. Stuttering : NO
ix. Enuresis: NO
x. Encopresis: NO
xi. Somnambulism : NO
c) EDUCATIONAL HISTORY :
o Age at beginning of formal education : 4 years
o Age of finishing formal education : 18 years
o Relationship with peers and teachers : fear from teachers
o School phobia : yes
o Truancy , non attendance : Yes
o Learning disabilities : present

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 o Reason for termination of studies : not taking interest in studies
o Bullying at school : no
d) PLAY HISTORY :
o Games played : outdoor games with friends
o Relationship with mates : good

e) ADOLESCENCE:
Emotional problems during adolescence :
o Running away from home : NO
o Delinquency : NO
o Smoking : NO
o Drug abuse : YES
o Any other : NO SIGNIFICANT HISTORY AVAILABLE
f) PUBERTY:
o Age at appearance of secondary sexual characteristics : 15 YEARS
o Anxiety related to puberty changes : YES
o Age at menarche : N/A
o Reaction to menarche : N/A
o Regularities of menstrual cycle : N/A
o Abnormalities : N/A
g) OBSTETRICAL HISTORY :
o Any abnormalities associated with delivery / puerperium/ pregnancy : N/A
o Number of children : N/A
o Termination of pregnancy : N/A
h) OCCUPATIONAL HISTORY :
o Age at starting work : 19 YEARS
o Jobs : waiter
o Reasons for change : deported from abroad
o Current job satisfaction : unemployed
i) SEXUAL HISTORY :
o Type of marriage : N/A
o Duration of marriage : N/A
o Interpersonal relationship with in laws: N/A
o Relationship with wife : N/A
o Relationship with children : N/A
j) SUBSTANCE ABUSE: Alcohol started at the age of 15 years
k) PRE-MORBID PERSONALITY
i. Interpersonal relationships:
o Interpersonal relationships with family : unsatisfactory
o Interpersonal relationships with friends : disputes

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 o Type of personality : introverted
o Making social relationships : Not good
ii. Use of leisure time :
o Hobbies : no significant history
o Interests : no significant history
o Intellectual activities : no significant history
o Energetic : no significant history
o Sedentary : no significant history
iii. Predominant mood :
o Anxious
o Prone to anxiety
o Despondant
o Reaction to stressful events : overt reaction to stress
iv. Attitude towards self and others :
o Self confidence level : low
o Self criticism : no
o Self consciousness : no
o Thoughts for others : no
o Self appraisal of activities : less
o General attitude towards others : no interaction with others
v. Attitude to work and responsibilities
o Decision making : less
o Acceptance of responsibility : no acceptance
o Flexibility : no
o Foresight : impaired
o Religious beliefs : faith in god
o Fantasy life : wants drugs
o Day dreams : yes , thinks about drugs
vi. Habits :
o Eating pattern : irregular
o Elimination : irregular
o Sleep : irregular
o Use of drugs / tobacco / alcohol: yes
 VITAL SIGNS

s. no. Vital signs Normal value Patient value Remarks

1 Temperature 98.6 F 98 F Normal
2 Pulse 72-100/min 82/min Normal
3 Respiration 20-24/ min 24/min Normal
4 B.P 120/80mm hg 120/90mm hg Normal

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INVESTIGATION

Investigations Normal Values Patient’s Values Remarks

Bilirubin
 Total 0.0-0.2 mg / dl 0.6 mg /dl Increased
 Direct 0.2-1.2 mg / dl 0.2 mg/dl Normal

SGOT 40 U/L 26 U/L Normal

SGPT 40 U/L 20 U/L Normal
Total protein 3.5-5.3 g/dl 6.9 g/dl Normal
Albumin 3.5-5.3 g/dl 4.0 g/dl Normal
Random sugar 80-120 mg/dl 75 mg/dl Slightly decreased
Urea 15-45 mg/dl 47 mg/dl Slightly increased
Creatinine 0.6-1.3 mg/dl 0.8 mg /dl Normal
Uric acid 3.5-7.2 mg /dl 4.9 mg/dl Normal
Sodium 135-158 mmol/dl 136 mmol/dl Normal
Potassium 3.8-5.6 mmol/dl 4.3 mmol/dl Normal
Calcium 1.1 – 1.3 mmol/dl 1.2 mmol/dl Normal
HIV Negative Positive Infected
HCV Negative Negative Normal
HBsAg Negative Negative Normal

MEDICATION

Name the drugs Composition Dosage Route Frequency Action

Tab. Eriprox ER Divalproex 500 mg Oral BD Anti Epileptic &Mood
Sodium Stabilizers

Tab. Ripdon Risperidone + 100 mg Oral TDS Antipsychotic

Plus Trihexyphenidyl

Tab. POP -TR Propanolol 20 mg Oral TDS Β blockers

Tab. BACLOF – baclofen 20 mg Oral TDS Muscle relaxant

OD

Tab. Pantop Pantoprazole 40 mg Oral TDS H2 blocker

Nursing care provided to patient

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Day 1 1) Rapport established with the patient.
2) Vital signs are monitored.
3) Administration of medication.
4) Patient is involved in activities like painting,
Day 2 1) Co-operation of patient gained.
2) Establishment of good IPR with Patient.
3) Assessment regarding personal hygiene done.
4) History collection is done including biodata, illness and other all
aspects.
5) Preparation of nursing care plan according to patient’s needs.
Day 3 1) Patient is involved in recreational activities .
2) Mental status examination is conducted.
3) Patient is assisted in self care activities.

MENTAL STATUS EXAMINATION

I. APPEARANCE

1. GROOMING AND DRESS

Inference:
Patient is wearing appropriate dress which is according to the place and season. Hair
are not combed. He is not well groomed

2. HYGIENE

Inference:
Hygienic condition of the patient is poor. Patient takes bath after 7 days and also
changes his clothes. Nails are unclean.

3. PHYSIQUE

Inference:
Patient has normal body physique

4. POSTURE

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 Inference:
Patient is having an open posture.

5. FACIAL EXPRESSIONS

Inference:
Facial expressions of the patient are anxious . They are congruent according to the
talk of the patient.

6. LEVEL OF EYE CONTACT

Inference:
Patient never maintains eye-to-eye contact throughout the conversation.
7. RAPPORT
N: Good morning
P: haaa…
N: Tuhada name ki hai ?
P: chaman
Inference:
Rapport is maintained with the patient. He took part in the conversation and less
responsive.
II. MOTOR ACTIVITY

Inference:
Patient is able to sit still. His psychomotor activity is decreased . Unusual gestures are
present

III. SPEECH

Inference:
Patient spoke in Punjabi language. Rate of speech is slow and in low tone.
IV. EMOTIONS

1. MOOD
N: Tuc kiwe ho ?
P: thik ha .
Inference:
Patient ‘s mood is anxious .

2. AFFECT

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 Inference:
Patient’s emotional response are not congruent according to his mood.

V. THOUGHT

1. FORMATION LEVEL

N: Tuc ethe kyu admit ho?

P: Mainu kujh nhi hoya
Inference:
Impaired formation level

2. CONTENT LEVEL

N: Tuhanu lagda ki tuhanu koi maarna chahunda hai

P: nhi
N: tuhanu lagda hai ki tuc sab kujh kar sakde ho ?
P: nhi
N: tuhanu kise cheez to darr lagda hai.
P: nhi.

Inference:
Delusions and phobias are absent

3. PROGRESSION LEVEL

N: Tuhanu ik hi khyaal baar baar mann ch ande ne

P: nhi
Inference:
Progression level of thought is normal .

VI. PERCEPTION

N: tuhanu awaaza sunayi dindiya ne ?

P: hanji
N: awaazan ki kendia ne tuhanu
P: awaazan mainu loka nu marn nu kendia ne
N: tuhanu koi cheeza dikhayi dindiya ne jehria asal vich nhi hundia
P: hanji

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 N: Tuhanu ki dikhayi dina hai
P: mainu mare hoye lok dikhde ne
Inference:
Patient is having visual and auditory kind of hallucinations. Perception in patient is
impaired .

VII. SENSORIUM AND COGNITIVE ABILITY

1. LEVEL OF ALERTNESS/CONSCIOUSNESS

Inference:
Patient is semi conscious. He is not listening to all the questions and is also giving
less responsive answers.

2. ORIENTATION
N: tuc ethe kado aye ?
P: pta nahi mainu ta.
N: tuc kitho de rehn wale ho?
P: pta nhi
N: ajj kehra din hai ?
P: pta nhi .
N: tuc iss time kithe ho?
P: pta nhi
Inference:
Patient is disoriented to time , place and person

3. MEMORY

a) Immediate memory

N: Main jo 5 no. bolu use dhyan se sunna aur phir batana:

4,21,5,2
P: 4…2..
Inference:
Immediate memory of the patient is impaired.

b) Recent memory

N: tuc ki khana khada sawere?

P: bread

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 N: tuc kinni war khana khande ho ?
P: 2 war
Inference:
Patient’s recent memory is intact.

c) Remote memory

N: tuhadi janam miti ki hai?

P: pta nhi
N: tuc hospital kad aye ?
P: pta nahi
Inference:
Patient’s remote memory is impaired .

4. CONCENTRATION AND ATTENTION

N: Ek sawal hai isse solve karo: 90 - 17 =?

P: pta nahi
N: 1 se 20 tak counting karo.
P: 1, 2, 3, 4, 5

Inference:
Patient is having loss of concentration and attention.

5. INFORMATION AND INTELLIGENCE

N: Bharat ka Pradhan mantri kon hai?

P: nahi
N: India ki capital kya hai?
P: pta nahi

Inference:
Patient general information level is less .

6. ABSTRACT THINKING

N: asi khana kyu khande ha ?

P: bhukh
Inference:
Abstract thinking of the patient is good.

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 7. JUDGMENT

a) Social

N: je kise nu tuhadi help di jarurat hai , tuc karoge?

P: pta nhi

Inference:
Patient has no logical social judgment.

b) Personal

N: je kise nu satt lag jandi hai ta tuc ki karoge?

P: hospital jawange

Inference:
Personal judgment of the patient is appropriate.

VIII. INSIGHT

N: tuhanu lagda ki tuhanu koi takleef hai

P: pta nhi
Inference:
Patient is having grade I insight as he completely declines his illness.

IX. GENERAL ATTITUDE

Inference:
General attitude of the patient is distressed . Patient is not co-operative.

X. SPECIAL POINTS

N: ajj sawere kujh khada tuc?

P: hanji.
N: Bukh theekh se lagti hai?
P: nhi
N: Neend theek se aati hai?
P: nhi … mann karda sara din ghumi jawa.

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 N: Kabji kabaz vagerah ki takliph toh nahi?
P: hanji hai .

Inference:
Patient’s appetite, bowel, bladder and sleep pattern is disturbed

XI. PSYCHOSOCIAL FACTORS

1. STRESSORS

N: tuhanu kise gal di takleef ten hi hai

P: nhi

Inference:
He is not worried

2. COPING SKILLS

N: tuc tension dur karn lyi ki karde ho?

P: kujh nhi

Inference:
His coping skills are not accurate

3. RELATIONSHIPS

N: tuhade dost haige ne?

P: hanji
N: tuhanu oh change lagde ne?
P: nhi

Inference
Patient has conflictory relationship with his friends and family .

4. SOCIO CULTURAL

N: tuhanu samaj ch badala chahida hai ?

P: hanji
Inference
Patient not ready to follow the rules of society.

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 5. SPIRITUAL
N: path karde ho?
P: nhi
N: gurudware jande ho?
P: kadi kadi
Inference:
Patient is not spiritual and but he believes in god.
SUMMARY : In MSE , it has been found that patient ‘s personal hygiene is not maintained .
Psychomotor activity is decreased . thought and speech are abnormal . There are visual and
auditory hallucinations and are present . Patient is distressed and affect is congruent. Grade I
insight is present . General attitude is aggressive and patient is incooperative.

NEUROLOGICAL EXAMINATION:

LEVEL OF CONCIOUSNESS:

 Alertness: patient is not alert and responsive immediately

 Lethargic: patient feel drowsy.

GLASGOW COMA SCALE:

RESPONSE TYPES POINTS PATIENTS

VALUE
Best eye opening response  Spontaneously 4 3
 To speech 3
 To pain 2
 No response 1
Best motor response  Obeys verbal command 6 6
 Localizes pain
 Flexion- withdrawal 5
 Flexion- abduction 4
 Extension 3
 No response 2
1

Best verbal response  Oriented to time, place, 5 3

person
 Confused conversation 4
 Speech inappropriate
 In comprehensive 3

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  No respose 2
1
Total score 15 12
ASSESSMENT OF CEREBRAL FUNCTIONS:

 Agnosia : absent as patient can recognize the common objects

 Apraxia: present as patient cannot carry out some skilled activities
 Aphasia: absent; patient can communicate.
 Finger to finger test: normal
 Finger to nose test: normal
 Romberg test: positive as patient can maintain his balance.
 Tandom walking test: positive patient can walk in straight line.

REFLEXES Biceps Triceps Supinator Knee Ankle Plantar Abdominal

Right +2 +2 + + + + +
Left +2 +2 + + + + +
MINI MENTAL STATUS EXAMINATION:

COMPONENT DESCRIPTION PATIENT POINTS

SCORE
I. ORIENTATION
 What is the year? 0 1
 Season? 0 1
 Date? 0 1
 Day? 1 1
1 1
 Month?
1 1
 Which state you live?
0 1
 Country?
1 1
 Town/city?
1 1
 Hospital name? 0 1
 Floor ?
II. ATTENTION AND CALCULATION:
 Count 1-10 forward 3 5
 Count 1-10 backward
 Add 5+10= 15
 Subtract 5-2= 3
 Spell word SUMMER.

III. REGISTRATION
2 3

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  Name three objects : register, cup, book
IV. RECALL:
 Register, cup book 2 3
V. LANGUAGE
 What is this ( patient was shown a book and he 1 2
gave right answer)?
 Patient was shown a wrist watch and time was
asked?
 Ask the person to repeat the following 1 1
 Command: take the pencil and draw a circle 1 3
 Fold the paper into four halves. 0 1
 write a sentence of your choice 0 1
 Copy: patient was asked to draw the following 0 1
shape and he did not draw it

Shapes:

Total score: 15 30
PHYSICAL EXAMINATION :
General survey :
Height : 5’5”
Weight : 60 kg.
Body makeup: Normal
Communication pattern : semiconscious
Skin :
o Color - Brown
o Turgor - Poor
o Bruises- Absent
o State of hydration – Dehydrated
Eyes:
 Sclera - Yellowish
 Pupils – contracted
Respiratory : Normal
Vital signs:
 Heart rate – 100 beats/ minute
 Temperature – 98 F
 Blood pressure- 120/90 mm hg.

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  Capillary refill – 4 seconds
 Respiratory rate – 22 breathes/ minute
Body position / alignment :
 Alignment – appropriate
Mental acuity :
disoriented , incoherent , inappropriately responsive
Sensory / Motor restrictions :
 Amputation : Absent
 Deformity : Absent
 Paresis: Absent
 Paralysis: Absent
 Fracture : Absent
 Gait : Normal
 Hearing disorders: Absent
 Speech : slurred
Emotional status:
Euphoric : Absent
Depressed : present
Apprehensive : Absent
Angry/ Hostile : Absent
Others : drowsy look , anxious
Medically imposed restrictions :
No
Other health related patterns :
Fatigue : Present
Restlessness : Absent
Weakness : Present
Insomnia : Absent
Coughing : Absent
Dyspnea : Absent
Dizziness : Absent
Pain: Present
Environment
Room temperature : Normal , adequate
Lightning : adequate
Safety :
Violations of medical asepsis: Absent
Violations of safety measures: Absent
Activities of daily living :
Feeding – able to perform

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 Dressing – not able to perform
Combing – not able to perform
Brushing –able to perform
Bathing – able to perform
Transferring – able to perform
PROCESS RECORDING

BIO –DATA OF THE PATIENT

 NAME OF THE PATIENT: Chamanjit Singh

 AGE : 39 years
 SEX : male
 MARITAL STATUS : unmarried
 EDUCATION : 10th
 OCCUPATION : unemployed
 MOTHER TONGUE : Punjabi
 ADDRESS : Moga
 WARD : psychiatry ward , GGS hospital , Faridkot
 TIME TAKEN : 15 min
 DIAGNOSIS : substance induced psychotic disorders

BRIEF HISTORY OF PATIENT:

Patient was admitted to psychiatry ward , GGS hospital , Faridkot with the chief complaints of

According to records:
 Violent behaviour
 Substance use cannabis
 Putting face in urinal
 Putting hands in feces
 Difficult to interrupt X 6 weeks
 Disturbed sleep pattern
 Irritability
 Restlessness
 Pacing around
 Self care deficit
 Auditory hallucinations
PROCESS RECORDING

Objectives for the patient:

1. To establish rapport and therapeutic IPR.

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 2. To socialize effectively.
3. To ventilate his feelings.
4. To identify the problems.
5. To learn healthy coping mechanisms.

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.

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Sr.no Partici Conversation Therapeutic Inference Communica
pants techniques tion
2. 1 Nurse Sat sri akal Giving Initiation of Verbal
. recognition communicatio
Patient Sat sri akal!! n
3. 2 Nurse Tuc kiwe ho? Giving Initiation of Verbal
. recognition communicatio
Patient Thik aa n
4. 4 Nurse Tuc aithe kyu aye ho ? Questioning Responding Verbal
. spontaneously
Patient Pta nahi
5. 5 Nurse Tuc ethe kis nal aye ho? Linking Answer Verbal
. adequately
Patient Pta nhi
6. 6 Nurse Tuhanu ki takleef hai ? Theme Answer Verbal
. identification adequately &
Patient Mainu koi takleef nhi haigi…. made
eye to
eye
contact.
7. 7 Nurse Tuhanu ethe kad leke aya ? Open general Answers Verbal
. lead adequately
Patient Pta nhi
8. 8 Nurse Tuc kithe rehnde ho ? Questioning Answers Verbal
. adequately
Patient Moga
9. 9 Nurse Tuhade ghar vich koun koun hai Questioning Answers Verbal
. ? adequately.
Patient Mummy
10. Nurse Hun kithe rehnde ho ? Questioning Answers Verbal
adequately.
Patient Gurudware vich
11. 1 Nurse Mummy nu milna hai tuc ? Questioning Maintains eye Verbal
0 to eye contact
. Patient Nhi

12. 1 Nurse Tuc koi nasha karde c Reinforcing the Answered Verbal
1 patient offering sadly
. Patient Nhi general lead
13. 1 Nurse Tuhanu nind aundi hai ? Asking divert Answers Verbal
2 question adequately
. Patient nhi

14. 1 Nurse Tuhanu awaazan sunayi dindiya Encouraging Answers Verbal

4 ne description of adequately
. Patient Hanji thought
15. Nurse Tuhanu awaazan ki kehndiya ne Encouraging Answers Verbal
? description of adequately
Patient Mainu awaazan loka nu marn lyi thought
kehndiya ne
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16. Nurse Jad awaazan sunayi dindiya ne .. Encouraging Answers Verbal
phir tuc ki karde ho ? ventilation of adequately
Patient Phir mainu gussa aunda hai feelings.
17. 1 Nurse Tuhada ki karn da mann karda Encouraging Answers Verbal
5 aa.. ventilation of adequately
. feelings.
Patient Mera kujh nhi karn da mann karda
aa..
18. 1 Nurse Tuhade ki shonk ne ? Divert Answers sadly Verbal
6 questioning
. Patient Kujh nhi about his
feelings
19. 1 Nurse Tuhanu nhi lagda tuhade karke Encouraging Answers Verbal
7 baki pareshan ne? description of adequately
. thought
Patient Nhi
20. 1 Nurse Tuhanu bhukh lagdi hai ? Encouraging Answers Verbal
8 description of adequately
. Patient Na … thought
21. 1 Nurse Tuc ilaaj karwauna chanhunde Divert Answers Verbal
9 ho? questioning adequately
. Patient Mainu kujh nhi hoya… about his
thinking
process
22. 2 Nurse Chalo thik hai apna dhyan Linking with Answers Verbal
0 rakheyo reality adequately
.
Patient Thik hai
23. 2 Nurse Psychoeducation: Suggestion Linking and Verbal
1  Kise nal ladhna nhi accepting my
. hai tuc suggestion
 Tuhanu koi kujh nhi
karuga
 Jo v dwai mile time
sir khani hai
 Bhajjan di koshish
nhi karni

Patient Thik hai ji

24. Nurse Chalo hun mai chaldi ha Informing and Over Verbal
terminating the responsive and
Patient Thik hai … interview termination of
the interview is
done in hyper
way ..

23
DESCRIPTION
OF
DISEASE

24
 SUBSTANCE INDUCED PSYCHOTIC DISORDER

Substance-induced psychosis is a form of psychosis brought on by alcohol or other drug use.

It can also occur when a person is withdrawing from alcohol or other drugs. The most
common symptoms include visual hallucinations, disorientation and memory problems.
Symptoms usually appear quickly and resolve within days to weeks. However, the person
may have another psychotic episode in the future if they use that drug again. While
substance-induced psychosis is typically brief, alcohol or other drug use can trigger the onset
of longer-lasting psychotic disorders in individuals who are predisposed to developing them.

Drugs That Cause Substance/Medication-Induced Psychotic Disorder

Any mind-altering substance has the potential to trigger psychosis, although it is more
common with some substances than others. Very large quantities of any drug taken over a
long period of time can cause psychotic symptoms. Drug induced psychosis is generally rare,
but some of the substances that are more likely to cause it include:
 Amphetamine and methamphetamine. These stimulant drugs can cause psychotic
symptoms after long periods of heavy use. The symptoms often include paranoia and
delusions. These are usually temporary, but in some exceptional cases of very heavy
and long-term use, the psychotic symptoms can last for months or even years.
 Cocaine. Another stimulant, cocaine also has the potential to cause psychosis, most
often paranoid delusions.
 Hallucinogens. By their very nature, these drugs cause hallucinations, but they
generally cease after stopping use of the drug. In some people they may cause other
temporary psychotic symptoms, including paranoia, delusions, and a sense of
depersonalization or dissociation. It is also possible that hallucinogen use will cause
chronic psychotic symptoms or even flashbacks.
 Alcohol. Withdrawal from alcohol can very dangerous for people who have been
long-term heavy drinkers. One potential complication from withdrawal is alcoholic
hallucinosis, which causes hallucinations. Withdrawal may also cause delirium
tremens, which can have symptoms of psychosis. Heavy and prolonged alcohol use
may trigger psychotic symptoms and a psychotic condition called Korsakoff’s
syndrome, which is related to vitamin B1 deficiency.
 Cannabis. Marijuana is known to induce psychosis in some people. Also of concern
are synthetic marijuana products, which contain laboratory-made compounds that are
designed to mimic natural cannabinoids, the mind-altering compounds found naturally
in the cannabis plant. These products may be even more likely to trigger psychosis.
Cannabis-related psychosis is more common in younger users.
 TYPES OF SUBSTANCE INDUCED PSYCHOTIC
DISORDERS
 Brief psychotic disorder : A person with brief psychotic disorder experiences
psychotic symptoms for less than one month. Symptoms are usually triggered by an
extremely stressful event (e.g., death of a loved one).
 Schizophreniform disorder : This is when a person has symptoms similar to
schizophrenia, that last more than one month, but less than six months.
 Schizophrenia : A diagnosis of schizophrenia is given when a person has had
symptoms of psychosis for at least six months. The major symptoms of schizophrenia
include delusions, hallucinations and jumbled thoughts. A person with schizophrenia
might also have thinking difficulties (e.g., trouble concentrating and remembering

25
 things much more than usual); they might experience loss of motivation to perform
everyday activities; they could have a significant reduction in their ability to
experience and express emotions; and they might withdraw from social settings and
personal relationships.
 Schizoaffective disorder : A person with schizoaffective disorder experiences the
symptoms of schizophrenia as well as the symptoms of a mood disorder, such as
depression or mania.
 Delusional disorder : A person with delusional disorder has strong beliefs about
things that could occur in real life but which are not true. For example, they might
think that people are following them, or are listening in to their phone calls. These
beliefs need to be present for at least one month.

 DEMOGRAPHICS :

Little is known regarding the demographics of substance-induced psychosis . However, it is

clear that substance-induced psychotic disorders occur more commonly in individuals who
abuse alcohol or other drugs. Psychotic disorders affect slightly more men than women. They
usually appear between the ages of 15 and 35.

Psychotic disorders most often appear in adolescence due to changes that occur during this
period, which affect:

 Personal and sexual identity

 The ability to detach from family and seek independence
 Intellectual development
 The start of a career or post-secondary studies
 The search for personal and financial autonomy

 PROGNOSIS
Psychotic symptoms induced by substance intoxication usually subside once the substance is
eliminated. Symptoms persist depending on the half-life of the substances (i.e., how long it
takes the before the substance is no longer present in an individual's system). Symptoms,
therefore, can persist for hours, days, or weeks after a substance is last used.

 CAUSES
 A substance-induced psychotic disorder, by definition, is directly caused by the
effects of drugs including alcohol, medications, and toxins.
 Psychotic symptoms can result from intoxication on alcohol, amphetamines (and
related substances), cannabis (marijuana), cocaine, hallucinogens, inhalants, opioids,
phencyclidine (PCP) and related substances, sedatives, hypnotics, anxiolytics, and
other or unknown substances.
 Psychotic symptoms can also result from withdrawal from alcohol, sedatives,
hypnotics, anxiolytics, and other or unknown substances.
 Some medications that may induce psychotic symptoms include anaesthetics and
analgesics, anticholinergic agents, anticonvulsants, antihistamines, antihypertensive
and cardiovascular medications, antimicrobial medications, anti parkinsonian
medications, chemotherapeutic agents, corticosteroids, gastrointestinal medications,

26
 muscle relaxants, non steroidal anti-inflammatory medications, other over-the-counter
medications, antidepressant medications, and disulfiram .
 Toxins that may induce psychotic symptoms include anticholinesterase,
organophosphate insecticides, nerve gases, carbon monoxide, carbon dioxide, and
volatile substances (such as fuel or paint).
 The causes of psychosis are not fully understood. However, it is likely that a
combination of factors lead to the development of psychosis or psychotic disorders,
including:
— A family history of psychosis or psychotic disorders
— Chemical imbalances in the brain
— Life experiences (e.g., stress, traumatic events, illness)
— Alcohol or other drug use

 DSM-V Criteria for Drug/Medication-Induced Psychotic

Disorder
Substance-induced psychotic disorder is diagnosed by the presence of delusions and/or
hallucinations that are determined to be caused by the use of a psychoactive substance. Most
psychotic symptoms unrelated to drugs continue even after complete abstinence from a
particular substance. Symptoms of drug-induced psychosis will typically wear off when use
is stopped. However, frequent and prolonged use can result in years of psychotic symptoms,
making it difficult to differentiate from other psychiatric disorders such as schizophrenia.

A diagnosis of drug-induced psychosis is only made when psychotic symptoms are severe
and go beyond the normal psychological symptoms of drug withdrawal. According to the
Diagnostic and Statistical Manual of Mental Disorders (DSM-V), meeting the following
criteria is necessary for diagnosis :

 The symptoms are not better explained by a psychotic disorder (schizophrenia, bipolar, etc.)
that is not medication induced.
 Evidence from medical examination, lab results, and patient history that psychotic symptoms
developed during substance use, or within one month of withdrawal from a substance known
to cause psychotic symptoms.
 Presence of delusions and/or hallucination
 Psychotic symptoms do not occur only during an episode of delirium.
 Symptoms are causing significant distress and/or impairment in one's daily life and ability to
function.
CLASSIFICATION OF SUBSTANCE INDUCED PSYCHOTIC
DISORDERS
CHARACTERISTICS ICD-10 DSM-IV/V
Core Cluster of psychotic
phenomena that occur during/
immediately after psychoactive
substance use

Characteristics Hallucinations, delusions, Prominent hallucinations or delusions

psychomotor disturbances,
abnormal affected

27
Insight/level of Usually clear, some level of No insight into symptoms being substance
consciousness clouding of conscious- induced
ness may occur, though not
severe confusion

When/duration Includes psychosis occurring Either (1) or (2):

during/immediately 1. Symptoms developed during/within 1 month of
after drug use (<48 h) as long substance intoxication or withdrawal
as not due to with- 2. Medication is etiologically related to the
drawal or delirium disturbance
Resolves at least partially Does not occur exclusively during delirium
within 1 month, fully
within 6 months

Not better accounted for by disorder that is not substance induced

Should only be made instead of intoxication or withdrawal if symptoms in excess of what is expected
and when symptoms severe enough to warrant clinical attention

SYMPTOMS OF SUSBTANCE INDUCED PSYCHOTIC DISORDERS

I. Thoughts

 Jumbled or disorganized thoughts

 Delusions — false beliefs that usually involve a misinterpretation of
perceptions or experiences (e.g., thinking that someone is out to get you, that
you have special powers, or that passages from the newspaper have special
meaning for you)
 Hallucinations — seeing, hearing, smelling, sensing or tasting things that
others cannot
II. Feelings

Confusion
Fear
Agitation
Lack of interest in activities
Behaviors

III. Difficulty carrying on or keeping track of conversations

o Having trouble remembering things

o Difficulty maintaining hygiene and other daily activities Inappropriate
o behaviour (e.g., silliness, laughing inappropriately)
o Becoming angry or upset for no particular reason
o Becoming very inactive or lethargic
o Becoming completely unaware of the surrounding environment.
 DIAGNOSIS
Substance-induced psychotic disorder also needs to be distinguished from delirium
, dementia , primary psychotic disorders, and substance intoxication and withdrawal. While
there are no absolute means of determining substance use as a cause, a good patient history
that includes careful assessment of onset and course of symptoms, along with that of

28
substance use, is imperative. Often, the patient's testimony is unreliable, necessitating the
gathering of information from family, friends, co-workers, employment records, medical
records, and the like. Differentiating between substance-induced disorder and a psychiatric
disorder may be aided by the following:

 Time of onset: If symptoms began prior to substance use, it is most likely a

psychiatric disorder.
 Substance use patterns: If symptoms persist for three months or longer after
substance is discontinued, a psychiatric disorder is probable.
 Consistency of symptoms: Symptoms more exaggerated than one would expect with
a particular substance type and dose most likely amounts to a psychiatric disorder.
 Family history: A family history of mental illness may indicate a psychiatric
disorder.
 Response to substance abuse treatment: Clients with both psychiatric and substance
use disorders often have serious difficulty with traditional substance abuse treatment
programs and relapse during or shortly after treatment cessation.
 Client's stated reason for substance use: Those with a primary psychiatric diagnosis
and secondary substance use disorder will often indicate they "medicate symptoms,"
for example, drink to dispel auditory hallucinations, use stimulants to combat
depression, use depressants to reduce anxiety or soothe a manic phase. While such
substance use most often exacerbates the psychotic condition, it does not necessarily
mean it is a substance-induced psychotic disorder.

 OVERDOSE AND PSYCHOSIS

Addiction to alcohol, prescription medications, or illicit substances tends to increase the risk
of overdose of those substances and episodes of psychosis. In 2011, there were more than 5
million drug-related emergency room (ER) visits. About half were attributable to substance
misuse or abuse. Current studies have shown an increase in the use of illicit substances and
ER visits. For instance, between 2009 and 2011, ER visits involving marijuana and
prescriptions medications (most commonly for anxiety, insomnia, or pain relief) more than
doubled. ER visits involving stimulants rose 68 per cent. Psychosis was often reported as a
symptom in emergency intervention, particularly with marijuana use.
In situations involving overdose and/or psychotic episodes, it is essential to seek medical help
to avoid additional dangers associated with both.

 TREATMENT
Effective treatments are available. Both psychological therapy and medication can
help people affected by psychosis.

 Psychological therapy
Psychological treatments usually involve hands-on support and guidance which is
aimed at teaching you about the early warning signs of psychosis. Treatments are also
aimed at stress management and anxiety, relaxation training, employment programs,
social and living skills training and family education, as well as drug and alcohol
programs. These treatments will also encourage you to keep healthy and get plenty of
exercise.
 Medication
Medication may be helpful alongside psychological therapy. There are many different
types of medication, which include anti-psychotic and anti-depressant medications.
Medications can be helpful in managing your psychotic symptoms; however, some
29
 people experience unpleasant and distressing side effects. In most instances there is a
choice of medication available, but it may take time to establish which medication is
best suited to your needs.

 Interactions with alcohol, tobacco or other drugs

It is very important that you follow your doctor’s instructions when taking any
medication that has been prescribed to you. Before being prescribed medication it is
important to tell your doctor about your alcohol or other drug use so that they may
give you the best possible care. Alcohol, tobacco and other drugs can interact with
some prescription medications and this interaction may alter the PSYCHOSIS +
substance use effectiveness of the medication. Mixing prescribed medications with
alcohol or other drugs can also have dangerous consequences including overdose and
possibly death.
 Coping with Cravings
The easiest way to cope with cravings or urges to use alcohol, tobacco or other drugs is to try
to avoid them in the first place. This can be done by reducing your exposure to craving
triggers (e.g., getting rid of drugs and fits/pipes in the house, not going to parties or bars,
reducing contact with friends who use, and so on).

A. Eat regularly, even when you don’t feel like it. Drink plenty of water —
especially when you get a craving. Instead of drinking, smoking or using,
drink water or chew gum.
B. Use ‘Delaying’ and ‘Distraction’ when your craving is set off.
C. When you experience a craving, put off the decision to drink or use for 15
minutes. Go and do something else like go for a walk, read, listen to music, or
do the dishes etc. This will help you to break the habit of immediately
reaching for alcohol, tobacco or other drugs when a craving hits.

30
 D. Use the relaxation and deep breathing techniques described earlier to cope
with a craving once it is set off. If a craving develops in response to stressful
situations, relaxation techniques and deep breathing exercises are really useful.
E. Ride out the craving by ‘urge surfing’. Form a picture in your mind of a wave
at the beach. This is a craving wave, and remember that the craving wave will
build up to its highest point, and then fall away as it rolls into shore.
F. Picture the craving wave building up, getting ready to break, see it break, see
the foam form, and see the wave fade away as it rolls into shore. Now, picture
yourself riding the wave, surfing the craving wave into shore. You don’t fall
off, you don’t get dumped and churned around, just picture yourself calmly
surfing the craving wave into shore.
G. Talk to someone, perhaps a friend or family member, about craving when it
occurs. Use positive self-talk. Tell yourself that cravings only last about 10
minutes. Tell yourself ‘this feeling will pass’. You will find that the urges and
cravings themselves will be easier to deal with. Say to yourself, ‘yes, this feels
pretty bad, but I know it will be over soon’.
H. Challenge and change your thoughts. When experiencing a craving, many
people have a tendency to remember only the positive effects of using drugs
and often forget the negative consequences of using.
I. Remind yourself of the benefits of not using and the negative consequences of
using. This way, you can remind yourself that you really don’t feel better if
you have ‘just one drink’ and that you stand to lose a lot by drinking, smoking
or using.

 Residential care
It can be very helpful when treating drug induced psychosis. Individualized programs can be
created to address mental and medical health issues in a safe, nurturing environment.
Treatment generally focuses on psychotherapy to address any root issues that may be leading
to substance abuse. Therapy also works to teach new skills to manage daily life stress, as well
as major events and significant stressors. In residential treatment, any co-occurring mental
health conditions can also be addressed and treated.
Treatment can be difficult due to the nature of addiction coupled with psychosis and the
potential for the presence of co-occurring disorders. But, with time and hard work, treatment
can be effective.
 Relapse Prevention
Relapse prevention is an integral part of any plan for continued sobriety. It begins just after
intensive therapy ends and is designed to give on going support as people transition back into
their daily lives. Programs seek to provide a network of support that helps with:
 Implementing relapse prevention plans
 Developing and maintaining positive social interactions
 Developing self-esteem and tools to increase individual empowerment
 Stress reduction techniques
 Support during major life crisis

 COMPLICATIONS

Living with an untreated psychotic disorder can lead to many consequences for the person
suffering from it as well as his or her family and friends. This could:

31
  Impact the person’s self-esteem negatively
 Hurt his or her relationships with others and lead to isolation
 Increase the distress of family and friends, who, for example, won’t always
understand his or her behaviour, which may lead to conflicts
 Increase certain risks for the person, such as:

 Living in greater poverty

 Drinking or using drugs excessively. People suffering from a disorder often try
to control their anxiety by drinking or doing drugs, which might lead to
addiction
 Becoming homeless, suffering from depression and thinking about suicide
 Behaving in ways that could land him or her in trouble with the law or result
in hospitalization

Impact on family and friends

When a person experiences a psychotic episode, people around him or her can be severely
affected. They may feel destabilized and powerless. They need help to understand the
psychotic disorder the person is suffering from and to better communicate with him or her.
They could, for example:

 Learn how to use effective communication techniques and adaptation strategies

 Participate in supportive interventions

Family and friends are in a good position to detect the signs of a psychotic episode in a
person who has the disorder. Also, they are an important source of support for that person
during his or her treatment.

NURSING CARE PLAN

NURSING ASSESSMENT

 Vital signs are monitored.

 On MSE, it is found that patient shows aggressive and increased psychomotor
activity.
 Nutritional status of patient is assessed.
 Collection of detailed history.
 Personal hygiene is assessed.

NURSING DIAGNOSIS

 Impaired social interaction related to delusional thought processes (grandeur and/or

persecution); underdeveloped ego and low self-esteem evidenced by inability to
develop satisfying relationships and manipulation of others for own desires
 Defensive coping related to repeated projection of falsely positive self-evaluation
based on a self-protective pattern that defends against underlying perceived threats to
positive self-regard.

32
  Disturbed thought processes related to disruption in cognitive operations and
activities.
 Chronic low self esteem related to lack of positive feedback evidenced by inability to
tolerate being alone.

Short Term Goals:-

 The client will verbalize which of his or her interaction behaviors are
appropriate and which are inappropriate within 1 week .
 To enhance role performance in family .
 The client will demonstrate increased feelings of self-worth within 4 to 5 days
 To promote coping skills.
 To promote the self esteem.
 The client will demonstrate orientation to person, place, and time.
 To make patient self dependent.

Long Term Goals:-

 The client will demonstrate use of appropriate interaction skills as evidenced by lack
of, or marked decrease in, manipulation of others to fulfill own desires. To prevent
further complications.
 To assist the patient in early recovery.

33
Nursing Diagnosis Expected Planning Implementation Rationale Evaluation
Outcome
Impaired social Patient will 1. Recognize 1. Helping patient to 1. Understanding the Client has
interaction related demonstrate behaviors serve for reduce feelings of motivation behind the started
to delusional ability to the client: to reduce insecurity by increasing manipulation may improve social
thought processes improve social feelings of insecurity feelings of power and facilitate acceptance of interaction
(grandeur and/or interaction with by increasing feelings control. the individual and his with family
persecution); family and of power and control. 2. Limits are set on or her behavior. 2. and friends.
underdeveloped ego friends 2. Set limits on manipulative behaviors. The client is unable to
and low self-esteem manipulative Terms of the limitations establish own limits, so
evidenced by behaviors. Explain to are taught to the patient this must be done for
inability to develop the client what is . him or her. Unless
satisfying expected and what the 3. Patient is confronted administration of
relationships and consequences are if with unacceptable consequences for
manipulation of the limits are violated. behaviour violation of limits is
others for own Terms of the 4. Positive consistent,
desires limitations must be reinforcement for non manipulative behavior
agreed on by all staff manipulative behaviors will not be eliminated.
who will be working is provided . Explore 3. Because of the
with the client. feelings and help the strong id influence on
3. Do not argue, client seek more client’s behavior, he or
bargain, or try to appropriate ways of she should receive
reason with the client. dealing with them. immediate feedback
Merely state the limits 5. The client is when behavior is
and expectations. recognized that he must unacceptable.
Confront the client as accept the Consistency in
soon as possible when consequences of own enforcing the
interactions with behaviors and refrain consequences is
others are from attributing them to essential if positive
manipulative or others. outcomes are to be
exploitative. Follow 6. The client is taught achieved.
through with to identify positive Inconsistency creates
established aspects about self, confusion and

34
 consequences for recognize encourages testing of
unacceptable accomplishments, and limits.
behavior. feel good about them. 4. Positive
4. Provide positive reinforcement
reinforcement for non enhances self esteem
manipulative and promotes
behaviors. Explore repetition of desirable
feelings and help the behaviors.
client seek more 5. The client must
appropriate ways of accept responsibility
dealing with them. for own behaviors
5. Help the client before adaptive change
recognize that he or can occur.
she must accept the 6. As self-esteem is
consequences of own increased, client will
behaviors and refrain feel less need to
from attributing them manipulate others for
to others. own gratification.
6. Help the client
identify positive
aspects about self,
recognize
accomplishments, and
feel good about them.
Patient will be  Ignore or  The client is  Minimizing or Patient is able
Defensive coping able to resume withdraw your Ignored and withdrawing to resume role-
related to repeated role-related attention from withdrawing attention given related
projection of falsely responsibilities. to unacceptable responsibilities
bizarre attention from
behaviors can
positive self- appearance bizarre in family .
be more
evaluation based on and behavior appearance and effective than
a self-protective and sexual behavior and negative
pattern that defends reinforcement

35
against underlying acting-out, as sexual acting- in decreasing
perceived threats to much as out, as much as unacceptable
positive self-regard. possible. possible. behavior.
 The client
 Set and  The limits are
needs to learn
maintain limits set and what is
regarding maintained expected before
inappropriate regarding he or she can
behaviors. inappropriate meet
Convey behaviors. expectations.
expectations Convey Limits are
intended to
for appropriate expectations for
help the client
behavior in a appropriate learn
nonjudgmental behavior in a appropriate
, matter-of-fact nonjudgmental, behaviors, not
manner. matter-of-fact as punishment
 You may need manner. for
inappropriate
to limit contact  The contact is
behavior.
between the limited between
 The client may
client and the client and need to gain
other clients or other clients or self-control
restrict visitors restrict visitors before he or
for a period of for a period of she can tolerate
time. Discuss time. the presence of
other people
the situation  The client is
and behave in
with the client encouraged to an appropriate
as tolerated. participate in manner.
 Initially, give recreational  The client may
the client activities be limited in
short-term, feedback is the ability to

36
 simple projects given related to deal with
or activities. each activity . complex tasks.
Gradually  The client is Any task that
the client is
increase the given positive
able to
number and feedback complete
complexity of whenever provides an
activities and appropriate. opportunity for
responsibilities positive
. Give feedback.
feedback at  Positive
feedback
each level of
provides
accomplishme reinforcement
nt. for the client’s
 Give client growth and can
positive enhance self-
feedback esteem. It is
whenever essential to
support the
appropriate.
client in
positive ways
and not to give
attention only
for
unacceptable
behaviors.
The client will  Set and  The limits are  Limits must be The client is
Disturbed thought demonstrate maintain limits maintained on established by demonstrating
processes related to orientation to on behavior behavior that is others when the orientation to
disruption in person, place, that is destructive or client is unable person, place,
cognitive operations and time. destructive or adversely to use internal and time.
and activities. adversely affects others. controls

37
 affects others.  The client is effectively. The
 Initially, assigned to the physical safety
assign the same staff and emotional
client to the members when needs of other
same staff possible, but clients are
members when keep in mind important.
possible, but the stress of  Consistency
keep in mind working with a can reassure the
the stress of client with client. Working
working with a manic behavior with this client
client with for extended may be difficult
manic periods of time. and tiring due
behavior for  The client is to his or her
extended reoriented to agitation,
periods of person, place, hyperactivity,
time. and time as and so on.
indicated (call  Your physical
 Reorient the
the client by presence is
client to
name, tell the reality.
person, place,
client your  Repeated
and time as
name, tell the presentation of
indicated (call
client where he reality is
the client by
or she is, etc.). concrete
name, tell the
client your  Time is spent reinforcement
with the client. for the client.
name, tell the
client where he  Positive  Positive
or she is, etc.). reinforcement is support can
reinforce the
 Spend time given to the
client about his client’s healthy
with the client.
good deeds. expression of
 Make only
feelings,
promises you
realistic plans,
can
and responsible
realistically
38
Chronic low self Client will a) Assess the self a) Client has very low a) Assessment Client’s self
esteem related to demonstrate concept of client. self esteem. provides the esteem is
lack of positive increased self b) Provide b) Psychological baseline data. enhanced . so
feedback esteem and psychological support is provided to b) It will enhance that she is able to
evidenced by perception of support to client. client. the self esteem do her work by
inability to himself as a c) Discuss c) Inaccuracies in self of client. her own and she
tolerate being worthwhile inaccuracies in perception are c) Client may not don’t need to
alone. person self perception discussed with client. see positive depend on others.
with client. d) Client is motivated aspects of self
d) Instruct the client to enlist the that others see.
to prepare a list of weaknesses and d) It will help the
weaknesses and strengths client develop
strengths. e) Positive feedback is internal self
e) Provide positive provided to client, worth.
feedback to client. when she has explored e) It will help the
her feelings. client to learn
new coping
behaviour.
keep. behavior after
discharge.

39
DISCHARGE PLAN

Patient not yet discharged and receiving treatments.

HEALTH EDUCATION
1) PERSONAL HYGIENE:
 Patient is taught about importance of personal hygiene of patient.
 He is advised to perform her self care activities independently.
 He is asked to perform hygiene practices daily.
2) DIET:
 Patient is taught about the importance of balanced diet.
 Patient is advised to take high fiber diet at small intervals.
 He is taught about foods that are contraindicated during taking particular medications.
3) EXERCISES:
 He is taught perform active and passive exercises.
 He is asked to take part in recreational activities
 He is asked to take help from family to carry out activities of daily life.
4) ENVIRONMENT:-
 Environment should be calm and safe for the patient.
 Attendant is asked to remove all the hazardous objects.
 No aggressive behaviour should be shown .
5) MEDICATIONS:-
 Patient is advised to take medication regularly.
 Patient is advised to inform immediately whenever any unusual symptoms appears.
 He is advised not to discontinue medicine by their own.
SUMMARY

I have taken the client with ' SUBSTANCE-INDUCED PSYCHOTIC DISORDER’ named
Chamanjeet Singh for my case study . The aim of the study is to demonstrate transfer of
knowledge of substance induced psychotic disorder pathophysiology, assessment, and treatment
planning to case situation. I interacted with the client and the family to understand the
predisposing factors and causes of the disease . The patient is 39 years old and has previous
history of substance induced psychotic disorder about 6 months ago . The patient was lived in
abroad and deported back to India because of intake of cannabis. The patient has problems of
auditory hallucinations , conflicts with the family , lack of personal hygiene . The patient has
complaints after non availability of drugs . A clear and logical case description ensuring essential
elements of the history , current care and outcome of the patient about substance induced
psychotic disorder are discussed and provided .

RECAPTUALIZATION

Upon completion of the case study, the researcher is able in :

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 1. Demonstrating transfer of knowledge of substance induced psychotic disorder
pathophysiology, assessment, and treatment planning to substance induced psychotic
disorder
2. Developing a multimodal treatment plan for a patient with substance induced
psychotic disorder patients according to their staging
3. Illustrating responsible therapy prescribing
4. Understanding complications of substance induced psychotic disorder

Bibliography:
 Ahuja Niraj. A short Textbook of Psychiatry. 7th ed. Jaypee Brothers.
 Lalitha K. Mental Health and Psychiatric Nursing.1st ed. VMG Book House.
 Sadock BJ, sadock VA. Kaplan &Sadock’s Synopsis of psychiatry. 10th ed. Lippincott.
 Mary CT. Psychiatric Mental Health Nursing. 4th ed. F.A.Davis.

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