Inpatient Psychiatric Unit

Case Study: 14

You are working on an inpatient psychiatric unit conducting the initial assessment on 22 year old man brought in last night by police after he was found sitting in the middle of the campus circular drive at Oakland University.  By way of explanation, he shares that “I was told to do it or else bad things would happen to us on campus. You don’t understand, people aren’t who they say they are.”

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Robert has never been treated psychiatrically before.  He tells you that he has been attending the university and living at home with his parents. He has always been a good student and has been active socially. Last semester his grades began declining, and he became very withdrawn.  He is enrolled in school but has been missing classes and is apathetic about his studies.  He spends most of his time alone in his room. His grooming has deteriorated; he may go days without bathing. For several weeks before admission he insisted on keeping all of the blinds and curtains in the house closed. For the past 2 days he will only eat things that are pre-packaged because “They have contaminated the food.”  He denies current drug or alcohol use, although he reports that he occasionally smoked marijuana in the past.  He says that he has discontinued this practice over the past 6 months because he can no longer afford it, and claims that marijuana was helping him feel more comfortable and relaxed.  Robert denies any medical problems and is taking no medications.

On a mental status examination, he does appear disheveled with marginal hygiene.  He appears somewhat hyper-vigilant with his new surroundings, scanning the room with his eyes and maintains his back to a wall as he paces back and forth in the room.  He states that his mood is “okay.”  His affect is congruent, although flat.  His speech is of normal rate, rhythm, and tone.  His thought processes are tangential, and loose associations are occasionally noted.  His thought content is positive for delusions and auditory hallucinations are suspected due to his latency of response and whispering under his breath during the evaluation.


1. Per the DSM criteria, please list the positive and negative symptoms that would indicate that Robert might have a Schizophrenia Spectrum Disorder? 

2. What other disorders may have psychotic presentations? Please list and contrast. 

3. Provide a list of nursing diagnoses for this scenario.

4. Psychotropic medications are the drugs of choice for psychotic or agitated conditions.  Please explain the benefits and risk profiles of “typical vs atypical antipsychotics”. 

5. What are extrapyramidal symptoms and how are they treated?


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