Nursing Care for Schizophrenic Patients with Violent Behavior from Amphetamine Use: Case Studies

Abstract

Objective : To compare the nursing care provided to two case studies of schizophrenic patients exhibiting violent behavior resulting from amphetamine use, and to utilize the findings as a clinical guideline for enhancing the efficiency of nursing interventions for this patient population.

Methodology : This study is a comparative case study of two schizophrenic patients with violent behavior induced by amphetamine use, who were admitted to the Ruam Jai Ward at Krabi Hospital between October 2023 and September 2024. Data were collected from medical records and analyzed by comparing the two cases through the application of the nursing process.

Results : The first case was a 29-year-old Thai male with a 6-year history of schizophrenia, complicated by methamphetamine and kratom use. Following methamphetamine consumption, he exhibited aggression, auditory hallucinations, and delirium, leading to the assault of a neighbor and destruction of property. After receiving care based on the clinical nursing practice guidelines for Serious Mental Illness with High Risk of Violence (SMI-V), there was no recurrence of violent behavior or complications from substance and psychiatric medication use, and his psychotic symptoms improved. The second case was a 39-year-old Thai male with a 15-year history of schizophrenia, co-occurring with the use of methamphetamine, kratom, and cannabis. Post-methamphetamine use, he presented with delirium, agitation, hallucinations, and a hostile gaze, leading to the assault of his brother-in-law and property damage. While managed under the SMI-V guidelines, he experienced complications from long-term substance abuse, including rhabdomyolysis, and developed acute dystonia due to the central nervous system depressant effects of multiple psychiatric medications, alongside amphetamine withdrawal. These conditions required intensive physical and mental health care, resulting in a prolonged hospital stay. Although both cases presented with psychiatric emergencies and violent behavior induced by amphetamine use, they differed significantly in disease severity, complications, and the complexity of problems, necessitating distinct nursing interventions.

Conclusion : Medical treatment combined with holistic nursing care ensured that both cases received individualized crisis management across all phases, including admission for aggressive behavior, stabilization, and pre-discharge. The care was guided by the protocols for Serious Mental Illness with High Risk of Violence (SMI-V) induced by amphetamine use. Discharge planning involved active caregiver participation to facilitate the patients' successful reintegration into their families and communities. Effective nursing processes were implemented, ranging from risk assessment and timely crisis intervention to rehabilitation aimed at preventing relapse. This included proactive care, close monitoring of vital signs and complications, and functional rehabilitation to enhance self-care abilities. Family readiness was prioritized through humanized counseling, emphasizing compassion and love. Caregivers played a vital role in ensuring treatment adherence, reducing aggressive behaviors, and preventing re-hospitalization. Furthermore, a multidisciplinary approach and community involvement were essential in providing continuous and sustainable care.