A patient with schizophrenia, aged 60 years, spent 5 years in a state hospital before being discharged to a community residence

Question

The patient requires persistent direction to accomplish daily activities of living, has difficulty determining what to do with his time, and is resistant to behaving independently, expecting others to provide meals or wash his clothes. The nurse assesses this passive behavior as being the probable result of: a. dependency caused by institutionalization.
b. cognitive deterioration from schizophrenia.
c. brain damage from recreational drug use.
d. side effects of neuroleptic medications.

Answer 1

A
Institutions such as state hospitals or corrections facilities tend to impede independent functioning; daily activities, for example, are planned and directed by staff, meals are provided by others and only at set times, and so forth. Over time, patients became dependent on the institution and its staff to meet their needs and adapt to being cared for rather than caring for themselves. When these patients were discharged into the community, many continued to demonstrate passive behaviors despite efforts to promote renewed independent activity. Cognitive dysfunction and neuroleptic side effects can make planning and carrying out activities more difficult, but the pattern here is more suggestive of adjustment to institutional care and difficulty readjusting to independence instead. The scenario does not suggest recreational drug use.