Mental Health Nursing-NUR 417 Schizophrenia Lecture 5 Mental Health Nursing-NUR 417 Schizophrenia NUR 472

Introduction The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind). NUR 472

Introduction (cont.) More than any other mental illness, schizophrenia probably causes more Lengthy hospitalizations Chaos in family life Exorbitant costs to people and governments Fears NUR 472

Nature of the Disorder Schizophrenia: A serious mental disorder characterized by: Disorganized and delusional thinking (Thought processes) Disturbed perceptions/hallucinations Inappropriate emotions and actions (affect) With schizophrenia, there is a severe deterioration of social and occupational functioning NUR 472

Etiological Implications Schizophrenia is probably caused by a combination of factors, including Biological and Heritability predisposition Biochemical Causes Physiological factors Psychosocial stress Environmental factors NUR 472

Etiological Implications Biological and Heritability predisposition Genetics plays an important role in the development of schizophrenia. Biochemical Causes Dopamine Hypothesis: schizophrenia is caused by excessive dopamine activity. NUR 472

Predisposing Factors (cont.) Physiological influences Examples of Various physical conditions Epilepsy Birth trauma Head injury Alcohol abuse Cerebral tumor NUR 472

Predisposing Factors (cont.) Psychosocial influences Deeply disrupted family. Stressful life events. Environmental influences Viral epidemics: associated with viral diseases Low-socioeconomic NUR 472

Diagnosis Schizophrenia is diagnosed based on talking with the patient, and looking at his or her behaviour and experiences.

Diagnosis – Examples of Important Tests MRI (Magnetic resonance imaging) Identifies brain changes PET (Positron emission tomography) (is a nuclear medicine imaging) Determines brain activity EEG )Electroencephalography( An electrophysiological monitoring method to record electrical activity of the brain Neurologic examination Neuropsychologic tests NUR 472 10

Types of Schizophrenia Catatonic schizophrenia Characterized by marked psychomotor disturbance Catatonic stupor: characterized by extreme psychomotor retardation; patient usually mute Catatonic excitement: Extreme psychomotor agitation; purposeless movements that must be curtailed to prevent injury to client or others NUR 472

Types of Schizophrenia Disorganized schizophrenia Inappropriate affect Extremely disorganized behavior Social interaction impaired NUR 472

Types of Schizophrenia Paranoid schizophrenia Characterized by hallucinations, delusions, and persecutory (feeling victimized) or grandeur Client may be argumentative, and aggressive NUR 472

Types of Schizophrenia Residual schizophrenia Used to diagnose a person who has a history of at least one episode of schizophrenia with prominent psychotic symptoms NUR 472

Types of Schizophrenia Schizoaffective disorder Schizophrenic symptoms accompanied by a strong element of symptomatology associated with mood disorders, either manic or depressive NUR 472

Types of Schizophrenia Brief psychotic disorder Sudden onset of psychotic symptoms following a severe psychosocial stressor Symptoms persist less than 1 month NUR 472

Types of Schizophrenia Schizophreniform disorder Same symptoms as schizophrenia. The duration of the disorder has been at least 1 month but fewer than 6 months NUR 472

Types of Schizophrenia Undifferentiated schizophrenia Characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior NUR 472

Nursing Process: Assessment Content of thought Delusions: False personal beliefs Religiosity: Excessive demonstration of obsession with religious ideas and behavior Paranoia: Extreme suspiciousness of others

Nursing Process: Assessment (cont.) Content of thought (cont.) Word salad: Group of words put together in a random fashion Magical thinking: Idea that if one thinks something, it must be true Mutism: Inability or refusal to speak

Nursing Process: Assessment (cont.) Form of thought Associative looseness: Shift of ideas from one unrelated topic to another Neologisms: Made-up words that have meaning only to the person who invents them Perseveration: Persistent repetition of the same word or idea in response to different questions

Nursing Process: Assessment (cont.) Perception Hallucinations: False sensory perceptions not associated with real external stimuli Illusions: Misperceptions of real external stimuli

Nursing Process: Assessment (cont.) Affect: Emotional tone Inappropriate affect: Emotions are incongruent with circumstances Apathy: Lack of interest in environment Emotional ambivalence: Coexistence of opposite emotions toward same object

Nursing Process: Assessment (cont.) Sense of Self: The uniqueness and individuality a person feels Echolalia: Repeating words that are heard Echopraxia: Repeating movements that are observed

Nursing Process: Assessment (cont.) Impaired interpersonal functioning and relationship to the external world Autism Deterioration in appearance: Impaired personal grooming and self-care activities

Nursing Process: Assessment (cont.) Psychomotor behavior (cont.) Anergia: Deficiency of energy Posturing: Voluntary assumption of inappropriate or bizarre postures Pacing and rocking: Pacing back and forth and rocking the body

Nursing Process: Assessment (cont.) Positive and negative symptoms Positive symptoms: Excess or distortion of normal functions Negative symptoms: Deficit or loss of normal functions

List of Nanda Nursing Diagnosis for Schizophrenia Ineffective role performance Powerlessness Risk for injury Risk for other-directed violence Risk for self-directed violence Social isolation Imbalanced nutrition: Less than body requirements Impaired home maintenance Impaired social interaction Impaired verbal communication Ineffective coping

List of Nanda Nursing Diagnosis for Schizophrenia Disturbed personal identity Disturbed sensory perception (auditory, visual) Disturbed sleep pattern Disturbed thought processes Dressing or grooming self-care deficit Fear Anxiety Bathing or hygiene self-care deficit Disabled family coping Disturbed body image

Planning The client Demonstrates an ability to relate to others satisfactorily Recognizes distortions of reality Has not harmed self or others Perceives self realistically Demonstrates ability to perceive the environment correctly Maintains anxiety at a manageable level Demonstrates ability to trust others Uses appropriate verbal communication in interactions with others Performs self-care activities independently

Nursing interventions for the client with schizophrenia are aimed at: Implementation Nursing interventions for the client with schizophrenia are aimed at: Decreasing anxiety and establishing trust Assisting client to define and test reality Encouraging interaction with others Ensuring safety of client and others Meeting client’s self-care needs Promoting adaptive family coping

Implementation -Client/Family Education Management of illness Appropriate medication management Side effects of medications Importance of not stopping medications When to contact healthcare provider Relaxation techniques Social skills training Daily living skills training

Treatment Modalities Schizophrenia requires treatment that is comprehensive and presented in a multidisciplinary effort. Psychological treatments Individual psychotherapy: Long-term therapeutic approach difficult because of client’s impairment in interpersonal functioning

Treatment Modalities (cont.) Psychological treatments (cont.) Group therapy: Some success if participating over long-term course of the illness; less successful in short-term treatment Behavior therapy Occupational therapy

Treatment Modalities (cont.) Psychological treatments (cont.) Social skills training: Use of role play to teach client appropriate eye contact, interpersonal skills, posture, and so on, aimed at improving relationship development Electroconvulsive therapy

Treatment Modalities (cont.) Social treatment Milieu therapy: a type of inpatient therapy, involving prescription of particular activities and social interactions according to a patient's emotional and interpersonal needs Family therapy: Aimed at helping family members cope with long-term effects of illness

Treatment Modalities (cont.) Psychopharmacology Antipsychotics: Used to decrease agitation and psychotic symptoms Antiparkinsonian agents Others: example: Diazepam (used to treat anxiety disorders, or muscle spasms.) Propranolol (used to treat tremors, angina (chest pain), hypertension, heart rhythm disorders, and other heart or circulatory conditions.)

Treatment Modalities (cont.) Side effects for Antipsychotics (e. x:) Nausea; GI upset; weight gain Sedation Decreased libido Gynecomastia; amenorrhea The client should Not stop taking the drug abruptly Not consume other medications (including over-the-counter drugs) without the physician’s knowledge

Evaluation Evaluation questions Has client established trust with at least one staff member? Is anxiety level maintained at a manageable level? Is delusional thinking still prevalent? Is client able to interrupt anxiety with adaptive coping mechanisms? Is client easily agitated?