Card Set Information
Which disorder is the biggie for the homeless population?
Chronic mentally ill are 35% to 50% of homeless population
What is schizophrenia?
Impairment in reality testing
Loss of ego boundaries
Has a biological basis
Is related to genetics
Problem with the way they think & perceive
Takes over the person’s life
What is the neurochemical theory on schizophrenia?
Overproduction of dopamine
Decreased blood flow to frontal cortex
Cat scans, MRI and PET scans- show brain changes
What is the Genetic theory of schizophrenia?
People have the
schizophrenic gene so strong genetic component.
Activated by early childhood life or traumatic experience (activating event), exposure to toxic substances
What is the typical course of the disease?
Experience symptoms 1 month to 1 year before first break:
May be withdrawn, lonely, and depressed as adolescents
Unwanted intrusive thoughts
Mistakes others as having a harmful intent
As disease develops:
Withdraws emotionally & physically, isolates
Unable to trust others
Withdraws from reality
Begins delusions & hallucinations
Has odd mannerisms
Some think their thoughts are controlled by others or broadcasted
Voices seem to come from outside the person
Preoccupied with religion, mysticism or metaphysical
What is the DSM-IV definition of schizophrenia?
Two or more of:
: fixed false belief that is inconsistent with social norms.
: misrepresentation of 5 senses. Auditory is the most common followed by visual.
: run off on tangents while speaking.
Disorganized or catatonic behavior
Social/occupational or ADL’s dysfunction
Signs persist for 6 months with at least 1 month of symptoms
R/O medical condition or other psychiatric disorder
What is paranoid type of schizophrenia?
Delusions- persecutory & grandiose & may be organized around a theme
Associated features: anxiety, anger, aloofness, & argumentativeness
Has a superior, patronizing manner, stilted or formal quality
What is the catatonic type schizophrenia?
Motor immobility or stupor, waxy flexibility
Excessive motor activity, purposeless
Negativism- moveless resistance, mute
Peculiarities of voluntary movement
--Posturing ( assuming inappropriate bizarre postures], prominent mannerisms & grimacing
: Will "echo" things said.
: Will mimic gestures.
What is undifferentiated type?
When you can't figure out which kind it is.
How can you tell the difference between schizophrenia and a brief psychotic reaction?
Not schizophrenia if one or more of:
Duration: 1 day to 1 month
With or without marked stressor present
What is schizoaffective disorder
Either a manic or depressive episode +
Symptoms of hallucinations and delusions
Speech has obscure symbolism
Speech often understood as their relating to a private world
May have doubts about sexuality & may become hypersexual
Has fears of intimacy
Preoccupied with self
What are some not-so-obvious assessment signs?
: making up new words
: rhyme conversation.
Depersonalization: a feeling of unreality from self, difficulty distinguishing self from others.
What are some nursing interventions for schizophrenia?
Protect the patient & others from harm
Administer Medications & monitor side effects
Administer medications as needed for side effects and behavioral management
Present reality (esp with hallucinations)
Monitor and deal with pts anxiety (increase in delusions & hallucinations
Prompt with self-care activities as needed
Focus on here & now
Deal with patients who refuse medication
Establish a relationship through consistency and predictability
Deal with aggression
May need PRN medication
Deal with pts who are escalating or getting out of control: De-escalate, distract, quiet room, contain as last resort
What is the focus or theme of nursing interventions for schizophrenics?
Focus on underlying unmet need or feeling. Will need to pick up on theme of delusion or hallucination.
Do not focus on content of delusion
DO NOT ATTEMPT TO LOGICALLY EXPLAIN THE DELUSION OR PROVE IT WRONG
Gain the content of the delusion without reinforcing it, ie “
Are they good voices or bad voices?
Nursing interventions of paranoid schizophrenia?
Ask indirect questions, i.e., "I'm wondering if..." "I suppose you..."
Be honest & consistent
Let patient set interpersonal distance
Evaluate delusional themes & feeling content
Use non-defensive stance
Use simple, clear words
Do not argue with content of delusions
Clarify & restate role
No touching, except for vital signs. Be sure to get BP for pts on antipsychotics (orthstatic hypotension.)
Not close, limit time &