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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- May be withdrawn, lonely, and depressed as adolescents
- Patient reports:
- Mind wandering
- Difficulty concentrating
- Unwanted intrusive thoughts
- Misinterprets things
- Mistakes others as having a harmful intent
- As disease develops:
- Feels rejected
- Lonely, hopeless
- 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:
- Delusions: fixed false belief that is inconsistent with social norms.
- Hallucinations: misrepresentation of 5 senses. Auditory is the most common followed by visual.
- Disorganized speech
- Derailment: run off on tangents while speaking.
- Disorganized or catatonic behavior
- Negative symptoms
- Flat affect
- 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
- Highly suspicious
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
- Echolalia: Will "echo" things said.
- Echopraxia: 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:
- Disorganized speech
- Disorganized behavior
- 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
- Regression occurs:
- Preoccupied with self
What are some not-so-obvious assessment signs?
- Neologisms: making up new words
- Word salad
- Concrete thinking
- --Literal meanings
- --Specific details
- Emotionally labile
- Clang associations: 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
- Structure environment
- 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.)
- Maintain boundaries
- Not close, limit time &
- No touching