Schizophrenia

• Psychotic:

  • Reality contact is distorted or lost
  • This is the primary symptom of schizophrenia and must be present at some point for one to get diagnosed
• Symptoms of Psychosis:

  • Hallucinations and/or illusions
  • Delusions: fixed false beliefs
  • Disorganized thought and/or speech
  • Extreme excitement
  • Confusion
  • Unfounded fear/suspicion
• Conditions that may induce psychotic symptoms:

  • Alcohol and Tobacco use disorder
  • Dementia and degenerative brain disorders
  • Delirium
  • Stroke, brain tumors, epilepsy
  • Metabolic disorders
  • Sleep deprivation
• Psychiatric Illnesses that involve Psychosis:

  • Bipolar mania
  • Severe depression
  • Schizophrenia
  • Schizoaffective
  • Delusions disorder
• Communication Principles with Hallucinations and Delusions:

  • Purpose of meeting:
  • "To see how you are doing today!"
  • Listen
  • Assess for Danger:
  • "What are the voices saying?"
  • Do not reinforce delusions, focus on the experience or feeling:
  • "It must be frightening to think the FBI is coming to hurt you"
  • Avoid logical arguments
• Types of Antipsychotic Medications:

  • Typical
  • Atypical
• Typical Antipsychotics:

  • Act primarily on positive symptoms
  • Dopamine is affected
• Atypical Antipsychotics:

  • Act on positive AND negative symptoms
  • Dopamine and serotonin are affected
  • Fewer EPS (Extrapyramidal symptoms)
  • Prolactin levels NOT impacted
• Nursing Care in the Acute Phase consists of:

  • Biological nursing roles
  • Psychological nursing roles
• Biological Nursing Roles (Acute phase):

  • Medication administration and education
  • Assessing for physical comorbidities
  • Prevention (nutrition, activity) to decrease potential weight gain and diabetes
  • Self-care for hygiene issues (if indicated)
  • Protection from temperature changes (thermoregulation issues)
• Psychological Nursing Roles (Acute phase):

  • Assessment of Mental Status changes:
  • Affect appropriateness, affect, lability, thought processes, delusions, hallucinations, anosognosia
  • Safety
  • Relationship building (purpose, consistent checking in, respect)
  • Redirect if possible
  • Acknowledge and indicate your differences in perception/thought
• Quality of Life Nursing Roles (Stabilization Phase):

  • Enhance social and work functioning
  • Identify and support links with family and social system
  • Illness management and recovery
  • Pursue personal goals and develop a sense of identity
  • CBT
  • Assertive community treatment
  • Relapse prevention
  • Coping skills training
• Typical Antipsychotics:

  • Haldol (Haloperidol)
  • Prolixin (Fluphenazine)
  • Thorazine (Chlorpromazine)
• Atypical Antipsychotics:

  • Clozaril (Clozapine)
  • Most effective and agranulocytosis risk
  • Risperdal (Risperidone)
• Positive (Excess) Symptoms:

  • Delusions
  • Hallucinations
  • Disorganized thinking (speech)
  • Grossly disorganized motor behavior
• Negative (Less of) Symptoms:

  • Flat affect (Diminished emotional expression)
  • Avolition (Decrease in motivation)
  • Anhedonia (Decrease in pleasure)
  • Alogia (Decreased speech)
  • Asociality (Lack of social interest)