Schizophrenia
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| What is schizophrenia? | a severe, lifelong illness that harms how your brain works and how you think.
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| What age do we usually start to see symptoms of schizophrenia in men & women? | Men = late teens to early 20s Women = mid-20s, to early 30s.
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| The primary mental mechanisms of schizophrenia are: | Repression, regression, projection & denial
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| What are negative symptoms? | "Negative" does not mean "bad." Negative symptoms are things that are "lost" from your personality or how you experience life because of schizophrenia.
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| NEGATIVE SYMPTOMS of schizophrenia include: | 1)not caring about things 2)having no interest or drive to do things 3)not taking care of oneself 4)they may find it hard to say how they feel or may become angry with strangers for no reason & react to others in harmful ways
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| What are positive symptoms? | "Positive" does not mean "good." Positive symptoms are things "added" or "new" to their personality or how they experience life because of schizophrenia.
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| POSITIVE SYMPTOMS of schizophrenia include: | 1)Hallucinations - HEAR & sometimes SEE see things that are not there 2)Delusions - often BELIEVE THINGS that are NOT TRUE 3)Thoughts & speech that are confusing
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| What is the most common form of hallucinations seen in schizophrenia? | AUDITORY FORMS are most common; VISUAL is the next most common.
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| With schizophrenia, their focus is __________; they create their own_____________. | thier focus is INWARD; they create their own WORLD --> they retreat to a fantasy world, rejecting the real world of painful experience while responding to reality in a bizarre or autistic manner
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| People with schizophrenia often have DISTURBED THOUGHT PROCESSES. This can be things such as: | 1)disorganized thoughts/confused thinking 2)loose associations 3)rapid or chaotic thoughts 4)jump from idea to idea 5)magical thinking 6)echolalia 7)neologism 8)word salad 9)concrete thinking
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| What are LOOSE ASSOCIATIONS? | a loss of the normal logical connections between one thought and the next; interrupted connections in thought, confused thinking.
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| What is ECHOLALIA? | a type of thought disorganization when one repeats words just spoken by another person; hear a word & repeat it.
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| What is NEOLOGISM? What do these words mean? What should the nurse do when the client uses NEOLOGISMS? | making up new words. These words do not mean anything. The nurse should SEEK CLARIFICATION - "I DON'T UNDERSTAND."
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| What is MAGICAL THINKING? | belief that thinking or wishing something can cause it to occur; belief that thoughts or wishes can control other people.
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| What is a WORD SALAD? | a mixture of words & phrases that lack comprehensive meaning or logical coherence; jumbles of words; incoherent speech
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| What is CONCRETE THINKING? | thinking characterized by immediate experience, rather than abstraction or interpretation.
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| What is an example of CONCRETE THINKING? | You can diagnose schizophrenia with asking the client an abstract question like "Can you please clean you plate" and they respond with concrete thinking by cleaning their plate with a towel.
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| People with schizophrenia can have a DISTURBED AFFECT. This can be: | 1)difficulty expressing emotions 2)inappropriate affect 3)flat affect 4)blunted affect 5)absent affect
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| INAPPROPRIATE AFFECT | an affect type that represents an unsual affective expression that does not match with the content of what is being said or thought
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| An example of an INAPPROPRIATE AFFECT is... | the client is laughing when they are talking about the death of their mother.
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| FLAT AFFECT | lack of emotional expression
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| BLUNT AFFECT | an affect type that represents significant reduction in the intensity of emotional expression
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| Which affect makes it difficult to form close relationships? | INAPPROPRIATE AFFECT
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| People with schizophrenia can have DISTURBANCE IN PSYCHOMOTOR BEHAVIOR. This can be: | 1)display of purposeless activity 2)behavior may be uninhibited & bizarre; abnormal posturing; waxy flexibility 3)often appears aloof, disinterested, apathetic & lacking motivation.
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| ABNORMAL POSTURING: | agitated or retardation catatonia
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| CATATONIA: | a syndrome of psychic & motoric disturbances, characterized by an extreme loss of motor skills
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| WAXY FLEXIBILITY | the feeling of plastic resistance, as if the person were made of wax, usually seen in catatonic schizophrenia
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| APATHY or APATHETIC | lack of feeling, emotion, concern or interest in others or the environment.
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| ALOOF | at a distance, especially in feeling or interst; apart; indifferent; disinterested
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| People with schizophrenia have DISTURBANCE IN INTERPERSONAL RELATIONSHIPS. This can mean: | 1)establishment of interpersonal relationships is difficult because of their inability to communicate clearly & react appropriately 2)difficulty relating to others
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| How does people with schizophrenia have difficulty relating to others? | 1)unable to form close relationships 2)has difficulty trusting others & experiences ambivilance, fear & dependency 3)"need-fear dilemma" 4)"as if" phenomenon
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| AMBIVALENCE | the coexistence of contradictory emotions, ideas, or desires with respect to a particular person, object or situation (ex: love & hate)
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| "NEED-FEAR DILEMMA" | withdraws to protect self from further hurt and consequently experiences lack of warmth, trust, and intimacy
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| "AS IF" PHENOMENON | feels rejected by others, which leads to increased isolation, perpetuating further feelings of rejection
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| IDEAS OF REFERENCE | the patient thinks that things completely disconnected from him are influencing him or conveying messages to him. For example, a person listening to the radio may believe that there is a special message in the broadcast directed specifically at them
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| DEPERSONALIZATION | feeling alienated/detached from oneself; difficulty distinguishing self from others; loss of boundries between self & environment
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| REGRESSION | childlike behavior that reappears in an adult under mental stress
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| NEGATIVISM | doing the opposite of what is asked; typical behavior is to speak to no one & answer no one; used to cover feelings of unworthiness & inadequacy
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| RELIGIOSITY | excessive religious preoccupation - they talk about the bible all the time
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| ****NOTE**** BUILDING TRUST IS THE PRIMARY GOAL FOR THE CLIENT WITH SCHIZOPHRENIA. | Maintain a therapeutic milieu; stay with cleint to promote safety; reducing fear & assisting client to communicate effectively are important nursing care measures.
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| What can the nurse do to build the trust of the schizophrenic client? | 1)use nonverbal communication to demonstrate warmth, concern & empathy because the client often distrusts words 2)the nurse should be CONSISTENT, RELIABLE, ACCEPTING & PERSISTENT - this helps to build trust
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| What can the nurse encourage the client to do in order to help build a trusting relationship between the nurse & the client? | 1)encourage free expression of feelings (either negative or positive) without fear of rejection, ridicule or retaliation. 2)allow the client to set the pace; proceed slowly in planning social contacts.
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| What can the nurse do to provide a safe and secure environment for the schizophrenic client? | 1)maintain familiar routines. Make sure persons who come in contact with the client are recognizable to the client. 2)avoid stressful situations or increasing anxiety.
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| What can the nurse do to clarify & reinforce reality? | 1)involve client in reality-oriented activities 2)help client find satisfaction in in the external environment & ways of relating to others 3)focus on clear communication & the IMMEDIATE situation
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| What can the nurse do to promote & build self-esteem in a client with schizophrenia? | 1)encourage SIMPLE activities with LIMITED concentration & NO COMPETITION 2)provide successful experiences with SHORT-RANGE GOALS realistic for client's level of functioning 3)relieve client of decision making until they are ready 4)avoid making demands
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| What can the nurse do to encourage independent behavior in a client with schizophrenia? | 1)anticipate & accept negativism 2)avoid fostering dependency 3)encourage client to make their own decisions, using POSITIVE REINFORCEMENT
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| What can the nurse do to help the cleint with schizophrenia to deal effectively with hallucinations? | 1)clarify & reinforce reality 2)encourage social interaction to help client find satisfactory ways of relating with others
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| What can the nurse do to clarify & reinforce reality in a schizophrenic client who is having hallucinations? | 1) help pt realize hallucination is a manifestation of anxiety 2)provide a safe, secure envt 3)avoid denying or arguing with pt when they are experiencing hallucinations 4) acknowledge pts experience but point out that you do not share the same experience
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| 5)do not give attention to content of hallucinations 6)direct client's attention to real situations, such as singing along with music 7)protect client from injury to self or others when they are prompted by "voices" or "visions"
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| SCHIZOPHRENIA - NURSING CONSIDERATIONS: | 1)Decrease stimuli 2)OBSERVE PT FREQUENTLY without looking suspicious 3)ORIENT PT FREQUENTLY (impt to know that pt may know person, place & time & still have delusions & hallucinations) 4)keep convo's REALITY based 5)make sure personal needs are met
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| What kind of medical treatment might the nurse assist in with a schizophrenic client? | 1)administer antipsychotic medications 2)assist with ECT; may be useful in some instances to modify behavior.
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| **NURSING PRIORITY** | The schizophrenic disorders constitute the LARGEST GROUP OF PSYCHOTIC DISORDERS IN SOCIETY (approximately 1% of the U.S. population)
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| **NURSING PRIORITY** | As the clients symptoms lessen, they will often discontinue therapy & medication, which can lead to recurrence of symptoms
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| ****NCLEX TIP***** What is the top nursing diagnosis for a schizophrenic client? | ALTERATION IN COMMUNICATION
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