SCHIZOPHRENIA
MENTAL HEALTH NURSING
SCHIZOPHRENIA
Exercise 1.1
A. Define the term schizophrenia
B. List four clinical types schizophrenia
C. Explain the following personality features of a patient with schizophrenia
• Hallucination
• Delusion
• Indifference
D. Outline the general management of a schizophrenic patient
Answer:
A. Schizophrenia is a group of functional psychotic disorders with distortion of the ego characterized by hallucination, delusion, anhedonia, disturbance of behaviour and speech, lasting for a period of at least six months.
B. The four types of schizophrenia are:
• Catatonic
• Hebephrenic / disorganized type
• Paranoid
• Simple schizophrenia
C. Explanation of the following features of a patient with schizophrenia
• Hallucination
o This refers to false sensory perception without external stimuli
o There are five types namely:
Auditory hallucination
Visual hallucination
Tactile hallucination
Olfactory hallucination
Gustatory hallucination
• Delusion
o This refers to false believes by a person which cannot be corrected by any form of reasoning or arguments irrespective of the person’s educational, spiritual or socio-cultural background.
o Example is the grandiose delusion where the person feels he is higher (like a president) above his level.
o The types of delusion includes:
Somatic delusion
Nehislistic delusion
Persecutory delusion
Hypochonriacal delusion
• Indifference
o This is a term used to describe the inability to differentiate between the deferent types of schizophrenia.
o For this condition, the individual shows mixed signs from all or most of the schizophrenia types.
D. General management of schizophrenia
• Personal hygiene
o Ensure regular care of the mouth
o Provide Skin care: assist patient during bathing if he cannot do it himself or perform for the patient if unconscious, especially care of the perineal area
o Groom the hair
• Nutrition
o Serve a well-balanced diet
o Serve copious fluid if dehydrated
o Serve food in bits but attractively
o If unconscious ,administer IV fluids
• Observation
o Observe the insertion of the IV fluids, if on IV fluids.
o Observe intake and output, by maintaining intake and output chart
o Observe the vital signs (TPR & BP)
o Observe the state of consciousness
o Observe the mental status of the patient
• Medication
o Serve the prescribed medication taking into consideration the 7 R’s of the patient
• Protection
o Nurse patient on low bed
o Ensure close observation of patient
o Medication should be under lock plus no medication should be left in patient’s room
o All dangerous articles should be removed from patients room to avoid suicide attempts
• Psychological
o Establish rapport
o Ensure good nurse-patient relationship
o Encourage family members to visit client regularly
o Explain all procedures to patient before carrying out
Exercise 1.2
Edem Kojovi a student aged 19 years is admitted to your ward with the diagnosis of schizophrenia
a. Explain the term schizophrenia
b. List six signs and symptoms of simple schizophrenia
c. Describe how you will manage Kojovi physically and psychologically
Answer:
a. Explanation of the term schizophrenia
o Schizophrenia is a functional psychotic disorder characterized by bizarre thinking, attitude, behaviour and an incongruous affect which affects the person’s social and occupational function and persist for a period of 6 months.
b. Six and symptoms of simple schizophrenia
o The patient exhibits progressive poor interpersonal relationship
o The patient shows disinterest in activities
o Unable to hold onto jobs or gainful employment
o Neglect of personal hygiene
o The patient usually drops out of school or is unable to cope with formal training
o The patient goes about begging for food
o The patient engages in criminal activities such as robbery, shoplifting and prostitution
o The patients takas to vagrancy
o He patient as shallow affect and for that matter is callous
o The patient has no remorse for his behaviour
o The patient engages in expensive jokes that can be damaging.
c. Management of Kojovi both physically and psychologically
• Physical management
o Personal hygiene
Assist or ensure that patient baths, brushed his teeth and is properly groomed and clothed
o Diet
Patient should be served a well-balanced diet, presented attractively
Ensure patient eats and is satisfied
Encourage adequate intake of fluid to prevent dehydration
o Rest and sleep
Provide patient with a comfortable bed and bedding
Encourage patient to take a shower to induce sleep
Engage patient in activities during the day to induce sleep at night
o Observation
Observe patients behaviour and record
Note signs of improvement or deterioration
Observe for signs of dehydration
Observe the elimination patterns
Monitor vital signs and record
o Protective care
Observe for and manage suicidal and homicidal tendencies
Protect patient from other patients during stupurous phase and also from other dangers
o Medication
Administer prescribed medication such as major tranquilizers. E.g. phenothiazine –chlorpromazine
Ensure and monitor appropriate administration of electro convulsive therapy (ECT) if drugs do not improve condition
• Psychological management
o Reassure patient and relatives
o Establish good nurse- patient relationship on admission
o Listen to patient’s concerns and show empathy
o Involve the patient in group activities since they tend to withdraw easily
o Involve patients in any task on the ward
o Allow visitors to visit patient regularly and during this period social learning is encouraged.
o Use Diversional therapy both on ward or outside the ward
o Token economy can be used to help patient establish activities of daily living, to help correct bizarre and disruptive behaviors.
o Counselling
Exercise 1.3
Outline both the positive and negative symptoms of schizophrenia
Answer:
Schizophrenia: Positive Symptoms
• Excessive dopamine D2 receptor activity,
• Disorganized thinking
• Unusual speech
• Odd behavior
• Delusion
• Hallucinations; still interacting with the "outside"
• Illusion
o Misperception of real external stimulus
Schizophrenia: Negative Symptoms
• Dopamine D1 receptor activity
• Social withdrawal and isolation
• Dull/blunted affect
• Poverty of speech
• Posturing or remaining in one position
• Autism,
• Apathy
Exercise 1.4
Describe the following types of schizophrenia
• Deficit schizophrenia
• Paranoid schizophrenia
• Disorganized schizophrenia
• Catatonic schizophrenia
• Undifferentiated
• Residual schizophrenia
Answer:
• Deficit schizophrenia
o A distinct subtype of schizophrenia characterized by significant and persistent negative symptoms with an insidious onset of schizophrenia, a progressive deteriorating course, poor social and occupational functioning, and resistance to antipsychotic meds. Strong genetic factor.
• Paranoid Type
o This involves preoccupation with one or more delusions or frequent auditory hallucinations and none of the following: disorganized speech, disorganized or catatonic behavior, or flat/inappropriate affect.
o Suspiciousness toward others and increased hostility is more characteristic of paranoid schizophrenia
• Disorganized Type
o Disorganized schizophrenia is characterized by regressive behavior with extreme social withdrawal and frequently odd mannerisms.
o This type is characterized by: Disorganized speech, disorganized behavior, flat or inappropriate affect, and criteria not met for catatonic type.
• Catatonic Type
o It is characterized by at least 2:
Motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor.
excessive motor activity (purposeless/not influenced by external stimuli)
Extreme negativism (motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or Mutism
Peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures)
Stereotyped movements
Prominent mannerisms, or prominent grimacing
echolalia/echopraxia
o Psychomotor immobility and presence of waxy flexibility are more indicative of catatonic schizophrenia.
• Undifferentiated Type
o Symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, disorganized, or catatonic type
• Residual Type Schizophrenia.
o It is characterized by absence of prominent acute symptoms and impaired role functions such as delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior and continuing evidence of the disturbance, as indicated by the presence of negative symptoms.
Exercise 1.5
What are the 3 main causes of schizophrenia?
Answer:
• Environmental
• Genetic
• Combined
Exercise 1.6
What environmental factors cause schizophrenia?
Answer:
• Maternal infections (rubella, polio, chicken pox),
• OB complications (bleeding, low birth weight, emergency C-section)
Exercise 1.7
What genetic factors cause schizophrenia?
Answer:
• Cerebral cortex injury (due to anemia, anoxia, ischemia),
• Advanced paternal age (mutations in the sperm),
• Neurobiology (development, neurochemicals, brain structure; nerve cells travel to the wrong place)
Exercise 1.8
What combined environmental factors cause schizophrenia?
Answer:
• (Diathesis-Stress Model) Maturational changes or life events trigger the onset
Exercise 1.9
Outline the phases of schizophrenia
Answer:
• Phase I The premorbid phase
o Stage of schizophrenia during which personality often indicates social maladjustment, social withdrawal, irritability, and antagonistic thoughts and behavior. May be very shy and withdrawn, having poor peer relationships, doing poorly in school, and demonstrating antisocial behavior. May enjoy solitary activities.
• Phase II The prodromal phase
o Stage of schizophrenia. This phase refers to certain signs and symptoms that precede the characteristic manifestations of the acute, fully developed illness. Begins with a change from premorbid functioning and extends until onset of symptoms. Stage can be as brief as a few weeks or months, but average length is between 2 and 5 years. Person experiences substantial functional impairment and nonspecific symptoms such as a sleep disturbance, anxiety, irritability, itchy, depressed mood, poor concentration, fatigue, and behavioral deficits such as social withdrawal.
o Positive symptoms such as: perceptual abnormalities, ideas of reference, suspiciousness
o Recognition provides opportunity for early treatment
• Phase III Schizophrenia
o This is the active phase of schizophrenia disorder; psychotic symptoms are prominent. Includes characteristic symptoms, social/occupational dysfunction, durational signs and symptoms. there is an exclusion of schizoaffective and mood disorder
o Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms are characteristic symptoms of schizophrenia which may be present for a significant portion of time during a 1-month period.
• Phase IV Residual phase
o Schizophrenia is characterized by periods of remission and exacerbation. This phase of schizophrenia usually follows an active phase; symptoms of the acute stage are either absent or no longer prominent. Negative symptoms MAY REMAIN, and FLAT AFFECT AND IMPAIRMENT IN ROLE FUNCTIONING ARE COMMON. Residual impairment often increases between episodes of active psychosis
Exercise 1.9
What are 3 broad outcomes for patients with schizophrenia?
Answer:
• Reducing or eliminating symptoms
• Improving quality of life and adaptive functioning
• Enabling recovery by helping clients attain personal life goals
Exercise 2.1
Outline the 3 priorities of planning care for a schizophrenic patient?
Answer:
• Prevention of violence
• Altered cognition
• Compromised social relationships
Exercise 2.2
State few Potential dx with/for patient with schizophrenia?
Answer:
• Altered thought process
• Social isolation
• Self-esteem disturbance
• Anxiety
• Knowledge deficit
• Fatigue
Exercise 2.3
Outline the focus of nursing interventions for schizophrenia?
Answer:
• Hospitalization
• Meds
• Individual and group therapy
Exercise 2.4
What is the long term goal for schizophrenia?
Answer:
• Recovery
Exercise 2.5
Describe the education for schizophrenic patient and family.
Answer:
• Offer support,
• Teach family to manage conflict,
• Avoid criticism of one another,
• Decrease overprotective behavior
• Develop appropriate expectations
• Share observations and experiences.
Exercise 2.6
Outline the effective communication techniques used with/foe patient with schizophrenia
Answer:
• Active listening,
• Asking appropriate questions,
• Decrease stimuli
• Avoid loud noises
SCHIZOPHRENIA
Exercise 1.1
A. Define the term schizophrenia
B. List four clinical types schizophrenia
C. Explain the following personality features of a patient with schizophrenia
• Hallucination
• Delusion
• Indifference
D. Outline the general management of a schizophrenic patient
Answer:
A. Schizophrenia is a group of functional psychotic disorders with distortion of the ego characterized by hallucination, delusion, anhedonia, disturbance of behaviour and speech, lasting for a period of at least six months.
B. The four types of schizophrenia are:
• Catatonic
• Hebephrenic / disorganized type
• Paranoid
• Simple schizophrenia
C. Explanation of the following features of a patient with schizophrenia
• Hallucination
o This refers to false sensory perception without external stimuli
o There are five types namely:
Auditory hallucination
Visual hallucination
Tactile hallucination
Olfactory hallucination
Gustatory hallucination
• Delusion
o This refers to false believes by a person which cannot be corrected by any form of reasoning or arguments irrespective of the person’s educational, spiritual or socio-cultural background.
o Example is the grandiose delusion where the person feels he is higher (like a president) above his level.
o The types of delusion includes:
Somatic delusion
Nehislistic delusion
Persecutory delusion
Hypochonriacal delusion
• Indifference
o This is a term used to describe the inability to differentiate between the deferent types of schizophrenia.
o For this condition, the individual shows mixed signs from all or most of the schizophrenia types.
D. General management of schizophrenia
• Personal hygiene
o Ensure regular care of the mouth
o Provide Skin care: assist patient during bathing if he cannot do it himself or perform for the patient if unconscious, especially care of the perineal area
o Groom the hair
• Nutrition
o Serve a well-balanced diet
o Serve copious fluid if dehydrated
o Serve food in bits but attractively
o If unconscious ,administer IV fluids
• Observation
o Observe the insertion of the IV fluids, if on IV fluids.
o Observe intake and output, by maintaining intake and output chart
o Observe the vital signs (TPR & BP)
o Observe the state of consciousness
o Observe the mental status of the patient
• Medication
o Serve the prescribed medication taking into consideration the 7 R’s of the patient
• Protection
o Nurse patient on low bed
o Ensure close observation of patient
o Medication should be under lock plus no medication should be left in patient’s room
o All dangerous articles should be removed from patients room to avoid suicide attempts
• Psychological
o Establish rapport
o Ensure good nurse-patient relationship
o Encourage family members to visit client regularly
o Explain all procedures to patient before carrying out
Exercise 1.2
Edem Kojovi a student aged 19 years is admitted to your ward with the diagnosis of schizophrenia
a. Explain the term schizophrenia
b. List six signs and symptoms of simple schizophrenia
c. Describe how you will manage Kojovi physically and psychologically
Answer:
a. Explanation of the term schizophrenia
o Schizophrenia is a functional psychotic disorder characterized by bizarre thinking, attitude, behaviour and an incongruous affect which affects the person’s social and occupational function and persist for a period of 6 months.
b. Six and symptoms of simple schizophrenia
o The patient exhibits progressive poor interpersonal relationship
o The patient shows disinterest in activities
o Unable to hold onto jobs or gainful employment
o Neglect of personal hygiene
o The patient usually drops out of school or is unable to cope with formal training
o The patient goes about begging for food
o The patient engages in criminal activities such as robbery, shoplifting and prostitution
o The patients takas to vagrancy
o He patient as shallow affect and for that matter is callous
o The patient has no remorse for his behaviour
o The patient engages in expensive jokes that can be damaging.
c. Management of Kojovi both physically and psychologically
• Physical management
o Personal hygiene
Assist or ensure that patient baths, brushed his teeth and is properly groomed and clothed
o Diet
Patient should be served a well-balanced diet, presented attractively
Ensure patient eats and is satisfied
Encourage adequate intake of fluid to prevent dehydration
o Rest and sleep
Provide patient with a comfortable bed and bedding
Encourage patient to take a shower to induce sleep
Engage patient in activities during the day to induce sleep at night
o Observation
Observe patients behaviour and record
Note signs of improvement or deterioration
Observe for signs of dehydration
Observe the elimination patterns
Monitor vital signs and record
o Protective care
Observe for and manage suicidal and homicidal tendencies
Protect patient from other patients during stupurous phase and also from other dangers
o Medication
Administer prescribed medication such as major tranquilizers. E.g. phenothiazine –chlorpromazine
Ensure and monitor appropriate administration of electro convulsive therapy (ECT) if drugs do not improve condition
• Psychological management
o Reassure patient and relatives
o Establish good nurse- patient relationship on admission
o Listen to patient’s concerns and show empathy
o Involve the patient in group activities since they tend to withdraw easily
o Involve patients in any task on the ward
o Allow visitors to visit patient regularly and during this period social learning is encouraged.
o Use Diversional therapy both on ward or outside the ward
o Token economy can be used to help patient establish activities of daily living, to help correct bizarre and disruptive behaviors.
o Counselling
Exercise 1.3
Outline both the positive and negative symptoms of schizophrenia
Answer:
Schizophrenia: Positive Symptoms
• Excessive dopamine D2 receptor activity,
• Disorganized thinking
• Unusual speech
• Odd behavior
• Delusion
• Hallucinations; still interacting with the "outside"
• Illusion
o Misperception of real external stimulus
Schizophrenia: Negative Symptoms
• Dopamine D1 receptor activity
• Social withdrawal and isolation
• Dull/blunted affect
• Poverty of speech
• Posturing or remaining in one position
• Autism,
• Apathy
Exercise 1.4
Describe the following types of schizophrenia
• Deficit schizophrenia
• Paranoid schizophrenia
• Disorganized schizophrenia
• Catatonic schizophrenia
• Undifferentiated
• Residual schizophrenia
Answer:
• Deficit schizophrenia
o A distinct subtype of schizophrenia characterized by significant and persistent negative symptoms with an insidious onset of schizophrenia, a progressive deteriorating course, poor social and occupational functioning, and resistance to antipsychotic meds. Strong genetic factor.
• Paranoid Type
o This involves preoccupation with one or more delusions or frequent auditory hallucinations and none of the following: disorganized speech, disorganized or catatonic behavior, or flat/inappropriate affect.
o Suspiciousness toward others and increased hostility is more characteristic of paranoid schizophrenia
• Disorganized Type
o Disorganized schizophrenia is characterized by regressive behavior with extreme social withdrawal and frequently odd mannerisms.
o This type is characterized by: Disorganized speech, disorganized behavior, flat or inappropriate affect, and criteria not met for catatonic type.
• Catatonic Type
o It is characterized by at least 2:
Motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor.
excessive motor activity (purposeless/not influenced by external stimuli)
Extreme negativism (motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or Mutism
Peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures)
Stereotyped movements
Prominent mannerisms, or prominent grimacing
echolalia/echopraxia
o Psychomotor immobility and presence of waxy flexibility are more indicative of catatonic schizophrenia.
• Undifferentiated Type
o Symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, disorganized, or catatonic type
• Residual Type Schizophrenia.
o It is characterized by absence of prominent acute symptoms and impaired role functions such as delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior and continuing evidence of the disturbance, as indicated by the presence of negative symptoms.
Exercise 1.5
What are the 3 main causes of schizophrenia?
Answer:
• Environmental
• Genetic
• Combined
Exercise 1.6
What environmental factors cause schizophrenia?
Answer:
• Maternal infections (rubella, polio, chicken pox),
• OB complications (bleeding, low birth weight, emergency C-section)
Exercise 1.7
What genetic factors cause schizophrenia?
Answer:
• Cerebral cortex injury (due to anemia, anoxia, ischemia),
• Advanced paternal age (mutations in the sperm),
• Neurobiology (development, neurochemicals, brain structure; nerve cells travel to the wrong place)
Exercise 1.8
What combined environmental factors cause schizophrenia?
Answer:
• (Diathesis-Stress Model) Maturational changes or life events trigger the onset
Exercise 1.9
Outline the phases of schizophrenia
Answer:
• Phase I The premorbid phase
o Stage of schizophrenia during which personality often indicates social maladjustment, social withdrawal, irritability, and antagonistic thoughts and behavior. May be very shy and withdrawn, having poor peer relationships, doing poorly in school, and demonstrating antisocial behavior. May enjoy solitary activities.
• Phase II The prodromal phase
o Stage of schizophrenia. This phase refers to certain signs and symptoms that precede the characteristic manifestations of the acute, fully developed illness. Begins with a change from premorbid functioning and extends until onset of symptoms. Stage can be as brief as a few weeks or months, but average length is between 2 and 5 years. Person experiences substantial functional impairment and nonspecific symptoms such as a sleep disturbance, anxiety, irritability, itchy, depressed mood, poor concentration, fatigue, and behavioral deficits such as social withdrawal.
o Positive symptoms such as: perceptual abnormalities, ideas of reference, suspiciousness
o Recognition provides opportunity for early treatment
• Phase III Schizophrenia
o This is the active phase of schizophrenia disorder; psychotic symptoms are prominent. Includes characteristic symptoms, social/occupational dysfunction, durational signs and symptoms. there is an exclusion of schizoaffective and mood disorder
o Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms are characteristic symptoms of schizophrenia which may be present for a significant portion of time during a 1-month period.
• Phase IV Residual phase
o Schizophrenia is characterized by periods of remission and exacerbation. This phase of schizophrenia usually follows an active phase; symptoms of the acute stage are either absent or no longer prominent. Negative symptoms MAY REMAIN, and FLAT AFFECT AND IMPAIRMENT IN ROLE FUNCTIONING ARE COMMON. Residual impairment often increases between episodes of active psychosis
Exercise 1.9
What are 3 broad outcomes for patients with schizophrenia?
Answer:
• Reducing or eliminating symptoms
• Improving quality of life and adaptive functioning
• Enabling recovery by helping clients attain personal life goals
Exercise 2.1
Outline the 3 priorities of planning care for a schizophrenic patient?
Answer:
• Prevention of violence
• Altered cognition
• Compromised social relationships
Exercise 2.2
State few Potential dx with/for patient with schizophrenia?
Answer:
• Altered thought process
• Social isolation
• Self-esteem disturbance
• Anxiety
• Knowledge deficit
• Fatigue
Exercise 2.3
Outline the focus of nursing interventions for schizophrenia?
Answer:
• Hospitalization
• Meds
• Individual and group therapy
Exercise 2.4
What is the long term goal for schizophrenia?
Answer:
• Recovery
Exercise 2.5
Describe the education for schizophrenic patient and family.
Answer:
• Offer support,
• Teach family to manage conflict,
• Avoid criticism of one another,
• Decrease overprotective behavior
• Develop appropriate expectations
• Share observations and experiences.
Exercise 2.6
Outline the effective communication techniques used with/foe patient with schizophrenia
Answer:
• Active listening,
• Asking appropriate questions,
• Decrease stimuli
• Avoid loud noises
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