lecture 6 community and mental health nursing-nur 472 schizophrenia
TRANSCRIPT
Introduction Introduction
The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind).
Introduction (cont.)Introduction (cont.)
More than any other mental illness, schizophrenia probably causes more Lengthy hospitalizations Chaos in family life Exorbitant costs to people and governments Fears
Nature of the Disorder Nature of the Disorder
Schizophrenia:A serious mental disorder characterized by:
Disorganized and delusional thinking (Thought processes)
Disturbed perceptions/hallucinations Inappropriate emotions and actions (affect)
With schizophrenia, there is a severe deterioration of social and occupational functioning
Nature of the Disorder (cont.)Nature of the Disorder (cont.)
Premorbid behavior of the client with schizophrenia can be viewed in four phases.
First PhaseFirst Phase
Schizoid personality Indifferent, these people are loners. They do not
enjoy close relationships with others.
Second PhaseSecond Phase
Prodromal phase
These people are socially withdrawn and show evidence of peculiar behavior
Neglect of personal hygiene and grooming Inappropriate affect Disturbances in communication Bizarre ideas
Third PhaseThird Phase
Schizophrenia
In the active phase of the disorder, psychotic symptoms are prominent Delusions Hallucinations Impairment in work, social relations, and self-care
Etiological ImplicationsEtiological Implications
Schizophrenia is probably caused by a
combination of factors, including Biological and Heritability predisposition Biochemical Causes Physiological factors Psychosocial stress Environmental factors
Etiological ImplicationsEtiological Implications
Biological and Heritability predispositionGenetics plays an important role in the development of schizophrenia.10% in those who have immediate family member.40% if disease affect in both parents.
Biochemical CausesDopamine Hypothesis: schizophrenia is caused by excessive dopamine activity.
Predisposing Factors (cont.)Predisposing Factors (cont.) Physiological influences Examples of Various physical conditions
Epilepsy Birth trauma Head injury Alcohol abuse Cerebral tumor
Predisposing Factors (cont.)Predisposing Factors (cont.)
Psychological influences Deeply disrupted family. Impaired sexual identity or body image. Stressful life events.
Environmental influences Viral epidemics: associated with viral diseases Prenatal malnutrition Low-socioeconomic
Schizophrenia is diagnosed based on talking with the patient, and looking at his or her behaviour and experiences.
DiagnosisDiagnosis
MRI Identifies brain changes
PET (Positron emission tomography) (is a nuclear medicine imaging) Determines brain activity
EEG Reveals electrical activity
Neurologic examination Neuropsychologic tests
Diagnosis – Examples of Important Tests
Types of SchizophreniaTypes of Schizophrenia
Catatonic schizophrenia Catatonic stupor: characterized by extreme
psychomotor retardation; patient usually mute
Catatonic excitement: Extreme psychomotor agitation; purposeless movements that must be curtailed to prevent injury to client or others
Disorganized schizophrenia Chronic variety with inappropriate affect Silliness and incongruous giggling common Behavior bizarre; social interaction impaired
Types of SchizophreniaTypes of Schizophrenia
Paranoid schizophrenia Characterized by delusions of persecution or
grandeur Auditory hallucinations Client may be argumentative, hostile, and
aggressive
Types of SchizophreniaTypes of Schizophrenia
Residual schizophrenia Used to diagnose a person who has a history
of at least one episode of schizophrenia with prominent psychotic symptoms
Types of SchizophreniaTypes of Schizophrenia
Schizoaffective disorder Schizophrenic symptoms accompanied by a
strong element of symptomatology associated with mood disorders, either manic or depressive
Types of SchizophreniaTypes of Schizophrenia
Brief psychotic disorder
Sudden onset of psychotic symptoms following a severe psychosocial stressor
Symptoms persist less than 1 month
Types of SchizophreniaTypes of Schizophrenia
Schizophreniform disorder
Same symptoms as schizophrenia.
The duration of the disorder has been at least 1 month but fewer than 6 months
Types of SchizophreniaTypes of Schizophrenia
Undifferentiated schizophrenia Bizarre behavior that does not meet the
criteria outlined for the other types of schizophrenia; delusions and hallucinations prominent
Types of SchizophreniaTypes of Schizophrenia
Nursing Process: AssessmentNursing Process: Assessment
Content of thought Delusions: False personal beliefs
Religiosity: Excessive demonstration of obsession with religious ideas and behavior
Paranoia: Extreme suspiciousness of others
Nursing Process: Assessment (cont.) Nursing Process: Assessment (cont.)
Content of thought (cont.)
Word salad: Group of words put together in a random fashion
Magical thinking: Idea that if one thinks something, it must be true
Mutism: Inability or refusal to speak
Nursing Process: Assessment (cont.) Nursing Process: Assessment (cont.)
Form of thought Associative looseness: Shift of ideas from one unrelated topic to another
Neologisms: Made-up words that have meaning only to the person who invents them
Perseveration: Persistent repetition of the same word or idea in response to different questions
Nursing Process: Assessment (cont.) Nursing Process: Assessment (cont.)
Perception
Hallucinations: False sensory perceptions not associated with real external stimuli
Illusions: Misperceptions of real external stimuli
Nursing Process: Assessment (cont.) Nursing Process: Assessment (cont.)
Affect: Emotional tone Inappropriate affect: Emotions are
incongruent with circumstances
Apathy: Lack of interest in environment
Emotional ambivalence: Coexistence of opposite emotions toward same object
Nursing Process: Assessment (cont.) Nursing Process: Assessment (cont.)
Sense of Self: The uniqueness and individuality a person feels
Echolalia: Repeating words that are heard
Echopraxia: Repeating movements that are observed
Nursing Process: Assessment (cont.) Nursing Process: Assessment (cont.)
Impaired interpersonal functioning and relationship to the external world
Autism
Deterioration in appearance: Impaired personal grooming and self-care activities
Nursing Process: Assessment (cont.) Nursing Process: Assessment (cont.)
Psychomotor behavior (cont.) Anergia: Deficiency of energy
Posturing: Voluntary assumption of
inappropriate or bizarre postures
Pacing and rocking: Pacing back
and forth and rocking the body
Nursing Process: Assessment (cont.) Nursing Process: Assessment (cont.)
Positive and negative symptoms
Positive symptoms: Excess or distortion of normal functions
Negative symptoms: Deficit or loss of normal functions
Ineffective role performance Powerlessness Risk for injury Risk for other-directed violence Risk for self-directed violence Social isolation Imbalanced nutrition: Less than body requirements Impaired home maintenance Impaired social interaction Impaired verbal communication Ineffective coping
List of Nanda Nursing Diagnosis for SchizophreniaList of Nanda Nursing Diagnosis for Schizophrenia
Disturbed personal identity Disturbed sensory perception (auditory, visual) Disturbed sleep pattern Disturbed thought processes Dressing or grooming self-care deficit Fear Anxiety Bathing or hygiene self-care deficit Disabled family coping Disturbed body image Disturbed personal identity
List of Nanda Nursing Diagnosis for SchizophreniaList of Nanda Nursing Diagnosis for Schizophrenia
PlanningPlanning
The client Demonstrates an ability to relate to others
satisfactorily Recognizes distortions of reality Has not harmed self or others Perceives self realistically Demonstrates ability to perceive the
environment correctly
Planning (cont.)Planning (cont.)
The client (cont.) Maintains anxiety at a manageable level Demonstrates ability to trust others Uses appropriate verbal communication in
interactions with others Performs self-care activities independently
ImplementationImplementation
Nursing interventions for the client with schizophrenia are aimed at: Decreasing anxiety and establishing trust Assisting client to define and test reality Encouraging interaction with others Ensuring safety of client and others Meeting client’s self-care needs Promoting adaptive family coping
Implementation -Client/Family Education Implementation -Client/Family Education
Nature of illness What to expect as illness progresses Symptoms associated with illness
Management of illness Connection of exacerbation of symptoms to times
of stress Appropriate medication management
Implementation -Client/Family Education (cont.)Implementation -Client/Family Education (cont.)
Management of illness (cont.) Side effects of medications Importance of not stopping medications When to contact healthcare provider Relaxation techniques Social skills training Daily living skills training
EvaluationEvaluation
Evaluation questions Has client established trust with at least one staff
member? Is anxiety level maintained at a manageable level? Is delusional thinking still prevalent? Is client able to interrupt escalating anxiety with
adaptive coping mechanisms? Is client easily agitated? Is client able to interact with others ppropriately?
Treatment ModalitiesTreatment Modalities
Schizophrenia requires treatment that is comprehensive and presented in a multidisciplinary effort.
Psychological treatments Individual psychotherapy: Long-term
therapeutic approach difficult because of client’s impairment in interpersonal functioning
Treatment Modalities (cont.)Treatment Modalities (cont.)
Psychological treatments (cont.) Group therapy: Some success if
participating over long-term course of the illness; less successful in short-term treatment
Behavior therapy
Occupational therapy
Treatment Modalities (cont.)Treatment Modalities (cont.)
Psychological treatments (cont.) Social skills training: Use of role play to
teach client appropriate eye contact, interpersonal skills, posture, and so on, aimed at improving relationship development
Electroconvulsive therapy
Treatment Modalities (cont.)Treatment Modalities (cont.)
Social treatment Milieu therapy: Best if used in conjunction
with psychopharmacology
Family therapy: Aimed at helping family members cope with long-term effects of illness
Treatment Modalities (cont.)Treatment Modalities (cont.) Psychopharmacology
Antipsychotics: Used to decrease agitation and psychotic symptoms
Antiparkinsonian agents
Others: Reserpine Lithium carbonate Carbamazepine Diazepam Propranolol
Treatment Modalities (cont.)Treatment Modalities (cont.) Side effects for Antipsychotics (e. x:)
Nausea; GI upset; weight gain Sedation Decreased libido Gynecomastia; amenorrhea
The client should Not stop taking the drug abruptly Not consume other medications (including
over-the-counter drugs) without the physician’s knowledge