Lecture 5

1. Lecture 5 Mental Health Nursing-NUR 417 Schizophrenia

2. Introduction • The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind).

3. 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

4. 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

5. Etiological Implications Schizophrenia is probably caused by a combination of factors, including • Biological and Heritability predisposition • Biochemical Causes • Physiological factors • Psychosocial stress • Environmental factors

6. Etiological Implications • Biological and Heritability predisposition Genetics plays an important role in the development of schizophrenia. • Biochemical Causes • Dopamine Hypothesis: schizophrenia is caused by excessive dopamine activity.

7. Predisposing Factors (cont.) • Physiological influences Examples of Various physical conditions • Epilepsy • Birth trauma • Head injury • Alcohol abuse • Cerebral tumor

8. Predisposing Factors (cont.) • Psychosocial influences • Deeply disrupted family. • Stressful life events. • Environmental influences • Viral epidemics: associated with viral diseases • Low-socioeconomic

9. Diagnosis • Schizophrenia is diagnosed based on talking with the patient, and looking at his or her behaviour and experiences.

10. MRI (Magnetic resonance imaging) Identifies brain changes PET (Positron emission tomography) (is a nuclear medicine imaging) Determines brain activity EEG )Electroencephalography( Anelectrophysiological monitoring method to record electrical activity of the brain Neurologic examination Neuropsychologic tests Diagnosis – Examples of Important Tests

11. Types of Schizophrenia • Catatonic schizophrenia Characterized by marked psychomotor disturbance • 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

12. Types of Schizophrenia • Disorganized schizophrenia • Inappropriate affect • Extremely disorganized behavior • Social interaction impaired

13. Types of Schizophrenia • Paranoid schizophrenia • Characterized by hallucinations, delusions, and persecutory (feeling victimized) or grandeur • Client may be argumentative, and aggressive

14. Types of Schizophrenia • Residual schizophrenia • Used to diagnose a person who has a history of at least one episode of schizophrenia with prominent psychotic symptoms

15. Types of Schizophrenia • Schizoaffective disorder • Schizophrenic symptoms accompanied by a strong element of symptomatology associated with mood disorders, either manic or depressive

16. Types of Schizophrenia • Brief psychotic disorder • Sudden onset of psychotic symptoms following a severe psychosocial stressor • Symptoms persist less than 1 month

17. Types of Schizophrenia • Schizophreniform disorder • Same symptoms as schizophrenia. • The duration of the disorder has been at least 1 month but fewer than 6 months

18. Types of Schizophrenia • Undifferentiated schizophrenia • Characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior

19. Nursing Process: Assessment Content of thought • Delusions: False personal beliefs • Religiosity: Excessive demonstration of obsession with religious ideas and behavior • Paranoia: Extreme suspiciousness of others

20. 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

21. 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

22. Nursing Process: Assessment (cont.) Perception • Hallucinations: False sensory perceptions not associated with real external stimuli • Illusions: Misperceptions of real external stimuli

23. 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

24. 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

25. Nursing Process: Assessment (cont.) • Impaired interpersonal functioning and relationship to the external world • Autism • Deterioration in appearance: Impaired personal grooming and self-care activities

26. 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

27. Nursing Process: Assessment (cont.) • Positive and negative symptoms • Positive symptoms: Excess or distortion of normal functions • Negative symptoms:Deficitor loss of normal functions

29. List of Nanda Nursing Diagnosis for Schizophrenia • 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

30. List 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

31. Planning • 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 • Maintains anxiety at a manageable level • Demonstrates ability to trust others • Uses appropriate verbal communication in interactions with others • Performs self-care activities independently

32. Implementation • 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

33. Implementation -Client/Family Education • Management of illness • Appropriate medication management • Side effects of medications • Importance of not stopping medications • When to contact healthcare provider • Relaxation techniques • Social skills training • Daily living skills training

34. Treatment 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

35. 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

36. 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

37. Treatment Modalities (cont.) • Social treatment • Milieu therapy: a type of inpatient therapy, involving prescription of particular activities and social interactions according to a patient's emotional and interpersonal needs • Family therapy: Aimed at helping family members cope with long-term effects of illness

38. Treatment Modalities (cont.) • Psychopharmacology • Antipsychotics: Used to decrease agitation and psychotic symptoms • Antiparkinsonian agents • Others: example: • Diazepam (used to treat anxiety disorders, or muscle spasms.) • Propranolol (used to treat tremors, angina (chest pain), hypertension, heart rhythm disorders, and other heart or circulatory conditions.)

39. 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

40. Evaluation • 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 anxiety with adaptive coping mechanisms? • Is client easily agitated?