lecture 6 community and mental health nursing-nur 472 schizophrenia

Lecture 6Lecture 6

Community and Mental Health Nursing-NUR 472

Schizophrenia

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These people are socially withdrawn and show evidence of peculiar behavior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

Fourth Phase Fourth Phase

Residual phase

Impairment in role functioning are prominent

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


Paranoid schizophrenia Characterized by delusions of persecution or

grandeur Auditory hallucinations Client may be argumentative, hostile, and

aggressive


Residual schizophrenia Used to diagnose a person who has a history

of at least one episode of schizophrenia with prominent psychotic symptoms


Schizoaffective disorder Schizophrenic symptoms accompanied by a

strong element of symptomatology associated with mood disorders, either manic or depressive


Brief psychotic disorder

Sudden onset of psychotic symptoms following a severe psychosocial stressor

Symptoms persist less than 1 month


Schizophreniform disorder

Same symptoms as schizophrenia.

The duration of the disorder has been at least 1 month but fewer than 6 months


Undifferentiated schizophrenia Bizarre behavior that does not meet the

criteria outlined for the other types of schizophrenia; delusions and hallucinations prominent


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


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


Perception

Hallucinations: False sensory perceptions not associated with real external stimuli

Illusions: Misperceptions of real external stimuli


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


Sense of Self: The uniqueness and individuality a person feels

Echolalia: Repeating words that are heard

Echopraxia: Repeating movements that are observed


Impaired interpersonal functioning and relationship to the external world

Autism

Deterioration in appearance: Impaired personal grooming and self-care activities


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


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


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


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

lecture 6 community and mental health nursing-nur 472 schizophrenia

Documents

disorder schizophrenia

word schizophrenia

development of schizophrenia

disorder cont

serious mental disorder

combination of factors

social relations

important role