Schizophrenia

Overview

1. A long term mental disorder characterized by abnormal social behavior, disturbances in mood, thought processes, behavior, affect.

Nursing Points

General

1. To be diagnosed, they need to have 2 of the following:
   1. Negative symptoms:  SUBTRACTS things.
      1. Decrease in emotional range
      2. Loss of interest/drive in life
      3. Loss of  inertia (tendency to do nothing or remain unchanged)
   2. Positive symptoms:  ADDS things.
      1. Hallucinations
      2. Delusions
      3. Disorganized speech
      4. Bizarre behavior

Assessment

1. 1. Delusions
      1. Definition:  false belief firmly held to be true, despite rational argument. They are real to the patient but they are not real.
      2. Note: there are MANY more kinds, these are the ones you’re most likely going to be tested on
         1. Persecution:  being singled out to be harmed by others
         2. Jealousy:  belief that spouse or love interest is being unfaithful despite being able to back up claims
         3. Grandeur:  belief that they are a very powerful or important in the world
   2. Hallucinations
      1. Definition: patient is experiencing external stimuli but they don’t have an organic cause.  They are real to the patient but they are not real.
      2. One for each of the 5 senses:
         1. Auditory
         2. Olfactory
         3. Tactile
         4. Visual
         5. Gustatory

Therapeutic Management

1. Delusions
   1. Ensure safety of the environment
   2. Ask patient to describe the delusion so you know what they’re experiencing
      1. Validate any real aspects of the delusion
   3. Don’t argue
   4. Reflect on how it makes them feel to make sure you connect with them
      1. “Ok, so I hear that you’re feeling this way…”
   5. Focus on the feelings the delusion creates, not the delusion itself
   6. Focus on reality; don’t get stuck in talking about the delusion
   7. Be upfront and honest with them so they don’t become paranoid or suspicious of you
   8. Set limits if they are obsessing about it
2. Hallucinations
   1. Ensure safety of environment
   2. Monitor them so you are aware when they start experiencing hallucinations
   3. Be direct about them, don’t tiptoe around the topic
      1. “Are you experiencing a hallucination?  What are you seeing, hearing, feeling?”
      2. Ensure safety by assessing if there is an auditory or visual hallucination telling patient to harm self or others
   4. Validate feelings but stay in reality
   5. Don’t perpetuate the hallucinations
   6. When patient does talk about real things, respond to those things
   7. Don’t bring yourself or others into the hallucination
      1. “Oh, you’re smelling burnt rubber?  I do too, I wonder if others do, too”
   8. Try to engage in one-on-one interaction
   9. Decrease stimuli
   10. Don’t touch them or increase stimuli
   11. Do not joke about the hallucinations
   12. Monitor for worsening symptoms (increasing fear, anxiety)
   13. Given PRN meds when appropriate
3. Other Interventions
   1. Always ensure safety (monitor for self-harm/suicide)
   2. Assess and address their physical needs
   3. Be genuine; don’t be overly interested/warm or make promises you can’t follow through on
   4. Communicate about basic things (when you don’t understand, when you need to end the conversation, reorienting to reality).  Silence may be required; be okay with just sitting and being quiet.
   5. Be present: don’t have calculated responses, try to read the scenario and respond appropriately.
      1. If they seem frightened, stay with them and reassure them that they are safe.  
      2. If they need someone to be with them but don’t want to talk, silently sit with them.  
   6. Make sure their behavior is appropriate before introducing them to group activities or therapy
   7. Start small, work to bigger things
      1. Start with one on one interactions, progress to group therapy
      2. Start with small tasks, move to more complex
      3. Start with direct tasks and no choices, move to allowing choices

Nursing Concepts

1. Safety
2. Mood Affect
3. Cognition

Patient Education

1. Importance of medication compliance
2. Reality orientation strategies