Nursing Management in Schizophrenia
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Questions and Answers

What are the four phases of schizophrenia?

The four phases of schizophrenia are: premorbid, prodromal, acute/active, and residual.

What brain chemical is blocked by antipsychotic drugs?

  • GABA
  • Serotonin
  • Acetylcholine
  • Dopamine (correct)

Which of the symptoms below are considered "negative" symptoms of schizophrenia? (Select all that apply)

  • catatonia
  • delusions
  • anhedonia (correct)
  • avolition (correct)
  • apathy (correct)
  • hallucinations
  • alogia (correct)

Schizophrenia is treatable with medication and psychosocial support.

<p>True (A)</p> Signup and view all the answers

What type of therapy focuses on improving communication and social interactions?

<p>Social skills training</p> Signup and view all the answers

Which of the following is NOT a symptom of catatonia?

<p>Hyperactivity (C)</p> Signup and view all the answers

What is the difference between Schizophreniform disorder and Schizophrenia?

<p>Schizophreniform disorder is characterized by symptoms that last for at least 1 month but less than 6 months, whereas schizophrenia requires symptoms to last for at least 6 months.</p> Signup and view all the answers

What two types of schizoaffective disorder are there?

<p>The two types of schizoaffective disorder are Bipolar Type and Depressive Type.</p> Signup and view all the answers

Which of the following is a key characteristic of Delusional Disorder, according to the DSM-5?

<p>The presence of one or more delusions (B)</p> Signup and view all the answers

Which of the following is NOT a nursing diagnosis commonly used in the care plan for patients with schizophrenia spectrum?

<p>Ineffective Coping (D)</p> Signup and view all the answers

Flashcards

Schizophrenia

A mental health disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior.

Delusions

False beliefs that seem real to the individual but are not based in reality.

Hallucinations

Sensory experiences that occur without a real external stimulus. Examples include hearing voices, seeing things that aren't there, or feeling a touch that isn't real.

Disorganized Speech

Difficulty with clear and logical speech, often characterized by loose associations, tangentiality, or word salad.

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Grossly Disorganized or Catatonic Behavior

Changes in behavior that are often sudden, unpredictable, and can range from agitation and hyperactivity to catatonia and social withdrawal.

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Negative Symptoms

A group of symptoms that reflect a decrease in normal functioning, including diminished emotional expression (blunted affect), lack of motivation (avolition), and reduced pleasure (anhedonia).

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Premorbid Phase

The phase before any symptoms appear, when the individual is functioning normally.

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Prodromal Phase

The phase where subtle changes in behavior and functioning start to occur, but full-blown psychotic symptoms are not yet present. These changes can be subtle and last for weeks, months, or even years.

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Active Phase

The phase where psychotic symptoms like hallucinations and delusions are prominent and are often at their most severe.

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Residual Phase

The phase after the active phase, where psychotic symptoms may lessen but negative symptoms can persist, and significant impairment in daily functioning is common.

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Schizophreniform Disorder

A disorder characterized by psychotic symptoms that last between 1 and 6 months. It is similar to schizophrenia but the duration is shorter.

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Brief Psychotic Disorder

A disorder characterized by sudden onset of psychotic symptoms that typically last less than one month. It is often associated with severe stress or trauma.

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Schizoaffective Disorder

A disorder characterized by the overlapping experience of schizophrenia symptoms and a mood disorder (either major depression or bipolar disorder).

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Delusional Disorder

A disorder characterized by non-bizarre delusions, meaning that the delusional beliefs could be possible in reality, even though they are not true. People with this disorder are often able to function well in their daily lives despite the delusion.

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Erotomanic Type (Delusional Disorder)

The belief that someone, often someone in a position of power, is in love with them, even though there is no evidence to support this.

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Grandiose Type (Delusional Disorder)

The belief that they have exceptional greatness, talent, power, or knowledge.

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Jealous Type (Delusional Disorder)

The belief that their partner is unfaithful, despite no evidence to support this.

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Persecutory Type (Delusional Disorder)

The belief that they are being targeted or persecuted by others.

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Somatic Type (Delusional Disorder)

The belief that they have a physical defect or medical condition, despite evidence to the contrary.

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Typical Antipsychotics (First Generation)

Antipsychotic medications that primarily block dopamine receptors in the brain. They are older than the second generation antipsychotics.

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Atypical Antipsychotics (Second Generation)

Antipsychotic medications that work on both dopamine and serotonin receptors in the brain. They are newer and have a lower risk of serious side effects compared to the first generation.

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Extrapyramidal Symptoms (EPS)

A group of drug-induced movement disorders that commonly occur in people taking antipsychotic medications.

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Antiparkinsonian Agents

Medications used to treat the movement problems caused by EPS.

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Impaired Verbal Communication

A nursing diagnosis used when a patient is experiencing a disturbance in their ability to express themselves verbally, often due to their symptoms (e.g., hallucinations or disorganized thinking).

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Impaired Social Interaction

A nursing diagnosis used when a patient is experiencing difficulties interacting socially, often due to their symptoms (e.g., social withdrawal, communication difficulties, or paranoia).

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Disturbed Sensory Perception: Auditory/Visual

A nursing diagnosis used when a patient is experiencing a disturbance in their sensory perception, often resulting in hallucinations (e.g., hearing voices).

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Disturbed Thought Process

A nursing diagnosis used when a patient is experiencing a disturbance in their thought processes, often resulting in delusions or disorganized thinking.

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Self-Care Deficit

A nursing diagnosis used when a patient is experiencing challenges caring for themselves in basic ways (e.g., bathing, dressing, or eating).

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Risk for Violence: Self-Directed or Other-Directed

A nursing diagnosis used when a patient is at risk for harming themselves or others, often due to their symptoms (e.g., delusions or hallucinations).

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Ineffective Health Maintenance

A nursing diagnosis used when a patient is struggling to manage their health effectively, often due to a lack of knowledge or understanding of their condition.

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Individual Psychotherapy

Type of therapy that involves a therapist working one-on-one with a patient to help them understand their illness, develop coping skills, and address their symptoms.

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Group Therapy

Type of therapy where a group of people with similar experiences come together to share their experiences and learn from each other. It can be helpful for social isolation.

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Social Skills Training

Type of therapy focused on improving social skills like communication and interacting with others. It can be particularly helpful for people with schizophrenia who struggle with social interaction.

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Family Therapy

Therapy that involves the patient's family members in the treatment process. It helps families understand the illness, learn how to manage difficult situations, and develop strategies to support their loved one.

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Study Notes

Nursing Management for Clients with Schizophrenia Spectrum Disorder

  • Students will understand nursing management for clients with schizophrenia spectrum disorder.
  • Students will identify the psychopathology of schizophrenia spectrum disorder.
  • Students will describe nursing interventions for schizophrenia spectrum disorder.

Schizophrenia

  • Schizophrenia is characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior.
  • Common experiences include hallucinations (hearing or seeing things not there), delusions (false beliefs), abnormal behavior, and disorganized speech. (WHO, 2019).
  • Worldwide, schizophrenia is associated with significant disability and impacts educational and occupational performance.
  • People with schizophrenia require lifelong treatment.
  • Treatment with medicine and psychosocial support is effective.

Predisposing Factors

  • Biological (Genetic): Relatives of individuals with schizophrenia have a significantly higher likelihood of developing the disease.
  • Biochemical (Dopamine Hypothesis): An excess of dopamine-dependent neuronal activity in the brain is a cause (along with other biochemical hypotheses). Excess serotonin may also be a contributing factor to symptoms.
  • Physiological: Alterations in brain structure (e.g., the prefrontal cortex) and physical conditions (e.g., brain abscesses, cerebrovascular disease, hypo/hyperthyroidism, epilepsy) can be predisposing factors.
  • Psychological: Family relationships and childhood trauma experiences may contribute to the development or severity of the illness.
  • Sociocultural: Lower socioeconomic status may increase risk.
  • Environmental: Cannabis and synthetic cannabinoids can induce schizophrenia-like symptoms.

Phases of Schizophrenia

  • Premorbid: A period of normal functioning. Indicators include shyness, withdrawn personality, poor peer relationships, poor academic performance, and antisocial behavior.
  • Prodromal: A change from normal functioning. Symptoms begin weeks/months to 2-5 years before acute symptoms, including poor concentration, anxiety, changes in mood, and deterioration in role functioning.
  • Acute/Active: Psychotic symptoms become prominent (hallucinations, delusions, disorganized speech). Other symptoms include blunted affect, alogia, avolition, and neglect of self-care, impacting social and occupational functioning.
  • Residual: Positive symptoms may improve, but negative symptoms (e.g., alogia, avolition, flat affect), and impairment in role functioning remain common.

Positive Symptoms

  • Hallucinations: Sensory experiences without external stimuli (auditory, visual, olfactory, tactile).
  • Delusions: False beliefs that seem real to the individual (persecutory, somatic, grandiose, erotomanic).
  • Disorganized Thinking/Speech: Loose associations, tangentiality, circumstantial thinking, and incoherence ("word salad").
  • Abnormal Motor Behavior: Hyperactivity, hypervigilance, agitation, and catatonia (stupor, waxy flexibility, mutism, stereotyped behaviors, echolalia, echopraxia).

Negative Symptoms

  • Alogia: Decrease in verbal communication.
  • Avolition: Lack of motivation and drive.
  • Anhedonia: Reduced ability to experience pleasure.
  • Apathy: Lack of interest or engagement in social activities.
  • Blunted Affect: Flat or diminished emotional expression.

DSM-5 Diagnostic Criteria for Schizophrenia

  • Two (or more) symptoms present for one month, including at least one of delusions, hallucinations, or disorganized speech.
  • Significant decline in social/occupational functioning.
  • Continuous signs of illness for at least six months (including at least one month of active symptoms meeting criteria A).
  • Exclude schizoaffective disorder, depressive disorder, bipolar disorder with psychotic features, substance abuse, or medical conditions.

Schizophrenia Spectrum Disorders

  • Schizophreniform Disorder: Psychotic symptoms lasting between 1 and 6 months.
  • Brief Psychotic Disorder: Psychotic symptoms lasting less than a month.
  • Schizoaffective Disorder: Psychotic symptoms occurring with a major mood episode (depressive or manic).
  • Delusional Disorder: One or more delusions lasting at least a month without other symptoms of schizophrenia.

Care Plan for Clients with Schizophrenia Spectrum Disorder

  • Nursing Diagnoses (Examples): Impaired verbal communication, impaired social interaction, disturbed sensory perception, disturbed thought process, risk for violence, ineffective health maintenance.
  • Interventions (Examples): Observe for signs of hallucinations or delusions, provide a calm and supportive environment, reality orientation, medication education and adherence, social skills training, family involvement.

Treatment for Schizophrenia

  • Psychological Treatment: Individual and group psychotherapy, social skills training, family therapy.
  • Social Treatment: Providing support systems, encouragement, and opportunities for socialization.
  • Pharmacological Treatment: Typical (first-generation) antipsychotics (often cheaper, but more side effects) and atypical (second-generation) antipsychotics (often fewer side effects).
  • Hospitalization: Important for severe cases, potentially harmful behaviors, or those unable to care for themselves.

Associated Side Effects of Antipsychotic Medications

  • First Generation (Typical): Extrapyramidal symptoms are more frequent, anticholinergic effects are also common.
  • Second Generation (Atypical): Weight gain, nausea, infrequent extrapyramidal symptoms. Anticholinergic effects are also common.

Antiparkinsonian Agents

  • Used to treat extrapyramidal side effects from antipsychotic medication.
  • Common side effects include: dry mouth, blurred vision, nausea, constipation, urinary retention.

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Nursing Management for Client with Schizophrenia Spectrum Disorder PDF

Description

This quiz focuses on nursing management for clients with schizophrenia spectrum disorder. It covers psychopathology, symptoms, and nursing interventions necessary for effective treatment. Gain insights into the biological factors and treatment approaches for individuals with schizophrenia.

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