Nursing Management in Schizophrenia

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 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.

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.

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 Indicators include shyness, withdrawn personality, poor peer relationships, poor academic performance, and antisocial behavior.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.

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).

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.

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.

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.

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.

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.

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