Schizophrenia Overview and Treatments

Schizophrenia

• Euphoric mood, hyperactivity, and distractibility are symptoms of mania, not schizophrenia.
• Aripiprazole is a third-generation atypical antipsychotic medication effective against both positive and negative symptoms of schizophrenia.
• Aripiprazole is a preferred choice for clients with obesity or heart disease as it causes little to no weight gain, and does not increase glucose, high- or low-density lipoprotein cholesterol, or triglycerides.
• Clozapine can cause agranulocytosis making it a poor choice as a first-line medication.
• Ziprasidone is not recommended for clients with cardiac disease, as it may prolong the QT interval
• Olanzapine is associated with weight gain.
• Loosely associated, confused, and disorganized speech is a hallmark characteristic of schizophrenia; the nurse should state that they are having difficulty in understanding what the patient is saying.
• Physiological Needs are the highest priority in caring for clients with catatonia.
• Self-care deficits in catatonic clients need to be addressed; a suitable client outcome would be performing self-care activities with coaching by the end of day 3.
• Command hallucinations are concerning as they can lead to harm; the nurse should prioritize asking the client what the voice is telling them to do.
• Neuroleptic malignant syndrome (NMS) is a medical emergency that can be triggered by antipsychotic medication, such as risperidone. Look for symptoms like severe muscle stiffness, difficulty swallowing, hyperpyrexia, autonomic symptoms (pulse elevation), and diaphoresis.
• Concrete thinking is a hallmark of schizophrenia, characterized by an impaired ability to think abstractly.
• Clients with schizophrenia benefit from improved social skills to engage in relationships and manage their condition.
• Clients with schizophrenia often have delusional thinking.
• Facebook has a new tracking capacity, this is not a relevant statement to study notes on schizophrenia.

Schizophrenia Spectrum Disorders

• A client with schizophrenia may experience paranoia, which is an irrational fear. The client might believe that others are plotting to harm them.
• Clients diagnosed with schizophrenia may perceive their environment as hostile and dangerous.
• The most common side effects of first-generation antipsychotics are sedation and extrapyramidal side effects, which could include stiffness, gait disturbance, and feelings of being robotic.
• Hallucinations that express paranoia can necessitate safety measures.
• Examples of signs that a client may be hallucinating: Darting eyes, tilted head, and mumbling to oneself.
• Aripiprazole is a third-generation atypical antipsychotic that tends to cause less weight gain than first-generation antipsychotics.
• Tips for communicating with a client with schizophrenia:
  • If a client is using disorganized or confused speech, let them know you are having a hard time understanding them.
  • Use concrete examples to explain things.
• Clients with catatonia are at risk of dehydration and other physiological problems because they are unable to care for themselves.
• A client with catatonia may exhibit waxy flexibility, which involves holding distorted postures for extended periods of time.
• First-generation antipsychotics can cause gynecomastia, which can negatively impact the client's body image.
• Clients diagnosed with schizophrenia may benefit from a psychoeducational group that helps them to develop problem-solving skills.
• Important information to teach clients about their antipsychotic medications:
  • Taking their medication regularly will reduce the severity of their symptoms.
  • If a client continues to experience auditory hallucinations, you can reduce the client's anxiety by staying with them and encouraging the client to focus on the conversation.
• Symptoms of pseudoparkinsonism:
  • Shuffling, propulsive gait
  • Mask-like face
  • Drooling
• Symptoms of Akathisia:
  • Internal and external restlessness
  • Pacing
  • Fidgeting
• Signs of an acute dystonic reaction:
  • Painful contractions of the tongue, face, neck, and back.
  • Opisthotonos (arching of the back)
  • Oculogyric crisis (eyes roll back in the head)
• Treatment for acute dystonic reaction:
  • Diphenhydramine (Benadryl)
  • Trihexyphenidyl (Artane)
  • Benztropine (Cogentin)
• Symptoms of tardive dyskinesia:
  • Involuntary spasmodic muscular contractions, especially of the face, tongue, and extremities
  • May be caused by long-term use of first-generation antipsychotics
  • May not be reversible, even after the medication is discontinued

Nursing Process

• Assessment:
  • Monitor the client's perception of the environment
  • Observe for symptoms of paranoia, hallucinations, catatonia, or tardive dyskinesia
• Planning:
  • Develop a care plan that addresses the client's physiological and psychosocial needs
  • Set realistic outcomes for the client based on their abilities.
• Implementation:
  • Maintain a therapeutic relationship with the client
  • Administer medications and monitor for side effects.
  • Provide psychoeducation and support groups.
• Evaluation:
  • Assess the client's progress in achieving their goals
  • Adjust the care plan as needed.

Anticholinergic Effects

• Common anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes.

Assessing Schizophrenia

• Negative symptoms: Apathy, anhedonia, poor social functioning, and poverty of thought (e.g., poor personal hygiene).
• Positive symptoms: Auditory hallucinations, delusions of grandeur, psychomotor agitation.
• Prodromal Stage: Characterized by withdrawal, misinterpreting information, poor concentration and religious preoccupations.
• Acute Stage: Marked by positive symptoms like auditory hallucinations, ideas of reference, thought insertion, and broadcasting.
• Paranoia is evident in delusional and unrealistic fears of harm.
• Neologisms: Invented words unique to the individual.
• Concrete thinking: Literal interpretation of language, unable to grasp abstract concepts.
• Poverty of content is a limited or inadequate amount of information.
• Looseness of association: Jumbled and incoherent thoughts expressed to the listener.
• Command hallucinations: Auditory hallucinations that instruct the individual to perform actions.

Second-generation Antipsychotics

• Second-generation antipsychotics (e.g., ziprasidone) are associated with a higher risk of weight gain, diabetes, and high cholesterol.

Schizophrenia Treatment & Management

• Psychoeducational therapy helps families understand the condition, manage medication, and provide support.
• Relapse: Signs include tension, poor sleep, difficulty concentrating, increased withdrawal, and bizarre thoughts.
• Medication nonadherence can be a cause for relapse.
• Word salad: Meaningless jumbled words that may be incomprehensible to both the speaker and the listener.
• **Command hallucinations can be terrifying and pose a psychiatric emergency. ** It is important to assess what the hallucinations are instructing the individual to do to ensure safety.

Nursing Interventions

• When working with clients experiencing auditory hallucinations, it is important to maintain a safe distance.
• Neuroleptic malignant syndrome (NMS) is a potentially fatal reaction to antipsychotic medications. It is characterized by severe muscle stiffness, difficulty swallowing, hyperpyrexia, and autonomic instability. This condition requires immediate medical intervention.
• Concrete thinking: Assessed by understanding the client's interpretation of proverbs.

Teaching and Education

• Psychoeducational groups are a valuable resource for clients with schizophrenia, helping improve social skills and coping strategies.

Key Considerations

• Paranoid delusions can lead to fear and anxiety. It is important to reassure the client of their safety.
• Positive symptoms include hallucinations and delusions.
• Negative symptoms can include apathy, social withdrawal, and a lack of motivation.
• Medication adherence is crucial for managing schizophrenia.
• Family support is essential for the recovery process.