Understanding Schizophrenia

• Schizophrenia is a complex psychiatric disorder where individuals struggle to interpret and interact with reality.
• Schizophrenia's causes include genetics, the environment, and brain chemistry.

Dopamine's Role

• Excessive dopamine leads to positive symptoms, affecting the limbic part of the brain.
• Insufficient dopamine results in negative emotions, impacting the prefrontal cortex.

Clinical Features

• Positive symptoms include hallucinations, delusions, disorganized thoughts/speech, and disorganized/agitated behavior.
• Hallucinations manifest as false sensory experiences, such as tactile, visual, auditory, or olfactory.
• Delusions are irrational beliefs and can be grandiose or related to reference or control.
• Disorganized thought includes neologisms, tangentiality, word salad, and echolalia. Catatonia and psychomotor slowing or agitation are aspects of disorganized behavior.
• Negative symptoms involve apathy, avolition, asociality, affective flattening, anhedonia, and alogia, such as poor hygiene or lack of motivation.

Treatment

• Antipsychotics are used to manage positive symptoms.
• First-generation antipsychotics, like haloperidol, can cause excessive movement as a side effect.
• Second-generation antipsychotics, like risperidone, olanzapine, and aripiprazole, may lead to weight gain.
• Long-acting injectables enhance treatment adherence and outcomes.

Nursing Interventions

• Establish trust by being honest and consistent.
• Short, frequent interactions and a calm presence are important.
• Avoid touching the client without informing them and maintain a balanced, neutral approach.
• Explain procedures step by step and initiate activities on a one-on-one basis, progressing to small groups.

Nursing Interventions for Hallucinations

• Monitor cues and directly ask about the content of hallucinations.
• Provide distraction, such as music with headphones.
• Assess for worsening anxiety and agitation, also check for suicidal/homicidal ideation.
• Decrease stimuli or assist the client to a different area.
• Verbally clarify what is real versus unreal.

Nursing Interventions for Delusions

• Use therapeutic communication techniques and avoid arguing or trying to convince the client.
• Shift conversations to reality-based topics.
• Use canned or pre-packaged foods, open medications in front of the client, and check the mouth and palms after medication administration.
• Employ positive reinforcement.

Nursing Interventions for Negative Symptoms

• Implement social skills training.
• Gauge the client's readiness to engage with others.
• Prioritize fluid and nutrition in a catatonic state.