Schizophrenia Group 5 B (2) PDF

schizophrenia Under Supervision of Dr: Tabaseem Fayez Dr: Wafaa Hussien Ass. Lect: Abd El-mouttelb Abd El-qawy First semester 2024/2025 1 | Page  ❖Prepared by.Adham Atef....

schizophrenia Under Supervision of Dr: Tabaseem Fayez Dr: Wafaa Hussien Ass. Lect: Abd El-mouttelb Abd El-qawy First semester 2024/2025 1 | Page  ❖Prepared by.Adham Atef. Introduction, Definition Eshak Shehata Incidence Adham Atef. Pathophysiology Eslam Ahmed. Risk factors Islam Naiem, eshak Signs, Symptoms Ahmed yasser. Phases Islam Waleed Hassan Types of schizophrenia Aya Ahmed Zatar. Management Aya Osama. Nursing Care Plan ( risk violence _ sensory ) Aya khames Nursing Care Plan ( selfcare_ communication) Aya Ahmed Mokhtar. Nursing care plan (thought _ interaction) Aya Ahmed marey Nursing care plan ( ineffective coping) Aya Mohammed abdelraheim. Health education 2 | Page  ❖Outline Introduction of schizophrenia Definition of schizophrenia Incidence of schizophrenia Pathophysiology of schizophrenia Risk factors of schizophrenia Signs &symptoms of schizophrenia Phases of schizophrenia Types of schizophrenia Management of schizophrenia Nursing Care Plan of schizophrenia Health Education of schizophrenia References 3 | Page  ❖Introduction of schizophrenia The term schizophrenia derived from the Greek 'schizo' (splitting) and 'phren' (mind). Schizophrenia is characterized by episodes of psychosis which include hallucinations, delusions and disturbances in thought, perception, and behavior. This can make it hard to live a normal life. ❖Definition of schizophrenia Schizophrenia is a complex illness or group of disorders results from Neuro transmitters abnormalities like Dopamine and glutamate hypothesis, characterized by Hallucinations and Delusions and Behavioral disturbances, disrupted social functioning and loss contact with Reality. ❖Incidence of schizophrenia According to WHO, Schizophrenia affects about 24 million people or 1 in 300 people (0.32%) worldwide. the Middle East and North Africa (MENA) region, including Egypt 14.7 per 100,000 people aged 35:39 male more than female 1.4:1. ❖Pathophysiology of schizophrenia Genetic theory: The genetics have a strong link with the development of schizophrenia. occurs is about 1% of population. The Risk increase to 40%if the parents have a schizophrenia. Dopamine Theory: The dopamine hyper activity in the meso limbic pathway result in the schizophrenia symptoms. The prefrontal and frontal , temporal cortices in brain have a decrease in its Activity during this hyperactivity. Decreased glutamate have an effect like dopamine hyper activity because glutamate regulate the activity of dopamine. 4 | Page  ❖Risk factors for schizophrenia Genetics: A family history of schizophrenia significantly increases the risk. If a first-degree relative (such as a parent or sibling) has schizophrenia, the risk is about 10%. Identical twins, the risk can be as high as 50% if one twin is affected Prenatal Factors: Complications during pregnancy and birth, such as exposure to viruses, malnutrition, or stress during pregnancy of brain development, can increase the risk of development disorder Early Childhood Adversities: Trauma, abuse, or significant stress during early childhood can contribute to the development of schizophrenia later in life. Substance Use: The use of psychoactive substances, particularly cannabis, during adolescence can increase the risk of developing schizophrenia. Urban Living: Growing up or living in urban areas has been associated with a higher risk of schizophrenia compared to rural areas. Social Isolation Lack of social support and isolation can also be contributing factors. 5 | Page  Neurodevelopmental Factors: Abnormalities in brain structure and function, which may be detectable through neuroimaging, are often present in individuals who develop schizophrenia. Neurotransmitters disturbed function of dopamine Reduced function of NMDA glutamate receptors ❖Signs and symptoms of Schizophrenia The DSM-IV criteria for the diagnosis of schizophrenia included: Presence of two or more of the following symptoms for a massive portion of time during a one-month period. 6 | Page  Positive symptoms : refer to the presence of symptoms that are not typically present in healthy individuals. 1. Delusions Delusions are fixed beliefs that are not amenable to change considering conflicting evidence. delusions of persecution: (Paranoid Schizophrenia) Delusions of persecution, Delusions of grandeur, Delusions of control: (Disorganized Schizophrenia) Delusions of guilt, Delusions of nihilism ,Delusions of reference: (Catatonic Schizophrenia) Persecutory delusions,grandiose delusions,Delusions of Reference, Somatic Delusions: (Residual Schizophrenia) persecutory delusions, referential delusions, delusions of control: (Undifferentiated Schizophrenia) 2. Hallucinations Hallucinations are perception-like experiences that occur without an external stimulus. There are several types of hallucinations that can occur in schizophrenia: auditory hallucinations: (Paranoid Schizophrenia) Auditory hallucinations: (Disorganized Schizophrenia) Catatonic Schizophrenia: (Command hallucinations,Visual hallucinations) auditory hallucinations, Visual Hallucinations,Tactile Hallucinations: (Residual Schizophrenia) auditory hallucinations:(Undifferentiated Schizophrenia) 3. Disorganized Thinking (Speech) 7 | Page Disorganized thinking (formal thought disorder) is typically inferred from the individual's speech. Cricumstantiality: The patient gives countless and unnecessary Details but gets from desired point to desired goal. Tangentiality: The patient never gets from desired point to desired goal. Incoherence: Mixture of phrases that have no meaning with no Logical connection. World salad: Mixture of words that have no meaning with no logical connection. Clang Association: The meaningless rhyming of words, in which the Connection between words is their sound rather than their meaning and words have no logical connection. Neologism: The patient creates new words or phrases, often by combining syllables of of other words. These new words only have a special meaning for the patient Preservation: Pathological repetition of the same response to different stimuli. In repetition to the same answer in response to different questions. 4. Catatonic behavior Grossly disorganized or abnormal motor behavior may manifest itself in a variety of ways, ranging from childlike "silliness" to unpredictable agitation. Catatonic stupor Catatonic motor behaviors include a marked decrease in reactivity to the environment, sometimes reaching an extreme degree of complete unawareness Catatonic rigidity Maintaining a rigid posture and resisting efforts to be moved Catatonic negativism Active resistance to instructions or attempts to be moved Catatonic posturing The assumption of inappropriate or bizarre postures 8 | Page  Catatonic excitement Purposeless and unstimulated excessive motor activity Negative Symptoms = 5A Refer to the absence or decrease in normal abilities and functions that are typically present in healthy individuals. A. Diminished emotional expression (Apathy ) Includes reductions in the expression of emotions in the face, eye contact, intonation of speech , and movements of the hand, head, B. Avolition: Is a decrease in motivated self-initiated purposeful activities. C. Alogia Is manifested by diminished speech output. D. Anhedonia Is the decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced. E. Asociality Refers to the apparent lack of interest in social interactions and may be associated with avolition. ❖Cognitive symptoms of schizophrenia include 1. Impaired working memory: Individuals with schizophrenia may have difficulty holding information in their memory and using it to guide their actions. This can make everyday tasks and problem solving challenging. 2.Impaired attention: People with schizophrenia may have trouble focusing on tasks or maintaining attention for long periods of time. This can lead to difficulties in completing tasks or following conversations. 9 | Page 3.Impaired executive function: Executive function refers to a set of cognitive abilities that help individuals plan, organize, and execute tasks. People with schizophrenia may have difficulty with these abilities, making it hard for them to set goals, make decisions, or solve problems. 4.Impaired processing speed: Individuals with schizophrenia may experience difficulties in processing information quickly and efficiently. This can result in delays in thinking and responding to stimuli in their environment. 5.Disorganized thinking: People with schizophrenia may exhibit disorganized thinking, which can manifest as disconnected or fragmented thoughts, speech, or behavior. This can make it difficult for them to communicate effectively or make sense of their experiences. These cognitive symptoms can significantly impact a person's ability to function in daily life and may contribute to difficulties in social interactions, relationships, work, and school. Phases of schizophrenia 1-The Premorbid Phase: The premorbid personality often indicates social maladjustment, social withdrawal, irritability, and antagonistic thoughts and behavior ,Premorbid personality and behavioral measurements that have been noted include being very shy and with- drawn, having poor peer relationships, doing poorly in school, and demonstrating antisocial behavior. patients had schizoid or schizotypal personalities characterized as quiet, passive, and introverted; as children, they had few friends. Pre- schizophrenic adolescents may have no close friends and no dates and may avoid team sports. 10 | P a g e  2-Prodromal stage Symptoms of prodromal schizophrenia include: lack of motivation difficulty concentrating erratic behavior sleep problems anxiety irritability mild or poorly formed hallucinations changes to one’s normal routine neglecting personal hygiene 3-Active stage Active schizophrenia, or active psychosis, involves obvious symptoms such as: hallucinations, including seeing, hearing, smelling, or feeling things that others do not delusions, which are false notions or ideas that a person believes even when presented with evidence to the contrary confused and disorganized thought. 4-Residual schizophrenia Symptoms of residual schizophrenia include: social withdrawal. difficulty concentrating. 11 | P a g e  difficulty planning and participating in activities. reduced or absent facial expression. flat, monotone voice. general disinterest. ❖Types of schizophrenia The type of schizophrenia is based on the kind of symptoms the person has at the time of assessment: A. Paranoid schizophrenia This is the most common type of schizophrenia it characterized by auditory hallucinations but relatively normal intellectual function and expression of affect. The delusions can often be about being persecuted or being some other person who is famous. people with Paranoid type schizophrenia can exhibit anger, aloofness, anxiety and argumentative. B. Disorganized schizophrenia People with this condition characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized type of schizophrenia may laugh at sad situation or at something not closely related to what they saying or doing, The disorganized behavior may-disrupt normal activities, such as showering dressing, and preparing meals C. Catatonic schizophrenia Catatonic Type of schizophrenia is characterized by disturbances of movement and manifested by marked psychomotor retardation, mutism, waxy flexibility [posturing], negativism, and rigidity) or excitement (extreme 12 | P a g e  psychomotor agitation, leading to exhaustion or the possibility of hurting self or others if not curtailed). D. Residual schizophrenia Residual type of schizophrenia is characterized by a past history of at least one episode of schizophrenia, but now the has no positive signs of schizophrenia and has some symptoms as social withdrawal decrease emotional express, decrease of interesting. E. Undifferentiated schizophrenia This type doesn’t fit into any other classification of schizophrenia because they are showing symptoms for more than one kind those people may exhibit both positive and negative symptoms. F. Schizoaffective Disorder. Schizoaffective disorder refers to behavior’s characteristic of schizophrenia, in addition to those indicative of disorders of mood, such as depression G. Schizophreniform disorder. is a short-term mental health condition that causes psychosis. This involves: Hallucinations. Delusions (firmly held beliefs in something untrue). Disorganized speech. Disorganized behavior. The symptoms of schizophreniform disorder last more than one month but fewer than six months. H. Brief Psychotic Disorder 13 | P a g e The essential features of brief psychotic disorder include a sudden onset of psychotic symptoms that last at least 1 day but less than 1 month and in which there is a virtual return to the premorbid level of functioning. The diagnosis is further specified by whether it follows a severe identifiable stressor or whether the onset occurs within 4 weeks postpartum. I. Delusional Disorder: Delusional disorder is characterized by the presence of one or more delusions that last for at least 1 month. Hallucinatory activity is not prominent. Apart from the delusions, behavior and functioning are not impaired. The following types are based on the predominant delusional theme 1. Persecutory Type. Delusions that one is being malevolently treated in some way. 2. Jealous Type. Delusions that one’s sexual partner is unfaithful 3. Erotomaniac Type. Delusions that another person of higher status is in love with him or her. 4. Somatic Type. Delusions that the person has some physical defect, disorder, or disease. 5. Grandiose Type. Delusions of power, knowledge, special identity, or special relationship to a famous person. J. Shared Psychotic Disorder: In shared psychotic disorder, a delusional system develops in the context of a close relationship with another person who already has a psychotic disorder with prominent delusions. K. Substance-Induced Psychotic Disorder: 14 | P a g e  The essential features of this disorder are the presence of prominent hallucinations and delusions that are judged to be directly attributable to the physiological effects of a substance (i.e., a drug of abuse, a medication, or toxin exposure. ❖Management of schizophrenia: 1- Non-pharmacological management Hospitalization Hospitals can be the best place for people with schizophrenia to learn to live with their illness. A hospital can help the patient get the full picture of his symptoms and learn how to treat them. The patient may need to go to one if the patient have hallucinations or if the patient want to harm himself For severe symptoms of schizophrenia, which require hospitalization, treatment takes from 3 weeks to 2 months on average, depending on the type of treatment and the severity of the disease. In times other than critical times, the patient with schizophrenia must continue with medication treatment and regular follow-up (preferably a monthly follow-up) with the treating physician, and the doctor will gradually reduce the medication according to the severity of the disease and the patient’s response. But sometimes the patient may need to continue drug treatment for long periods.It may reach longevity, in order to preserve the patient’s quality of life, from a practical, familial, and social perspective Brain Synchronization therapy (B S T ) or Electrical stimulation therapy (E S T ) Sometimes, medications are not successful enough in controlling hallucinations and other symptoms of schizophrenia. 15 | P a g e  In that case, The doctor may recommend brain stimulation therapy to support or replace medications. This type of therapy tries to either stimulate or ease certain brain activity with electrical impulses (which are either carried to electrodes in the body or generated by magnetic fields applied to the head). Individual psychotherapy During sessions, a therapist or psychiatrist can teach the patient how to deal with his thoughts and behaviors. The patient ’ll learn more about his illness and its effects, as well as how to tell the difference between what’s real and what’s not. It can also help him manage everyday life. Cognitive behavior therapy (CBT) Cognitive behavioral therapy (CBT) can help the patient change his thinking and behavior. The patient learn to recognize what thinking patterns are causing his negative emotions or behaviors and how to replace them with positive thoughts. For example, The patient learn to identify voices and hallucinations and how to deal with them. CBT sessions usually last an hour. Most people get CBT for several months. This type of therapy is also called cognitive remediation. It teaches the patient how to better recognize social cues, or triggers. It also helps him improve his attention, memory, and ability to organize his thoughts. It combines computer-based brain training and group sessions. Art therapy Art therapy can help the patient express his feelings in new and creative ways. It can help the patient process his experiences, relate to others, and even reduce his schizophrenia symptoms. The patient can meet with an art therapist one-on-one or in a small group. 16 | P a g e  Group therapy Refer to Two or more patient at same session. It focusses on real life plans. As patients listen and learn Experiences from each other. It’s more effective at outpatients than inpatients 2- Pharmacological management: Advanced psychopharmacology for schizophrenia involves a combination of traditional and novel approaches to manage symptoms and improve patient outcomes. Here are some key aspects: 1. First-Generation Antipsychotics (FGAs) Typical: These include drugs like haloperidol and chlorpromazine. They primarily target dopamine receptors but can have significant side effects, such as extrapyramidal symptoms (EPS) and tardive dyskinesia1. 2. Second-Generation Antipsychotics (SGAs) Atypical: Also known as atypical antipsychotics, these include drugs like clozapine, risperidone, and olanzapine. They target both dopamine and serotonin receptors, offering a broader spectrum of symptom control with fewer EPS. 3. Long-Acting Injectable Antipsychotics (LAIs): These formulations, such as paliperidone palmitate and aripiprazole lauroxil, improve medication adherence by reducing the frequency of dosing. 4. Novel Mechanisms of Action: Recent advancements focus on drugs that target glutamate receptors, inflammation pathways, and other neurotransmitter systems beyond dopamine and serotonin. These include drugs like lumateperone and pimavanserin. 5. Adjunctive Therapies: Combining antipsychotics with other psychotropic medications, such as mood stabilizers or antidepressants, can help manage co- occurring symptoms and improve overall functioning1. 17 | P a g e  6. Side Effect Management: Addressing the side effects of antipsychotic medications, such as metabolic syndrome, weight gain, and cardiovascular issues, and to prevent relapse is crucial. This often involves lifestyle interventions and additional medications. 18 | P a g e  Nursing care plan of schizophrenic patients Nursing diagnosis Expected outcome Intervention Evaluation Risk For Self/Other- Short term 1. Maintain low level of stimuli in client’s environment After the nursing Directed Violence 1.Patient have remained free from (low lighting, few people, simple decor, low noise intervention the Related to injury and self-harm level). Anxiety level rises in a stimulating environment. patient after 2 Suspiciousness of others Through first half hour to 2 hours A suspicious, agitated client may perceive individuals weeks he able to 2.Patient haven’t harm other staff, as threatening. recognize and patients, or family members after 48 2. Observe client’s behavior frequently (every 15 report signs of hours minutes). Do this while conducting routine activities to wanting to harm Long term avoid creating suspiciousness in the individual. Close himself or others 3.Patient have recognized and report observation is necessary so that intervention can occur signs of wanting to harm himself or if required to ensure client’s (and others’) safety. others within 2 weeks 3. Remove all dangerous objects from client’s environment so that in his or her agitated, confused state client may not use them to harm self or others. 4. Try to redirect the violent behavior with physical outlets for the client’s anxiety (e.g., punching bag). Physical exercise is a safe and effective way of relieving pent-up tension. 5. Staff should maintain and convey a calm attitude toward client. Anxiety is contagious and can be transmitted from staff to client. 19 | P a g e  6. Have sufficient staff available to indicate a show of strength to client if it becomes necessary. This shows the client evidence of control over the situation and provides some physical security for staff. 7. Administer tranquilizing medications as ordered by physician. Monitor medication for its effectiveness and for any adverse side effects. The avenue of the “least restrictive alternative” must be selected when planning interventions for a psychiatric client. 8. If client is not calmed by “talking down” or by medication, use of mechanical restraints may be necessary. Restraints should be used only as a last resort, after all other interventions have been unsuccessful, and the client is clearly at risk of harm to self or others. Be sure to have sufficient staff available to assist. 9. Observe the client in restraints every 15 minutes (or according to institutional policy). Ensure that circulation to extremities is not compromised (check temperature, color, pulses). Assist client with needs related to nutrition, hydration, and elimination. Position 20 | P a g e  client so that comfort is facilitated, and aspiration can be prevented. Continuous one-to-one monitoring may be necessary for the client who is highly agitated or for whom there is an elevated risk of self- or accidental injury. Client safety is a nursing priority. 10. As agitation decreases, assess client’s readiness for restraint Removal or reduction. Remove one restraint at a time while Assessing client’s response. This minimizes risk of injury to Client and staff Nursing diagnosis Expected outcome Intervention Evaluation Disturbed Sensory Perception Short-Term Goal 1.Observe client for signs of hallucinations After nursing (Auditory/Visual) Client will discuss content of (listening pose, laughing, or talking to self, intervention, the patient Related to hallucinations with nurse or stopping in midsentence). Ask, “Are you is felling free from Schizophrenia as evidenced by therapist within 1 week. hearing the voices again?” hallucinations after few Inappropriate responses, anxiety, 2. Avoid touching the client without weeks. hallucinations, and illusion. Long-Term Goal warning him or her that you are about to do And he able to be Client will be able to define and so. effective between the assess reality, reducing or 3. An attitude of acceptance will encourage reality and eliminating. the client to share the content of the hallucinations the occurrence of hallucinations. hallucination with you. Ask, “What do you This goal may not be realistic for hear the voices saying to you?” the individual with severe and 4. Do not reinforce the hallucinations 21 | P a g e  persistent illness who has Use “the voices” instead of words like experienced auditory “they” that imply validation. Let client hallucinations know that you do not share the perception. for many years. A more realistic Say, “Even though I realize the voices are goal may be: real to you, I do not hear any voices Client will verbalize speaking.” understanding 5. Help the client understand the connection that the voices are a result of his or between increased anxiety and the presence her illness and demonstrate ways of hallucinations. to 6. Try to distract the client from the interrupt the hallucination Hallucinations 7.Do not reinforce the hallucination. Use words such as “the voices” instead of “they” when referring to the hallucination. Words like “they” validate that the voices are real. CLINICAL PEARL Let the client who is “hearing voices” know that you do not. share the perception. Say “Even though I realize that the voices are real to you, I do not hear any. voices speaking.” The nurse must be honest with the client so that he or she may. realize that the hallucinations are not real. 22 | P a g e  8.Try to connect the times of the hallucinations to times of increased anxiety. Help the client to understand this connection. If client can learn to interrupt escalating anxiety, hallucinations may be prevented. Nursing diagnosis Expected outcomes Intervention Evaluation Altered of though Short-term Goal 1. Convey your acceptance of client’s need for the false process related to [By specified time deemed belief, After 8 hours of Schizophrenia as appropriate], client will while letting him or her know that you do not share the nursing intervention, manifested by delusion recognize and belief. It is important to communicate to the client that the patient was able. verbalize that false ideas you do not accept the delusion as reality. To occur at times of increased 2. Do not argue or deny the belief. Use reasonable doubt Identify ways to anxiety. as a therapeutic technique: “I understand that you believe compensate for Long-term Goal this is true, but I personally find it hard to accept.” cognitive Depending on chronicity of Arguing Impairment and disease process, choose the with the client or denying the belief serves no useful memory deficits most. purpose, because delusional ideas are not eliminated by Demonstrate realistic long-term goal for this approach, and the development of a trusting behaviors to the client: relationship may be impeded. minimize changes. 3. Help client try to connect the false beliefs to times of increased anxiety. Discuss techniques that could be used 23 | P a g e  1. By time of discharge from to control anxiety (e.g., deep-breathing exercises, other After 2 weeks of treatment, client’s speech relaxation exercises, thought stopping techniques). If the RLE rotation, the will reflect reality-based client can learn to interrupt escalating anxiety, delusional patient was able to thinking. thinking may be prevented. maintain usual 2. By time of discharge from 4. Reinforce and focus on reality. Discourage long reality orientation. treatment, client will be able ruminations about the irrational thinking. Talk about real to events and real people. Discussions that focus on the false differentiate between ideas are purposeless and useless and may even aggravate delusional thinking and the psychosis. reality. 5. Assist and support client in his or her attempt to verbalize feelings of anxiety, fear, or insecurity. Verbalization of feelings in a nonthreatening environment may help client come to terms with long- unresolved issues. 24 | P a g e Nursing Diagnosis Expected Outcome Intervention Evaluation SELF-CARE Immediate goal 1-Provide assistance with self-care as 1-within 24h patient can perform self-care DEFICIT Patient will can perform self- he needs activities (eating, drinking, cleaning, Related care activities (eating, 2-Show how to perform activities with toileting, clothing, with assistance by the To Withdrawal, drinking, cleaning, toileting, which he is having difficulty with nurse, regression, panic clothing, with assistance by *Bathing and hygiene self care deficit 2- within 1weekpatient can performed self- anxiety, the nurse, -Encourage the use of soap, care without assistance. perceptual or Short-Term Goal washcloth, toothbrush, shaving 3-Pt the time Client abled to perform cognitive Client will verbalize a desire equipment, ADLs in an independent manner impairment, to perform ADLs by end of -educate the patient the way of self 4-Patient experience normal elimination inability to trust. 1 week. care hygiene for face and how to clean with aid of diet and fluid Long-Term Goal the body by soap and water, clean the EVIDENCED BY: Client will be. head by soap and water, how to comb Difficulty able to perform. the hair, cut nails, how to clean after conducting ADLs in an toilet from front to back tasks associated. independent -If client is soiling self, establish with hygiene, (Inability [or manner and routine schedule for toileting needs. refusal] to wash body or demonstrate a Assist client to bathroom on hourly or body part) willingness to do. bi-hourly Schedule, as need is dressing, so determined, until he or she can. grooming (Impaired Fulfil this need without assistance. ability or lack of interest in 25 | P a g e selecting appropriate _educate the patient to change clothes clothing to wear, dressing, and groom and dress continually. grooming, or maintaining *Imbalance in nutrition appearance at satisfactory -weight the client weekly level) eating (inability to -encourage eating with other bring food from receptacle -serve foods, drinks as he like to mouth) *If client is not eating because of and toileting (Inability or suspiciousness and fears of unwillingness to conduct Being poisoned, provide canned foods toileting procedures and allow client to without assistance] Open them; or, if possible, suggest , imbalance in nutrition) that food be served family style so that client may see everyone eating from the same Servings. -offer fluids between meal to avoid constipation -records fluid and fluid intake to avoid imbalance in nutrition -give step by step reminders such as Brush the teeth 3-Encourage client to perform many normal ADLs to his level of ability Successful performance of 26 | P a g e  independent activities enhances self- esteem. -Encourage independence, but intervene when client is unable to perform. Client comfort and safety are nursing priorities. _Provide positive reinforcement enhances self-esteem and encourages repetition of desirable behaviors. 4_provide equipment needed for personal hygiene for all patient) toothbrush, shaving equipment, soap, 5-provide positive reinforcement for independent accomplishments Nursing diagnosis Expected outcomes Intervention Evaluation Impaired social Short-Term Goal 1. Convey an accepting attitude by making brief, frequent After interaction Client will willingly attend therapy contacts. An accepting attitude increases feelings of self- nursing related to distrusted activities accompanied by trusted staff worth and facilitates trust. intervention thought process, lack of member within 1 week. 2. Show unconditional positive regard. This conveys your patient will social knowledge. Long-Term goal belief in the client as a worthwhile human being. be well as manifested by spend Client will voluntarily spend time with 3. Be with the client to offer support during group activities social time alone, difficulty other clients and staff. that may be frightening or difficult for him or her. The interaction focusing members in group 27 | P a g e  therapeutic activities. presence of a trusted individual provides emotional security for the client. 4. Be honest and keep all promises. Honesty and dependability promote a trusting relationship. 5. Orient client to time, person, and place, as necessary. 6. Be cautious with touch. Allow client extra space and an avenue for exit if he or she becomes too anxious. Suspicious client may perceive touch as a threatening gesture. 7. Administer tranquilizing medications as ordered by physician. Monitor for effectiveness and for adverse side effects. Antipsychotic medications help to reduce psychotic symptoms in some individuals, thereby facilitating interactions with others. 8. Discuss with client the signs of increasing anxiety and techniques to interrupt the response (e.g., relaxation exercises, thought stopping). Maladaptive behaviors such as withdrawal and suspiciousness are manifested during times of increased anxiety. 9. Give recognition and positive reinforcement for client’s voluntary interactions with others. Positive reinforcement enhances self-esteem and encourages repetition of acceptable behaviors. 28 | P a g e Nursing diagnosis Expected outcome Intervention Evaluation Impaired in Verbal Immediate goal 1- Asses if incoherent in speech chronic or if 1_within 1 hr. of nursing communication Within 1 hr. of nursing it is more sudden. interventions, the patient Related to: Altered perceptions. interventions, the patient was able 2- Develop a trusting. was abled to establish Disturbed thought to establish method of Relationship to facilitate trust and the method of processes, Withdrawal into the communication in which needs can ability to understand client’s actions and communication in which self, Disordered, unrealistic be expressed. communication Patients with needs can be expressed thinking. Schizophrenia that can by understood by Lack of Short term goal: 3- Establishing a therapeutic relationship and others social interactions) Ability to remain on one topic, promoting communication with patients 2_At the end of three-day And Inability to trust. using Appropriate, intermittent eye involves creating a safe and non- rot duty in providing of contact for 5 minutes with nurse. judgmental environment where the adequate nursing Others Or therapist. individual feels comfortable expressing interventions Evidence by At the end of three-day rot duty in themselves. Client expressed though, Use of words that are symbolic providing adequate nursing 4- Use the techniques of consensual feelings in a coherent, to the individual (neologisms)] interventions validation and seeking clarification to logical, goal-directed [Use of words in a meaningless, Client will express though, feelings decode communication patterns. manner. in a logical disconnected manner (word in a coherent, logical, goal-directed (Examples: “Is it manner with no Salad)] manner. That you mean…?” or “I don’t understand hesitation [Repetition of words that are That can be understand by others. what you mean by That. Would you please 3-Daily Patient spent heard (echolalia)] Long term goal: explain it to me?”) These techniques Reveal to two to three 5-minute [Does not speak (mutism) By time of discharge from the client how he or she is being perceived by sessions with nurses Fearful or anxious treatment, client will demonstrate. others, 29 | P a g e around others, Ability to continue a verbal 5 -Provide positive reinforcement. without showing signs Inappropriate communication in a socially 6-Encourage group activities of hesitancy and pressure emotional acceptable manner with staff and 7- Create an environment that is calm, quiet, responses, peers. well-lit, and conducive to effective Patient verbalize feeling Poor eye contact, participating in group communication Safe and Spends time alone. activities 8-Speak slowly, keep voice in low volume, and comfortable in and disorganized speech or Patient will build trusting use clear and simple words social situations thoughts relationship and 9-use simple words and keep directions simple by participating in group speak openly. 10-Use simple, concrete, and literal activities with the nurse explanations. Minimizes misunderstanding , spoke openly with patient. nurses. 11-Anticipate and fulfill client’s needs until satisfactory communication patterns return. 30 | P a g e Nursing diagnosis Expected Intervention Evaluation outcome Ineffective coping Short-term 1. Encourage same staff to collaborate with client as much as possible in order to 1. Client can Client will promote development of trusting relationship. appraise Related to develop trust in 2. Avoid physical contact. Suspicious clients may perceive touch as a threatening situations Schizophrenia as at least one gesture. realistically and manifested by poor staff member 3. Avoid laughing, whispering, or talking quietly where client can see but not hear refrain from in sight,social within what is being said. Suspicious clients often believe others are discussing them, and projecting own withdrawal, 1 week. secretive behaviors reinforce the paranoid feelings. feelings onto the negative symptoms Long-term 4. Be honest and keep all promises. Honesty and dependability promote a trusting environment. : diminished Client will relationship. 2. Client can emotional demonstrate 5. A creative approach may have to be used to encourage food intake (e.g., canned recognize and expression, use of more food and own can opener or family-style meals). Suspicious clients may believe clarify Avolition, adaptive they are being poisoned and refuse to eat food from the individually pre-pared tray. misinterpretations ,Alogia,Anhedonia, coping skills 6. Mouth checks may be necessary following medication administration to verify of the behaviors Asociality as whether client is swallowing the tablets or capsules. Suspicious clients may believe and evidenced by they are being poisoned with their medication and attempt to discard the pills. verbalizations of appropriateness 7. Activities should never include anything competitive. Activities that encourage others. of interactions a one-to-one relationship with the nurse or therapist are best. Competitive activities 3. Client eats and willingness are very threatening to suspicious clients. food from tray to participate in 8. Encourage client to verbalize true feelings. The nurse should avoid becoming and takes defensive when angry feelings are directed at him or her. Verbalization of feelings medications 31 | P a g e  the therapeutic in a non-threatening environment may help client come to terms with long- without evidence community. unresolved issues. of mistrust. 9. An assertive, matter of fact, yet genuine approach is least threatening and most 4.Client therapeutic. A suspicious person does not have the capacity to relate to an overly appropriately friendly, overly cheerful attitude. interacts and cooperates with staff and peers in therapeutic community setting 32 | P a g e Health education Patient and family education Explain to the patient and the family member regarding thought disturbance, mood changes, hallucinations. Instruct the family member that if the patient poses any treat or danger to self-harm or aggressive behavior, hospitalize him immediately. Teach the patient and family member two recognize families’ stressors which increase the symptoms and methods two prevent them. Explain the patients and family that schizophrenia is a chronic disorder with symptoms that affect the person thought process, mood, emotion, and social function throughout the person lifetime. Maintain communication with the effective people. Treatment education Take medicine regularly. Teach about medication compliance like Dizziness and vertigo, dry mouth, anxiety and tension, restless legs, weight gain, high blood pressure. Teach about therapeutic and the non-therapeutic effect of antipsychotic medication. The side effects of antipsychotics cannot be completely avoided. Depression, movement disorders, and sexual life disorders often occur. These symptoms often disappear on their own after several weeks. This is because your body adapts over time to the medication. If particularly strong side effects appear or do not go away within a few weeks, talk to your doctor immediately. Relapse education Follow up regularly. Take medicine regularly. 33 | P a g e  Avoid alcohol and taking any psychiatric medications and avoid smoking. Coping with stressors Talk to family and friends, make sure to exercise and get enough sleep. Avoid stressful situations and excessive loads as much as possible. Healthy nutrition Psychosocial interventions of schizophrenic patients 1. Promoting Client Safety ○ Monitor for self-harm or aggression: Regularly assess for suicidal ideation or violent behavior. ○ Safe environment: Ensure the patient's environment is free from potential hazards. 2. Establishing Therapeutic Relationships ○ Build trust and rapport: Engage in consistent, non-judgmental communication. ○ Active listening: Validate the patient's feelings and experiences. 3. Medication Management ○ Administer antipsychotic medications: Monitor for side effects and efficacy. ○ Educate about medications: Explain the importance of adherence and potential side effects. 4. Improving Thought Organization and Reality Orientation 34 | P a g e  ○ Reality-based interventions: Use clear, simple language and provide reality orientation. ○ Cognitive Behavioral Therapy (CBT): Help patients challenge and change distorted thoughts. 5. Promoting Effective Coping Strategies ○ Stress management techniques: Teach relaxation exercises and coping skills. ○ Encourage participation in activities: Promote engagement in structured activities to improve social skills. 6. Patient Education and Health Teachings ○ Psychoeducation: Provide information about schizophrenia, treatment options, and self-care. ○ Family education: Teach family members about the disorder and how to support the patient. 7. Medication Adherence ○ Regular follow-ups: Schedule consistent appointments to monitor medication adherence. ○ Simplify medication regimens: Use long-acting injectable antipsychotics if appropriate. 8. Early Identification of Relapse Signs ○ Educate patients and families: Teach them to recognize early warning signs of relapse, such as increased paranoia or social withdrawal. 35 | P a g e  ○ Develop a relapse prevention plan: Create a plan that includes steps to take if early signs of relapse appear. 9. Supportive Services ○ Case management: Provide ongoing support through case managers or community mental health services. ○ Vocational training: Help patients develop skills for employment and daily living. 10. Lifestyle Modifications ○ Healthy lifestyle: Encourage regular exercise, a balanced diet, and adequate sleep. ○ Avoid substance use: Educate about the risks of alcohol and drug use. 11. Therapeutic Interventions ○ Regular therapy sessions: Continue with individual or group therapy to address ongoing issues. ○ Family therapy: Involve family members in therapy to improve communication and support. 36 | P a g e  ❖References Brown, AS (April 2006). "Prenatal Infection as a Risk Factor for Schizophrenia". Schizophrenia Bulletin. 32 (2): 200–2. doi:10.1093/schbul/sbj052. PMC 2632220. PMID 16469941 Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001; 178:506-1. Kopelowicz, A., Liberman, R. P., & Zarate, R. (2006). Recent advances in social skills training for schizophrenia. Schizophrenia bulletin, 32 Suppl 1(Suppl 1), S12–S23. https://doi.org/10.1093/schbul/sbl023 Langdon, R., Connors, M. H., & Connaughton, E. (2014, December 4). Social cognition and social judgment in schizophrenia. Science Direct. https://www.sciencedirect.com/science/article/pii/S2215001314000262 Medically Reviewed by Jabeen Begum, MD on April 23, 2024Written by Deanna Altomarahttps://www.webmd.com/schizophrenia/medical-reference/default.htm Rn, A. C. (2021, January 29). Schizophrenia nursing diagnosis and nursing care plan. Nursestudy.net. https://nursestudy.net/schizophrenia-nursing-diagnosis The nurse. (2023, February 8). Nursing care plan for schizophrenia. The Nurse Page. https://www.thenursepage.com/nursing-care-plan-for-schizophrenia/ Wagner, M. (2022, February 26). Schizophrenia: Nursing diagnoses & care plans. NurseTogether. https://www.nursetogether.com/schizophrenia-nursing-diagnosis-care-plan/ WHO. Mental health systems in selected low- and middle-income countries: a WHO-AIMS cross- national analysis. WHO: Geneva, 2009 37 | P a g e 38 | P a g e