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Schizophrenia is a clinical syndrome of variable, but profoundly disruptive, psychopathology that involves cognition, emotion, perception, and other aspects of behavior. The expression of these manifestations varies across patients and over time, but the effect of the illness is always severe and is usually long lasting. The disorder usually begins before age 25, persists throughout life, and affects persons of all social classes. Although schizophrenia is discussed as if it is a single disease, it probably comprises a group of
emotion. and courses of illness vary. schizophrenia need not have a deteriorating course. He chose the term to express the presence of schisms between thought. affective disturbances. called dissociative identity disorder. There is no laboratory test for schizophrenia. . to mean split personality. This term is often misconstrued. These symptoms included associational disturbances of thought. autism. and it includes patients whose clinical presentations.disorders with heterogeneous etiologies. and ambivalence. and ambivalence. summarized as the four As: associations. which included those symptoms that Kraepelin saw as major indicators of dementia precox: hallucinations and delusions. The Four As Bleuler identified specific fundamental (or primary) symptoms of schizophrenia to develop his theory about the internal mental schisms of patients. and behavior in patients with the disorder. SYMPTOMS The symptoms of schizophrenia are divided into two major categories: positive or hard symptoms/signs and negative or soft symptoms/signs. autism. Bleuler stressed that. HISTORY Eugene Bleuler Bleuler coined the term schizophrenia. Split personality. unlike Kraepelin's concept of dementia precox. affect. treatment response. Bleuler also identified accessory (secondary) symptoms. in the text revision of the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) differs completely from schizophrenia. especially looseness. especially by lay people.
as if in a trance Flat affect: Absence of any facial expression that would indicate emotions or mood Lack of volition: Absence of will. and events Blunted affect: Restricted range of emotional feeling. activities. word. or situation Associative looseness: Fragmented or poorly related thoughts and ideas Delusions: Fixed false beliefs that have no basis in reality Echopraxia: Imitation of the movements and gestures of another person whom the client is observing Flight of ideas: Continuous flow of Negative or Soft Symptoms Alogia: Tendency to speak very little or to convey little substance of meaning (poverty of content) Anhedonia: Feeling no joy or pleasure from life or any activities or relationships Apathy: Feelings of indifference toward people. or mood Catatonia: Psychologically induced immobility occasionally marked by periods of agitation or excitement. or drive to take action or accomplish tasks verbalization in which the person jumps rapidly from one topic to another Hallucinations: False sensory perceptions or perceptual experiences that do not exist in reality Ideas of reference: False impressions that external events have special meaning for the person Perseveration: Persistent adherence to a single idea or topic. verbal repetition of a sentence. ambition. resisting attempts to change the topic . or phrase.Positive Hard Symptoms Ambivalence: Holding seemingly contradictory beliefs or feelings about the same person. tone. the client seems motionless. event.
social withdrawal. Motor immobility may be manifested by catalepsy (waxy flexibility) or stupor. catatonic type: characterized by marked psychomotor disturbance. mutism. . and extremely disorganized behavior. and. undifferentiated type: characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought. flat affect. echolalia. Schizophrenia. loose associations. incoherence. The diagnosis is made according to the client’s predominant symptoms: Schizophrenia. though not a current. excessive religiosity (delusional religious focus) or hostile and aggressive behavior. 2000). occasionally. Schizophrenia. and behavior Schizophrenia. and echopraxia. paranoid type: characterized by persecutory (feeling victimized or spied on) or grandiose delusions. Excessive motor activity is apparently purposeless and is not influenced by external stimuli. Other features include extreme negativism.TYPES The following are the types of schizophrenia according to the DSM-IV-TR (APA. disorganized type: characterized by grossly inappropriate or flat affect. episode. hallucinations. residual type: characterized by at least one previous. peculiarities of voluntary movement. Schizophrenia. either motionless or excessive motor activity. and looseness of associations. affect.
Genetics. Environmental a. but the cells in the brains of nonschizophrenic individuals appeared to be arranged in an orderly fashion. & Andreasen. This excess activity may be related to increased production or release of the substance at nerve terminals. Physiological a. Whereas the lifetime risk for developing schizophrenia is about 1 percent in most population studies. or a combination of these mechanisms (Sadock & Sadock. Anatomical Abnormalities. The studies have shown a ―disordering‖ of the pyramidal cells in the brains of schizophrenics. Indeed epidemiological statistics have shown that greater numbers of individuals from the lower socioeconomic classes experience symptoms . Ventricular enlargement is the most consistent finding. occurring in the hippocampus region of the brain. sulci enlargement and cerebellar atrophy are also reported. b. 2003). Sociocultural Factors. Black. 2. This theory suggests that schizophrenia (or schizophrenia-like symptoms) may be caused by an excess of dopamine-dependent neuronal activity in the brain. c.ETIOLOGY 1. With the use of neuroimaging technologies. Studies show that relatives of individuals with schizophrenia have a much higher probability of developing the disease than does the general population. Further research is required to determine the possible link between this birth defect and the development of schizophrenia. too many dopamine receptors. Twin and adoption studies add additional evidence for the genetic basis of schizophrenia. The Dopamine Hypothesis. increased receptor sensitivity. Histological Changes. d. however. Many studies have been conducted that have attempted to link schizophrenia to social class. 2003). structural brain abnormalities have been observed in individuals with schizophrenia. and related to an influenza virus encountered by the mother during the second trimester of pregnancy. Jonsson and associates (1997) have suggested that schizophrenic disorders may in fact be a birth defect. the siblings or offspring of an identified client have a 5 to 10 percent risk of developing schizophrenia (Ho.
associated with schizophrenia than do those from the higher socioeconomic groups (Ho, Black & Andreasen, 2003). This may occur as a result of the conditions associated with living in poverty, such as congested housing accommodations, inadequate nutrition, absence of prenatal care, few resources for dealing with stressful situations, and feelings of hopelessness for changing one’s lifestyle of poverty. An alternative view is that of the downward drift hypothesis (Sadock & Sadock, 2003). This hypothesis relates the schizophrenic’s move into, or failure to move out of, the low socioeconomic group to the tendency for social isolation and the segregation of self from others— characteristics of the disease process itself. Proponents of this notion view poor social conditions as a consequence rather than a cause of schizophrenia. b. Stressful Life Events. Studies have been conducted in an effort to determine whether psychotic episodes may be precipitated by stressful life events. There is no scientific evidence to indicate that stress causes schizophrenia. It is very probable, however, that stress may contribute to the severity and course of the illness. It is known that extreme stress can precipitate psychotic episodes (Goff, 2002). Stress may indeed precipitate symptoms in an individual who possesses a genetic vulnerability to schizophrenia. Sadock and Sadock (2003) state: ―The stress can be biological, environmental, or both. The environmental component can be either biological (e.g., an infection) or psychological (e.g., a stressful family situation)‖ (p. 477). Stressful life events may be associated with exacerbation of schizophrenic symptoms and increased rates of relapse.
EPIDEMIOLOGY In the United States, the lifetime prevalence of schizophrenia is about 1 percent, which means that about 1 person in 100 will develop schizophrenia during their lifetime. The Epidemiologic Catchment Area study sponsored by the National Institute of Mental Health reported a lifetime prevalence of 0.6 to 1.9 percent. According to DSM-IV-TR, the annual incidence of schizophrenia ranges from 0.5 to 5.0 per 10,000, with some geographic variation (e.g., the incidence is higher for persons born in urban areas of industrialized nations). Schizophrenia is found in all societies and geographical areas, and incidence and prevalence rates are roughly equal
worldwide. In the United States, about 0.05 percent of the total population is treated for schizophrenia in any single year, and only about half of all patients with schizophrenia obtain treatment, despite the severity of the disorder. In The Philippines, sixty percent (60%) of the case of mental illness is schizophrenia. It is equally prevalent in men and women and paranoid type schizophrenia is the most common form. Onset of the case is between 15-25 years old with few patients aged after 50 years old.
RECENT UPDATES New research identifies the brain chemicals and circuits involved in mental illnesses like schizophrenia, depression, and anxiety, giving potential new directions to their treatment. In addition, research with children shows that early-life depression and anxiety changes the structure of the developing brain. The findings were presented at Neuroscience 2011, the Society for Neuroscience's annual meeting and the world's largest source of emerging news about brain science and health. One in 17 Americans suffer from a serious mental illness, such as schizophrenia, major depression, or bipolar disorder, making it one of the leading causes of disability. Yet science is only beginning to understand the underlying physical causes of these diseases. New findings shows Childhood anxiety and depression alter the way the amygdala connects to other regions of the brain. This finding may help explain how early life stress can lead to future emotional and behavioral issues.
PSYCHIATRIC NURSING HISTORY
A. Preliminary Identifications Name: Gender: Adress: Birthday: Birth Place: Age: Height: Weight: Marital Status: Occupation: Language: Ethnicity: Nationality: Religion: Siblings: Education: Attending Physician: Mr. Schitz Male *toot* *toot* *toot* *toot* 5’4 Not assessed Single N/A *toot* Cebuano Filipino Roman Catholic *toot* College Undergraduate (1st year level only) *toot* .
10% Informants: Name: Mrs.Diagnosis: Source of Information: Schizophrenia Undifferentiated Type Patient .40% Patient’s Mother .50% Chart . Mommy Age: Relationship: Mother Length of acquaintance: Interviewer’s impression or Reliability: 95 % Chief Complaints: *toot* Personal Identification: *toot* History of Present Illness: *toot* History of Past Illness: *toot* .
Previous Admission: *toot* Medications: *toot* Family History: *toot* Psychosexual History: *toot* .
Infancy *toot* Primary need for bodily contact and tenderness Prototaxic mode dominates (no relation between experiences) Primary zones are oral and anal.Mistrusting Autonom y Vs. unmet needs lead to dread and anxiety. . .Rigid thought patterns. *toot* Toilet Training and developing sense of independence and control.36 mos.36 mos.Smokes . Shame and Doubt 18 .Fearful . (Toodler ) Achieving a sense of control and free will.Stinginess .Introvert *toot* . . Establishing trust.ANAMNESIS Psychosocial History Psychosexual History Cognitive Stages of Development Stages Tasks Fixations Stages Prenatal and Perinatal History Stages Age Tasks Stages Age Tasks *toot* Infancy and Early Childhood *toot* Trust Vs. infant has sense of wellbeing. Anal 18 . If needs are met. Mistrust 0-18 mos Infancy) *toot* Oral 0 -18 mos.
Inferiority . *toot* Shift to the sytaxic mode begins (thinking about self and others based on analysis of experiences in a variety of situations). Guilt 3-6 years (Presch ool) Beginning development of a conscience. taking pleasure in accomplishmen ts Latency 5–11 or 13 years Group identification Juvenile *toot*. Moderate anxiety leads to uncertainty and insecurity.Poor social skills. Learn to negotiate own needs Severe anxiety . learning to manage conflict and anxiety Phallic 3-5 years Establishing sexual identity. Childhood *toot* Parents viewed as source of praise and acceptance Shift to parataxic mode (experiences are connected in sequence to each other) Primary zone is anal. Inferiorit y 6 . severe anxiety results in selfdefeating patterns of behavior.12 years (School Age) Emerging confidence in own abilities. Opportunities for approval and acceptance of others.Middle Childhood *toot* Initiative Vs. Insecurity *toot* Industry Vs. Gratification leads to positive selfesteem. .
Low selfesteem *toot* *toot* .adult Developing social control over instincts. Identity Vs. Move to genuine intimacy with friend of the same sex Move away from family as source of satisfaction in relationships Major shift to syntaxic mode Capacity for attachment.Financially dependent . love. Need for special sharing relationship shifts to the opposite sex. If the selfsystem is intact. areas of concern expand to . prejudicial attitudes. Adolescen ce Lust is added to interpersonal equation.Preadolesc ence may result in a need to control or restrictive. and collaboration emerges or fails to develop. Role Confusio n 12 . New opportunities for social experimentatio n lead to the consolidation of self-esteem or self-ridicule. Adolescen ce *toot* .18 years (Adoles cent) Formulating a sense of self and belonging Genital 11 or 15 .
.include values. Young Adulthood *toot* Intimacy Vs. ideals. and social concerns.Persistent isolation and aloneness . loving relationships and meaningful attachments to others. Isolation 18 25/30 years (Young Adult) Forming adult.Jealousy *toot* . career decisions.
GENOGRAM Ќ .
Schizophrenia Undifferentiated Ќ .Gastritis .Male .Kidney Disease .Female .Deceased .LEGEND: .Smoker .PTB .Close relationship .Diarrhea and .Separated Dehydration .Patient .
Attending Physician: Evaluation Activity Area of Mental Function Evaluated Orientation to time Orientation to Place Attention and Immediate Recall Abstract Thinking Recent Memory Naming Objects Ability to follow simple verbal commands Ability to follow simple written commands Ability to use language correctly Ability to Concentrate Understanding spatial relationships TOTAL SCORE Assessed by: Date: Time: .MINI MENTAL STATUS EXAMINATION Name of Patient: Date: DSM IV TR Diagnosis/Impression: Schizophrenia Undifferentiated Age: Gender: Civil Status: Maximum Score 3 1 3 3 3 2 2 2 3 4 5 31 Actual Score 3 1 3 3 3 2 2 2 3 4 5 31 Normal .
Name of Patient: DSM IV TR Diagnosis/Impression: Age: Gender: Civil Status: Maximum Score 3 1 3 Actual Score 3 1 3 Date: Attending Physician: Evaluation Activity Area of Mental Function Evaluated Orientation to time Orientation to Place Attention and Immediate Recall Abstract Thinking Recent Memory Naming Objects Ability to follow simple verbal commands Ability to follow simple written commands Ability to use language correctly Ability to Concentrate Understanding spatial relationships TOTAL SCORE 3 3 2 2 3 3 2 2 2 2 3 3 4 5 4 5 .
interacts withobeys instructions. cooperative. friendly. nails trimmed and clean.COMPREHENSIVE MENTAL STATUS EXAMINATION WEEK 1 General Appearance Patient wearing white t-shirt and blue short pants with black slippers. Patient is normoactive. easy to talk with. shows interest in doing with. nails trimmed and clean. combed hair and brushed his teeth daily. sometimes look depressed and sometimes happy. can walk and stand normally. interacts with his student nurse. seems happy while interacting with other patients near the entrance. Patient has a normal gait and posture. Patient has spontaneous character. cooperative. take a bath every day. smile. PROBLEM IDENTIFIED Social Isolation Self-care Deficit EVALUATION General appearance was assessed objectively. Emotional State and Reaction Patient has euthymic mood and Patient has euthymic mood and No problem identified appropriate flat affect with a rate appropriate flat affect with a rate of mood 8/10. cooperative and warm. shows interest in doing things. No problem identified General mobility was assessed objectively. organization of talk is relevant and has good accessibility. it was assessed subjectively. General Mobility Patient has a normal gait and posture. easy to talk his student nurse. loves to talk with someone who looks friendly but someone who looks friendly but he chooses sometimes people he chooses sometimes people NPI was the key tool used to assessed patient’s emotional state. cooperative and warm. WEEK 2 Patient wearing dark blue tshirt and dirty red short pants with black slippers. Speech Pattern No problem identified Speech pattern was assessed objectively. . organization of talk is relevant and has good accessibility. take his medications and eat his breakfast. loves to talk with things. lunch and dinner. looks happy. friendly. combed hair and brushed his teeth daily. cooperate with his student nurse and interact with other people. Patient has spontaneous character. Patient looks of mood 8/10. well groomed. obeys instructions. well groomed. Patient is normoactive. Patient looks friendly because he always friendly because he always smile. looks happy. take a bath everyday. can walk and stand normally.
with good appetite and diurnal variation. be with. depersonalization or derealizations nor illusions. can count and can solve some mathematical No problem identified Nurse patient interaction: Neurovegetative Functions No problem identified General Sensorium and Intellectual Status No problem identified Nurse patient interaction: . He never attempt commit suicide or homicide. he wanted to live in a peaceful place. He didn’t have preoccupation but at times he ruminates and regrets the things that he had done. weight and libido not assessed. person and place. He is always alert. depersonalization or derealizations nor illusions. He is always alert. He didn’t have preoccupation but at times he ruminates and regrets the things that he had done. Thought Content Patient likes to talk about assembling his motor vehicle and the most important thing for him is his motor and his mother. He never attempt commit suicide or homicide. patient has negative hallucinations. He viewed himself as a shy person. Patient has a normal sleep. can calculate numbers. like when he broke his components and when he kicked his mother. In terms of perceptual disturbances. weight and libido not assessed. Patient is well oriented to time. He viewed himself as a shy person. patient has negative hallucinations. person and place. and don’t want to be in a crowded and noisy place. Patient is paranoid coz he didn’t easily trust people like her mother and other student nurse. can calculate numbers. Patient is paranoid coz he didn’t easily trust people like her mother and other student nurse. with good appetite and diurnal variation. He chooses those persons he’d like to interact with. he wanted to live in a peaceful place. Patient is well oriented to time. like when he broke his components and when he kicked his mother. can count and can solve some mathematical Patient likes to talk about assembling his motor vehicle and the most important thing for him is his motor and his mother. Patient has a normal sleep. He has a delusion type of erotomania in which he thinks that someone is inlove with him. and don’t want to be in a crowded and noisy place. In terms of perceptual disturbances. He has a delusion type of erotomania in which he thinks that someone is inlove with him. He chooses those persons he’d like to interact with.he would like to talk with and to he would like to talk with and to be with.
. can interpret the information given to him but it takes a time before he can finalize his answers. has the ability to understand certain facts and draw conclusions from relationships. sometimes he is able to deal with concepts.question/abstract. has the ability to understand certain facts and draw conclusions from relationships. has an insight and his ego defense mechanism: acting out. he can identify things which is not belong to the group and can give meanings when you ask him to say something about certain things. has an insight and his ego defense mechanism: denial. can understands what student nurse wants him to answer and he can response slowly but surely correct. recent and remote memory. he can identify things which is not belong to the group and can give meanings when you ask him to say something about certain things. recent and remote memory. can interpret the information given to him but it takes a time before he can finalize his answers. question/abstract. can recall immediate. can recall immediate. sometimes he is able to deal with concepts. can understands what student nurse wants him to answer and he can response slowly but surely correct.
Care Deficit Integumentary System Self.Care Deficit .Care Deficit Self. WEEK 1 Objective Problem Identified Objective WEEK 2 Problem Identified No Problem Identified Self.PEROS Subjective General Health Survey .
Head and Face . Eyes No problem identified No problem identified .HEENT a. No problem identified No Problem identified b.
Nose No problem identified No problem identified e. Ears No problem identified No problem identified d. Oral Cavity No problem identified No problem identified Neck No problem identified No problem identified Respiratory System No problem identified No problem identified .c.
No problem identified Genitourinary System Musculoskeletal System Neurologic System . No problem identified Gastointestinal System/ Abdomen No Problem Identified. No problem identified No problem identified No problem identified No problem identified .Cardiovascular System Breast and Axilla No Problem Identified.
No problem identified No problem identified .
No problem identified Lymphatic / Hematologic System No problem identified Endocrine System No problem identified No problem identified No problem identified No problem identified .
Spiritual Assessment *toot* Cultural Assessment *toot* .
2 0 0 0 0 0 Normal Values 40-75 19-48 3-9 0-7 0-2 Interpretations Significance results CHEMISTRY Creatinine SGPT SGOT 1.1 0.5 3.0-41.3 335 4.3 6.DIAGNOSTIC TEST Complete Blood Count Examination White blood cell Hemoglobin Hematocrit MCV(Mean corpuscular volume) MCH(mean corpuscular hemoglobin) Red blood count MCHC RDW MPV Platelet count Results 6.7-6.3 24.0 Normal Normal Normal .2 22.40 95.1 150-400 DIFFERENTIAL COUNT Examination Neutrophils Lymphocytes Monocytes Eosinophils Basophils Stab Atypical Lymphocytes Metamyelocytes Myelocytes Blast Results 65.1 330-370 11-16 7.2-11.8-10.0 Normal Values 4.4 7.0-35.6 133 0.3 0.7 0.42-0.0 0.2 332 12.9-1.8 140-180 0.6 27-31 4.22 28.52 80-94 Interpretations Date: Significance results 31.
1 tab per day Positive Symptoms Frontal Deficit Detachment to reality Ineffective coping r/t inabitlity to trust/ low self-esteem/ inadequate support systems/ possible hereditary factors. lack of trust and history of violence. interactions with others Anhedonia DSM-IV-TR Social Isolation r/t lack of trust/delusional thinking/past experiences of difficulty in interactions with others Self-care deficit r/t withdrawal into the self Symptoms: Delusions + Anhedonia Social/occupational dysfunction Duration: signs of the disturbance persist for at least six months . Risperidone 2mg.CONCEPT MAP: Schizophrenia Undifferentiated Head Trauma Intrauterine Influences: STRESS Poverty Stressful Life Situation: Separation of Parents Brain physiology alteration Distubance in brain development Failure of coping mechanisms: Acting Out Denial LEGEND: Predisposing Factors Pathogenesis Medications Nursing Diagnoses Precipitating Factors Signs & Symptoms Decreased brain volume Continued disequilibrium Diagnostic Tool Functional Deficit Temporal Deficit Biperiden 2mg/tab. 1 tab BID Labile Mood + Negative Symptoms Schizophrenia Undifferentiated Disturbed thought process r/t delusional thinking /possible hereditary factors Delusions: Erotomania Paranoia Risk for self-directed or otherdirected violence r/t false fixed beliefs.
1984 December 1989 1996 1997-1999 *toot* *toot* *toot* *toot* *toot* *toot* *toot* *toot* *toot* *toot* . 24.LIFE CHART 1983 1997-1999 Nov.
2000 2002 2006 2008-2009 2010 *toot* *toot* *toot* *toot* *toot* *toot* *toot* *toot* *toot* *toot* .
2011 Nov. 2011 *toot* *toot* *toot* *toot* *toot* .Aug. 24.-Sept. 2011 Oct 2011 Oct 27. 10. 2011 Dec.
2. crying frequently) or catatonic behavior Negative symptoms . which is a manifestation of formal thought disorder Grossly disorganized behavior (e. or hallucinations consist of hearing one voice participating in a running commentary of the patient's actions or of hearing two or more voices conversing with each other. dressing inappropriately. Delusions Hallucinations Disorganized speech. This six-month period must include at least one month of symptoms (or less.DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDER According to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). to be diagnosed with schizophrenia. (DSM code 295. disorganized behavior. interpersonal relations. only that symptom is required above. one or more major areas of functioning such as work. The speech disorganization criterion is only met if it is severe enough to substantially impair communication. and affective flattening are absent.3/ICD code F20. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance. each present for much of the time during a one-month period (or less.affective flattening (lack or decline in emotional response). if symptoms remitted with treatment). if symptoms remitted with treatment). Duration: Continuous signs of the disturbance persist for at least six months. three diagnostic criteria must be met: 1.0) . are markedly below the level achieved prior to the onset. or avolition (lack or decline in motivation) If the delusions are judged to be bizarre. or self-care.g. alogia (lack or decline in speech). 3. Characteristic symptoms: Two or more of the following. Subtypes The DSM-IV-TR contains five sub-classifications of schizophrenia. Paranoid type: Where delusions and hallucinations are present but thought disorder.
or catatonic types have not been met. (DSM code 295.5) . Symptoms can include catatonic stupor and waxy flexibility.2/ICD code F20. disorganized.2) Undifferentiated type: Psychotic symptoms are present but the criteria for paranoid.3) Residual type: Where positive symptoms are present at a low intensity only. (DSM code 295. Where thought disorder and flat affect are present together. (DSM code 295.6/ICD code F20.9/ICD code F20. purposeless movement.1) Catatonic type: The subject may be almost immobile or exhibit agitated. (DSM code 295.1/ICD code F20. Disorganized type: Named hebephrenic schizophrenia in the ICD.
Honesty and dependability promote a trusting relationship. Because the client believes the delusion.Lack of trust: paranoid (poor eye to eye contact. the client will voluntarily spend time with other clients. (2004). immediate. person. he or she may examine the room periodically or speak in hushed.An accepting attitude increases feelings of self-worth and facilitates trust. and total certainty with which the client holds these beliefs.Orient client to time. For example. the client demonstrated willingness and desire to socialize with others. p. LTOE: Long term goals were met.This conveys your belief in the client as a worthwhile human being. and place. the client will willingly attend therapy activities accompanied. the client voluntarily attended group activities. After 4 hours of nurse-client interactions. . answered questions with hesitations. frequent contacts. student nurses and staff members in group activities.Convey an accepting attitude by making brief. the client with delusions of persecution will probably be suspicious.The presence of a trusted individual provides emotional security for the client.Be honest and keep all promises. Psychiatric Mental Health nd Nursing. Allow client extra space and an avenue for exit if he or she becomes too anxious. . .PSYCHIATRIC-MENTAL HEALTH NURSING CARE PLAN Name of patient: Diagnosis: Schizophrenia. Cues Subjective: Objective: -Preoccupation with own thoughts (thoughts of assembling his own bicycle) . and guarded about disclosing personal information. mistrustful. . . secretive tones. 309 Nursing Diagnosis: Social Isolation r/t lack of trust/delusional thinking/past experiences of difficulty in interactions with others Cause Analysis: Clients with schizophrenia usually experience delusions (fixed. 2 ed. Intervention Nurse Patients Relationship: .A suspicious client may perceive touch as a threatening gesture. Shiela L. as necessary. and approached others in appropriate manner for one-to-one interaction. he or she will therefore act accordingly.Show unconditional positive regard. . After 4 days of nurse-client interactions. . . Honesty and dependability promote a trusting relationship.Be cautious with touch. Undifferentiated Type Admission Date: Implementation Date: Shift: Ward: References Videbeck.) Nursing Outcomes STO: Within 4 hours of nurseclient interactions. LTO: Within 4 days of nurseclient interactions. Rationale STOE: Evaluation Short term goals were met. . . A common characteristic of schizophrenic delusions is the direct.Be with the client to offer support during group activities that may be frightening or difficult for him or her. false beliefs with no basis in reality) in the psychotic phase of the illness. .
Mary C.g.To prevent occurrence of new problems References: Townsend. thought stopping). . tab . relaxation exercises. . (2008).Give recognition and positive re inforcement for client’s voluntary interactions with others.Monitor medication for its effectiveness and for any adverse side effects. Nursing Diagnosis in Psychiatric Nursing. 103-105 . thereby facilitating interactions with others..Maladaptive behaviors such as withdrawal and suspiciousness are manifested during times of increased anxiety.Positive reinforcement enhances self-esteem and encourages repetition of acceptable behaviors.Discuss with client the signs of increasing anxiety and techniques to interrupt the responses (e.Administer medications as ordered by physician such as: a. 7 ed. th . p.Antipsychotic medications help to reduce psychotic symptoms in some individuals. . Psychoparmacology: . Risperidone 2mg/tab. 1 tab BID b. Biperiden 2mg/tab.. .
Maintain and convey a calm attitude toward client. was able to recognize signs of increasing anxiety and agitation and verbalized to report to staff for assistance with intervention. 313 Nursing Diagnosis: Risk for self-directed or other-directed violence r/t false fixed beliefs. the client will recognize signs of increasing anxiety and agitation and report to staff for assistance with intervention. Do this while carrying out routine activities. . agitated client may perceive individuals as threatening.Delusions of Erotomania Nursing Outcomes STO: Within 4 hours of nurse-client interactions.So that in his or her agitated. low noise level). answered questions with hesitations. The client may be paranoid and suspicious of the nurse and the environment and may feel threatened and intimidated. Milieu Management: . the client also is feeling unsafe & may believe his or her well-being to be in jeopardy. Intervention Nurse Patients Relationship: . Rationale STOE: Evaluation Short term goals were met. After 3 days of nurse-client interactions. .Physical exercise is a safe and effective way of relieving pent-up tension. confused state client may not use them to harm self or others.Maintain low level of stimuli in client’s environment (low lighting. Cues Subjective: Objective: . Although the client’s behavior may be threatening to the nurse.Try to redirect the violent behavior with physical outlets for the client’s anxiety.Have sufficient staff available to indicate a show of strength to client if .This shows the client evidence of control over the situation and provides some physical security for . Close observation is necessary so that intervention can occur if required to ensure client (and others’) safety. the client caused no harm to self or others.Lack of trust: paranoid (poor eye to eye contact. LTO: Within 3 days of nurseclient interactions. . Shiela L. . . . (2004).) . Psychiatric Mental Health nd Nursing. few people. the client will not harm self or others. Undifferentiated Type Admission Date: Implementation Date: Shift: Ward: References Videbeck.Name of patient: Diagnosis: Schizophrenia. He also demonstrated trust of others in his environment. p. . After 4 hours of nurse-client interactions.Observe client’s behavior frequently (every 15 minutes).Anxiety level rises in a stimulating environment.So as to avoid creating suspiciousness in the individual. 2 ed. LTOE: Long term goals were met.Remove all dangerous objects from client’s environment . A suspicious.Anxiety is contagious and can be transmitted from staff to client. simple decor. lack of trust and history of violence. Cause Analysis: Safety for both the client and the nurse is the priority when providing care for the client with schizophrenia. .
Biperiden 2mg/tab.Encourage same staff to work with client as much as possible. Intervention Nurse Patients Relationship: . 7 ed. Nursing Diagnosis in Psychiatric Nursing. Psychiatric Mental Health nd Nursing.In order to promote development of trusting relationship.it becomes necessary.Monitor medication for its effectiveness and for any adverse side effects. 1 tab BID b. p. 2 ed. 318 Nursing Diagnosis: Ineffective coping r/t inabitlity to trust/ low self-esteem/ inadequate support systems/ possible hereditary factors. Rationale Evaluation STOE: Short term goals were met. 102-103 Name of patient: Diagnosis: Schizophrenia. resulting in: • Alteration in societal participation Nursing Outcomes STO: Within 4 hours of nurseclient interactions. .Suspicious clients may perceive touch as a threatening gesture. Cues Subjective: Objective: . the client will develop trust in the SN or at least one staff member. p.To prevent occurrence of new problems. tab .Avoid physical contact.Suspiciousness of others. Undifferentiated Type Admission Date: Implementation Date: Shift: Ward: References Videbeck. The nurse helps the client to manage his or her illness and health needs as independently as possible. staff. . the client was able to eats food from tray and takes medications without evidence of . This can be accomplished only through education and ongoing support. but this is a particular challenge for clients with schizophrenia because their health needs can be complex and their ability to manage them may be impaired. Mary C. After 4 hours of nurse-client interactions. Psychoparmacology: . Risperidone 2mg/tab. References: Townsend. . Shiela L. . (2008). th .The avenue of the ―least restrictive alternative‖ must be selected when planning interventions for a psychiatric client. Cause Analysis: Identifying and managing one’s own health needs are primary concerns for everyone.Administer medications as ordered by physician such as: a. (2004).
. matter-of-fact.Verbalization of feelings in a non-threatening environment may help client come to terms with long-unresolved issues.Activities should never include anything competitive. 7 ed. The nurse should avoid becoming defensive when angry feelings are directed at him or her.Mouth checks may be necessary following medication administration to verify whether client is swallowing the tablets or capsules. overly cheerful attitude. -Be honest and keep all promises. Nursing Diagnosis in Psychiatric Nursing. (2008). mistrust. Mary C. p. the will demonstrate use of more adaptive coping skills as evidenced by appropriateness of interactions and willingness to participate in the therapeutic community. 105-106 . . Psychoparmacology: . . yet genuine approach is least threatening and most therapeutic. the client appropriately interacted and cooperated with staff and SN in therapeutic community setting. . th -Suspicious clients may believe they are being poisoned with their medication and attempt to discard the pills.Avoid laughing.A suspicious person does not have the capacity to relate to an overly friendly. . Competitive activities are very threatening to suspicious clients. After 3 days of nurse-client interactions.Encourage client to verbalize true feelings.An assertive.• Inability to meet basic needs • Inappropriate use of defense mechanisms LTO: Within 3 days of nurseclient interactions. or talking quietly where client can see but not hear what is being said. .Activities that encourage a oneto-one relationship with the nurse or therapist are best.Suspicious clients often believe others are discussing them. . whispering.Honesty and dependability promote a trusting relationship. References: Townsend. LTOE: Long term goals were met. and secretive behaviors reinforce the paranoid feelings. . .
Psychiatric Mental Health nd Nursing.This information is necessary to acquire an accurate nutritional assessment. but intervene when client is unable to perform. . Cues Subjective: Objective: . 319 Nursing Diagnosis: Self-care deficit r/t withdrawal into the self Cause Analysis: Because of apathy or lack of energy over the course of the illness. . Nursing Diagnosis in Psychiatric Nursing.Offer recognition and positive reinforcement for independent accomplishments. . LTO: Within 4 days of nurseclient interactions. .lack of interest in maintaining appearance at a satisfactory level Nursing Outcomes STO: Within 4 hours of nurse-client interactions. . 7 ed.Because concrete thinking prevails.Encourage client to perform normal ADLs to his or her level of ability. Risperidone 2mg/tab. Psychoparmacology: .The avenue of the ―least restrictive alternative‖ must be selected when planning interventions for a psychiatric client. the client was able to take a bath. how to perform activities with which he or she is having difficulty.Keep strict records of food and fluid intake.Successful performance of independent activities enhances self-esteem. Mary C. (2004). After 4 days of nurse-client interactions. 111-112 .Administer medications as ordered by physician such as: a. on concrete level.Refusal to take a bath . (2008). Undifferentiated Type Admission Date: Implementation Date: Shift: Ward: References Videbeck. LTOE: Long term goals were met.Client comfort and safety are nursing priorities. poor personal hygiene can be a problem for clients who are experiencing psychotic symptoms as well as for all clients with schizophrenia. the client maintained optimal level of personal hygiene by bathing daily and carrying out essential toileting procedures without assistance. . explanations must be provided at the client’s concrete level of comprehension. . After 4 hours of nurse-client interaction.Encourage independence. change clothing and brush teeth. References: Townsend. p.Monitor medication for its effectiveness and for any adverse side effects. Intervention Nurse Patients Relationship: . Biperiden 2mg/tab. Shiela L. p. . tab . . 2 ed.Show client. 1 tab BID b. STOE: Evaluation Short term goals were met. the client will verbalize a desire to perform ADLs. the client will be able to perform ADLs in an independent manner and demonstrate a willingness to do so by time of discharge from treatment.Name of patient: Diagnosis: Schizophrenia. th Rationale .Positive reinforcement enhances self-esteem and encourages repetition of desirable behaviors.
Short attention span— distractibility . Discuss techniques that could be used to control anxiety (e. client will experience (verbalize evidence of) no delusional thoughts and will be able to differentiate between delusional thinking and reality. thought stopping techniques). LTOE: Long term goals were met. After 4 hours of nurse-client interaction.Reinforce and focus on reality.Verbalization of feelings in a nonthreatening environment may . Cues Subjective: Objective: .Help client try to connect the false beliefs to times of increased anxiety. . . Undifferentiated Type Admission Date: Implementation Date: Shift: Ward: References Videbeck.. and may even aggravate the psychosis. delusional thinking may be prevented.Name of patient: Diagnosis: Schizophrenia. .Discussions that focus on the false ideas are purposeless and useless. and the development of a trusting relationship may be impeded. 2 ed. the client will verbalize that false ideas occur at times of increased anxiety. Intervention Nurse Patients Relationship: . Use reasonable doubt as a therapeutic technique: ―I find that hard to believe. . Psychiatric Mental Health nd Nursing. Shiela L. other relaxation exercises.Do not argue or deny the belief. p.Delusional thinking (false ideas) . was able to maintain activities of daily living (ADLs) to his maximal ability and refrained from responding to delusional thoughts. Discourage long ruminations about the irrational thinking.‖ Rationale reality-based thinking . (2004). 314 Evaluation STOE: . On the day of the discharge.Convey your acceptance of client’s need for the false belief.Inappropriate non- Nursing Outcomes STO: Within 4 hours of nurse-client interactions. LTO: By time of discharge from treatment. because delusional ideas are not eliminated by this approach.It is important to communicate to the client that you do not accept the delusion as reality.g. Talk about real events and real people.Assist and support client in his or .If the client can learn to interrupt escalating anxiety. deep breathing exercises. . Short term goals were met. Such delusions powerfully influence the client’s behavior. while letting him or her know that you do not share the belief. .Arguing with the client or denying the belief serves no useful purpose. the verbalized reflect thinking processes oriented in reality. Nursing Diagnosis: Disturbed thought process r/t delusional thinking /possible hereditary factors Cause Analysis: The client (with schizophrenia) experiencing delusions utterly believes them and cannot be convinced that they are false or untrue.
(2008). 1 tab BID b. fear.Administer medications as ordered by physician such as: a.Monitor medication for its effectiveness and for any adverse side effects.her attempt to verbalize feelings of anxiety. Biperiden 2mg/tab. The avenue of the ―least restrictive alternative‖ must be selected when planning interventions for a psychiatric client References: Townsend. Risperidone 2mg/tab. or insecurity. 7 ed. tab . p. help client come to terms with long unresolved issues. Psychoparmacology: . Mary C. 108-109 th . Nursing Diagnosis in Psychiatric Nursing.
PSYCHOTHERAPIES DEFINITION Music therapy Forms of music therapy generally are based around cognitive/behavioral. concerns and conflicts. There are usually both active and receptive parts of the therapy. And generates those good feelings that come from being others. -Remain calm and state limits on behavior in a firm manner. Dance therapist believes that mental and emotional problems are often held in the body in the form of muscle tension and constrained movement patterns. laugh or crazy in response. As human service profession that uses art media. images. and patient/client responses to the created products as reflections of individuals development. as well as an adequate amount of time for the session. Moving rhythmically eases Practice is based on knowledge of human developmental and psychological theories which are implemented in the full spectrum of models of assessment and treatment including -Ensures that appropriate materials and space are available for the client-artist. meaning that at times music is listened to and at other times there is the use of musical improvisation or creation. out. both positive and negative. creates powerful social and emotional bonds. interest. It can help people to express feelings by making musical sounds and music . Promote healing in a number of ways. Moving in a group brings people out of isolation. Dance therapy A method of psychological treatment in which movement and dance are used to express and deal with feelings and experiences. abilities. Conversely. personality. -provide protection in the . -provide protection in the environment by constant observation and removal of objects that could harm self/ others. they believe that the state in the body can affect attitudes and feelings. Be truthful but not judgmental. creates powerful social and emotional bonds. Use of music as an addition to relaxation therapy in psychotherapy to elicit expression of suppressed emotion by promoting patients to dance. humanistic or psychoanalytic frameworks or a mixture of approaches. Moving rhythmically eases muscle rigidity. -Gives him reason to value himself and increase his selfrespect. -Stimulate patient to think about something and talk about himself. Moving in a group brings people out of isolation. And generates those good feelings that come from being others. -music is selected which evoke the client’s long term memory processes and stimulates reminiscence. Also called movement therapy is based on the premise that the body and mind are interrelated. INDICATION NURSING RESPONSIBILITIES MECHANICS Is the most frequently used to help the mentally or physical disabled. both positively and negatively. diminishes anxiety. and increases energy Art therapy Promote healing in a number of ways. the creative process.
developing social skills. reducing anxiety. A climate or warm friendliness and acceptance are essential. . reading. improves musculoskeletal function. props are used to promote discussion of topics. and increases energy educational. -provide protection in the environment by constant observation and removal of objects that could harm self/ others. -Accept the client manipulative behaviorism such as anger without reacting an emotional basis. solving problems . environment by constant observation and removal of objects that could harm self/ others.muscle rigidity. foster selfawareness. transpersonal. -Remain calm and state limits on behavior in a firm manner. poetry and current events from bridge to reality. Exercise therapy Prescription of bodily movement to correct impairment. and other therapeutic means of reconciling emotional conflicts. Improve exercise performance and functional capacity (endurance). and increasing self esteem. managing behavior. Be truthful but not judgmental. psychodynamic. Improve muscle strength and maintain maximal voluntary contractile force. Improve circulation and respiratory capacity. diminishes anxiety. cognitive. or maintains a state of wellbeing.
Monitor blood pressure. extrapyramidal reactions. Advise patient to use effective bedtime routine to avoid sleep disorders. nervousness. Dosage Adverse Reactions. anorexia GU: difficulty urinating. Patient Teaching Instruct patient to remove orally disintegrating tablet from blister pack. tachycardia. other dopamine agonists: decreased antiparkinsonian effects of these drugs Drug-behaviors Alcohol use: increased CNS depression Sun exposure: increased risk of photosensitivity Patient Monitoring Closely monitor Mechanism of Action Route. sedative hypnotics: additive CNS depression Carbamazepine: increased metabolism and decreased efficacy of risperidone Clozapine: decreased metabolism and increased effects of risperidone Levodopa. extrapyramidal reactions. dyspepsia. unstable blood pressure. rhinitis. transient ischemic attack (TIA). agitation. fatigue. cerebrovascular accident (CVA). dizziness. drowsiness. pharyngitis GI: nausea. Drug-drug Antihistamines. Teach patient to . CVA. akathisia. coffee. Side Effects Interactions Nursing Implications neurologic status. anxiety. headache. particularly for orthostatic hypotension. hyperkinesia. Antagonizes serotonin2 and dopamine2 receptors in CNS. diarrhea. longer sleep periods.PSYCHOPHARMACOLOGY Indications Generic Name: risperidone Trade Names: Risperdal Classification: Therapeutic: Antipsychotics. place on tongue immediately. vomiting. muscle rigidity. menorrhagia. increased salivation. orange juice. abdominal pain. sedation. TIA. tardive dyskinesia. especially for neuroleptic malignant syndrome (high fever. sweating. stupor. arrhythmias EENT: vision disturbances. Tell him solution isn’t compatible with cola or tea. decreased libido Musculoskeletal: joint or back pain Respiratory: cough. and autonomic dysfunction). galactorrhea. or low-fat milk. mood stabilizers Pharmacologic: Benzisoxazoles Schizophrenia in adults and adolescents age. Check for fever and other signs and symptoms of infection. Also binds to alpha1and alpha2 adrenergic receptors and histamine H1 receptors. constipation. polyuria. insomnia. opioids. increased dreams. and swallow as tablet dissolves. Tell patient to mix oral solution with water. Frequency. sinusitis. Assess body temperature. dry mouth. neuroleptic malignant syndrome CV: orthostatic hypotension. Oral: 2mg/tab. dysmenorrhea. 1 tab BID CNS: aggressive behavior. chest pain. and tardive dyskinesia.
. vomiting. increased pigmentation. Advise patient not to drink alcohol. diaphoresis.dyspnea. Tell patient that excessive fluid loss (as from sweating. including tardive dyskinesia and neuroleptic malignant syndrome. fever. Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. As appropriate. photosensitivity Other: toothache. review all other significant and life-threatening adverse reactions and interactions. upper respiratory tract infection Skin: pruritus. seborrhea. dry skin. rash. weight changes recognize and immediately report signs and symptoms of serious adverse reactions. Advise female patient to tell prescriber if she is or plans to become pregnant. especially those related to the drugs and behaviors mentioned above. or diarrhea) and inadequate fluid intake increase risk of lightheadedness (especially in hot weather). Instruct patient to move slowly when sitting up or standing. Caution her not to breastfeed during therapy. to avoid dizziness from sudden blood pressure decrease. impaired temperature regulation.
haloperidol). Oral: 2m/tab 1 tab/day CNS: Disorientation. elevated temperature. blurred vision (avoid driving or engaging in activities that require alertness and visual acuity). muscular weakness. nervousness. Drug inerferes with sweating and ability of body to maintain heat equilibrium. acute suppurative parotitis. NURSING INTERVENTIONS: Decrease dosage or discontinue temporarily if dry mouth makes swallowing or speaking difficult. lightheadedness. Avoid the use of alcohol. palpitations. nausea. give before meals to patients with dry mouth. WARNING: Give with caution. which relaxes muscle movement and decreases rigidity and tremors. excitement. heaviness of the limbs (centrally acting anticholinergic effects). urinary hesitancy. weakness. confusion. sometimes fatal. Give with meals ig GI upset occurs.drug : Paralytic ileus. and over the counter drugs (can cause dangerous effects) You may experience these side effects. OTHER: flushing. euphoria. TCAs) Additive adverse CNS effects (toxic psychosis) with drugs that have CNS anticholinergic properties (phenothiazines. constipation. give after meals if drooling or nausea occurs. difficulty achieving or maintatining an erction. other dermatoses.paralytic ileus.nausea (eat frequent small meals). Blocks acetylcholine’s action at cholinergic receptor sites. dilation of the colon. TCAs). anhidrosis and fatal hyperthermia have occurred.drowsiness. diplopia.dizziness. dry mouth (suck sugarless lozenges or . sedative. Interactions: Drug. Biperidenalso may inhibit dopamine reuptake and storage. which prolongs dopamine’s action. paranoia. tardive dyskinesia. paresthesia.with drugs that have anticholinergic properties (phenothiazines. Ensure that patient voids just before receiving each dose of drug if urinary retention is a problem. muscular cramping. delirium. agitation. possibly due to central antagonism. Dermatologic: Rash. giddiness. deacreased sweating. increased intraocular tension. depression. hypotension. CV: tachycardia. in long term therapy with antipsychotics (phenothiazines.dysuria. psychoses.Generic Name: Biperiden Trade Name: Akineton Classifications: Anticholinergic. orthostatic hypotension (peripheral anticholinergic effects). This action restores the brain’s normal dopamine and acetylcholine balance. and reduce dosage in hot weather. confusion. epigastric distress GU: Urinary retention. vomiting. Patient Teaching: Take this drug exactly as prescribed. with other anticholinergics. angle closure glaucoma GI: Dry mouth. Possible masking of extrapyramidal symptoms . dizziness. EENT: Blurred vision. Antidyskenitic Pharmachologic: Anti-parkinsonian Relief of symptoms of extrapyramidal disorders that accompany phenothiazine therapy. delusions. drowsiness. mydriasis. urticaria.
Report difficult or painful urination.constipation (maintain adequate fluid intake and exercise regularly). rapid or pounding heartbeat. use caution in hot weather (you are susciptible to heat prostration). or rash. painful or difficult urination (empty the bladder immediately before each those).eye pain. .ice chips ).constipation. confusion.
or low-fat milk. blurred vision. constipation.once a day Instruct patient to remove orally disintegrating tablet from blister pack. Report difficult Or painful urination. Teach patient to recognize and immediately report signs and symptoms of serious adverse reactions. vomiting. including tardive dyskinesia and neuroleptic malignant syndrome. Instruct patient to move slowly when sitting up or standing. or diarrhea) and inadequate fluid intake increase risk of lightheadedness (especially in hot weather). rashes risperidone 2mg/tab. dizziness. dry mouth. coffee. Tell patient that excessive fluid loss (as from sweating. confusion. rapid or pounding heartbeat. . orange juice. place on tongue immediately. Tell patient to mix oral solution with water. nausea.sedative and over the counter drugs(can cause dangerous effect) You may experience these side effects: drowsiness.DISCHARGE PLAN MEDICATIONS Medications Biperiden Dosage/Frequency 2mg/tab. once a day Nursing Instructions Take this drug exactly prescribed. Tell him solution isn’t compatible with cola or tea. to avoid dizziness from sudden blood pressure decrease. constipation. difficulty urination. confusion. Avoid the use of alcoholism . and swallow as tablet dissolves. eye pain. Advise patient to use effective bedtime routine to avoid sleep disorders.
-Be aware of the common side effect that may because by your medications. -Encourage client to regain his/her activities. (independent accomplishment and positive reinforcement enhance self-esteem and promote repetition of desirable behaviors). It is important that goals be attainable. As appropriate. holding the breath for a few seconds. -Do not stop prescription medications without taking to your doctor. especially for medication relapse cases and when patient is combative. then exhaling slowly through the mouth pursing the lips. Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. abilities. EXERCISE -Stretching exercise -Deep breathing exercises involves inhaling slowly and deeply through the nose. -Encourage client to perform independently as many activities as possible. OPD VISITS/REFERRALS -Follow check-up after one to two weeks of discharge. Advise patient not to drink alcohol. -Ensuring that client continues to get treatment after hospitalizations. THERAPY -Group Therapy A form of psychological treatment in which a number of clients meet together with a therapist for purposes of sharing gaining personal insight and improving interpersonal coping strategies. especially those related to the drugs and behaviors mentioned above. . -Do not skip doses of medications. since the patient feels paranoid and/ repeatedly criticized by others will probably experience irritation that may worsen the symptoms. review all other significant and lifethreatening adverse reactions and interactions. HEALTH TEACHINGS -Avoid smoking and drinking alcoholic beverages.
Encourage to participate in bible studies.DIET 1 cup rice 3 ounce of salmon 1 boiled egg ½ serving of bas-uy 1 glass of milk and water SPIRITUAL CARE -Encourage the patient to pray and ask for help to our heavenly father to give him more strength. . in order to cope with his problems as well as for faster recovery from his condition.
Failing to take medications as prescribed is one of the most frequent reasons for recurrence of psychotic symptoms and hospital admission. issues. and neglected hygiene. p. (Kane and Marder.. p. 286) Maintaining the medication regimen is vital to a successful outcome for clients with schizophrenia. 277) Coping with schizophrenia is a major adjustment for both clients and their families. (videbeck 3 ed. unusual behavior... 2005) Family Support Strong . the need for continuing medication and follow-up. Understanding the illness.Good Document Onset may be abrupt or insidious..Good Mood and Affect Appropriate Good Willingness to take medication . p.Good Depression Feature Absent . p. Clients and families need help to cope with the emotional upheaval that schizophrenia causes. They often are described as having flat affect (no facial expression) or blunted affect (few observable facial rd expressions). 296) Pattern of depressive cognitions and behaviors in a variety of contexts is absent. 351) Clients with schizophrenia report and demonstrate wide variances in mood and affect. rd (videbeck 3 ed. (videbeck rd 3 ed.PROGNOSIS Prognosis Onset of Illness Acute . rd (videbeck 3 ed. but most clients slowly and gradually develop signs and symptoms such as social withdrawal. and loss of interest in school or work.
The PORT review recommends that intermittent maintenance therapy — a strategy of stopping antipsychotics until symptoms reappear or worsen — be reserved only for patients who refuse to continue taking an antipsychotic or for those who cannot tolerate the side effects.and secondgeneration antipsychotics are equally effective for treating schizophrenia. Because patients experiencing psychosis for the first time are both more responsive to medications and more likely to have side effects. Studies that have followed patients with first-episode or chronic schizophrenia for one to two years have concluded that continuous maintenance antipsychotic treatment reduces risk of relapse. side effects. and medical history. because these drugs are most likely to cause significant weight gain and other metabolic side effects.or second-generation antipsychotic other than clozapine. Patients who initially responded to medication but suffer a relapse of symptoms have several options. . two large clinical trials have compared efficacy of first.and second-generation antipsychotics: the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and the Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS). past medication response. antipsychotics should be prescribed at doses that are lower — generally about half — compared with those recommended for patients with chronic schizophrenia. First-episode of Psychosis. Choice of which antipsychotic to use depends on patient preference. Relapse. Maintenance therapy. The PORT team recommends any first. The PORT review recommends using any antipsychotic except clozapine (Clozaril) and olanzapine (Zyprexa). the PORT reviewers noted that in many cases. and stipulates that medication be prescribed at the lowest effective doses to reduce side effects.Schizophrenia Treatment Recommendations Medication advice Since the last PORT review. first. Based on the findings of these studies.
clozapine is an option for patients with schizophrenia who are hostile or persistently violent. either with or without nicotine replacement therapy. Long-acting injectable antipsychotics provide another option in maintenance therapy.For patients with chronic schizophrenia. as well as for patients who are at risk for suicide. For example. mainly because of a lack of randomized controlled studies. The PORT review also offers advice about clinical situations that are less common. The PORT review recommends that patients who have not responded adequately to two previous antipsychotics try clozapine for at least eight weeks. Patients who continue to experience auditory hallucinations in spite of antipsychotic treatment may respond to low-frequency transcranial magnetic stimulation. During maintenance therapy. Smoking cessation. Treatment resistance. a blood test may be useful to determine whether the medication has reached a therapeutic level (defined as blood levels above 350 nanograms per milliliter). If this does not alleviate a patient's symptoms. alone or combined with a rapid-acting benzodiazepine. The PORT team recommends that patients who want to stop smoking take bupropion (Wellbutrin) twice a day for 10 to 12 weeks. especially for patients who have trouble taking medication. As many as nine in 10 patients with schizophrenia smoke cigarettes. Some patients require higher doses of clozapine to achieve this blood level. but long-term success remains unclear.and second-generation antipsychotics are equally effective at preventing relapse. The PORT review concluded that it is unclear whether injectable medications are any more effective than pills at preventing relapse. first-generation drugs may be used at lower doses than those required to treat the initial (acute) episode. The report notes that this approach may help patients to quit at least temporarily. Other challenges. while second-generation drugs can be prescribed at whatever dose was effective in the initial phase. both first. . Patients who become agitated may respond to oral or injectable antipsychotics. and supplement it with a support group or some type of psychosocial intervention.
resulting from an organic disease or a disorder of the brain. It refers to the ―what‖ of the patients thinking. Social isolation – persons spends most of the day alone or only with close friend. Denial – failure to admit the reality. hallucinations. olfactory. Paranoia – in psychology. systematized. Antipsychotic – are used primarily to treat most dorms of psychosis such as schizophrenia. Schizoparanoid – is the presence of auditory hallucinations or prominent delusional thoughts about persecution agitations. Schizodisorganized – there is impairment of the emotional processes of the individual. concentration. Delusion – a false fixed belief or opinion. Thought content . logically reasoned delusions. or false beliefs. usually resulting from a mental disorder or as response to a drug.GLOSSARY Ambivalence – holding seemingly contraindicating beliefs of feelings about the same persons or event or situation. and judgment. Echopraxia – imitation of posture of others. or gustatory experiences without an external stimulus and with a compelling sense of their reality. Dementia – deterioration of intellectual faculties. Anhedonia – feeling of no joy or pleasure from life or any activities or relationships. unalterable. . auditory. such as memory. Anergia – lack of energy. Apathy – lack of emotion. often a symptom of autism or some types of schizophrenia. Schizophernia – a severe mental disorder characterized by delusion. incoherence and physical agitations. usually of persecution or grandeur. Echolalia – the immediate and voluntary repetition of words or phrases just spoken by others. inactivity. schizoaafective disorder and others.is the specific meaning expressed in the patients communication. Hallucinations – perception of visual. a term denoting persistent. tactile. Flat affect – absence or near absence of any signs of affective responses. Illusions – the condition of being deceived by a false perception or belief. Thought blocking – sudden stop in train of thought.
3rd Edition Wilson. (2008) Nursing Diagnoses in Psychiatric Nursing. (2008) Psychiatric-Mental Health Nursin.BIBLIOGRAPHY BOOKS Videbeck.ebscohost. (2008) Manual of Laboratory & Diagnostic Tests ELECTRONIC SOURCES www. Deglin. H.com www. 11th Edition Nicoll. al. Louise R. (2008) Davi’s Drug Guide.php?type=doc&id=8806 . Diana et.mentalhelp. P. D. 7th Edition Schull.search. 2rd Edition Shives. Denise D. Sheila L. Mary C. 5th Edition.net/poc/view_doc. (2010) Nursing Spectrum Drug Handbook. 7th edition Townsend. J. (2004) Psychitric Mental Health Nursing. (2001) Pocket Guide to Diagnostic Test.
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