Saint Mary’s University

Bayombong, Nueva Vizcaya

School of Health & Natural Sciences

NURSING DEPARTMENT
Course No. NCM 117 Lecture
Subject: Care of Client with Maladaptive Patterns of Behavior, Acute and Chronic
Yr. Level: BSN 3
Contact Hours/Credit Units: 4 fours/week(4units)_____________________________________

CHAPTER 20

SCHIZOPHRENIA AND OTHER PSYCHOSIS

l. Introduction

Schizophrenia is a brain disease that interferes with normal brain functioning. It causes
affected people to exhibit odd and often highly irrational or disorganized behavior.

ll. Learning Objectives

1. Apply the moral and ethical-legal principles in dealing with the care of client with schizophrenia
disorder.
2. Obtain a comprehensive psychiatric history and conduct a thorough assessment of mental
status of a client with schizophrenia disorder.
3. Formulate a holistic nursing care plan for client with schizophrenia disorder.
4. Execute a safe, appropriate mental health activity for client with schizophrenia disorder.
5. Utilize effectively the therapeutic use of self in caring client with schizophrenia disorder.

lll. Core Content of the Chapter

SCHIZOPHRENIC DISORDER: It is a serious type of mental disorder that involves disturbances

in reality, thought process, perception, affect, social and occupational functioning. Patient have
weak ego.

SCHIZEIN from Greek word that means to “SPLIT” PHREN means the mind.

Etiology:
- Genetic factor
- Changes in the brain structure(temporal and frontal lobe) enlarge ventricles, atrophy,
decrease blood flow, decrease brain volume
- Increase in neurotransmitters such as dopamine, serotonin, norepinephrine,
acetylcholine
- Marital problems/stress
- Children born in a crowded area, cold weather, respiratory ailments, infection and
poisoning.
- Double bind communication pattern within a poor family relationship.
Assessment: assess the 4 A’s by BLEULER
1. Affect – flat, absence of facial expression, tense/inappropriate
2. Associative looseness – disorganized words, no connection between thoughts and ideas. Word
salad, echolalia.
3. Ambivalent – inability to make decisions, with two conflicting emotions. Have poor interpersonal
relationship.
4. Autistic – unable to relate to others, have self-world, withdraws from people and reality.
PLUS 5. Auditory hallucinations-altered perception with no external stimulus.

SYMPTOMS:

POSITIVE OR THE HARD: Normal people do not exhibit

- Associative looseness
- Disorganized
- Word salad
- Echolalia
- Delusion - fixed false beliefs that have no basis in reality
1. Paranoid - “somebody is going to kill me” “they are talking about me”
2. Grandiose - being famous “I am the owner of that company”
3. Religious - “the devil told me to do this”
4. Somatic - “I might get sick because I am not feeling well”
5. Ideas of reference - “I saw it in the T.V she told me that I need to do it”
- Echopraxia - imitating the movement and gesture of a person
- Flight of ideas - continuous flow of verbalization in which the person jumps rapidly from
unrelated one topic to another.
- Hallucination - false sensory perceptions that do not exist in reality.

AVOID COMMAND HALLUCINATION

1. Auditory - hearing voices
2. Visual - seeing things
3. Olfactory - I can smell it
4. Tactile - I can feel it crawling
5. Gustatory - It tasted bitter sweet
- Ideas of reference - false impression that external events have special meaning for the
person.
- Perseveration-resistance to change the topic, verbally repeating of a sentence.

NEGATIVE OR THE SOFT: Normal people exhibits

- Alogia - speaks little or not at all
- Anhedonia - feeling of no joy or pleasure, activity or relationship
- Apathy - feeling of indifference towards a person, activity or events
- Blunt affect - restrictive range of emotional feelings, tone and mood.
- Catatonia - state of immobility or unresponsiveness
- Flat affect - absence of facial expression that would indicate ones mood.
- Lack of volition - absence of will, ambition or drive to take action or accomplish a task.

PHASES OF SCHIZOPHRENIA:
1. Schizoid personality (pre morbid phase) - loner, indifferent to social relationship and
limited range with regards to emotions and expressions.
2. Prodromal phase - avoidance of social interaction, isolation and exhibits neg. and
positive symptoms.
 3. Schizophrenia - acute sign and symptoms are present.
4. Residual impairment - period of remission when S/S are relieved or can be controlled by
the person.

Types of schizophrenic:
1. CATATONIC – A marked psychomotor disturbances the patient is incompletely immobile or
he moves all over the place, they do echolalia and echopraxia.

TYPE of CATATONIC:
1. Catatonic stupor – the patient assumes a fixed position for a period of hours (12 hrs.)
2. Catatonic negativism – the patient doesn’t communicate, mute, sluggish and inactive.
(resist to instructions)
3. Catatonic rigidity – the patient assumes body rigidity against effort to be moved. This
is the effect of the disorder.
4. Catatonic posturing – the patient voluntarily assumes a bizarre posture which is called
“Waxy flexibility”
5. Catatonic excitement – the patient exhibits increase motor activity which is not
influenced by external stimulus.

2. DISORGANIZED/Hebeprenic – The patient has disorganized speech, incoherent, mumbles

instead of talking, disorganized behavior and with flat or inappropriate affect.

3. PARANOID – The patient is having auditory hallucination, impulsive, irritable and

unpredictable, with delusion of grandiose.

4. UNDIFFERENTIATED – Mixed symptoms the patient is heavily deluded, hallucinates,

incoherent and disorganized.

5. RESIDUAL – The patient has at least one previous symptoms.

OTHER PSYCHOSIS
1. Schizoaffective disorder - A disorder characterized by mood symptoms of (depression/mania)
and symptoms of schizophrenia.

A presence of one of the following:

1. Major depressive episode
2. Manic episode
3. Mixed episode

PLUS a presence of at least 2 of the following symptoms, for at least one month.
1. delusion
2. hallucination
3. disorganized speech
4. catatonic behavior
5. negative symptoms

2. Schizophreniform disorder - A disorder with symptoms identical of that with Schizo. but last
only from 1 to 6 months.

3. Delusional disorder = a disorder with the presence of one or more false beliefs that exist for at
least one month.
Other Symptoms observed:
1. Blocking - sudden thought disturbances in the middle of a sentence and unable to
continue the train of thought. Due to interruption by anxiety delusion and hallucination.
2. Neologism - coining of words that only the client can understand.
3. Echolalia
4. Confabulation - filling memory gaps with detailed fantasy believed by the client.
5. Word salad
6. Poverty of speech - unable to formulate thoughts in words.
7. Concrete thinking - unable to conceptualize / interpret the meaning of words, idioms
sayings or phrases
8. Verbigeration - purposeless repetition of words and phrases.
9. Metonymic speech - mental confusion of words that is not the term intended but has
similar meaning. EXAMPLE: Lend me your ears.. Give me a hand..
10. Clang association - repeating words that are similar in sounds.
11. Stilted language - overly formal speech.
12. Pressured speech

Nursing Management:
1. Don’t touch the client. - It has a meaning to the client
2. Let the client trust one person before engaging into activities.
3. Avoid whispering, laughing and acting secretively.
4. Keep promises. - Can cause mistrust
5. Be consistent and honest - Secure structure to the client and extremely sensitive.
6. Don’t embarrass the patient.
7. Reinforce reality.
8. Don’t argue with the client or agree with the hallucinations. Recognized it only so as to feel
how they are feeling.
9. Orient patient to time, place and person.
10. Allow verbalization of feelings but do not pry-probing causes suspicion.
11. Let the client feel they are accepted and safe.
12. Explain procedures to be done to the client and be sure they understand-so as not to feel
tricked by the nurse.
13. Give + feedbacks-enhance well-being.
14. Interact on the real thing not on their delusions. - Interacting about reality is healthy for the
client
15. Engage on one on one activity, then small group, then gradually in larger groups. - Client
is distrustful so gradual introduction of things is less fearful and threatening.
16. Recognize and support clients accomplishments it increases self-esteem.
17. Show empathy - It conveys caring

Therapy: - Psycho - Behavioral - Social skills training - Family group

Medication: Antipsychotic (Thorazine, Prolixin, Stelazine, Haldol, Serentil, Trilafon, Loxitane)

Side Effects:
- Dystonia
- T.D
- Akathisia
- EPSE or induced parkinsonism
- Seizures and Sedation
IV. Activity:
Students are advised to watch the movie “Beautiful Mind” Russell Crowe (Schizophrenia) There will be a
SHORT QUIZ about the Film.
Long Quiz

V. Bibliography:
Videbeck, S. (2020). Psychiatric-Mental Health Nursing. Wolters
Keltner, N., Bostrom C., & McGuiness T. (2012). Psychiatric Nursing. Elsevier Inc.

Prepared by:

Mrs. Rosalie C. Carreon, RN, MSN

Nursing Department