You are on page 1of 70

Prepared by: AGNES S.

TAMISEN, RN, MAN


Assessment of Mentally Ill Client
 Physical
 Mental Status Examination (MSE)

General Description
1)Appearance
- overall physical impression conveyed to the therapist
- posture, poise, clothing, grooming, nails, hair, signs of
anxiety, signs of depression, chronological age
General Description con’t
2) Overt Behavior and Psychomotor Activity
- quantitative and qualitative aspect of patient’s motor
behavior
- mannerisms, gestures, twitches, hyperactive, agitation,
convulsiveness, rigidity, psychomotor retardation

3) Attitude toward examiner


- cooperative, hostile, seductive, defensive, guarded
MOTOR BEHAVIOR
 Echopraxia – pathological imitation of movements
 Catatonia – motor anomalies in nonorganic disorder
- Cataleps
- Catatonic Excitement
- Catatonic stupor
- Catatonic Rigidity
- Catatonic Posturing
- Correo Flexibilitas

 Negativism – motiveless resistance to all attempts to be


moved
Motor Behavior con’t
 Cataplexy – temporarily loss of muscles and weakness
 Mannerisms – ingrained habitual involuntary
movement
 Automatism – automatic performance of an act
 Mutism – voicelessness without structural abnormalities
 Overactivity
- psychomotor agitation
- hyperactivity
- Involuntary spasmodic movement
- Sleepwalking
- Akathisia
- Compulsion – Dipsomania, Kleptomania,
Nymphomania, Salvriasis, Tricbotilomania
Motor Behavior con’t
 Hypoactivity – decreased motor and cognitive activity

 Mimicry – simple imitative motor act

 Aggression – forceful goal directed action

 Acting Out – direct expression of an unconscious wish

 Abulia – reduced impulse to act and think


MOOD and AFFECT
Mood – pervasive and sustained emotion that colors the
patient’s perception of the world
- voluntarily mentioned or patient may be ask how
she feels
- depth, intensity, duration and fluctuation of mood
- depressed, despairing, euphoria, irritable

MOOD
 Dysphoria – unpleasant
 Euthemia – normal range
 Expansive – expression of feelings with ought restraint
MOOD con’t
 Anxiety – apprehension
 Free floating anxiety – pervasive unfocused fear not
attached to any idea
 Fear – anxiety cause by unrecognized danger
 Agitation – motor restlessness
 Tension – unpleasant increase in motor and psychological
activity
 Panic – acute episode attack of anxiety with autonomic
discharge
 Apathy – dulled emotional tone
 Ambivalence – 2 opposing impulses toward the same
thing, person and individual
 Irritable – easily annoyed/ provoked
MOOD con’t
 Mood Swings – consolation between depressive and
euphoria
 Elevated – air of confidence and improvement
 Euphoria – intenseclation
 Fostacy – intense rapture
 Depression – psychopathological sadness
 Anhedonia – loss of interest in and withdrawal from
regular activities
 Grief or Mourning – sadness appropriate to real loss
 Aloxithemia – inability or difficulty in describing or being
aware of one’s moods
 Shame – failure to live up to self expectation
 Guilt – emotion secondary to doing what is committed as
wrong
AFFECT
Affect – present emotional responsiveness inferred from facial
expression and range of expressive behavior; observed
expression of behavior

 Appropriateness of affect – based on the context of the subject matter


being discussed
 Appropriate Affect– emotional tone in harmony with idea, thought or
speech
 Inappropriate Affect– disharmony between emotion and ideas or speech
 Blunted Affect– severe reduction of in intensity of externalized feeling,
tone
 Restricted or Constricted Affect– reduced intensive of feeling , tone, less
severe than blunted affect
 Flat affect – absence or near absence of any affective expression , voice
monotonous, face immobile
 Labile Affect – rapid and abrupt changes in emotional feeling
Psychological Disturbances with Mood
 Anorexia – loss/decrease appetite
 Hyperphagia – increase in appetite and increase in food
 Insomnia – lack of or diminished ability to sleep
- initial insomnia
- middle insomnia
- terminal insomnia
 Hypersomnia – excessive sleeping
 Diurnal Variation – mood is regularly worst in the morning
immediately after up and improve as the day progress
 Diminished Libido – decreased sexual interst, drive or
performance
 Constipation
Speech Characteristics
 Physical characteristics of speech
 Quantity, rate of production, quality
 Rate and tone of voice
 Talkative, unspontaneous, rapid, slow, hesitant, pressured,
emotional, dramatic, monotonous, loud, mumbled,
stuttering

Perception
 Hallucination – false sensory perception not associated
with real external stimuli ( auditory, visual, olfactory, tactile)
 Depersonalization
 Derealization
 Illusion
General Disturbances in Thought Content and Process
 Psychosis – inability to distinguish reality from fantasy, impaired reality
testing

 Reality testing – objective evaluation and judgment of the world outside


self

 Formal thought disorder – disturbance in thought process

 Illogical thinking, erroneous conclusion or internal contradictions

 Dereism - mental activity not concordant with logic or experience

 Autistic thinking – preoccupation with inner private world

 Magical thought similar to preoperational phase

 Primary process thinking – dereistic, magical. Illogical thought


Disorder of Thought Process
Thought Process – way in which person puts together ideas
and associations, the form in which the person thinks
 Neologism – new word
 Word salad – incoherent mixture of words / phrases
 Circumstantiality – indirect, delayed in reaching the
point
 Tangentiality – no goal directed association of thoughts
 Incoherence – no logical connection of thoughts
 Perseveration – persistent response to a prior stimulus
after a new stimulus
 Verbigeration – meaningless repetition of specific words
or phrases
 Echolalia – psychopathological repeating of words
Disorder of Thought Process con’t
 Condensation – fusion of various concept into one
 Irrelevant Answer – not in harmony with the question
 Looseness of association – ideas shift from one subject to
another in a complete unrelated way
 Derailment – gradual or sudden deviation in train of
thoughts
 Flight of Ideas – rapid, continuous verbalization or play of
words
 Clang Association – associate of words similar in sound but
not in meaning
 Blocking – abrupt disruption in train of thinking
 Glossolalia – expression of a revelatory message thought
unintelligible words (speaking in tongues)
Disorder of Thought Content
Thought Content – what a person is actually thinking about
 Poverty of Content – little information due to vagueness
 Overvalued Ideas – unreasonable sustained false belief
 Delusion – false belief not consistent about external reality
that can not corrected by reasoning
 Bizarre – absurd, totally implausible
 Systematized – false belief united by a single theme
 Mood Congruent – delusion and mood are appropriate
 Mood Incongruent – mood and content not associated
 Nihilistic – false belief that self and others are nonresistant
 Delusion of Poverty – false belief that one is benefit
 Somatic Delusion – false belief that involving the function
of the body
Disorder of Thought Content con’t
 Paranoid
- Persecutory
- delusion of reference
- grandeur
 Delusion of Self Accusation – false feeling of
guilt
 Delusion of Control
- through withdrawal
- through insertion
- through broadcasting
- through control
Disorder of Thought Content con’t
 Delusion of Fidelity
 Erotomania – delusional belief that someone is
deeply in love with them
 Pseudologia Phantastica – belief in reality of his
fantasies
 Preoccupations
 Obsession
 Compulsions
 Coprolalia
 Phobias
Sensorium and Cognition
 Consciousness – alertness and level

 Orientation and memory

 Concentration and attention

 Reading and Writing

 Visuospalial Ability

 Obstruct Thought – dealing with concept

 Information and Intelligence


Disturbance of Consciousness
 Disorientation – time, place, person
 Clouding of Consciousness – incomplete clear
mindedness
 Stupor – lack of motion, unaware of surroundings
 Delirium – bewilded, restless with hallucination
 Coma – profound unconsciousness
 Coma Vigil – asleep but arousable, akinetic mutism
 Twilight State – disturb consciousness with
hallucination
 Dreamlike State – complex partial seizure
 Somnolence – abnormal drowsiness
Disturbance of Attention
 Distractibility – inability to concentrate attention drawn to
irrelevant stimuli
 Selective Inattention – blocking out only those generating
anxiety
 Hypervegelance - excessive attention and focused in all
internal and external stimuli
 Trance – focused attention and altered consciousness, hypnosis

Memory Tests
 Remote – childhood data, events prior to illness
 Recent Past – past few months
 Recent – few days, yesterday, a day before
 Immediate – repeat six figures after examiner dictates them,
repeat three words immediately and 3.5 minutes later
Level of Insight
 Complete Denial
 Slight awareness of illness, needing help but denying it
 Aware of illness, blaming it on others
 Aware that illness is due to something unknown in the patient
 Intellectual Insight
 Through Emotional Insight

Impulsivity
 Capacity to control sexual aggressiveness and other impulses
 Ascertain patient’s awareness of sexually appropriate behavior
 Measure of patient’s potential danger to himself and to others
Judgment and Insight
 Capacity for sexual judgment

 Understanding of the outcome of his behavior

 Insight – patient’s degree of awareness and


understanding about being ill
Psychiatric Interview and Mental Status
Examination
 60% of all patient with mental disorder visit a non-
psychiatric physician during any 6 months period

 Patients with mental disorder are twice as likely to visit a


primary care physician as are other patients

 10.2 – 21% of primary care out patients are suffering are


clinically significant mood disorders

 Patients with mood disorders are very high users of non-


psychiatric medical and primary care and emergency
services
Psychiatric Interview
GOALS:
1) Formulate a diagnosis

2) Formulate factors influencing the development of


the disorder

3) Develop treatment plan

4) Provide immediate but partial relief


Psychiatric vs. Med-Surg. Interview
Dimension of Psychiatric Interview
1) Establishing Rapport
2) Mental status examination
3) Using a specific technique
4) Diagnosing

Factor Influencing Interview


1) Patient’s personality and character
2) Interviewer’s style, orientation, experience
3) Clinical situation
4) Technical factors
Interviewer’s Attitude
1) Non- judgmental
2) Interested
3) Concerned
4) Kind

Establishing Rapport
1) Ease
2) Ears to listen
3) Empathy
4) Expertise
5) Evaluate insight and be ally
6) Establish authority
Beginning the Interview
 Know and use patient’s name
 Introduce your name
 Ascertain company
 Appropriate opening remarks
 Be interested, ally anxiety, encourage disclosure
 Maintain privacy, minimize interruption
 Why now?

Interview Proper
 Detailed history and Anamnesis
 Systematic to identify relevant problems
 Open ended questions
Psychiatric Interview

 Time management
- 30 – 60 minutes

- shorter period for agitated, or psychotic patients

- seating arrangement

- note taking ( legal and medical reasons)


Common Interview Techniques
 Let patient talk freely enough to observe how tightly the
thought are connected
 Open and closed ended questions
 Don’t be afraid to ask about topics that you or the patients be
find difficult ( ex. about suicidal thought)
 Give patient chance to ask question
 Conclude interview by conveying confidence in a possible
hope
 Establish rapport as early as possible
 Determine chief complaint
 Use the chief complaint to develop provisional deferential
diagnosis
 Rule in or out diagnosis possibilities
 Follow up vague or obscure replies with enough persistence
Identifying Data
 Demographic summary of name, age, mental status, sex,
occupation, religion, ethnic background
 Provide potentially important patient’s characteristics
affecting diagnosis, prognosis, treatment and compliance

Chief Complaint
 Written in patient’s own words
 Reason for seeking help
 Recorded even if he is unable to speak
 Patient’s explanation verbatum
History of Present Illness
 Comprehensive and chronological picture of events leading
up to the current moment
 Summary of evolution of symptoms
 Precipitation of events
 Level of functioning

Personal History ( Anamnesis)


 Major developmental period
 Predominant emotions, behavior and character with the
different life period
 Prenatal and perinatal history
 Early, middle and late childhood
 adulthood
Ending the Interview
 Give chance for the patient to ask questions

 Appropriate information

 Assure confidentiality

 Clearly and simply spell out prescriptions


Special Treatment Modalities
I. Individual Psychotherapy

 Involves one to one relationship between the therapists


and the client
 It is a method of bringing about change in a person by
exploring his/her feelings, attitudes, thinking and
behavior
 People generally seek this kind of therapy base on their
desire to understand themselves in their behavior, to
make personal changes, to improve IPR or get relieve
from emotional pain or unhappiness
II. Group Therapy
 Clients participate in sessions with a group of people
 The members share a common purpose and are expected to
contribute to the group to benefit others and receive benefits
from others in return

Therapeutic Results:
1) Gain new information or learning
2) Gain inspiration or hope
3) Interacting with others
4) Feeling of acceptance and belonging
5) Becoming aware that from now on his is not alone and that
others share the same problem
6) Gaining insight into one’s problem
7) Giving of oneself for the benefit of others
Forms of Group Therapy
1)Psychotherapy Group

 Is for members to learn about their behavior and to


make positive changes in their behavior by
interacting and communicating with others as a
member of a group
 Groups may be with specific medical diagnosis like
depression, managing anxiety, etc.
 Can be open/close group
2) Family Therapy
 A form of group therapy in which the client on his/her
family members participate
 Goals includes:
- understanding how dynamics contribute to the
client’s psychopathology
- mobilizing the family’s inherent strength and
functional resources
- restructuring maladapted family behavioral styles
- Strengthening family solving behaviors
3) Educational Groups
 The goal is to provide information to members on a
specific issue (stress management, medication)

4) Support Groups – organize to help members who


share a common problem
Ex. Cancer or stroke victims, persons with AIDS

5) Self Help Groups


 Members share a common experience
 There is a rule of confidentiality
ex. Alcoholics Anonymous , Gamblers Anonymous
6)Psychiatric Rehabilitation
 Involves providing services to person’s with severe and
persistent mental illness to help them live in the community
 Focuses on client’s strength not just his/her illness
 Client is active participant in program planning designed to
help the client manage the illness and symptoms, gain access
to needed services in live successfully in the community
Ex.
 Assist with ADL (transportation, shopping, food preparation,
hygiene, money management)
 Vocational referral
 Job coaching
 Training
SCHIZOPHRENIA
 Schizophrenia or Split Mind or Split Personality
- is a syndrome or disease process with many different varieties
and symptoms much like the varieties of CANCER.
- a disease process causing distorted and bizarre thoughts,
perception, emotions and behavior

Dementia Praecox – also known as “Youthful Insanity”

** Schizophrenia is usually diagnosed in late adolescence


or early childhood. The peak incidence of onset is 15-25
years of age in Men and 25 – 85 years of age in
Women
The symptoms of Schizophrenia are divided into
2 Major Categories
1) Positive or Hard Symptoms which includes:
- delusions
- hallucinations
- disorganized thinking
- speech and behavior

2) Negative or Soft Symptoms which includes:


- flat affect
- lack of
- social withdrawal or discomfort
Positive or Hard Symptoms
1) Ambivalence – holding, contradictory beliefs or feeling about
the same person, event or situation
2) Associative – fragmented a poorly thoughts and ideas
3) Delusions – fixed false beliefs that have no bases in reality
4) Echopraxia – imitation of the movement and gestures of
another persons when the client is observing
5) Flight of Ideas – continuous form of verbalization in which the
person jumps rapidly from the topic to another
6) Hallucinations – false sensory perceptions or perceptual
experiences that do not have reality
7) Ideas of Reference – false impressions that external events
have a special for the person
8) Perseveration – persistent adherent to a single idea or topic,
verbal repetition of a sentence, word, or phrase, resisting
attempts to change the topic
Negative or Soft Symptoms
1) Alogia – tendency to speak very little or to convey little
substance of meaning (Poverty of Content)
2) Anhedonia – feeling no joy or pleasure from life or any
activities or relationship
3) Apathy – feelings of indifference towards people, activities
and events
4) Blunted Affect – restricted range of emotional feeling, tone
or mood
5) Catatonia – psychologically induced immobility occasionally
marked by period of agitation or excitement; the client
seems motionless as if in Trance
6) Flat Affect – absence of any facial expression that would
indicate emotions and mood
7) Lack of volition – absence of will ambition, or drive to take
action or accomplish tasks
Type of Schizophrenia (accdg to DSM IV)
DSM IV – Diagnostic and Statistical manual of Mental
Disorders (4th Edition)

1) Schizophrenic Paranoid Type – characterized by


persecutory or grandiose delusions, hallucinations
occasionally excessive religious or hostile and
aggressive behavior
2) Schizophrenic Disorganized Type – characterized
by grossly inappropriate or flat affect. Incoherence,
loose association and extremely disorganized
behavior
3) Schizophrenia Catatonic Type - characterized by
marked psychomotor disturbance, either motionless or
excessive motor activity
4) Schizophrenia Undifferentiated Type – characterized by
mixed schizophrenic symptoms (of any type) along with
disturbances of thoughts, affect and behavior
5) Schizophrenic Residual Type – characterized by at least
are previous thought not current episodes, social
withdrawal, flat affect and looseness of associations

** Schizoaffective Disorder – is diagnosed when the


client has the psychotic symptoms of Schizophrenia and
meets the criteria for major affective or mood disorder
(Ex. mania, depression , mixed mood)
Etiology of Schizophrenia
I. Genetic Factors
 Immediate Families- parents, siblings, offspring or even distant
relatives.
 Identical Twins- 50% risk for Schizophrenia that is of one twin has
Schizophrenia , the other has a 50% chance of developing it as well.
 Children in one biologic parents with Schizophrenia have a 15% risk,
35% of both biologic parents have Schizophrenia.

II. Neuroanatomic and Neurochemical Factors


 Neuroanatomy- deals with the brain structure.
 Neurochemistry- deals with the brain activity.

 Findings have demonstrated that people with Schizophrenic have


relatively less brain tissue and CFS than those who do not have. The
research shows that decrease volume and abnormal brain function in
the frontal and temporal areas of persons with Schizophrenia , this
pathology correlates with the positive signs of Schizophrenia such as
Psychosis, and the negative signs (frontal lobe) such as lack of volition
or motivation and anhedonia (feeling no joy or pleasure).
 Neurochemical studies have consistently
demonstrated alterations in the neurotransmitter
system of the brain in people with Schizophrenia the
NEURONAL NETWORKS that transmit information by
electrical signals from a nerve cell through its exam
and across synapses to post synaptic receptor on other
nerve cell seem to malfunction.

 Studies have also implicated the action of certain


drugs such as dopamine and serotonin EXCESS
dopamine as a cause also with serotonin.
A theory was develop in 2 observations:
 First, drugs that increase in the Dopaminergic System such
as Amphetamines and Levodopa induced a Paranoid
Psychotic Reaction similar to Schizophrenia.

 Second, drugs blocking post synoptic Dopamine Receptors


reduce Psychotic Symptoms

** The greater the ability of the drugs to block


Dopamine Receptors, the more effective it is, in
decreasing symptoms of Schizophrenia.
III. Immunovirologic Factors
 Popular theories have emerged stating that exposure to a
virus on the body and immune response to a virus could
alter the brain physiology of people with Schizophrenia.

1) Cytokines – are chemicals messengers between immune


cells, immediate inflammatory and immune responses. It
also plays a role in signaling the brain to produce
behavioral and neurochemical changes needed in physical
or psychological stress to maintain homeostasis. It is
believe to have a role in the development of major
psychiatric disorders such as Schizophrenia.
2)Infection - in pregnant women has a possible origin also
for schizophrenia, also there higher rates of schizophrenia
among children born in crowded areas, in cold weather,
isolations that are hospitatable to respiratory ailments.

IV. Cultural Considerations:


 Psychotic behavior observed in countries or among
particular ethnics groups has been identified as a
“Culture Bound Syndrome”
Some Psychotic Behavior Identified as a CULTURE BOUND SYNDROME
1) Bouffee Delirante – a syndrome involving a sudden
outburst, an agitated and aggressive behavior work
confusion and psychomotor excitement. Sometimes,
a accompanied by visual and auditory hallucination
or paranoid ideation (found in West Africa and
Haiti)
2) Ghost Sickness – is preoccupation with death
frequently observed among Native American
Tribes. Symptoms included bad dreams weakness,
feelings of danger, loss of appetite, fainting,
dizziness, fear, anxiety, hallucinations, loss of
consciousness, confusion, feeling of futility and
sense of suffocation.
3) Locuma – a chronic psychosis experienced by Latinos in
the U.S. and Latin America
Symptoms:
 Incoherence
 Agitation
 Visual and auditory hallucination
 Inability to fallow social rules
 Unpredictability
 Possible violent behavior

4) Qi- Gang Psychotic Reaction – is an acute, time –


limited episode Characterized by:
 Dissociative paranoid or other psychotic symptoms that
occur after participating in the Chinese Folk Health
enhancing practice of Qi-Gang.
5) Zar – an experience of spirits possessing a person seen
in Ethiopia, Somali, Egypt, Sudan, Iran and other
North African and Middle Eastern societies

Symptoms:
a) The affected person may laughh, shout, wait, bang
his head on a wall or be apathetic and withdrawn.

b) Refusing to eat or carry daily task.


TREATMENT:
1) Psychopharmacology – the primary treatment of
Schizophrenia
a) Thorazine
b) Neuroleptic – an antipsychotic prescribed primarily for medication their
efficacy in decreasing psychotic symptoms. They do not cure
Schizophrenia rather they are used to manage the symptoms of the
disease.
c) Dopamine Antagonists – never a atypical antipsychotic medications
(Dopamine / Serotonin)

 The Conventional antipsychotics target the positive signs and


schizophrenia such as delusions, hallucinations, disturbed
thinking.

 The atypical antipsychotics not only distinguished positive


symptoms but also lessen the negative signs of luck volition and
motivation, social withdrawal and anhedonia.
Maintenance Therapy
1) Antipsychotic in depot infection forms
a) Flupherazine (Prolixin) in decanoate
b) Enasthate preparation and Haloperidol (Hadol) in
decanoate
- Effect lasts for 2-4 weeks
- Duration of Action is 7-28 days for Fluphenazine and 4 weeks
for Haloperidol (Haldol)

SIDE EFFECTS:
1) Extrapyramidal Side Effects(EPS) – are reversible
movement disorders induced by neuroleptic medications.
They include dystonic reactions, parkinsonism and
akathisia.
2) Akathisia – intense need to move about characterized
by restless movement, pacing, inability to remain still,
and the clients report for restlessness result when it is
started or increased.
** Beta-Blockers (Propanolol) is most effective in treating
Akathisia.
3) Dystonic Reaction – appears early in the course of
treatment characterized be spasm in discrete muscle
groups such as the neck muscle group (Terticollis) or eye
muscles (Coculogyric Crisis)
4) Pseudoparkinsonism or Neuroleptic – Induced
Parkinsonism – includes a shuffling gait, mask- like
faces, muscle stiffness (continuous) or cog wheeling
rigidity(rachet-like movements of pants, drooling or
akinesia (slowness and difficulty and irritating
movements)
5) Tardive Dyskinesia – late appearing side effect is
characterized by abnormal involuntary movements
such as Lip-Smucking, Tongue Protrusion, chewing,
blinking, grimacing and choreiform movement of the
limbs.
 Clozapine (Closaril) – is often recommended for
clients who have experienced Tardive Dyskinrsia

 AIMS – Abnormal Involuntary Movement Scale is used


to screen for symptoms of movements disorders
administered every 3-4 months.
6) Seizures – are in frequent side effects associated with
antipsychotic medications associated with high dosage
of medications.
 Clozapine – an exception in causing seizures.
7) Neurologic Malignant Syndrome(NMS) – is a
serious and frequently fatal condition characterized by
muscle rigidity, high fever, increased muscle enzymes
and leukocytosis (increased Leukocytes).
8) Agranulocytosis – is the failure of the bone marrow
to produce white blood cells. It is characterized by
fever, malaise, ulcerative sore throat and leukopenia. It
occurs between 18- 24 weeks after the initiation of the
therapy . The drug must be discontinued
immediately.
Psychosocial Treatment:
1) Individual and group Therapies – gives the client the opportunity of
social contact and meaningful relationship with other people.
 Client with Schizophrenia can improve their social competence
with social skills training which translate to more effective
functioning in the community.

2) Cognitive Enhancement Therapy – combined computer based


cognitive training with group session that allow clients to practice
and develop social skills. This is designed to improve the client’s
social and neurocognitive deficits such as attention, memory and
information processes.

3) Family Education and Therapy – known to diminish the negative


effects of Schizophrenia and reduce the relapse rate.
Nursing Process:
I. Assessment
a) History – first elicit information about the client’s
previous history with Schizophrenia to establish baseline
data.
b) General Appearance , Motor Behavior and Speech –
dressing appropriately or exhibiting odd or bizarre
behavior, agitation, restless or appear to be catatonic or
unmoving and odd facial expression, exhibiting
echopraxia and echolalia.
c) Mood and Affect – describe as having flat affect or
blanked affect. Affect may be describe as setly,
characterized by giddy laughter for no apparent reason.
The client may report feeling depressed and archedonia
d) Thought Process and Content – thought processes are
disordered and the continuity of thoughts and information
is disrupted. Client exhibit blocking thoughts broad
casting, thought withdrawal and thought insertion.

 Exhibit an unusual speech patterns such as clang


association, neologism, verkigeration, echolalia, shifted
language( use flowering words, perseveration and word
salad)

 Poverty of Content is also evident (alogia)


II. Nursing Diagnosis
Example: Client with Delusio
Delusions:
 Client with Schizophrenia experience delusion, (fixed, false
beliefs with no basis in reality) in the psychotic phase of
the illness. A common characteristic of Schizophrenia
delusions is suspicious, mistrust and guarded about
disclosing personal information.

Types of Delusions:
1) Persecutory/Paranoid Delusion – involves the clients
belief that “others” are planning or harm or spying or
ridiculing or belittling him.
2) Grandiose Delusion – characterized by client’s claim
to association with famous people or celebrities or
client’s behalf that he is famous or capable of great
feast.
Ex. Client claim to be the daughter of the President.

3) Religious Delusions – often center around the


Secong Coming Christ and another dignificant
religious figure or Prophet.
Ex. Client claim to be the Messiah or some phrophet sent
by God.
4) Somatic Delusion – vague and realistic beliefs about the
client’s health or bodily functions. Factual information or
diagnostic testing does not change those beliefs.
Ex. Client claiming that she is pregnant or client claiming he
has worm in his brain.

5) Referential elusion – ideas of reference involve the


clients belief that television broadcast music or
newspapers articles have a special meaning for him.
Ex. The client may report that the President was directly
speaking to him on a news broadcast.

Ex. The client claim that the rape victim in the news was her,
and pointing a specific person to have raped her.
Sensorium and Intellectual Processes
a) Hallucination – of false sensory perception, or
perceptual experiences that do not exist in reality

Type of Hallucinations:
1) Auditory Hallucination – most common type which
involves hearing sounds, not open voices, talking to
or about the client
2) Visual – involve seeing images that do not exist at all
such as light or dead person.
3) Olfactory – involve smells or odors
4) Gustatory – involve a taste lingering in the mouth or a
sense that food tasted like something else.
5) Cenesthetic – involves the client’s report that he feels
bodily functions that are usually undetectable.
Ex. Sensation of impulses being transmitted through the
brain
6) Kinesthetic – occur when the client is motionless but
reports the sensation of bodily movement such as floating
above the ground

 Assessing the intellectual processes of a client with


schizophrenia is difficult if he experiencing psychosis. The client
usually demonstrate poor intellectual function as a result of
disordered thoughts
7) Judgment and Insights – judgment is frequently impaired
in the client or with schizophrenia. It follows that the client
with disordered thoughts processes and environmental
misinterpretation will have great difficulty with judgment.
8) Self Concept – deterioration of self concept is a major
problem in Schizophrenia, the phase loss of Ego boundaries
describes the clients lack of a clear sense of where he own
mind, body. The lack of ego boundaries is evidence by the
personalization, derealization and ideas of reference. Clients
believe that they are fused with another person or object may
not recognized body part as their own, or may feel to know
whether they are male or female. Bizarre behavior such as
public undressing or misbehaving, speaking about oneself in
the third person or physically clinging to objects in the
environment. Body image distortion may occur.
9) Roles and Relationship
 Social Isolation - is prevalent in client with Schizophrenia
partly as a result of positive signs such as delusion,
hallucination, and as of Ego Boundaries. Clients have
problems in trust and intimacy which interferes with the
ability to establish satisfactory relationship. Role
identification is difficult for the client as well as adjustment
to fulfill within the community.
10) Physiologic and Self Care Consideration
 Client with Schizophrenia may have significant self care
deficits. In attention to grooming needs is common and
fails to perform even activities of daily living. Client also
may feel to recognize sensations as well as hunger or thirst
which results malnourishment and constipation.
Nursing Care Plan