Schizophrenia

Question 1

What is schizophrenia?

Answer 1

A severe mental illness defined by a constellation of positive symptoms which commonly distance society from the patient and negative symptoms that frequently distances the patient from society

Question 2

What are positive symptoms of schizophrenia?

Answer 2

1. Hallucinations
2. Delusions
3. Disorganized Speech
4. Disorganized Behavior
5. Catatonia

Question 3

What are negative symptoms of schizophrenia?

Answer 3

1. Anhedonia: lack of pleasure
2. Flat Affect: lack of expression
3. Apathy: lack of interest
4. Anergia: lack of energy
5. Alogia: lack of speech
6. Avolition: lack of motivation

Question 4

What are predisposing factors in the development of schizophrenia?

Answer 4

1. Preexisting personality disorder
2. Substance or alcohol abuse
3. Child Abuse
4. Complications associated with pregnancy and birth
5. Genetic Variations
6. Physiological Factors such as sleep deprivation

Question 5

Prioritize Assessment of Clients Living with Schizophrenia

Answer 5

1. AIRWAY, BREATHING, CIRCULATION
2. SAFETY
3. Outward signs that something else is going on
4. Assessment of current condition

Question 6

History Assessment

Answer 6

1. Obtain information from family, family, co-worker if needed
2. Rapport building is very important
    This is where delegation is important (if starting to develop rapport and something needs to be done right then, ask someone else to do it; if you decide to stop assessing/getting information from patient and go to something else, patient may lose sense of trust and not confide in you
3. Questions should be straight-forward, concrete and open-ended question
    Allow additional time for patient to answer questions
4. Develop questions using non-clinical terms
    Ex: Do you ever see or hear things that other people can’t see or hear
5. Use therapeutic communication
   o Areas to Assess:
    Risk Factors
    Medical History
    Family History
    Mental Health History
    Substance/Alcohol Use
    Perinatal Trauma
    Developmental History
    Trauma Exposure
    Culture and Beliefs

Question 7

Physical Assessment

Answer 7

1. Vital Signs:
    Explain each step to the patient (therapeutic communication)
    Don’t rush on in with equipment right away
    Explain that the equipment is safe and not going to hurt them
2. Mental Status Examination:
    Appearance
    Attitude
    Behavior
    Mood and Affect
    Speech
    Thought Process
    Thought Content
    Perception
    Cognition
    Insight
    Judgement

Question 8

Diagnostic Testing

Answer 8

1. No specific test can confirm psychosis
2. Specific labs and neuroimaging studies may be useful to detect conditions that contribute to psychosis
    Labs: CBC, thyroid function test, rapid plasma, HIV test, heavy metals panel, urinalysis, urine drug screen, urine culture and sensitivity
    Diagnostic Screening:
   * CT and MRI: detects cerebrovascular accident (CVA), brain tumor, cause of seizures, intracranial infection, cerebral changes (dementia), and trauma
   * EEG: detects epilepsy, intracranial infections or tumors
   *PET or SPECT scan: evaluates neurochemical brain functions

Question 9

Nursing Interventions for Schizophrenia (Primary Prevention)

Answer 9

1. Aim at reducing risk factors
2. Facilitate protective factors
3. Decreasing early use of substance
4. Early Detection and Intervention during prodromal states

Question 10

Pharmacology Therapy: Typical Antipsychotics

Answer 10

1. First Generation Antipsychotic:
    Also known as TYPICAL ANTIPSYCHOTIC
    Examples: Haloperidol (Haldol), Chlorpromazine
   
   • Remember: if you are having HALLUCINATION then you may need HALOPERIDOL to help control these
   • Meds that end in the suffix “ -azine”

Question 11

How do Typical Antipsychotic Medications Work?

Answer 11

Alter the action of dopamine in the central nervous system

Question 12

Side Effects of Typical Antipsychotic Medication

Answer 12

1. Extrapyramidal Effects: dystonia (involuntary muscle contractions) muscle rigidity
   o If having EPS symptoms, give BENZTROPINE (anticholinergic agent) to reduce symptoms
2. Tardive Dyskinesia: Lip smacking, tongue rolling, grimacing or frowning, chewing movements, puffing your cheeks out, rapid eye blinking
3. Nonmalignant Syndrome: Fever, BP fluctuations, dysrhythmias
   o If having NMS, give DANTROLENE
4. Agranulocytosis (decreased WBC; prone to INFECTION)
5. Anticholinergic Effects (dry effect): can’t see, can’t pee, can’t spit, can’t poop
6. Orthostatic Hypotension
7. Seizures
8. Sedation

Question 13

What should nurses monitor with Typical Antipsychotic Medications

Answer 13

1. Assess mental status; positive and negative symptoms of schizophrenia
2. Assess weight
3. Monitor for akathisia (inability to hold still), tardive dyskinesia
4. Monitor CBC and liver function
5. Evaluation: decreased in hallucination and delusions

Question 14

Pharmacology Therapy: Atypical Antipsychotics

Answer 14

1. Also known as ATYPICAL ANTIPSYCHOTICS
2. Examples: Risperidone (Risperdal), Olanzapine and Clozapine
   * End in the suffixes “-apine” or “-idone”

Question 15

How do Atypical Antipsychotic Medications Work?

Answer 15

Act as serotonin and dopamine antagonist (preventing a response) in the body

Question 16

Side Effects of Atypical Antipsychotics

Answer 16

1. Diabetes
2. Weight Gain (if used for long periods of time)
3. Dyslipidemia
4. Agranulocytosis (decreased WBC; prone to infections)
5. Decreased libido, Menorrhagia
6. Anticholinergic Effects- can’t see, can’t pee, can’t spit, can’t poop
7. Orthostatic Hypotension
8. Sedation

Question 17

What should nurses monitor with Atypical Antipsychotics?

Answer 17

1. Assess for suicidal thoughts, behaviors, and depression, especially during early treatment
2. Include Orthostatic blood pressure with vital signs
3. Assess weight
4. Evaluation: decrease in schizophrenia symptoms

Question 18

Non-pharmacological Therapies for Schizophrenia

Answer 18

1. Social Skills Training: teaches individuals about verbal, nonverbal and paraverbal communication
2. Family-Focused Therapy: educates the family on the nature of psychosis, its symptoms and common management strategies
3. Group Therapy
4. Cognitive Behavioral Therapy: premised on the notion that how one perceives and interprets sensory stimuli has a direct bearing on the reaction one has to that situation
5. Cognitive Enhancement Therapy: focuses on improving mental health stamina, active information processing and learning how to negotiate unrehearsed social challenges
6. Electroconvulsive Therapy (ECT): medical procedure in which electrical currents are passed through the brain with the intent to trigger seizure activity, which has the potential to cause change in the brain chemistry and subsequently influence psychotic symptoms

Question 19

Lifestyle Modifications for Schizophrenia

Answer 19

1. Serial Health Monitoring: assesses abdominal obesity, triglycerides, HDL cholesterol, blood pressure and fast glucose
2. Nutrition Counseling
3. Exercise/Yoga

Question 20

Community Integration for Schizophrenia

Answer 20

1. Case Management: employs a team of healthcare workers to serve as a liaison between the patient and the community to maximize patient autonomy without compromising patient’s health and well-being
2. Vocational Therapy: process that individualizes resources for those with functional, psychological, developmental or cognitive impairments
    Intended to overcome barriers to accessing, maintaining or returning to employment