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Download THE CLIENT EXPERIENCING SCHIZOPHRENIA
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THE PATIENT EXPERIENCING SCHIZOPHRENIA SCHIZOPHRENIA • Thought process disorder Schizophrenia means “splitting of the mind” & reflects its effects on thought & language • Major cause of prolonged psychosis Loss of rational thought & the ability to accurately interpret the environment • Characterized by: disordered thoughts, delusions, and hallucinations • Dispelling common myths about schizophrenia Schizophrenia does not mean spilt personality Schizophrenics are not usually prone to violence Schizophrenia is not caused by family dysfunction DISORDERED THOUGHTS • Major characteristic of schizophrenia • “Loose” flow of thoughts Topics & ideas flow from one to another with little or no order • Ideas are unrelated May make sense individually, but not when put together • Evolves slowly over years Thought disorders may be subtle & hard to recognize in early stages • May lose ability to communicate as the condition evolves INCOMPREHENSIBLE LANGUAGE • Neologisms • • • • Individuals frequently invent their own vocabularies – may offer definitions Derailment Going off the point or subject Tangentiality Failure to reach a goal or stick to the original point Incoherence Speech that is not logically connected Word salad A group of disconnected words LOSS OF FUNCTION • Cannot maintain social norms Due to loss of ability to think & communicate • Behavior disordered Social & verbal • Inappropriate appearance and dress May range from sloppy to eccentric or even bizarre • Catatonia may be present Among the most striking manifestations of psychosis Marked decrease in reactivity to environment – to complete unawareness Maintains rigid posture & resists efforts to be moved DELUSIONS • Fixed, false beliefs Misrepresent either experiences or perceptions • Major defining characteristic of psychosis Grandiose – involve perceptions of importance; often believe they have special powers & may claim to be a religious Messiah Persecutory – paranoid; believe that others intend to do them harm Referential – believe that common events have reference to them Examples: passages in songs, patterns of clouds in the sky, comments of others HALLUCINATIONS • Another major characteristic of psychosis • Very common in schizophrenia • Sensory experiences not perceptible to others Can involve any sensory modality • Auditory most common May be one or more voices: may be talking with each other or commenting on the individual’s stream of thought Voices are perceived as very distinct from the individual’s own thoughts Voices usually have a specific content – most frequently a threatening or negative nature Voices emanate from inside the body or from the sky Occur while fully awake SYMPTOMS OF SCHIZOPHRENIA Positive symptoms • Disordered thought/behavior • Delusions • Hallucinations Negative symptoms • Flattened affect Loss of expressiveness • Alogia Tendency to speak very little • Avolition Tendency to lack motivation for work or other activities that are goal-directed • Anhedonia Inability to find joy in activities that are pleasurable to unaffected persons CLINICAL COURSE • Organic disease with genetic component • Appears in early to mid-twenties in men • Later in women – typically the late twenties • Outcome improved in past 20 years • Course of illness unpredictable • Increased risk of suicide • High social cost Current Views on Causes Genetics • Overall lifetime risk of developing schizophrenia is 1% • An individual with 2 schizophrenic parents has a 50% chance of becoming schizophrenic • Clearly a disorder with a major genetic component • Highest risk occurs in identical twins with both parents having schizophrenia • Currently believed that 70% of risk for developing schizophrenia is due to genetic factors • However, the majority of schizophrenics have absolutely no family history (63%) • No certain answer has emerged to date Organic Causes • Something physically & structurally wrong with the brain • Little progress until CT scanners were brought into use in the mid-1970s to evaluate the brains of schizophrenics • Males with schizophrenia have larger lateral ventricles than those that do not have schizophrenia – but not females • The meaning of this finding remains unclear – is it a cause or a consequence of schizophrenia? • Some evidence indicates that ventricular enlargement may progress during the course of the disease & cause some cerebral atrophy • Schizophrenia could come to be viewed as a progressive degenerative neurological disease Dopamine Hypothesis • States that the functional abnormalities in schizophrenia are due to excessive activity of brain dopamine • Dopamine is normally produced in the brain & serves as a neurotransmitter • Dopamine has its most important effects in the basal ganglia of the brain – reduction of dopamine in these structures leads to Parkinson’s • Drugs effective in controlling the positive symptoms all seem to have significant dopamine receptor blocking activity – they work by reducing the effect of the individual’s own dopamine on his or her brain • Drugs that can cause schizophrenic-like psychoses act by increasing brain dopamine concentrations (amphetamines) • Multiple autopsies have shown an increase in the brain’s basal ganglia in persons dying with schizophrenia Other Neurotransmitters • Dopamine levels & receptor numbers may be affected by other processes Especially those in the prefrontal & cortical areas, which have shown to be abnormal in imaging studies • Recent research shows a decrease in the number of inhibitory neurons in schizophrenia • Expression of choleycystokinin & somatostatin is also decreased in schizophrenia Loss of inhibitory function may account for increased brain activity seen in the hippocampus & parts of the prefrontal cortex TREATMENT Psychosocial • Clinical & Family support • Providing specific skills training for patient & family stress management & functional coping responses are high priority • Educating family about the nature & meaning of the disease • Assisting family members is a nursing care priority • Educating families on the purpose & side effects of medication • Rehabilitative services • Primary focus is on enhancing social skills – negative symptoms • May be directed toward vocational goals for some individuals • Humanitarian aid/public safety • Deinstitutionalization • Least restrictive care needed to provide psychosocial & rehab services - often means • homeless • starving • without treatment Nursing Alert !!! • Tardive Dyskinesia - Frequently cannot be reversed by withdrawing medications ASSESSMENT • Delusional thought • Hallucinations • Disorganized speech • Grooming • Negative symptoms of schizophrenia • Level of independence and functioning NURSING DIAGNOSIS • Disturbed thought processes, sensory perceptions, sleep patterns • Self-care deficit (specify) • Ineffective role performance • Social isolation • Ineffective therapeutic regimen management OUTCOME IDENTIFICATION • Set appropriate goals • Outcomes differ for acute and rehabilitative phases Acute phase – immediate goal of treatment is to bring symptoms under control Rehab phase – goals aimed at helping the patient & his family to make the best adjustment possible to a chronic disease PLANNING/INTERVENTIONS • All based on alleviating acute symptoms • Establish safe and trusting environment EVALUATION • Have identified outcomes been met?
