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Schizophrenia LESSON OBJECTIVES: 1. Distinguish key symptoms of schizophrenia. 2. Analyze the prevailing biologic, psychological, and social theories that are the basis for understanding schizophrenia. 3. Analyze human responses to schizophrenia with emphasis on hallucinations, delusions, and social isolation. 4. Formulate nursing diagnoses based on a biopsychosocial assessment of persons with schizophrenia. 5. Formulate nursing interventions that address specific diagnoses based on a continuum of care. 6. Identify expected outcomes and their evaluation. 7. Analyze special concerns within the nurse-patient relationship common to treating those with schizophrenia. CONTENT OUTLINE 1. Clinical Course 1.1. Diagnostic Criteria 1.1.1. Positive Symptoms of Schizophrenia 1.1.2. Negative Symptoms of Schizophrenia 1.1.3. Neurocognitive Impairment 2. Phases of Schizophrenia 2.1. Phase I: Initial Diagnosis and Early Schizophrenia 2.2. Phase II: Adaptation 2.3. Phase III: Relapse 3. Schizophrenia in Special Populations 3.1. Children 3.2. Elderly People 4. Epidemiology 4.1. Risk Factors 4.2. Age of Onset 4.3. Gender Differences 4.4. Ethnic and Cultural Differences 4.5. Familial Differences 5. Comorbidity 5.1. Substance Abuse and Depression 5.2. Diabetes Mellitus 5.2.1. Disordered Water Balance 5.2.2. Prevalence 5.2.3. Etiology of Disordered Water Balance 6. Clinical Characteristics 6.1. Etiology 6.2. Biologic Theories 6.3. Neuroanatomic Findings 7. Familial Patterns 8. Neurodevelopment 8.1. Neurotransmitters, Pathways, and Receptors 8.2. Positive Symptoms: Hyperactivity of Mesolimbic Tract 8.3. Negative Symptoms and Cognitive Impairment: Hyperactivity of the 8.4. Mesocortical Tract 8.5. Role of Other Dopamine Pathways 8.6. Role of Other Receptors 9. Psychological Theories 10. Social Theories 11. Interdisciplinary Treatment 11.1. Priority Care Issues 12. Family Response to Disorder 13. Nursing Management: Human Response to Disorder 13.1. Biologic Domain 13.2. Biologic Assessment 13.2.1. Present and Past Health Status and Physical Examination 13.3. Physical Functioning 13.4. Nutritional Assessment 13.5. Fluid Imbalance Assessment 13.6. Pharmacologic Assessment 13.7. Nursing Diagnosis Related to Biologic Domain 14. Biologic Interventions 14.1. Promotion of Self-Care Activities 14.2. Activity, Exercise, and Nutritional Interventions 14.3. Thermoregulation Interventions 14.4. Promotion of Normal Fluid Balance and Prevention of Water 14.5. Intoxication 15. Pharmacologic Interventions 15.1. Monitoring and Administering Medications 15.2. Monitoring Side Effects 15.3. Medication Emergencies 16. Psychological Domain 16.1. Psychological Assessment 16.2. Responses to Mental Health Problems 16.3. Speech 16.4. Thought Process 16.5. Behavioral Responses 16.6. Self-Concept 16.7. Stress and Coping Patterns 16.8. Risk Assessment 17. Nursing Diagnoses Related to Psychological Domain 17.1. Psychological Interventions 18. Special Issues in the Development of the Nurse-Patient Relationship 18.1. Management of Disturbed Thoughts and Sensory Perceptions 18.2. Self-Monitoring and Relapse Prevention 18.3. Enhancement of Cognitive Functioning 19. Behavioral Interventions 19.1. Stress and Coping Skills 20. Patient Education 21. Family Education 22. Social Domain 22.1. Social Assessment 22.1.1. Functional Status 22.1.2. Social Systems 22.1.3. Quality of Life 22.2. Family Assessment 22.3. Nursing Diagnoses Related to Social Domain 23. Social Interventions 23.1. Promotion of Patient Safety on Psychiatric Units 23.2. Support Groups 23.3. Milieu Therapy 23.4. Psychiatric Rehabilitation 23.5. Family Interventions 24. Evaluation and Treatment Outcomes 25. Continuum of Care 25.1. 25.2. 25.3. 25.4. Inpatient-Focused Care Emergency Care Community Care Mental Health Promotion LEARNING ACTIVITIES: 1. Study Guide: Chapter 18: Pages79-84 2. Participation in Critical Thinking Exercises in Class 3. Quiz CRITICAL THINKING FOCUS: The mental health nurse's response to individuals exhibiting symptoms of schizophrenia, having a diagnosis of schizophrenia, and/or prescribed anti-psychotic medications. REQUIRED READING: Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 332-383). Philadelphia: Lippincott. WEB LINKS: http://www.nami.org This is the website of the National Alliance for the Mentally Ill. http://www.nimh.nih.gov/publicat/schizmenu.cfm The National Institute of Mental Health website presents all aspects of the diagnosis and treatment of schizophrenia. http://www.narsad.org This is the site of the National Alliance for Research on Schizophrenia and Depression, which is a national organization that raises and distributes money for research. http://www.schizophrenia.ca This is the site of the Schizophrenia Society of Canada, an organization committed to alleviating suffering caused by schizophrenia. http://www.schizophrenia.com This is a not-for-profit information, support, and education center. http://www.mentalhealth.com This site of the Mental Health Network provides extensive information on schizophrenia.