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Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition CHAPTER 15 SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Schizophrenia Illness defined by Eugene Bleuler Means “split mind” (NOT multiple personality disorder) There is a “split” between a patient’s thoughts and feelings; between his/her reality and society’s reality Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Schizophrenia (cont’d) Very serious, debilitating, lifelong psychiatric disorder Seems to strike people between ages 16 and 35 most frequently; first psychotic break rarely after age 40 Viewed on a gradient of psychopathology from least to most severe (spectrum disorder) Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Clicker Question 1. Which statement is most true about schizophrenia? A. It is a disorder of the frail elderly B. It can be diagnosed at birth C. Initial psychotic break often occurs when away at college D. Can become evident at any age Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Answer Correct answer: C Rationale: Schizophrenia is most often diagnosed in young people with the first psychotic break occurring in the teens and 20s. Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Clicker Question 2. Which statement is most true about schizophrenia? A. Diagnosis identified during World War II B. Debilitating chronic illness C. Cause is disturbed mother/child bond D. All of the above Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Answer Correct answer: B Rationale: Schizophrenia is a lifelong chronic illness that is often characterized by remissions and exacerbations. Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Schizophrenia is characterized by: Delusions Hallucinations Disorganized Speech & Behavior Causes social, personal and occupational dysfunction. Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition “Insidious” Onset School grades lower Quietness Withdrawal “Just a stage” Change in personality Change in way person relates to others Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Common Symptoms Delusions Fixed, false beliefs that cannot be changed with logic Hallucinations False sensory perceptions Can affect all five senses Illusions Mistaken perceptions of reality Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Common Symptoms (cont’d) Echolalia Repetition of words Echopraxia Repetition of actions Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Positive Symptoms Those that are found among people with schizophrenia but are not present among those who do not have the disorder Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Positive Symptoms Delusions, Neologisms, Thought disorders, Concrete thinking, Hallucinations, Loose associations Disorganized speech , Magical thinking, “Word Salad”, Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Negative Symptoms Those found among people who do not have the disorder but are missing or lacking among individuals with schizophrenia and reflect a lessening or loss of normal functions Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Negative Symptoms Apathy Avolition Affect Alogia Autism like Lack of desire to form social relationships, Inappropriate social behaviors (pacing, rocking), Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Positive Negative Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Cognitive Impairment Poor Executive Function Difficulty with Focus Problems with Working Memory Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Causes It is now known to be a brain disorder Theories include disruption of neurotransmitters and/or neuron functioning, cortical abnormalities Genetic predisposition Family dysfunction is no longer believed to be primary cause Stress Vulnerability Model Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Other Types of Psychotic Disorders Delusional Schizoaffective Schizophreniform Psychotic depression or mania Psychosis due to general medical condition or substance abuse/withdrawal Postpartum psychosis Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Schizoaffective Disorder A disorder characterized by s/s of schizophrenia along with s/s of depression or manic episode that requires treatment of both set of symptoms. Treated with antipsychotics, mood stabilizers, antidepressants, talk therapy, and skills building. Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Delusional Disorder A disorder with delusions without diagnosis of schizophrenia. Apart from the impact of the delusions or its ramifications, functioning is not markedly impaired & behavior is not obviously odd or bizarre. Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Delusional Disorder cont… Many types: erotomanic, grandiose, jealous, persecutory, somatic, mixed. Affects women> men, Difficult to diagnose because person conceals delusional thought. Treated with antipsychotics, talk therapy. Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Brief Psychiatric Rating Scale See Handout Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Multidisciplinary Treatment Medications –Primary TX Antipsychotics Anticholinergics (to counteract extrapyramidal symptoms) Psychotherapy (group and family) Electroconvulsive therapy Supportive milieu Ongoing support and education Skill building Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Antipsychotics These medications are the main focus of treatment Patient may need to be on these for the rest of his/her life Side effects management of these medications is key part of treatment EPS (extrapyramidal symptoms) are common with many of these drugs Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Nursing Interventions NEVER reinforce hallucinations, delusions, or illusions “I don’t see a snake. Let’s walk to the dining room together now.” This is one of the few times when it is acceptable to change the subject in communications NEVER whisper or laugh when the patient is not aware of the whole conversation Keep patient out of competitive or embarrassing situations Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Nursing Interventions (cont’d) Develop trust Maintain calm, structured milieu Maintain clear, concise communication State what is acceptable and expected behavior Give rationale and consequences at the same time Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Clicker Question 3. Which statement reflects the best approach by the nurse to a schizophrenic patient who tells you she sees a snake in her room? A. “I will catch the snake and then you can eat.” B. “I don’t see a snake in the room. Let’s get you ready for lunch.” C. “I am afraid of snakes. Please don’t talk about them.” D. “That’s interesting. Describe the snake to me.” Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Answer Correct answer: B Rationale: This response acknowledges that the snake does not exist in reality and then changes the focus on reality for the next activity. This way the image is not dwelled on. If the nurse focused on the snake hallucination, it would reinforce this as reality. Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition Which of the following are valid nursing interventions in treating schizophrenic patients? (Select all that apply) A. Do not reinforce hallucinations, delusions, or illusions. B. Provide a stimulating environment for the patient to provide distraction. C. Keep communication simple. D. Promote the patient’s problem-solving skills. E. Emphasize behavior that is appropriate to the situation. F. Encourage the patient to confront stressful situations. Copyright © 2014. F.A. Davis Company Gorman and Anwar Neeb’s Fundamentals of Mental Health Nursing, 4th Edition ANS: A, C, E These responses reinforce reality without creating more stress for the patient, which would be the case in promoting more stimulation, problem solving, and confrontation. Copyright © 2014. F.A. Davis Company