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Mental Health
Vocab for Chapter 12: Schizophrenia Spectrum Disorders
| Term | Definition |
|---|---|
| Schizophrenia Spectrum Disorders | Schizophrenia Spectrum Disorders is a group of mental health problems characterized by psychotic features (hallucinations and delusions), disordered thought processes, and disrupted interpersonal relationships. -Symptoms last less then 6 months |
| Delusional Disorder (Positive Symptoms) - Alteration in reality testing | Delusional disorder is characterized by delusions (i.e., false thoughts or beliefs) that have lasted 1 month or longer. The delusions include grandiose, persecutory, somatic, and referential themes. They are usually not severe enough to impair functioning. Individuals with this disorder do not tend to behave strangely or bizarrely. 1. Grandiose 2. Persecutory 3. Somatic 4. referential themes 5. Erotomaniac 6. Nihilistic |
| Brief Psychotic Disorder | Sudden onset of at least one of the following: Delusions, hallucinations, disorganized speech, and disorganized or catatonic behavior Duration: Must last longer than 1 day but no longer than 1 month, with the expectation of a return to normal functioning |
| Schizophreniform Disorder | Symptoms: Exactly like those of schizophrenia, except that symptoms have thus far lasted less than 6 months. Impaired social or occupational functioning may not be apparent May or may not return to the previous level of functioning -With MDD, Manic or Mixed episodes. |
| Schizoaffective Disorder | The major depressive, manic, or mixed episode, concurrent with symptoms that meet the criteria for schizophrenia. Not caused by any substance use or general medical condition |
| Substance-Induced Psychotic Disorder & Psychotic Disorder Due To Another Medical Condition | Delusions or hallucinations from illicit drugs, alcohol, medications, or toxins --or— Delusions or hallucinations from delirium, neurological disease, hepatic or renal disease, and many more |
| DSM-V Criteria: Highlights Two or more of the following for a significant portion of time in 1 month: | Delusions Hallucinations Disorganized speech Gross disorganization or catatonia Negative symptoms (diminished emotional expression or avolition) Functional impairment of some kind -Continuous disturbance for at least 6 months Ruled out: substances or other disorders |
| Phases of Schizophrenia | Prodromal (The period between the appearance of initial symptoms and the full development) Acute Stabilization Maintenance or Residual (Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and cases varying degrees of dysfunction or disabilities. |
| Prodromal | Onset; mild changes Schizophrenia is often preceded by a prodromal phase during which milder symptoms of the disorder occur, often months or years before the full disorder becomes manifest. During the prodromal phase, people may experience diminished school performance and cognitive ability. They may become less socially engaged or adept. They may also demonstrate attenuated (mild) psychotic symptoms, such as suspiciousness and/or eccentric or disorganized speech or thought |
| Acute | Exacerbation of symptoms -Acute symptoms vary from and mild to many and disabling. Symptoms such as hallucinations, delusions, apathy, social withdrawal, diminished affect, anhedonia, disorganized behavior, and impaired judgment and cognition |
| Stabilization | Symptoms diminishing Movement toward previous level of functioning Stabilization—In this phase, symptoms stabilize and diminish, and there is a movement toward a previous level of functioning. This phase can last for months. Care in an outpatient mental health center or a partial hospitalization program may be needed. The person may receive care in a residential crisis center (similar to a mental health unit but based in the community) or a staff-supervised residential group home or apartment. |
| Maintenance or Residual | New baseline is established -Maintenance or Residual—In this phase, the condition has stabilized, and a new baseline may be established. Positive symptoms are usually significantly diminished or absent, but negative and cognitive symptoms remain a concern. Ideally, recovery with few or no residual symptoms will occur, and the patient is again able to live independently or with family. |
| Positive symptoms | The presence of symptoms that should not be present. Positive symptoms include: Hallucinations Delusions Paranoia or Disorganized or Bizarre thoughts, Behavior or Speech. |
| Negative symptoms | The absence of qualities that should be present. Negative symptoms include the inability to enjoy Activities (anhedonia), social discomfort, or lack of goal-directed behavior (Avolition). |
| Cognitive symptoms | Subtle or obvious impairment in memory, attention, and thinking (e.g., disorganized or irrational thoughts); impaired executive functioning (e.g., impaired judgment, impulse control, prioritization, and problem-solving). |
| Affective symptoms | Symptoms involve emotions and their expression. Affective symptoms involve an altered experience and expression of emotions. Mood may be unstable, erratic, labile (changing rapidly and easily), or incongruent (not what would be expected for the circumstances). **A serious affective change often seen in schizophrenia is comorbid major depressive disorder.*** Depression may occur as part of a shared inflammatory reaction affecting the brain, or it may simply be a reaction to the stress and despair t |
| Grandiose (Positive symptom) | Delusions of grandeur, in which the client attaches special significance to self in relation to others or the universe and has an exaggerated sense of self that has no basis in reality |
| Persecutory (Positive symptom) | Delusions of persecution in which the client believes that she or he is being harassed, threatened, or persecuted by some powerful force. *Believe will be harmed |
| Somatic (Positive Symptom) | Somatic delusions, in which the client believes that her or his body is changing or responding in an unusual way, which has no basis in reality |
| Referential (Positive Symptom) | A belief that events or circumstances that have no connection to you are somehow related to you Patient would say "This song has a secret message" |
| Erotomaniac (Positive Symptom) | Believing that another person desires you romantically. |
| Nihilistic (Positive Symptom) | The conviction that a major catastrophe will occur. |
| Control (Positive Symptom) | Believing that another person, group, or external force controls your thoughts, feelings, impulses, or behavior. |
| Alterations in speech (Positive Symptom) | Associative looseness Word salad Clang association Neologisms Echolalia |
| Associative looseness, or looseness of association | Results from haphazard and illogical thinking where concentration is poor and thoughts are only loosely connected. “My friends talk about French fries, but how can you trust the French?” |
| Word salad, the most extreme form of associative looseness | is a jumble of words that is meaningless to the listener. Example: “agents want strength of policy on a boat reigning supreme” |
| Clang association | Is choosing words based on their sound rather than their meaning and often involves words that rhyme or have a similar beginning sound. Example: (“On the track … have a Big Mac” or “Click, clack, clutch, close”). |
| Neologisms | Are words that have meaning for the patient but a different or nonexistent meaning for others. A patient may use a known word differently than others or create a completely new word that others do not understand. Example: “His mannerologies are poor” |
| Echolalia | Is the pathological repetition of another’s words, occurring perhaps because the patient’s thought processes are so impaired that she is unable to generate speech of her own |
| Abnormal Speech Pattern (Positive Symptom) | Circumstantiality Tangentiality Cognitive retardation Pressured speech Flight of ideas Symbolic speech |
| Circumstantiality: | Including unnecessary and often tedious details in conversation but eventually reaching the point. |
| Tangentiality: | Wandering off topic or going off on tangents and never reaching the point. |
| Cognitive Retardation | Generalized slowing of thinking, which is represented by delays in responding to questions or difficulty finishing thoughts. |
| Pressured speech | Urgent or intense speech; reluctance to allow comments from others. |
| Flight of ideas: | Moving rapidly from one thought to the next, often making it difficult for others to follow the conversation. |
| Symbolic speech: | Using words based on what they symbolize, not what they mean. For example, a patient reports “demons are sticking needles in me” when what he means is that he is experiencing a sharp pain (symbolized by needles). |
| Disorders or Distortions of Thought (Positive system) | Thought blocking Thought insertion Thought deletion Magical thinking: Paranoia |
| Thought blocking: | A reduction or stoppage of thought. Cognitive disorganization or interruption of thought by hallucinations can cause this. |
| Thought insertion: | The often uncomfortable belief that someone else has inserted thoughts into the patient’s brain. |
| Thought deletion: | A belief that thoughts have been taken or are missing |
| Magical thinking: | Believing that reality can be changed simply by thoughts or unrelated actions. This thinking is common in children (e.g., “Because I was mad at him, he fell down”). |
| Paranoia: | An irrational fear, ranging from mild (being suspicious, wary, guarded) to profound (believing irrationally that another person intends to kill you). Fear may result in dangerous defensive actions, such as harming another person before that person can harm the patient. |
| Alterations in Perception - Hallucination (Positive system) | Auditory Visual Olfactory Gustatory Tactile Command |
| Auditory | Hearing voices or sounds |
| Visual | Seeing people or things |
| Olfactory | Smelling odors |
| Gustatory | Experiencing tastes |
| Tactile | Feeling bodily sensations (e.g., feeling an insect crawling on one’s skin) |
| Command | Doing on command |
| Illusions (Positive symptom) | Misinterpretations of a real experience. For example, a man sees a coat on a shadowy coat rack and believes it to be a bear. |
| Depersonalization (Positive symptom) | A feeling of being unreal or having lost an element of one’s person or identity. For example, body parts do not belong, or the body has drastically changed (e.g., a patient may see her fingers as being smaller than they actually are or not as hers). |
| Derealization (Positive symptom) | A feeling that the environment has changed (e.g., that one is detached from the environment, that everything seems bigger or smaller, or that familiar surroundings seem somehow strange and unfamiliar). |
| Alterations in Behavior (Positive system) | Catatonia Motor retardation Motor Agitation Stereotyped behavior Echopraxia Negativism Impaired impulse control Gesturing or posturing Boundary impairment |
| Catatonia | A pronounced increase or decrease in the rate and amount of movement. Excessive motor activity is purposeless. The most common form of catatonia is when the person moves little or not at all. Muscular rigidity, or catalepsy, may be so severe that the limbs remain in whatever position they are placed. Persistent catatonia may contribute to exhaustion, pneumonia, blood clotting, malnutrition, or dehydration. |
| Motor retardation | A pronounced slowing of movement. |
| Motor agitation | Excited behavior, such as running or pacing rapidly, often in response to internal or external stimuli. It can put the patient at risk (e.g., from exhaustion, by running into traffic) or put others at risk (e.g., by being knocked down). |
| Stereotyped behaviors | Repetitive behaviors that do not serve a logical purpose. |
| Echopraxia | The mimicking of movements of another. |
| Negativism | A tendency to resist or oppose the requests or wishes of others. |
| Impaired impulse control | A reduced ability to resist one’s impulses. Examples include interrupting others or throwing unwanted food on the floor. It can increase the risk of assault. |
| Gesturing or posturing | Assuming unusual and illogical expressions (often grimaces), posture, or positions. |
| Boundary impairment | An impaired ability to sense where one’s body or influence ends and another’s begins. For example, a patient might stand too close to others or might drink another person’s beverage, believing that because the beverage is near, it is the patient’s. |
| The absence of essential human qualities (Negative Symptoms) | Anhedonia Avolition A sociality Affective blunting Apathy Alogia |
| Anhedonia | (an = without + hedonia = pleasure): A reduced ability or the inability to experience pleasure. |
| Avolition | (a = without + volition = initiating an action): reduced motivation or goal-directed behavior; difficulty beginning and sustaining goal-directed activities. |
| A sociality | Decreased desire for social interaction or discomfort during it; social withdrawal. |
| Affective blunting | Reduced or constricted affect. |
| Apathy | Decreased interest in activities or beliefs that would otherwise be interesting or important or little attention to them. |
| Alogia | Reduction in speech, sometimes called poverty of speech. |
| Affect: Outward expression of a person’s internal emotional state (Negative Symptoms) | Flat Blunted Constricted Inappropriate Bizarre |
| Flat | Immobile or blank facial expression |
| Blunted | Reduced or minimal emotional response |
| Constricted | Reduced in range or intensity (e.g., shows sadness or anger but no other moods) |
| Inappropriate | Incongruent with the actual emotional state or situation (e.g., laughing in response to a tragedy) |
| Bizarre | Odd, illogical, inappropriate, or unfounded; includes grimacing |
| Cognitive Symptoms | Concrete Thinking Impaired memory Impaired information processing Impaired executive functioning Anosognosia |
| Concrete thinking (Cognitive Symptoms) | Is an impaired ability to think abstractly, resulting in interpreting or perceiving things in a literal manner. For example, a nurse might ask what brought the patient to the hospital, and the patient answers “a cab” rather than “a suicide attempt.” The meanings of proverbs can be used to assess abstract thought. |
| Impaired memory (Cognitive Symptoms) | impairment primarily affects short-term memory and the ability to learn. Repetition and verbal or visual reminders (cues) may help the patient to learn and recall information. For example, a picture of a toothbrush in the bathroom may serve as a reminder to brush teeth. |
| Impaired information processing (Cognitive Symptoms) | can lead to problems such as delayed responses, misperceptions, or difficulty understanding others. Patients may lose the ability to screen out insignificant stimuli such as background sounds or objects in their peripheral vision, leading to overstimulation. Reducing stimulation can be helpful. |
| Impaired executive functioning (Cognitive Symptoms) | includes difficulty with reasoning, setting priorities, comparing options, placing things in logical order or groups, anticipating and planning, and inhibiting undesirable impulses or actions. Impaired executive functioning interferes with problem solving and can contribute to inappropriateness in social situations. |
| Anosognosia (Cognitive Symptoms) | is the inability to realize one is ill—an inability caused by the illness itself. It is common in severe mental illness. Anosognosia may lead the patient to resist or stop treatment, making care more challenging and frustrating to others. Anosognosia can interfere with requesting or accepting help. |
| Affective Symptoms | Affective symptoms involve an altered experience and expression of emotions. Mood may be unstable, erratic, labile (changing rapidly and easily), or incongruent (not what would be expected for the circumstances). Assessment for depression is crucial May herald impending relapse Increases substance abuse Increases suicide risk Further impairs functioning |
| Acute dystonia | Sudden, sustained contraction - very painful -Facial grimacing -Involuntary upward eye movement -Muscle spasms of tongue, face, neck and back -Laryngeal spasms |
| Akathisia: | Motor restlessness causing an inability to stay still or remain in one place -Restlessness -Trouble Standing Still -Pacing the floor -Feet in constant motion rocking back and forth |
| Pseudoparkinsonism: | A temporary group of symptoms that resemble Parkinson’s disease |
| Tardive dyskinesia: | Involuntary rhythmic movements -Protrusion and rolling the tongue -Sucking and smacking movements of lip -Chewing motion -Involuntary movement of body and extremities -Facial dyskinesia (repetitive movement) Cause: Long term use of Antipsychotic drugs (More than 2 years) |
| Schizophrenia: Nursing Assessment | • Any medical problems • Medical problems that mimic psychosis • Drug or alcohol use disorders • Mental status examination • Include cognitive assessment (e.g., reality testing • Assess for hallucinations • Assess for delusions • Assess for suicide risk • Assess ability to ensure personal safety and health • Assess prescribed meds • Assess symptoms’ impact on functioning • Assess family knowledge |
| Schizophrenia: Nursing Diagnoses | Hallucinations / Delusions Risk for violence Distorted thinking / Impaired abstract thinking Impaired communication Anosognosia Negative self-image Risk for loneliness Powerlessness Risk for suicide Impaired health maintenance |
| Schizophrenia: Nursing Outcomes Identification | Phase I—acute Patient safety and medical stabilization Phase II—stabilization Help the patient understand illness and treatment Stabilize medications Control or cope with symptoms Phase III—maintenance Maintain achievement Prevent relapse Achieve independence, satisfactory quality of life |
| Schizophrenia: Nursing Planning | Phase I—acute Best strategies to ensure patient safety and provide symptom stabilization Phase II—stabilization Phase III—maintenance Provide patient and family education Relapse prevention skills are vital |
| Schizophrenia: Nursing Implementation: Acute Phase | Acute phase Psychiatric, medical, and neurological evaluation Psychopharmacological treatment Support, psychoeducation, and guidance Supervision and limit setting in the milieu Monitor fluid intake Working with aggression • Regularly assess for risk and take safety measures |
| Schizophrenia: Nursing Implementation: Stabilization and maintenance phases | Stabilization and maintenance phases Medication administration/adherence Relationships with trusted care providers Community-based therapeutic services Teamwork and safety Activities and groups Implementation (Cont.) Counseling and communication techniques Hallucinations Delusions Associative looseness Health teaching and health promotion |
| Schizophrenia: Nursing Evaluation: | Reevaluate progress regularly and adjust treatment when needed Even after symptoms improve outwardly, inside the patient is still recovering. Set small goals; recovery can take months. Active, ongoing communication and caring is essential. |
| Treatment Modalities: Biological: Pharmacotherapy | Antipsychotic medications First-generation Second-generation Third-generation |
| Treatment Modalities: Biological: Pharmacotherapy: Injectable antipsychotics | Short-acting Long-acting • First-generation: haloperidol, fluphenazine decanoate • Second-generation: olanzapine pamoate, paliperidone palmitate |
| First-Generation Antipsychotics | Dopamine antagonists (D2 receptor antagonists) Target positive symptoms of schizophrenia Advantage Less expensive than second generation Disadvantages Extrapyramidal side effects (EPS) Anticholinergic (ACh) side effects Tardive dyskinesia Weight gain, sexual dysfunction, endocrine disturbances |
| Second-Generation Antipsychotics | -Serotonin (5-HT2A receptor) and dopamine (D2 receptor) antagonists example Clozapine (Clozaril) Treat both positive and negative symptoms Minimal to no EPS or tardive dyskinesia Disadvantage—tendency to cause significant weight gain; risk of metabolic syndrome Other Second Generation Antipsychotics are: -Clozapine (Watch WBC; make sure not less than 5,000) -Risperidone -Olanzapine (Watch WBC; make sure not less than 5,000) -Quetiapine |
| Third-Generation Antipsychotics | Really a subset of the SGAs: Aripiprazole (Abilify), brexpiprazole (Rexulti), and cariprazine (Vraylar) They are: Dopamine system stabilizers May improve positive and negative symptoms and cognitive function Little risk of EPS or tardive dyskinesia |
| Dangerous Responses to Antipsychotics: Anticholinergic toxicity | Reduced or absent peristalsis (can lead to bowel obstruction); urinary retention; mydriasis; hyperpyrexia without diaphoresis (hot dry skin); delirium with tachycardia, unstable vital signs, agitation, disorientation, hallucinations, reduced responsiveness; worsening of psychotic symptoms; seizure; repetitive motor movements Give: Diphenhydramine Hydrochloride (Antihistamine) 25mg IM or IV |
| Dangerous Responses to Antipsychotics: Neuroleptic malignant syndrome (NMS) | Neuroleptic malignant syndrome (NMS) Severe muscle rigidity, dysphasia Flexor-extensor posturing Reduced or absent speech and movement Decreased responsiveness. Hyperpyrexia: temperature over 103°F Autonomic dysfunction: hypertension, tachycardia, diaphoresis, incontinence Delirium, stupor, coma -Complication of 1st Gen medication - Haloperidol give: DANTROLENE to reverse |
| Dangerous Responses to Antipsychotics: Severe neutropenia | Reduced neutrophil counts and increased frequency and severity of infections. Any symptoms suggesting infection (e.g., sore throat, fever, malaise, body aches) should be carefully evaluated |
| Dangerous Responses to Antipsychotics: Prolongation of the QT interval | Delay of ventricular repolarization. May result in tachycardia, fainting, seizures, and even sudden death Ziprasidone hydrochloride (Geodon) - causes hypotension which widens QT interval. |
| Dangerous Responses to Antipsychotics: Liver impairment | Impairment usually occurs in the first weeks of therapy. Jaundice, abdominal pain, ascites, vomiting, lower extremity edema, dark urine, pale or tar colored stool, easy bruising |
| Metabolic Syndrome | Weight gain (especially in the abdomen), dyslipidemia, increased blood glucose, and insulin resistance Increases risk of diabetes, certain cancers, hypertension, and cardiovascular disease |
| Extrapyramidal Side Effects (EFSs) | 1. Acute dystonia: sudden, sustained contraction 2. Akathisia: motor restlessness causing an inability to stay still or remain in one place 3. Pseudoparkinsonism: a temporary group of symptoms that resemble Parkinson’s disease 4. Tardive dyskinesia: involuntary rhythmic movements |
| Helping Patients Who Are Experiencing Hallucinations Nursing Care - 1-2 | 1. Watch the patient for hallucination indicators, such as eyes tracking an unheard speaker, muttering or talking to self, appearing distracted, suddenly stopping conversing as if interrupted, or intently watching a vacant room area. 2. Ask about the content of the hallucinations and how the patient is reacting to them. Assess for command hallucinations and assess for resulting fear or distress. |
| Helping Patients Who Are Experiencing Hallucinations Nursing Care 3-4 | 3. Avoid referring to hallucinations as if they were real. Do not ask, “What are the voices saying to you?” Ask, “What are you hearing?” 4. Be alert to signs of anxiety, which may indicate that hallucinations are intensifying or that they are of a command type. 5. Do not negate the patient’s experience but offer your own perceptions and convey empathy. “I don’t hear angry voices that you hear, but that must be very frightening for you.” |
| Helping Patients Who Are Experiencing Hallucinations Nursing Care - 5-6 | 5. Do not negate the patient’s experience but offer your own perceptions and convey empathy. “I don’t hear angry voices that you hear, but that must be very frightening for you.” 6. Focus on reality-based “here and now” activities, such as conversations or simple projects. |
| Helping Patients Who Are Experiencing Hallucinations Nursing Care - 7 | 7. Address any underlying emotion, need, or theme that seems to be indicated by the hallucination, such as fear with menacing voices or guilt with accusing voices. |
| Helping Patients Who Are Experiencing Hallucinations Nursing Care - 8 | 8. Promote and guide reality testing. If the patient has frightening hallucinations, guide her or him to scan the area to see if others appear frightened; if they are not, encourage the patient to consider that these might be hallucinations. Teach the patient to compare such beliefs and perceptions to those of trusted others. |
| Helping Patients Who Are Experiencing Hallucinations Nursing Care - 9 | 9. As the patient begins to develop insight and reality testing improves, guide him or her to interpret the hallucinations as symptoms of illness. “The voice you hear is part of your illness, and it cannot hurt you. Try to listen to me and the others you can see around you.” |
| Helping Patients Who Are Experiencing Hallucinations Nursing Care - 10-11 | 10. Cognitive interventions, such as teaching the patient to question perceptions if they are unusual or unlikely, can help him or her to cope with hallucinations by altering how the experience is perceived (see Chapter 2). 11. Transcranial magnetic stimulation may enhance relief from auditory hallucinations. |
| Teach the Patient to: 1. Manage stress and stimulation | • Avoid overly loud or stressful places or activities. • Avoid negative or critical people and seek out supportive people. • Learn assertive communication skills so you can tell others “no” if they pressure or upset you. • When stressed, slow and deepen your breathing. Count slowly from one to four as you inhale, hold the breath, and exhale. |
| Teach the Patient to: 1. Manage stress and stimulation cont. | • Gently tense and then relax your muscles, one area of the body at a time, starting at your head (e.g., closing your eyes then opening them, clenching your teeth then relaxing your jaw) and working your way down to your hands and feet. • Discover other ways that help manage your stress (e.g., going for a walk, meditation, taking a hot bath, reading or listening to music, imagining yourself in a less stressful situation [sometimes called a mental vacation]). |
| Teach the Patient to: 2. Use other sounds that compete with the hallucinations (sometimes called competing auditory stimuli). | • Talk with others. • Listen to music or television (but not too loud). • Read aloud. • Sing, whistle, or hum. |
| Teach the Patient to: 3. Find out what is and isn’t real (called promoting reality testing). | • Look at others; do they seem to be hearing/seeing what you are? • Ask trusted others if they are experiencing what you are. • If the answers to these questions are “no” then, although it seems very real to you, it is most likely not real, and you can safely ignore the voices/images. |
| Teach the Patient to: 4. Engage in activities that can take your mind off what you hear. | • Walk. • Clean. • Take a relaxing bath or shower. • Play music or an instrument or sing. • Go to any place where you enjoy being where others will be present, such as a coffee shop, mall, or library. |
| Teach the Patient to: Talk (if others are nearby, quietly or silently to self). | • Tell the voices or thoughts to go away. • Tell yourself that the voices and thoughts are a symptom and aren’t real. • Tell yourself that no matter what you hear, you will be safe and you can ignore what you hear. |
| Teach the Patient to: Make contact with others | • Talk with a trusted friend, relative, or staff member. • Call a help line or go to a drop-in center. • Visit a public place where you are comfortable. |
| Teach the Patient to: Develop a plan for how to cope with hallucinations; options include | • Any of the activities already mentioned that work for you • Taking extra medication when ordered (call your prescriber) • Using breathing exercises and other relaxation methods |
| Helping Patients Who Are Experiencing Delusions | • Build trust by being open, honest, genuine, and reliable. • Respond to suspicion in a matter-of-fact, empathic, supportive, and calm manner. • Ask the patient to describe beliefs. “Tell me more about someone trying to hurt you.” • Never debate the delusional content. |
| Helping Patients Who Are Experiencing Delusions | • As the patient’s reality testing improves, supportively convey doubt as tolerated. “Although it is frightening for you, it seems as if it would be hard for a girl that small to hurt you.” • Validate if part of the delusion is real. “Yes, there was a man at the nurse’s station, but I did not hear him talk about you.” • Focus on the feelings or themes within the delusion. If a patient believes that he is a famous leader, comment: “It would feel good to be more powerful.” If the patient believes that other |
| Helping Patients Who Are Experiencing Delusions | • Validate if part of the delusion is real. “Yes, there was a man at the nurse’s station, but I did not hear him talk about you.” • Focus on the feelings or themes within the delusion. If a patient believes that he is a famous leader, comment: “It would feel good to be more powerful.” If the patient believes that others intend to hurt him, comment: “It must feel frightening to believe others want to hurt you.” |
| Helping Patients Who Are Experiencing Delusions | • Use reality-based interventions that help meet underlying needs. If the patient believes that he is powerful, it may represent a sense of powerlessness. Increase the patient’s control, such as asking the patient when he would like to take his medications. |
| Helping Patients Who Are Experiencing Delusions | • Acknowledge that although the belief seems real to the patient, illnesses can make things seem true even though they aren’t. Introducing this indirectly can make it less confrontational: “I wonder if that might be what is happening here, because what seems true to you does not seem true to others.” • Do not dwell excessively on the delusion. Instead, refocus onto reality-based topics. |
| Helping Patients Who Are Experiencing Delusions | • Help the patient to identify triggers of delusions and find ways to avoid them. • Promote reality testing by questioning beliefs: “I wonder if there might be any other explanation why others might be avoiding you? Instead of hating you, mightn’t they simply be busy?” |
| 1st Generation Antipsychotic Drugs May Cause Toxic Effect: | Haloperidol, Fluphenazine, Decanoate, Chlorpromazine, Loxpine will cause: Cholestatic Jaundice - A collection of bile juice in the gallbladder. The patient needs to be on bedrest and a diet rich in protein & carbs |
| 1st Generation Antipsychotic Drugs May Cause Sexual Dysfunction: | Haloperidol, Fluphenazine, Decanoate, Chlorpromazine, Loxpine will cause: Gynecomastia (Enlarge Breast Tissue) Amenorrhea (Absence of Menstruation) Galactorrhea (Discharge from Nipples) |
| For Extrapyramidal Side Effects an Antihistamine is given: | Antipsychotic drugs cause extrapyramidal side effects such as tremors, abnormal involuntary movements such as tardive dyskinesia (irreversible) give: Diphenhydramine hydrochloride 25 mg (IM or IV) |
| Second Generation Antipsychotics | Clozapine Risperidone Olanzapine Quetiapine DO NOT GIVE TO DEMENTIA PATIENTS Helps with Positive and Negative Symptoms in Schizophrenia |
| Clozapine | Causes WBC to go down; less than 5,000 is abnormal |
| First Generation Antipsychotics | Haloperidol Fluphenazine Decanoate Chlorpromazine Loxpine |
| Third Generation Antipsychotics | Aripiprazole (Abilify) Brexpiprazole (Rexulti) Cariprazine (Vraylar) |
| Benzodiazepines (Anxiolytics) can be given for Anxiety: Short Acting | Alprazolam(Xanax) Midazolam (Nayzilam) |
| Benzodiazepines (Anxiolytics) can be given for Anxiety: Intermediate Acting | Lorazepam (Ativan) Clonazepam (Klonapin) |
| Benzodiazepines (Anxiolytics) can be given for Anxiety: Long Acting | Diazepam |
| 1. Which characteristics suggest a man is experiencing the prodromal phase of schizophrenia? Select all that apply. a. Always afraid that others will steal his belongings. b. Displays unusual interest in numbers and specific topics. c. Has increasingly unusual thoughts and uses words oddly. d. Demonstrates increasing difficulty with concentration. | A,B,C |
| 2. Which nursing interventions are particularly well chosen for addressing a population at high risk for developing schizophrenia? Select all that apply. a. Screening 15- to 25-year-olds for early symptoms. b. Forming a support group for females aged 25 to 35 who are diagnosed with substance use disorders. c. Teaching ways to cope and build resiliency. d. Educating about the risk of psychosis with marijuana use. | A,C,D |
| 3. To provide effective care for the patient who is taking a second-generation antipsychotic, the nurse should frequently assess for a. Alcohol use disorder b. Major depressive disorder c. Stomach cancer d. Polydipsia e. Metabolic syndrome | E |
| 4. A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? a. Her memory problems will likely decrease. b. Depressive episodes should be less severe. c. She will probably enjoy social interactions more. d. She should experience a reduction in hallucinations. | D |
| 5. Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? a. Depersonalization b. Pressured speech c. Negative symptoms d. Paranoia | D |
| 6. Which therapeutic communication statement might a psychiatric–mental health registered nurse use when a patient’s nursing diagnosis is hallucinations? Select all that apply. a. “I know you say you hear voices, but I cannot hear them.” b. “Stop listening to the voices, they are NOT real.” c. “Tell me more about what you hear.” d. “Please tell the voices to leave you alone for now.” | A,C |
| 7. When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that a. The medications provided are ineffective. b. Nurses are trying to control their minds. c. The medications will make them sick. d. They are not actually ill. | D |
| 8. Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) a week ago. You find him sitting stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply. a. Hold his medication and contact his prescriber stat. b. Wipe him with a washcloth that has been wetted with cold water or alcohol. | A,B |
| 9. Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disorder and can be an effort to: Select all that apply. a. Self-medicate for social discomfort. b. Cope with anxiety. c. Enhance mood. d. Enable Tomas to better express himself. | A,B,C |
| 10. A patient reports that “the voices are really bad today.” Helpful nursing responses would include a. Giving an additional “as needed” dosage of his antipsychotic medication. b. Telling him that the voices are not real and that he should ignore them. c. Directing him to return to his room and try not to think about the voices. d. Encouraging the patient to use competing auditory stimuli, such as humming or listening to music. | D |
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