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in Psychiatric nursing
by : Ghada Almukhaini
BSTRACT
Schizophrenia is a devastating psychiatric disorder thatAaffects ~1% of the population worldwide. It is
characterized by so-called ‘positive symptoms’–including delusions and hallucinations–‘negative symptoms’–
including blunted emotions and social isolation–and cognitive deficits–including impairments in attention and
working memory. Studies of the inheritance of schizophrenia have revealed that it is a multifactorial disease that is
characterized by multiple genetic susceptibility elements.
Outlines
• Introduction.
• What is schizophrenia?
• Periods of schizophrenia
• Assessment of schizophrenia.
• Conclusion.
• Introduction.
The clinical picture of schizophrenia is complex. No one really knows what
the course of schizophrenia would be if patients were able to adhere to a
treatment regimen throughout their lives. ; individuals differ from one
another; and the experience for a single individual may be different from
episode to episode.
• What is schizophrenia?
In the early 1900s, Eugene Bleuler renamed the disorder schizophrenia,
meaning split minds, and began to determine that there was not just one
type of schizophrenia, but rather a group of schizophrenias. More recently,
Kurt Schneider differentiated behaviors associated with schizophrenia as
“first rank” symptoms (psychotic delusions, hallucinations) and “second
rank” symptoms (all other experiences and behaviors associated with the
disorder). These pioneering physicians had a great influence on the current
diagnostic conceptualizations of schizophrenia that emphasize the
heterogeneity of the disorder in terms of symptoms, course of illness, and
positive and negative symptoms.
Schizophrenia It is one of the most severe mental illnesses and is
present in all cultures, races, and socioeconomic groups. Schizophrenia is
thought of as a syndrome or disease process with many different varieties
and symptoms
• Positive symptoms:
• Negative symptoms:
Alogia, Anhedonia, Apathy, Blunted affect, Catatonia, Flat affect ,Lack
of volition.
• Periods of schizophrenia.
1-Acute Illness Period: initially, the illness behaviors may be both
confusing and frightening to the patient and the family. The changes in
thought and behavior become so disruptive or bizarre that they can no
longer be overlooked such as, incoherent conversations, or aggressive
acts against self or others. patients are less able to care for basic needs,
such as eating, sleeping, and bathing. Patients usually are hospitalized to
protect themselves or others. The initial treatment focuses on alleviation
of symptoms through initiation of medications, decreasing the risk of
suicide through safety measures, normalizing sleep.
4- Relapses: can occur at any time during treatment and recovery. it occurs
with sufficient regularity to be a major concern in the treatment of
schizophrenia. Relapses can occur and are very detrimental to the successful
management of this disorder. With each relapse, there is a longer period of
time to recover. Combining medications and psychosocial treatment greatly
diminishes the severity and frequency of recurrent relapses.
• Assessment of schizophrenia.
By assessing any kind of psychiatric nursing cases, the nurses are getting
some tricks in diagnosing the patient as schizophrenia . it is really
challenging For example, clients may refuse to communicate or
communicate ineffectively as a result of impaired cognition or the presence
of psychotic symptoms such as hallucinations or delusions. For example, the
nurse may care for a client in an acute inpatient setting. The client may
appear frightened, hear voices (hallucinating), make no eye contact, and
mumble constantly. The nurse would deal with the positive or psychotic signs
of the disease. Another nurse may encounter a client with schizophrenia in a
community setting who is not experiencing psychotic symptoms; rather, this
client lacks energy for daily tasks and has feelings of loneliness and isolation
(negative signs of schizophrenia).
• Taking history:
1-The nurse first elicits information about the client’s previous history with
schizophrenia to establish baseline data. she asks questions about how the
client functioned before the crisis developed
2- assesses the age of onset of schizophrenia, knowing that poorer outcomes
are associated with an earlier age of onset.
3-the client’s previous history of hospital admissions and response to
hospitalization.
4-The nurse also assesses the client for previous suicide attempts. 10% of
all people with schizophrenia eventually commit suicide.
5-elicit information about any history of violence or aggression because a
history of aggressive behavior is a strong predictor of future aggression.
6-The nurse assesses if the client has been using current support systems by
asking the client or significant others the following questions:
• Has the client kept in contact with family or
friends?
• Has the client been to scheduled groups or
therapy appointments?
• Have the client’s living arrangements
changed recently?
7-Finally the nurse assesses the client’s perception of her current situation
that is, what the client believes to be significant present events or stressors.
The nurse can gather such information by asking, “What do you see as the
primary problem now?” or “What do you need help managing now?”
The nurse can assess thought process by inferring from what the client says.
r she can assess thought content by evaluating what the client actually says.
For example, clients may suddenly stop talking in the middle of a sentence
and remain silent for several seconds to 1 minute (thought blocking). They
also may state that they believe others can hear their thoughts (thought
broadcasting); that others are taking their thoughts (thought withdrawal); or
that others are placing thoughts in their mind against their will (thought
insertion). Clients also may exhibit tangential thinking, which is veering onto
unrelated topics and never answering the original question
• Roles& Relationships:
Social isolation is prevalent in clients with schizophrenia, partly as a result of
positive signs such as delusions, hallucinations, and loss of ego boundaries.
Low self-esteem, one of the negative signs of schizophrenia, further
complicates the client’s ability to interact with others. The client may
experience great frustration in attempting to fulfill roles in the family and
community. it is difficult for the client to fulfilling family roles.
The nurse must analyze assessment data for clients with schizophrenia to
determine priorities and establish an effective plan of care. Not all clients will
have the same problems and needs, Levels of family and community support
and available services also will vary. The analysis of assessment data
generally falls into two main categories: data associated with the positive
signs of the disease and data associated with the negative signs.
•
• Conclusion.