Undifferentiated

Definition

A form of schizophrenia that is characterized by a number of schizophrenic symptoms such as delusion(s), disorganized behavior, disorganized speech, flat affect, or hallucinations but does not meet the criteria for any other type of schizophrenia. Schizophrenia, undifferentiated type is characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior. The largest group of people with schizophrenia, whose dominant symptoms come from more than one subtype. Undifferentiated schizophrenia is the most common of all types of schizophrenia

ETIOLOGICAL THEORIES Psychodynamics Psychosis is the result of a weak ego. The development of the ego has been inhibited by a symbiotic parent/child relationship. Because the ego is weak, the use of ego defense mechanisms in times of extreme anxiety is maladaptive, and behaviors are often representations of the id segment of the personality.

Biological Certain genetic factors may be involved in the susceptibility to develop some forms of this psychotic disorder. Individuals are at higher risk for the disorder if there is a familial pattern of involvement (parents, siblings, other relatives). Schizophrenia has been determined to be a sporadic illness (which means genes cannot currently be followed from generation to generation). It is an autosomal dominant trait.

However, most scientists agree that what is inherited is a vulnerability or predisposition, which may be due to an enzyme defect or some other biochemical abnormality, a subtle neurological deficit, or some other factor or combination of factors. This predisposition, in combination with environmental factors, results in development of the disease.
Some research implies that these disorders may be a birth defect, occurring in the hippocampus region of the brain. The studies show a disordering of the pyramidal cells in the brains of schizophrenics, while the cells in the brains of non-schizophrenic individuals appear to be arranged in an orderly fashion.

Ventricular brain ratio (VBR) or disproportionately small brain (or specific areas of the brain) may be inherited and/or congenital. The cause can be a virus, lack of oxygen, birth trauma, severe maternal malnutrition, or cellular damage resulting from an RhD immune response (mother negative/fetus positive).

A biochemical theory suggests the involvement of elevated levels of the neurotransmitter dopamine, which is thought to produce the symptoms of overactivity and fragmentation of associations that are commonly observed in psychoses

Family Dynamics
Family systems theory describes the development of schizophrenia as it evolves out of a dysfunctional family system. Conflict between spouses drives one parent to become attached to the child. This overinvestment in the child redirects the focus of anxiety in the family, and a more stable condition results. A symbiotic relationship develops between parent and child; the child remains totally dependent on the parent into adulthood and is unable to respond to the demands of adult functioning. Interpersonal theory relates that the psychotic person is the product of a parent/child relationship fraught with intense anxiety. The child receives confusing and conflicting messages from the parent and is unable to establish trust. High levels of anxiety are maintained, and the childs concept of self is one of ambiguity. A retreat into psychosis offers relief from anxiety and security from intimate relatedness. Some research indicates that clients who live with families high in expressed emotion (e.g., hostility, criticism, disappointment, over protectiveness, and over involvement) show more frequent relapses than clients who live with families who are low in expressed emotion.

Physical symptoms of undifferentiated include different subtype of schizophrenia:

auditory hallucinations delusions, disturbances of movement, disorganized speech, behavior that are difficult to understand lack of motivation or desire maintaining a strange position for a long time (catatonia) The symptoms may be classified as undifferentiated schizophrenia if they are not specific enough to meet the definition for paranoid, catatonic, or disorganized schizophrenia. .

Tests and diagnosis

When doctors suspect someone has schizophrenia, they typically ask for medical and psychiatric histories, conduct a physical exam, and run medical and psychological tests and exams. These tests and exams generally include: Laboratory tests. These may include a complete blood count (CBC), other blood tests that may help to rule out other conditions with similar symptoms, screening for alcohol and drugs, and imaging studies, such as an MRI or CT scan. Psychological evaluation. A doctor or mental health provider will check mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance abuse, and potential for violence or suicide.

Diagnostic criteria for schizophrenia To be diagnosed with schizophrenia, a person must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions. Diagnosis of schizophrenia involves ruling out other mental health disorders and determining that symptoms aren't due to substance abuse, medication or a medical condition. In addition, a person must:
Have at least two of the common symptoms of the disorder delusions,

hallucinations, disorganized speech, disorganized or catatonic behavior, or presence of negative symptoms for a significant amount of time during one month
Experience significant impairment in the ability to work, attend school or

perform normal daily tasks

Have had symptoms for at least six months

NURSING CARE PLAN

ASSESSMENT Subjective: Client verbalizes Wala..Wala po to many questions(orientati on phase)Client gives out confusing answers in some moments Client answer words repeatedly, sometimes inappropriate to question asked Objective: Answers questions slowly stares blankly for a seconds Perserveration (daot -daot ba, patay na kopatay) Alogia (one or two word answers) Speaks in monotone voice Displays affect NURSING DAIGNOSIS Impaired verbal communication r/t psychological barriers secondary to substance abuse induced schizophrenia PLANNING At the end of our 6 days of duty, the client will manifest improved verbal communication as evidenced by: answers incoherent speech improved response time to questions reduced perseverat ion reduced slurring displays proper affect INTERVENTION >Evaluate degree/ type of communication impairment. RATIONALE >Degree of impairment of verbal / nonverbal communications will affect clients ability to interact with staff and others and to participate in care. EVALUATION Within our 6 days of duty, the goals were partially met as evidenced by: answers in more coherent speech reduced repetitions improved response time to questions reduced perseverat ion reduced slurring improper affect displayed (blunt or flat)slurring is still present

>Note level of anxiety present; presence of angry, hostile behaviour , frustration >Demonstrate a listening attitude within the nurseclient relationship.

>Presence of conflicting emotions may impair need and desire to talk

>Provide a nonthreatening environment(assur ing client of privacy, confidentiality, having therapeutic distance, proper positioning and

>Enables the nurse to listen carefully, observe the client, and anticipate and watch certain patterns of clients communication that may emerge. >Atmosphere in which a person feels free to express self without fear of

>Use therapeutic communication skills, such as Active Listening, paraphrasing, reflecting, and restating.

>Clients flow of communications (too fast/ too slow) may require regulation. These techniques assist with reality orientation, there by minimizing misinterpretation and facilitating accurate communications >Client has increased sensitivity to nonverbal messages. Honesty increases sense of trust, a loss of which is at the base of the clients problem. Openness and genuineness in expression of feelings provide a role model for client.

>Be open and honest in therapeutic use of verbal and nonverbal communications.

>Use a supportive approach to client by communicating desire to understand.

>Recognizes that clients past experiences have created distrust, which produces attempt to maintain distance by being vague and unclear in sending messages.

Three board question and rationale

1).A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:
A. take an as-needed dose of psychotropic medication whenever they hear voices. B. practice saying "Go away" or "Stop" when they hear voices. C. sing loudly to drown out the voices and provide a distraction. D. go to their room until the voices go away.

Rationale: Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren't likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.

2). A client with catatonic schizophrenia is mute, can't perform activities of daily living, and stares out the window for hours. What is the nurse's first priority?

A. Assist the client with feeding. B. Assist the client with showering. C. Reassure the client about safety. D. Encourage socialization with peers.
Rationale: According to Maslow's hierarchy of needs, the need for food is among the most important. Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging.

3). A client is admitted to the psychiatric unit of a local hospital with chronic undifferentiated schizophrenia. During the next several days, the client is seen laughing, yelling, and talking to herself. This behavior is characteristic of: A. delusion. B. looseness of association. C. illusion. D. hallucination.

Rationale: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.