Etiology
True or False: There is a genetic component to schizophrenia.
True
Recent studies have shown that schizophrenia is polygenic. Having an immediate family member with schizophrenia increases risk of having schizophrenia yourself.
What are the two major categories of schizophrenia symptoms?
Positive and negative symptoms
Positive symptoms are changes in behavior or thought patterns. Negative symptoms are withdrawal from the world around them.
True or False: protecting the patient's safety is the number one nursing intervention for a patient exhibiting psychotic behavior.
True
True or False: Antipsychotic medications can cure schizophrenia.
False, antipsychotics only manage symptoms of the disease
Your patient complains of 3 days of constipation after starting a new antipsychotic medication. What medications and nursing interventions do you expect to perform with this patient?
Educate on hydration, fiber intake, and increasing activity/mobility. Expect a stool softener (Colace) to be given if unrelieved by non pharmacological interventions.
These two neurotransmitters in excess are thought to be a cause of schizophrenia.
Dopamine and serotonin.
Drugs that increase dopamine activity in the brain have been seen to create paranoid psychotic reactions in some patients. Drugs that block dopamine receptors have been seen to reduce symptoms of psychosis. Serotonin in excess is thought to contribute to schizophrenia.
3 positive symptoms of schizophrenia.
Ambivalence, associative looseness, delusions, echopraxia, flight of ideas, hallucinations, ideas of reference, preservation, bizarre behavior
True or False: Nursing interventions can be modified and customized to accommodate specific signs and symptoms of the patient with schizophrenia.
True
Identify two examples of a neurological side effect of taking antipsychotic medications.
Tardive dyskinesia, Parkinsonism, seizures, neuroleptic malignant syndrome, acute dystonic reactions.
A patient on the inpatient psychiatric unit refuses to eat or drink anything due to the belief that all of the hospital food is poisoned. How can you ensure that they receive enough nutrients and hydration?
Offer sealed bottles of water or juice, sealed packages of foods if possible. Reassure them that the food is not poisoned but if it makes them more comfortable they can have sealed options.
What two lobes of the brain show decreased volume and abnormal function in patients with schizophrenia?
Temporal and frontal lobes.
It is unknown whether these changes are a result of trauma or underdevelopment. These correspond to the positive and negative signs of schizophrenia.
This disorder is characterized by a mixture of symptoms such as hallucinations, mania, and depression which can be found in schizophrenia, depression or bipolar disorders.
Schizoaffective disorder.
Many disorders are related to schizophrenia, and it is important to distinguish the minute differences between the two in regards to treatment and clinical course, even if they have similar names.
When creating a care plan for a patient with schizophrenia, what would be the most likely used Nursing Diagnosis for this patient?
Disturbed thought process: disruption in cognitive operations and activities
First generation antipsychotic medications target _______ symptoms, while the second generation antipsychotic medications target ________ & __________ symptoms.
First generations target positive symptoms, Second generations target positive and negative symptoms
A patient on an inpatient psychiatric unit is becoming agitated because they received the wrong breakfast. They believe the kitchen did this on purpose to target them. How do you de-escalate them?
Talk to them in a calm voice. Offer to get the correct meal. Utilize coping skills like deep breathing, pacing. Say it was probably an honest mistake but you are sorry that happened. Offer a quiet room to calm down.
How does age of onset affect outcomes in schizophrenia?
People who develop schizophrenia at an earlier age have worse outcomes than those who develop it later.
Younger people have a lesser ability to make social and intimate relationships and academic achievements before onset of psychotic symptoms, more notable negative signs, and greater cognitive impairments than older adults.
This symptom of schizophrenia is characterized by imitating the movements and gestures of another person whom the client is observing.
Echopraxia
What are three examples of nursing intervention that would be most applicable for a patient with schizophrenia exhibiting delusions?
Establish and maintain reality for the patient, refrain from arguing with the patient about their delusions, encourage the patient to engage in positive self-talk in an attempt to ignore delusional beliefs.
Name three topics that support groups could use to help patients cope with schizophrenia.
Medical management, social skills, use of community supports, management of ADLS, hygiene, coping skills.
These create social contact and educate the patient.
A 75 year old patient comes to ED stating she wants a pregnancy test, as she can feel a baby moving inside her. She says she has no recollection of the conception but “definitely feels the baby moving”. After completing a short history and getting a list of medications, you as the nurse determine the patient is on Risperidone for schizophrenia. What would be the most effective way to therapeutically communicate with this patient?
Try to avoid openly confronting or arguing with the patient’s delusions. Establish and maintain a reality for the patient using positive self-talk, and clarify thoughts/feelings when the patient may seem confused with speech or talk that is disorganized.
Name three risk factors associated with higher relapse rates of worsening symptoms.
Noncompliance with medications, substance use, caregiver criticism, negative attitude towards treatment.
This “cultural-bound” syndrome localized to West-Africa is characterized by schizophrenia-like symptoms of sudden outbursts of agitation and aggressive behavior, marked confusion, psychomotor excitement, visual and auditory hallucinations.
Bouffée délirante.
It directly translates to “a puff of delirium” or short-term psychosis, and is predominant in Haiti and West Africa. It’s important to recognize that what one culture may perceive schizophrenic-like symptoms to be sorcery, witchcraft, or an illness may be accepted as normal in another.
A patient is prescribed an antipsychotic medication that has a side effect of photosensitivity. What education will the nurse provide to the patient about medication?
Caution the patient to avoid sun exposure, advise the patient to wear sunscreen and protective clothing if they know they will be exposed to the sun.
What is the treatment for an acute dystonic reaction?
IM or IV benadryl (diphenhydramine), IM congentin (benztropine).
Both are used for their anticholinergic effects and CNS penetration.
A patient is brought into the emergency room by EMS, and is exclaiming, “I can hear them, they’re telling me I’ve got a unicorn in my belly. You gotta get this checked out, I need the urine checked right now. I’m an American, I have rights.” They then begin talking to the wall and saying, “come meet me at Burlington aunt Mary!.” What positive symptoms of schizophrenia is this patient experiencing?
Flight of ideas (continuous flow of verbalization in which the person jumps rapidly from one idea to another).
Hallucinations (false sensory perceptions or perceptual experiences that don’t exist in reality).