Symptomatology
Many patients with schizophrenia do this, which also can affect medication metabolism.
What is smoking?
Smoking may increase dopamine, manage stress, an it may be an attempt to increase GABA (the calming neurotransmitter).
Therefore, it is important to know if our patients smoke to be aware of its effect on medication metabolism.
"The neophim sent me here" is an example of this.
What is a neologism?
This is a newly invented word that is meaningless to others but has symbolic meaning to the patient.
This is an important side effect to be aware of when administering antipsychotics, therefore, every patient admitted to a psychiatric unit will have a baseline EKG (look for it when you examine their chart).
What is a risk for cardiac arrhythmia?
Antipsychotics, also called neuroleptics, can affect cardiac ion channels, leading to a prolonged QT interval. A prolonged QT interval doesn't necessarily mean we would stop the antipsychotic but will continue to monitor and avoid additional drugs that have an additive effective (i.e. antiemetics (Zofran) can do this). Remember it is always a risk versus benefits situation.
This is always the nurse's priority when a patient has hallucinations.
What is safety?
Ask the patient what are you hearing? to assess if they are experiencing command auditory hallucinations (CAH). Often times, command auditory hallucinations tell the patient to do something harmful, to themselves or others.
When patients are nonadherent to daily pill form medications, this is an option.
What are long-acting injectionables *LAIs*?
LAIs, or depot injections, deposit a depot, or reservoir of medication into a large muscle and may provide medication for up to one month. A visiting nurse typically comes to give the injection.
These are added symptoms, "excess" symptoms in schizophrenia.
What are delusions (fixed, false beliefs), neologisms (creating new words that have meaning for them), and echolalia (repeating another person's words)?
"My mother went to school in NY. There are great museums in Manhattan. The train will take you and the mayor to Canada."
What is loose associations? Thinking is characterized by speech in which ideas shift from one unrelated subject to another. Typically, the individual with loose associations is unaware that the topics are unconnected. When the condition is severe, speech may be incoherent (e.g., “We wanted to take the bus, but the airport took all the traffic. Driving is the ticket when you want to get somewhere. We have it all in our pockets”).
This medication would be given for muscle rigidity.
What is benztropine (Cogentin)?
If a patient becomes agitated, the nurse should do this.
What is provide adequate space between the nurse and patient to respect the patient's space, which may reduce anxiety and threat of violence?
Other patients may also need to be "cleared" or asked to go to their room temporarily.
Patients often have this belief regarding their food.
What is a persecutory delusion that their food is poisoned?
These symptoms are associated with a poorer prognosis.
What are negative symptoms?
Negative symptoms are a core component of schizophrenia that account for a large part of long-term disability and poor functional outcomes. Remember that negative symptoms refer to a diminution or absence or normal behaviors related to motivation and interest, or expression. Although positive symptoms are generally managed well with medication, limited treatment options are available for the negative symptoms.
The choice of words is governed by sounds.
What are clang associations?
The choice of words is governed by sounds, often taking the form of rhyming, which forms clang associations. For instance, “It is very cold. I am cold and bold. The gold has been sold.”
This is a dangerous side effect of antipsychotics because it can predispose the patient to infection.
What is agranulocytosis?
Social skills training is important because it helps with this:
What is making eye contact when communicating?
Social skills training teaches specific skills to help with social situations.
This is a false idea about a person's body.
What is a somatic delusion?
The individual has a false idea about the functioning of their body. They may believe that they have some type of general medical condition or that there has been an alteration in a body organ or its function (e.g., “The doctor says I’m not pregnant, but I know I am”; “There is an alien force that is eating my brain”).
This is the term for patients who do not believe they are ill.
This is a group of words that appear to be put together randomly, without any logical connection (e.g., “Most forward action grows life double plays circle uniform”).
What is word salad?
This is typically seen in more decompensated cases.
Antipsychotics given along with other medications may cause this side effect.
What is hypotension?
The nurse would teach the patient to change positions slowly.
The nurse should use this approach with a patient with command auditory hallucinations.
What is focus on the feelings and present reality?
Interestingly, AVH, or auditory visual hallucinations often arise from general themes or specific areas of distress, including anxiety, depression, and paranoia. An individual may hear voices that are critical of themselves, "bossy", even insulting (perhaps internal judgmental alert of failures to meet moral standards)-one of the most common types of auditory hallucinations-and the voices then tell the patient to hurt themselves or someone else. Another phenomenon consistent with AVH being rooted in the conscience is evidence that even people with schizophrenia who have been deaf their whole lives may hear AVH as messages consistent with an internalized understanding of what others may think of them.
A patient declines their medication. How do you respond?
What is "tell me what you don't like about this medication"?
A patient with catatonia who does not move should have their needs prioritized in this manner.
What is attending to their physiological needs?
Patients who are catatonic may not initiate movements. Nurses must prioritize the basics, such as hydration, eating, and toileting.
A patient believes Jesus gives him special messages.
What is a grandiose delusion?
What is akathisia?
Continuous restlessness and fidgeting, or akathisia, occurs most often in women and may manifest 50 to 60 days after therapy begins. Combining atypical antipsychotics and administration at doses greater than target ranges increases the incidence of akathisia. The continued need to remain in motion has caused some patients to feel so distressed that it can lead to suicide in order to end the suffering.
These treatments are the core to schizophrenia treatment.
What are group therapy, medication, supportive family therapy, and social skills training?
Schizophrenia is an illness that can puzzle, disrupt, and sometimes tear apart families. Even when families appear to cope well, there is a notable effect on the mental and physical health of the family when a family member has this illness.
The importance of the expanded role of family in the aftercare of those with schizophrenia has been recognized, thereby stimulating interest in family intervention programs designed to support the family system, prevent or delay relapse, and help to maintain the patient in the community. These psychoeducational programs treat the family as a resource rather than a stressor, with the focus on practical problem-solving and specific behaviors for coping with stress. These programs recognize the biological basis for schizophrenia and the effect that stress has on the individual’s ability to function. By providing the family with information about the illness and suggestions for effective coping, psychoeducational programs reduce the likelihood of the patient’s relapse and the possible emergence of mental illness in previously nonaffected relatives.
What is remaining with the patient, especially since short-term memory loss and confusion can occur?