Transcript Gorman and Anwar Neeb`s Fundamentals of Mental

Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
CHAPTER 15
SCHIZOPHRENIA SPECTRUM
AND OTHER PSYCHOTIC
DISORDERS
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Schizophrenia
 Illness defined by Eugene Bleuler
 Means “split mind” (NOT multiple
personality disorder)
 There is a “split” between a patient’s thoughts
and feelings; between his/her reality and
society’s reality
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Schizophrenia (cont’d)
 Very serious, debilitating, lifelong psychiatric
disorder
 Seems to strike people between ages 16 and
35 most frequently; first psychotic break rarely
after age 40
 Viewed on a gradient of psychopathology from
least to most severe (spectrum disorder)
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Clicker Question
1. Which statement is most true about
schizophrenia?
A. It is a disorder of the frail elderly
B. It can be diagnosed at birth
C. Initial psychotic break often occurs when away
at college
D. Can become evident at any age
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Answer
Correct answer: C
Rationale: Schizophrenia is most often diagnosed
in young people with the first psychotic break
occurring in the teens and 20s.
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Clicker Question
2. Which statement is most true about
schizophrenia?
A. Diagnosis identified during World War II
B. Debilitating chronic illness
C. Cause is disturbed mother/child bond
D. All of the above
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Answer
Correct answer: B
Rationale: Schizophrenia is a lifelong chronic
illness that is often characterized by remissions and
exacerbations.
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
 Schizophrenia is characterized by:
 Delusions
 Hallucinations
 Disorganized Speech & Behavior
 Causes social, personal and occupational
dysfunction.
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
“Insidious” Onset
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School grades lower
Quietness
Withdrawal
“Just a stage”
Change in personality
Change in way person relates to others
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Common Symptoms
 Delusions
 Fixed, false beliefs that cannot be changed with logic
 Hallucinations
 False sensory perceptions
 Can affect all five senses
 Illusions
 Mistaken perceptions of reality
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Common Symptoms (cont’d)
 Echolalia
 Repetition of words
 Echopraxia
 Repetition of actions
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Positive Symptoms
 Those that are found among
people with schizophrenia but are
not present among those who do
not have the disorder
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Positive Symptoms
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Delusions,
 Neologisms,
Thought disorders,
 Concrete thinking,
Hallucinations,
 Loose associations
Disorganized speech ,
Magical thinking,
“Word Salad”,
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Negative Symptoms
 Those found among people who do not have the
disorder but are missing or lacking among
individuals with schizophrenia and reflect a
lessening or loss of normal functions
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Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Negative Symptoms
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Apathy
Avolition
Affect
Alogia
Autism like
Lack of desire to form social relationships,
Inappropriate social behaviors (pacing, rocking),
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Positive
Negative
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Cognitive Impairment
 Poor Executive Function
 Difficulty with Focus
 Problems with Working Memory
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Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Causes
 It is now known to be a brain disorder
 Theories include disruption of neurotransmitters
and/or neuron functioning, cortical abnormalities
 Genetic predisposition
 Family dysfunction is no longer believed to be
primary cause
 Stress Vulnerability Model
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Other Types of Psychotic Disorders
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Delusional
Schizoaffective
Schizophreniform
Psychotic depression or mania
Psychosis due to general medical condition or
substance abuse/withdrawal
 Postpartum psychosis
Copyright © 2014. F.A. Davis Company
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Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Schizoaffective Disorder
 A disorder characterized by s/s of schizophrenia
along with s/s of depression or manic episode
that requires treatment of both set of symptoms.
 Treated with antipsychotics, mood stabilizers,
antidepressants, talk therapy, and skills building.
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Delusional Disorder
 A disorder with delusions without diagnosis of
schizophrenia.
 Apart from the impact of the delusions or its
ramifications, functioning is not markedly
impaired & behavior is not obviously odd or
bizarre.
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Delusional Disorder cont…
 Many types: erotomanic, grandiose, jealous,
persecutory, somatic, mixed.
 Affects women> men,
 Difficult to diagnose because person conceals
delusional thought.
 Treated with antipsychotics, talk therapy.
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Brief Psychiatric Rating Scale
 See Handout
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Multidisciplinary Treatment
 Medications –Primary TX
 Antipsychotics
 Anticholinergics (to counteract extrapyramidal
symptoms)
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Psychotherapy (group and family)
Electroconvulsive therapy
Supportive milieu
Ongoing support and education
Skill building
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Antipsychotics
 These medications are the main focus of
treatment
 Patient may need to be on these for the rest of
his/her life
 Side effects management of these medications is
key part of treatment
 EPS (extrapyramidal symptoms) are common
with many of these drugs
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Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Nursing Interventions
 NEVER reinforce hallucinations, delusions, or illusions
 “I don’t see a snake. Let’s walk to the dining room together
now.”
 This is one of the few times when it is acceptable to change the
subject in communications
 NEVER whisper or laugh when the patient is not aware
of the whole conversation
 Keep patient out of competitive or embarrassing
situations
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Nursing Interventions (cont’d)
 Develop trust
 Maintain calm, structured milieu
 Maintain clear, concise communication
 State what is acceptable and expected behavior
 Give rationale and consequences at the same time
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Clicker Question
3. Which statement reflects the best approach by the nurse
to a schizophrenic patient who tells you she sees a
snake in her room?
A. “I will catch the snake and then you can eat.”
B. “I don’t see a snake in the room. Let’s get you ready for
lunch.”
C. “I am afraid of snakes. Please don’t talk about them.”
D. “That’s interesting. Describe the snake to me.”
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
Answer
Correct answer: B
Rationale: This response acknowledges that the
snake does not exist in reality and then changes
the focus on reality for the next activity. This way
the image is not dwelled on. If the nurse focused on
the snake hallucination, it would reinforce this as
reality.
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
 Which of the following are valid nursing
interventions in treating schizophrenic
patients? (Select all that apply)
 A. Do not reinforce hallucinations, delusions, or
illusions.
 B. Provide a stimulating environment for the patient to
provide distraction.
 C. Keep communication simple.
 D. Promote the patient’s problem-solving skills.
 E. Emphasize behavior that is appropriate to the
situation.
 F. Encourage the patient to confront stressful situations.
Copyright © 2014. F.A. Davis Company
Gorman and Anwar
Neeb’s Fundamentals of Mental Health Nursing, 4th Edition
 ANS:
A, C, E
 These responses reinforce reality without
creating more stress for the patient, which would
be the case in promoting more stimulation,
problem solving, and confrontation.
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