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CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders
TEST YOUR CLINICAL REASONING AND CLINICAL JUDGMENT SKILLS Sara, a 23-year-old single woman, has just been admitted to the psychiatric unit by her parents. They explain that over the past few months, she has become increasingly withdrawn. She stays in her room alone but lately has been heard talking and laughing to herself. Sara left home for the first time at age 18 to attend college. She performed well during her first semester, but when she returned after Christmas, she began to accuse her roommate of stealing her possessions. She started writing to her parents that her roommate wanted to kill her and that her roommate was turning everyone against her. She said she feared for her life. She started missing classes and stayed in her bed most of the time. Sometimes she locked herself in her closet. Her parents took her home, and she was hospitalized and diagnosed with schizophrenia. Sara has since been maintained on antipsychotic medication while taking a few classes at the local community college. Sara tells the admitting nurse that she quit taking her med- ication 4 weeks ago because the pharmacist who fills the prescriptions is plotting to have her killed. She believes he is trying to poison her. She says she got this information from a television message. As Sara speaks, the nurse notices that she sometimes stops in midsentence and listens; sometimes she cocks her head to the side and moves her lips as though she is talking. Answer the following questions related to Sara: 1. From the assessment data, what would be the most immedi- ate nursing concern in working with Sara? 2. What is the nursing diagnosis related to this concern? 3. What interventions must be accomplished before the nurse can be successful in working with Sara?
Communication Exercises 1. Hal, a patient on the psychiatric unit, has a diagnosis of schizophrenia. He lives in a halfway house, where last evening he began yelling that “aliens were on the way to take over our bodies! The message is coming through loud and clear!” The residence supervisor became frightened and called 911. As Hal was being admitted to the psychiatric unit, he told the nurse, “I’m special! I get messages from a higher being! We are in for big trouble!” How would the nurse respond appropriately to this statement by Hal? 2. The nurse notices that Hal is sitting off by himself in a corner of the dayroom. He appears to be talking to himself and tilts his head to the side as if listening to something. How would the nurse intervene with Hal in this situation? 3. Hal says to the nurse, “We must choose to take a ride. All alone we slip and slide. Now it’s time to take a bride.” How would the nurse respond appropriately to these statements by Hal? MOVIE CONNECTIONS I Never Promised You a Rose Garden (Schizophrenia) • A Beautiful Mind (Schizophrenia) • The Fisher King (Schizophrenia) • Bennie & Joon (Schizophrenia) • Out of Darkness (Schizophrenia) • Conspiracy Theory (Paranoia) • The Fan (Delusional disorder) • The Soloist (Schizophrenia) • Of Two Minds (Schizophrenia)
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movement abnormalities that distinguish schizophrenia cases from controls with exceptional accuracy. Biological Psychiatry, 72 (9), 716–724. Boland, R., & Verduin, M. L. (2022). Kaplan & Sadock’s synopsis of psychiatry (P. Ruiz, Ed.). (12th ed.). Wolters Kluwer. Bora, E. (2015). Neurodevelopmental origin of cognitive impair- ment in schizophrenia. Psychological Medicine, 45 (1), 1–9. https://doi.org/10.1017/S0033291714001263 Caqueo-Urízar, A., Rus-Calafell, M., Urzúa, A., Escudero, J., & Gutiérrez-Maldonado, J. (2015). The role of family therapy in the management of schizophrenia: Challenges and solu- tions. Neuropsychiatric Disease and Treatment, 11 , 145–151. https://doi.org/10.2147/NDT.S51331
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