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 fright- ened and called 911. As Hal was being admitted to the psychiatric unit, he told the nurse, “I’m special! I get mes- sages 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 to himself in a cor- ■ Recognizes distortions of reality ■ Has not harmed self or others ■ Perceives self realistically ■ Demonstrates the ability to perceive the environ- ment correctly ■ Maintains anxiety at a manageable level ■ Relinquishes the need for delusions and hallucinations ■ Demonstrates the ability to trust others ■ Uses appropriate verbal communication in inter- actions with others ■ Performs self-care activities independently Planning and Implementation ner 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 this statement by Hal? The following section presents a group of selected nursing diagnoses, with short- and long-term goals and nursing interventions for each. In general, nursing interventions should be directed toward establishing trust, because suspiciousness is a common symptom in this disorder. Use of a passive rather than a directive Communication Exercises let students practice their communication skills with vignettes and questions that prepare them for clinical and practice. planning care for patients with psychotic disorders. Outcome Criteria The following criteria may be used for measure- ment of outcomes in the care of the patient with schizophrenia. The patient: ■ Demonstrates an ability to relate satisfactorily to others
tical Manual of Mental Disorders, Fifth Edition (DSM-5), supports this concept by describing schizophrenia as one of the schizophrenia spectrum disorders (American Psychiatric Association [APA], 2013). Although current consensus points to schizophrenia as a neurodevelopmental disorder (Álvarez et al., 2015), schizophrenia spectrum disorders may have several etiological influences, including genetic pre- disposition, biochemical dysfunction, physiological factors, and psychosocial stress. Tripathi, Kar, and Shukla (2018) believe that the neurodevelopmental hypothesis falls short in explaining the magnitude of brain changes that occur in schizophrenia. They suggest that these changes can be better explained “as the cumulative effect neurodevelopmental abnor- mality, change in neural plasticity and alteration in neuronal maturation.” One factor with which clinicians agree is that there is not now and may never be a single treatment that cures schizophrenia. Effective treatment currently requires a comprehensive, multidisciplinary effort, including pharmacotherapy and various forms of psychosocial care, such as living skills and social skills training, cognitive remediation therapy, rehabilitation and recovery, and family therapy. Emerging evidence indicates that a comprehensive, patient-centered approach offers hope for a recovery process and improved quality of life in this population. Of all the mental illnesses, schizophrenia is likely responsible for longer hospitalizations, greater chaos in family life, more exorbitant costs to individuals and governments, and more fear than any other. Studies also have shown that people with a severe mental illness (SMI) such as schizophrenia have, on
373 various theories of predisposing factors implicated in the development of schizophrenia. Symptomatol- ogy associated with different diagnostic categories of the disorder is discussed. Nursing care is pre- sented in the context of the six steps of the nursing process. Various dimensions of medical treatment are explored. Nature of the Disorder Movie Connections list films that demonstrate relevant conditions and behaviors. Schizophrenia is a disabling psychological disorder. Characteristically, disturbances in thought processes, perception, and affect invariably result in a severe deterioration of social and occupational functioning. The lifetime prevalence of schizophrenia is about 1% in the general population (Sadock, Sadock, & Ruiz, 2015). Symptoms generally appear in late adolescence or early adulthood, although they may occur in middle or late adult life. Early-onset schizo- phrenia refers to symptoms that begin in childhood and adolescence before age 18 years. This condition, although rare, is recognized as a progressive neurode- velopmental disorder with a chronic and severely A severe mental condition in which there is disorgani- zation of the personality, deterioration in social function- ing, and loss of contact with, or distortion of, reality. There may be evidence of hallucinations and delusional thinking. Psychosis can occur with or without the presence of organic impairment. CORE CONCEPT Psychosis
retations of the on to an earlier bstract thinking uals with schizo- h schizophrenia ing the abstract mbing the walls”
CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders Build a solid foundation with either text.
and other psychotic disorders has been identified. These include (on a gradient of psychopathology from least to most severe): schizotypal personal- ity disorder, delusional disorder, brief psychotic disorder, substance-induced psychotic disorder, psychotic disorder associated with another medi- cal condition, catatonic disorder associated with another medical condition, schizophreniform dis- order, schizoaffective disorder, and schizophrenia. ■■ Nursing care of the patient with schizophrenia is ac- complished using the six steps of the nursing process. ■■ Nursing assessment is based on knowledge of symptomatology related to thought content and processes, perception, affect, volition, interper- sonal functioning and relationship to the external world, and psychomotor behavior. ■■ Symptoms of schizophrenia are categorized as posi- tive (an excess or distortion of normal functions) or negative (a diminution or loss of normal functions). ■■ Antipsychotic medications remain the mainstay of treatment for psychotic disorders. Atypical antipsy- chotics have become the first line of therapy and treat both positive and negative symptoms of schizo- phrenia. They have a more favorable side-effect pro- file than the conventional (typical) antipsychotics. ■■ Individuals with schizophrenia require long-term integrated treatment with pharmacological and other interventions. Some of these include indi- vidual psychotherapy, group therapy, behavior therapy, social skills training, milieu therapy, fam- ily therapy, and assertive community treatment. For the majority of clients, the most effective treat- ment appears to be a combination of psychotropic medication and psychosocial therapy. ■■ Some clinicians are choosing a course of therapy based on a model of recovery, somewhat like that which has been used for many years with prob- lems of addiction. The basic premise of a recovery model is empowerment of the consumer. The re- covery model is designed to allow consumers pri- Core Concepts listed at the beginning of each chapter and defined in boxes throughout the text emphasize important takeaways.
on in which the ody parts to be positions. This . Once placed in s in that position uncomfortable it rse may position n to take a blood cuff is removed, osition in which
oluntary assump- ures.
ocking (a slow, ying of the trunk are common psy- h schizophrenia. er level of devel- anism of schizo- empt to reduce of the behaviors
communication approach, which offers the patient the opportunity to make his or her
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) Summary and Key Points ■■ Of all of the mental illnesses, schizophrenia un- doubtedly results in the greatest amount of per- sonal, emotional, and social costs. It presents an enormous threat to life and happiness. ■■ For many years, there was little agreement as to a definition of the concept of schizophrenia. The decisions about activities, treatment goals, and other aspects of care, helps establish trust while incorporat- ing a patient-centered approach. For example, saying, “Would you like to attend group now?” is a less directive approach than saying “You need to go to group now.”
Quality and Safety Education for Nurses (QSEN) Activities help students attain the knowledge, skills, and attitudes required to fulfill the initiative’s quality and safety competencies.
Case Studies challenge your students’ clinical judgment and critical-thinking skills to prepare them for real-world practice and certification.
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