Psychiatric Mental Health, part 30: Disorders - Schizophrenia
by Cathy Parkes July 24, 2023 Updated: August 10, 2023 4 min read
Hi, I'm Cathy with LevelUpRN. In this video, we are going to talk about schizophrenia. And at the end of the video, I'm going to provide you guys a little quiz to test your knowledge of some of the key points I'll be covering. So definitely stay tuned for that. And if you have our LevelUpRN psychiatric, mental health nursing flashcards, definitely pull out your cards on schizophrenia and follow along with me.
Schizophrenia is a psychotic disorder that causes disturbances in thought, behavior, and perception. With schizophrenia, we have both positive and negative symptoms. Positive symptoms are things that are added to a patient with schizophrenia that should not be there. Positive symptoms include delusions, which are false beliefs, such as, "I am the president of the United States." Positive symptoms also include hallucinations, which are false sensory perceptions. So for example, auditory hallucinations are when a patient hears voices or sounds that are not real. So for example, a patient may hear a voice tell him, "We are coming to get you," which is obviously very scary. And then disorganized speech is another positive symptom associated with schizophrenia. And we will definitely be talking about altered speech patterns in this video.
Negative symptoms of schizophrenia are things that are taken away from an individual that should be there. And our Cool Chicken hint to help you remember these things is to think of the six A's. So we have anhedonia, which means lack of pleasure. We have a flat affect, which means lack of expression. We have apathy, which means lack of interest. Anergia, which means lack of energy. Alogia, which means lack of speech. And avolition, which is a lack of motivation.
Let's now review speech alterations that are often present with schizophrenia. So flight of ideas means the patient is talking about one thing and then quickly talking about another, and then another. So they're moving from one unrelated topic to another. Pressured speech means the patient is talking very rapidly without any pauses. And then neologisms are new, unrecognizable words. So they're basically like made-up words. So if I said, "I'm drinking from my coopa dupa," then that would be an example of a neologism. And then echolalia is where the patient echoes or repeats back what they heard. So if the nurse came in and said, "I have your medications," and the patient responds by saying, "Medications, medications, medications," that's an example of echolalia. And then word salad means we are combining real words in an incoherent way. So our Cool Chicken hint to help you remember word salad, it's like taking words from a dictionary, putting them into a salad bowl and mixing them around, and then pulling them out randomly to create a sentence. For example, if I said camera, picture, hungry, late, water, card, those are all real words, but I have strung them together in an incoherent way. So that is word salad. And then we have clang association, which is where we combine related or rhyming words together. For example, if I said, "Dan ran to get his can. The tan man is--" I can't think of any more an words. But I'm obviously rhyming words, and that would be an example of clang association.
Schizophrenia is diagnosed when the individual has two or more symptoms that last at least six months and those symptoms interfere with the patient's ability to work or maintain social relationships. It's also important when diagnosing schizophrenia that you rule out any physiological causes of the symptoms, such as electrolyte imbalances, hypoglycemia, or substance use.
Treatment of schizophrenia includes medications such as first generation and second generation antipsychotics. If you need a review of those drug classes, then definitely watch my video earlier in this video playlist that is dedicated to antipsychotics. In addition, I want to note that there are some slow release IM medications that can be administered every two to four weeks as opposed to oral medications that need to be taken daily. So this can be really helpful with certain patients when treatment compliance is an issue.
Other treatment options include cognitive, behavioral therapy, individual and group therapy, social skills training, as well as ACT, which stands for assertive community treatment. ACT is really effective with individuals who have persistent and severe schizophrenia. And it is focused on caring for high-risk individuals in the community, which helps to prevent hospitalizations, incarceration of the individual, and other complications.
In terms of nursing care, safety is priority. Therefore, you need to ask your patient directly about hallucinations because command hallucinations place the patient and others at risk. So you need to ask your patient, "Are you hearing voices?" And if they say yes, then you need to ask them, "What are the voices saying?" In addition to asking the patient directly about hallucinations, you want to make sure you are acknowledging but not validating those hallucinations. So you could say something like, "I do not hear any voices, but I believe you when you say you are hearing voices."
When caring for a patient with schizophrenia, you should decrease stimuli in the environment. You should never whisper to others in the patient's presence. You should warn the patient before touching them. You should reorient the patient to reality as needed and provide distraction for hallucinations. And then you should monitor your patient for suicide ideation.
All right, it's quiz time. And I have five questions for you this time. Question number one. A patient with schizophrenia states, "I am a spy for the Secret Service. This is an example of a blank." The answer is delusion.
Question number two. Is a flat affect a positive or negative symptom of schizophrenia? The answer is negative symptom.
Question number three. What is the priority nursing action when caring for a patient experiencing command hallucinations? The answer is you need to ask the patient what the voices are saying.
Question number four. What speech alteration is associated with schizophrenia and characterized by the combination of similar or rhyming words? The answer is clang association.
Question number five. Blank is a multidisciplinary team approach focused on treating individuals with severe and persistent schizophrenia in the community. The answer is ACT or assertive community treatment.
All right. That is it for this video. I hope you have found it helpful. Take care and good luck with studying.
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