Schizophrenia Lecture Notes

Introduction

• Presented by Cathy from LevelUpRN.
• Focus on schizophrenia, a psychotic disorder.
• A quiz will be provided at the end to test knowledge.
• Suggested: Use LevelUpRN psychiatric, mental health nursing flashcards.

Overview of Schizophrenia

• Causes disturbances in thought, behavior, and perception.
• Symptoms categorized into positive and negative.

Positive Symptoms

• Delusions: False beliefs (e.g., "I am the president of the United States").
• Hallucinations: False sensory perceptions.
  • Example: Auditory hallucinations (hearing non-existent voices).
• Disorganized Speech: Altered speech patterns.

Negative Symptoms

• Referred to as the "six A's":
  • Anhedonia: Lack of pleasure.
  • Flat Affect: Lack of expression.
  • Apathy: Lack of interest.
  • Anergia: Lack of energy.
  • Alogia: Lack of speech.
  • Avolition: Lack of motivation.

Speech Alterations

• Flight of Ideas: Rapid transition between unrelated topics.
• Pressured Speech: Rapid speaking without pauses.
• Neologisms: Use of new, unrecognizable words.
  • Example: "I'm drinking from my coopa dupa."
• Echolalia: Repeating what is heard.
• Word Salad: Incoherent combination of real words.
• Clang Association: Combining rhyming words.

Diagnosis

• Presence of two or more symptoms lasting at least six months.
• Symptoms interfere with work or social relationships.
• Rule out physiological causes (e.g., electrolyte imbalances, hypoglycemia, substance use).

Treatment

• Medications: First and second generation antipsychotics.
  • Slow release IM medications for compliance issues.
• Therapies:
  • Cognitive behavioral therapy.
  • Individual and group therapy.
  • Social skills training.
• ACT (Assertive Community Treatment): Effective for severe schizophrenia.
  • Focus on community care, prevents hospitalizations and complications.

Nursing Care

• Safety is Priority:
  • Directly ask about hallucinations (e.g., "Are you hearing voices?").
  • Avoid validating hallucinations but acknowledge them.
  • Decrease environmental stimuli.
  • Avoid whispering in patient's presence.
  • Warn before touching the patient.
  • Reorient to reality and provide distractions.
  • Monitor for suicidal ideation.

Quiz Questions

1. Delusion example: "I am a spy for the Secret Service."
2. Flat affect is a negative symptom.
3. Priority action for command hallucinations: Ask what the voices are saying.
4. Speech alteration with rhyming words: Clang association.
5. ACT: Multidisciplinary approach for treating severe schizophrenia in the community.

• End of video. Encouragement to continue studying.