Schizophrenia (longer)

Identify 5 types of psychosocial treatments that may be used to treat R.B.'s schizophrenia?

Cognitive Behavioral Therapy (CBT) Social Skills Training Social Support Groups Psychotherapy Cognitive Remediation Individual therapy Milieu therapy, family therapy, group therapy, recreational therapy, vocational therapy

Identify at least 2 positive symptoms of schizophrenia that R.B. might be experiencing

Disorganized speech Bizarre behavior Flight of ideas Trouble concentrating Movement disorders

What diagnostic screenings are important in evaluating R.B

Family history: medical, neurologic, psychiatric Mental status examination Physical examination Blood and urine drug screen; blood alcohol level Complete blood count Complete metabolic panel Urinalysis

Give the definition of each of the following types of delusional thinking

Grandeur - A false or unusual belief about one's greatness. They may believe they are immortal, famous, etc. Persecutory/Paranoid - Persecutory delusions are when the person believes they are being persecuted despite proof. Paranoia is similar and can include delusions of unwarranted jealousy, exaggerated self-importance, etc. Thought Insertion - Feelings as though one's thoughts are not their own but are someone else's and were inserted into their mind Ideas of Reference - A perception that irrelevant, unrelated things in the world are referring to them directly or have a personal significance . Somatic Delusions - A false belief that one's bodily function or appearance is grossly abnormal

Is he experiencing a delusion or a hallucination?

He is experiencing a visual hallucination. Hallucinations are a sensory experience while delusions are false beliefs.

Which condition is a risk associated with second-generation antipsychotics, such as olanzapine?

Metabolic syndrome- can cause risk for type II diabetes and obesity

Why is it important to know R.B.'s history before he is diagnosed with schizophrenia?

Other factors or conditions can cause psychotic symptoms that are common with schizophrenia. Drug use, certain medical or neurologic conditions, and alcohol withdrawal may cause psychosis. It is common for people with schizophrenia to experience deterioration in their level of functioning for up to a year before developing frank psychotic symptoms.

What symptoms indicate that R.B. has paranoid schizophrenia?

Paranoid Delusions--Believes food was contaminated and believes that he is being watched.

What are the most important initial interventions for treating R.B.?

Protect him from harm to self and others; create a supportive, structured environment Engage in supportive and directive communications Establish a relationship with the patient in which he feels safe Perform acute symptom stabilization—psychopharmacologic treatment

R.B. will need to be monitored closely. How will this be done?

R.B. can be guided to stay in community areas rather than in his room to be able to observe his behaviors and whether he is improving or not. Records of his signs and self-reports of symptoms can be kept daily to see if the medications are working. Labs would need to be drawn to monitor if the drug is within therapeutic range. Many antipsychotics cause metabolic side effects so BMI, weight, waist circumference, and nutritional lab values should be monitored.

Identify the class of antipsychotic medications considered as first-line therapy for schizophrenia?

Second-generation antipsychotics (SGAs) with an exception of clozapine. Clozapine is not recommended because of its risk of agranulocytosis

What are the common side effects of second-generation antipsychotics such as olanzapine (Zyprexa)?

a. Nausea b. Dry mouth c. Drowsiness e. Weight gain f. Tardive dyskinesia-serious side effect but not as common

Identify the appropriate nursing response you would state to R.B

b. "Tell me more about what you are seeing." d. "The voice you are hearing is part of your illness. It can't hurt you." e. "I don't see a bird over your head. I can understand how that would be upsetting to you."

Identify at least 3 negative symptoms of schizophrenia that R.B. might be experiencing

withdrawing from social situations, struggling with the basic aspects of daily life such as not bathing, and extreme isolation. Lack of motivation Inability to experience pleasure Flat/blunted affect Reduced speech (alogia) Poor attention