Undifferentiated Schizophrenia

 

Undifferentiated Schizophrenia?> "Undifferentiated schizophrenia" is used as a label for cases of o f schizophrenia that don't match any of the established types of o f schizophrenia. Undifferentiated type schizophrenia differs from "residual schizophrenia," which refers to chronic conditions after an acute schizophrenia episode.

Undifferentiated Schizophrenia Symptoms Sy mptoms Although they're just as severe, the symptoms s ymptoms of undifferentiated schizophrenia are not as specific as the symptoms of other types of o f schizophrenia. In some cases, undifferentiated schizophrenia symptoms change often, o ften, resembling the symptoms of various types of schizophrenia at different times and defying classification. In other cases of  undifferentiated schizophrenia, symptoms are stable but they don't match the description of the symptoms of other types of schizophrenia. Undifferentiated schizophrenia symptoms vary from case to case. Any symptoms seen in other  types of schizophrenia may be present, including:          

y

Catatonic

y

Delusions

y

Disorganized thinking

y y

symptoms

A flat affect characterizing dulled emotions Hallucinations.

A gradual worsening of "negative" symptoms sympto ms often occurs in cases of undifferentiated schizophrenia. Negative symptoms result from the loss of mental function. "Positiv "Po sitive" e" symptoms such as hallucinations or delusions result from excessive mental functioning.  Negative symptoms associated with undifferentiated schizophrenia include:          

y

y y y

y

Deadened

or dulled emotions Improvised or impaired speech Inability to feel pleasure Loss of interest in activities Social withdrawal.

Diagnosing

Schizophrenia, Undifferentiated Type

A diagnosis of undifferentiated schizophrenia must meet the criteria for general schizophrenia, sc hizophrenia,  but cannot match any of the three established types of schizophrenia: paranoid schizophrenia, disorganized schizophrenia or catatonic catato nic schizophrenia.

 

Furthermore,

undifferentiated schizophrenia must include psychotic symptoms. If psychotic psychot ic symptoms are not present or they cause only minimal problems, a diagnosis of residual schizophrenia or post-schizophrenic depression may be the t he preferred diagnosis.

Treatment of Undifferentiated Schizophrenia The treatment of undifferentiated schizophrenia symptoms similarantipsychotic to general schizophrenia treatment and faces the same challenges. Treatment optionsisinclude medication, therapy and, in severe cases, hospitalization. The wide range of symptoms sympto ms coupled with the fact that persons with undifferentiated schizophrenia are only rarely aware that t hat they need treatment complicates treatments plans for  undifferentiated schizophrenia.

Types of Schizophrenia The different types of schizophrenia have specific, spec ific, distinct symptoms. S pecialists believe that undifferentiated schizophrenia symptoms result from several different d ifferent disorders. Researchers hope that eventually they'll have evidence that undifferentiated schizophrenia is actually a combination of disorders. Time and research may provide more information about undifferentiated schizophrenia.

Resources Bengston, M. (2006).Undifferentiated (2006).Undifferentiated schizophrenia. schizophrenia. Retrieved July 5, 2010, from http://psychcentral.com/lib/2006/undifferentiated-schizophrenia/ Mulhauser, G. (2010). Undifferentiated schizophrenia diagnostic criteria. criteria. Retrieved July 5, 2010, from http://counsellingresource.com/distress/schiz http://counsellingresource.com/distress/schizophrenia/icd/undifferentiated.html ophrenia/icd/undifferentiated.html PSYweb.(n.d.). web.(n.d.).Schizophrenia Schizophrenia (undifferentiated type). type). Retrieved July 5, 2010, from http://psyweb.com/Mdisord/SchizoDis/undtype.jsp psychot ic features, the inability to Schizophrenia is a group of mental disorders characterized by psychotic trust others, and unordered thought processes. processes. The client c lient also withdraws from reality, reality, shows regressive behavior, has ineffective communication and a reversely impaired inter-personal relationship. Typical onset occurs in early adulthood adulthoo d with diagnosis based on observation and the t he  patient¶s experiences.

Types of Schizophrenia 1. 

Disorganized or Hebephrenic Schizophrenia. There is severe and pronounced mental incapacity.  The client manifests a flat affect and peculiar behavior. Social withdrawal and delusions are common. 

 

2.  Catatonic Schizophrenia.

The client has catatonic stupor wherein he manifests waxy flexibility, withdrawal, distorted reality, and ambivalence.  3.  Paranoid Schizophrenia. The patient undergoes delusions as compensatory mechanism and hallucinations.  4.  Undifferentiated Schizophrenia. There are mixed symptoms. The client also manifests a flat affect. Factor Factors: s: severe emotional problem, chronic insecurity or a total failure in inter-personal inter-personal relationships, difficulty in restoration of integrity and personality. 

Delusion

Delusions are false beliefs considered to be true even though there is sufficient evidence on the contrary. The client also believes the certain events, situations, or actions are directly related to self .  Types of Delusions:

 

y

   

y

y

Delusions of Grandeur. The client believes that one is powerful and an important person or being.  Delusions of Persecution. The client believes that he is being singled-out for harm by others.  Delusions of Jealousy. The client believes that hes partner is going out with another person. 

Assessment 1.  4

2. 

3.  4.  5.  6. 

for Schizophrenia

As  o  o  o  o 

Affect. If client manifests flat or blunted it is considered inappropriate.  Associative looseness. The clients verbalization is disorganized.  Ambivalence. The client has two conflicting emotions.  Autism. Thoughts on self, extreme withdrawal, and the inability to relate to the outside world.  Ability to perform Activities of Daily Living (ADLs). Clients with Schizophrenia have difficulties in performing self-care activities. Also, client have nutritional deficit.  Aggression  Suicidal Potential  Any changes in thoughts or feelings.  Disturbances in inter-personal relationships. 

Nursing Diagnosis

for Clients with Schizophrenia

1. 

Anxiety related to disturbed thought processes.  2.  Impaired verbal communication related to inappropriate use of words .   3.  Ineffective family coping related to ambivalent family relationsh relationships ips.  4.  Sensory perceptual alterations related to misinterpret misinterpretation ation of stimuli. 

Nursing    

Care for Clients with Schizophrenia

y

Encourage the client to follow drug regimen . 

y

Observe adverse drug

 

y

reactions especially major tranquilizers tranquilizers.  Encourage the development of interpersonal interpersonal relationships. 

 

     

y y y

Encourage

the client towards presentation to reality .  Accept the level of functioning.  Respect the patient as a human being with dignity and worth. 

Nursing Management-Nursing Process  History

Outline of psychiatric history  Name, age , address of patient, name of informant if any and their relationship to the patient  History of present condition 

Family

History 

Personal

 



History 

early development, health during childhood, nervous problems in childhood, education, occupation, menstrual history, sexual history, marriage, 

Past illness 

 



past physical illness, medical illness, forensic history 

Personality 

 



relationships, leisure activities, prevailing mood, character, attitudes and standards, premorbid personality 

Drugs, alcohol, tobacco 

Mental Status Examination  Appearance

 



and behaviour 

General

appearance, facial appearance, posture and movement, social behaviour, consciousness, orientation 

Speech ±  

     

 



coherent, relevant, goal-directed  rate and quantity  flow of speech 

Mood 

     







cheerful, elation, euphoric, exaltation  depression, anxiety  congruent or incongruent 

 

Depersonalization and

derealization derealization 

Delusions  

 



 



content and form-persecutory, grandiose, nihilistic, hypochondriacal, religious, reference, guilt, unworthiness, jealousy  Well-systematized 

Illusions   hallucinations-auditory or visual, command hallucinations, second person, third person  Attention and concentration  Memory-short term, recent and remote  Insight- Grade 1 to 5 

A. Nursing Diagnosis Disturbed Thought Processes  -Disruption in cognitive operations and activities Assessment Data § Non-reality-based thinking, Disorientation, Labile affect, Short attention span, Impaired I mpaired  judgment, Distractibility Expected Outcomes § Be free from injury § Demonstrate decreased anxiety level § Respond to reality-based interactions initiated initiated by others ot hers § Verbalize recognition of delusional thoughts tho ughts if they persist § Be free from delusions or demonstrate the ability to function without responding to  persistent delusional thoughts NURSING INTERVENTIONS

R ATIONALE 

Be sincere and honest when communicating with the client. Avoid vague or evasive remarks. 

Delusional

Be consistent in setting expectations, expectations, enforcing rules, and so forth.   Do

not make promises that you cannot keep.  

Encourage the client to talk with you, but do not pry for information. 

clients are extremely sensitive se nsitive about others and can recognize reco gnize insincerity. Evasive comments or hesitation reinforces mistrust or delusi d elusions. ons. Clear, consistent limits provide a secure structure for the client. Broken promises reinforce the client¶s mistrust of others. Probing increases the client¶s suspicion and

 

interferes with the therapeutic relationship. re lationship. Explain procedures, and try to be sure the client When the client has full knowledge of  understands the procedures before carrying them  procedures, he or she is less likely to feel out.  tricked by the staff. Give positive feedback for the client¶s successes.  Positive feedback for genuine success enhances the client¶s sense of well-being and helps make non-delusional reality a more  positive situation for the client. Recognize the client¶s delusions as the client¶s Recognizing the client¶s c lient¶s perceptions perceptions can help perception of the environment.  you understand the feelings he or she is experiencing. Initially, do not argue with the client or try to Logical argument does not dispel delusional convince the client that the delusions are false or ideas and can interfere with the development of  unreal.  trust. Interact with the client on the basis of real things; do Interacting about reality is healthy for the not dwell on the delusional material.   client. Engage the client in one-to-one one-to-one activities at first, then A distrustful client can best deal with one activities in small groups, and gradually activities in  person initially. Gradual introduction of others larger groups  when the client can tolerates t olerates is less threatening. Recognize and support the client¶s accomplishments (projects completed, responsibilities fulfilled, or interactionss initiated). interaction Show empathy regarding the client¶s feelings; reassure the client of your presence and acceptance. Never convey to the client that you accept the delusions as reality.  Ask

the client if he or she can see that the delusions interfere with or cause problems in his or her life.  

Recognizing the client¶s c lient¶s accomplishments can lessen anxiety and the need for delusions as a source of self-esteem. The client¶s delusions can be distressing. d istressing. Empathy conveys your caring, interest and acceptance of the client. Indicating belief in the delusion reinforces the delusion (and the client¶ c lient¶ illness). illness). iscussion on of o f the problems caused by the Discussi delusions is a focus on the present and is reality based.

B. Nursing Diagnosis: D A isturbed Sensory Perception (Specify: Visual, uditory, Kinesthetic K inesthetic,, Gustatory, Tactile, Olfactory   -Change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or im impaired paired response to such stimuli Assessment  

· Hallucinations (auditory, visual, tactile, gustatory, kinesthetic, or olfactory) · Listening intently to no apparent stimuli stimuli · Talking out loud when no one is present · Rambling, incoherent, or o r unintelligible speech

 

· Inability to discriminate between real and unreal perceptions · Attention deficits · Inability to make decisi dec isions ons · Feelings of insecurity · Confusion Expected Outcomes 

· Demonstrate decreased hallucinations · Interact with others in the external environment e nvironment · Verbalize knowledge of hallucinations or illness and safe use of medications · Participate in the real environment env ironment · Make sound decisions based on reality · Participate in community activities or programs NURSING INTERVENTIONS

R ATIONALE 

Be aware of all surrounding stimuli, including sounds from other rooms (such as television or stereo in adjacent areas). 

Many seemingly normal stimuli will trigger or  intensify hallucinations. The client can be overwhelmed by stimuli. Decreased stimuli decreases chances of  misperception. The client has a diminished d iminished ability to deal with stimuli. You must be honest with the client, letting him

Try to decrease stimuli or move the client to another area.  Avoid

conveying to the client the belief that D

hallucinations are real. o not converse with the in ³voices´ or otherwise reinforce the client¶s belief the hallucinations as reality. Explore the content of the client¶s hallucinations during the initial assessment to determine what kind of stimuli the client is receiving, but do not reinforce the hallucinations as real. You might say, "I don¶t hear any voices-what are you hearing?" Use concrete, specific verbal communication with the client. Avoid gestures, abstract ideas  Avoid

asking the client to make choices. Don¶t ask  ³Would you like to talk or be alone?´ Rather, suggest that the client talk with you.  

or her know the hallucinations are not real. It is important to determine if auditory hallucinations are "command" hallucinations that direct the client to hurt himself or herself  or others. Safety is always a priority. The client¶s ability to deal in abstractions is diminished. The client may misinterpret your  gestures The client¶s ability to make decisions is impaired, and the client may choose to be alone (and hallucinate) rather than deal with reality (talking to you).

 

Respond verbally and reinforce the client¶s conversation when he or she refers to reality.

Positive reinforcement increases the likelihood of desired behaviors. Encourage the client to tell staff members about The client has the chance to seek others (in hallucinations. reality) and to cope with problems caused by hallucinations. If the client appears to be hallucinating, attempt to It is more difficult for the client to respond to engage the client¶s in conversation or a concrete hallucinations when he or she is engaged in activity. real activities and interactions. Maintain simple topics of conversation to provide a The client is better able to talk t alk about basic base in reality. things; complexity is more difficult. difficult. Provide simple activities that the client can co mplicated tasks may be frustrating Long or complicated realistically accomplish (such as uncomplicated craft for the client. He or she may be unable to projects). complete them. Encourage the client to express any feelings of  It may help the client c lient to express such feelings, remorse or embarrassment once he or she is aware of   particularly if you are a supportive, suppo rtive, accepting psychotic behavior; be supportive. listener. Show acceptance of the client¶s behavior and of the The client may need help to see that client as a person; do not joke about or judge the hallucinations were a part of the illness, not client¶s behavior.  under the client¶s control. Joking or being  judgmental about the client¶s c lient¶s behavior is not appropriate and can be damaging to the client. C.

Nursing Diagnosis: Disturbed Personal Identity  -Inability to distinguish between self and nonself  Assessment data · Bizarre behavior, Regressive behavior, Loss of ego boundaries (inability to differentiate self from the external environment), Disorientation, Disorganized, illogical thinking, Flat or inappropriate affect, Feelings of anxiety, fear, or agitation, Aggressive  behavior toward others or property Expected Outcomes · Be free from injury · Not harm others or destroy property · Establish contact with reality ·

Demonstrate

or verbalize decreased psychotic symptoms and feelings of anxiety, agitation, and so forth

· Participate in the therapeutic milieu

 

· Express feelings in an acceptable manner  · Reach or maintain his or her optimal level of functioning · Cope effectively with the illness ·

Continue

compliance with prescribed regimen, such as medications and follow-up appointments

NURSING INTERVENTIONS

R ATIONALE 

Reassure the client that the environment is safe by briefly and simply explaining routines, procedures, and so forth.

The client is less likely to feel threatened if the surroundings are known.

Protect the client from harming himself or herself or others

Client

Remove the client from the group if his or her behavior becomes too bizarre, disturbing, or dangerous to others.  Decrease

excessive stimuli in the environment. The client may not respond favorably to competitive activities, or large groups if he or she is still actively psychotic. *Be aware of SOS medications and the client¶s varying need for them. Reorient the client to person, place, and time as indicated (call the client by name, tell the client where he or she is, and so forth).  Spend time with the client even when he or she is unable to respond coherently. Convey your interest and caring.  Make only promises that you can realistically keep. Help

the client establish what is real and unreal. Validate the client¶s real perceptions, and correct the client¶s misperceptions in a matter-of-fact manner. Do not argue with the client, but do not give support for misperceptions.

safety is a priority. Self-destructive ideas may come from hallucinations or  delusions. The benefit of involving the client c lient with the group is outweighed by the group¶s need for  safety and protection. The client is unable to deal with excess stimuli.. The environment should not be stimuli threatening to the client. Medication can help the client gain control over his or her own behavior. Repeated presentation of reality is concrete reinforcement for the client. Your

physical presence is reality. Nonverbal caring can be conveyed to the client even when verbal caring is not understood. Breaking your promise can result in increasing the client¶s mistrust. The unreality of psychosis must not be reinforced; reality must be reinforced. Reinforced ideas and behavior will w ill recur more frequently.

 

Stay with the client when he or she is frightened. Touching the client can sometimes be therapeutic. Evaluate the effectiveness of the use of touch with the client before using it consistently.

Your

Be simple, direct, and concise when speaking to the client.

The client is unable to process complex ideas effectively.

Talk with the client about simple, concrete things; avoid ideologic or theoretical discussions.

The client¶s ability to deal with abstractions is impaired.

presence and touch can provide reassurance from the real world. However, touch may not be effective if the client feels that his or her boundaries are being invaded.

Direct activities toward helping the client accept and remain in contact with reality.

Increased reality contact decreases the client¶s c lient¶s retreat into unreality.

Initially, assign the same staff members to work with the client. Begin with one-to-one interactions, and then progress to small groups as tolerated (introduce slowly).

Consistency

Set realistic goals. Set daily goals and expectations. Unrealistic goals will frustrate the client.  

Daily

At

first, do not offer choices c hoices to the client (³Would you like to go to activities?´ ³What would you like to eat?´). Instead, approach the client in a directive manner (³It is time to eat. Please pick up your fork.´).

The client¶s ability to make decisions is impaired. Asking the client to make decisi dec isions ons at this time may be very frustrating.

Gradually,

The client needs to gain independence as soon as he or she is able. Gradual addition of  responsibilities responsibili ties and decisi dec isions ons gives g ives the client a greater opportunity for success.

as the client can tolerate it, provide opportunities for him or her to accept responsibility and make personal decisions. 

D. Nursing Diagnosis:

can reassure the client.

Initially, the client will better tolerate and deal with limited contact. goals are short term and easier for the client to accomplish.

Impaired Social Interaction

³Aloneness experienced by the individual and perceived as imposed by others and as a negative or threatening state.´ Assessment

data 

· Inappropriate or inadequate emotional responses, Poor interpersonal relationships, Feeling threatened in social situations, Difficulty with verbal communication, Exaggerated responses to stimuli, Difficulty trusting others, Difficulties in relationships with significant others, Poor social skills Expected Outcomes 

· Report increased feelings of self-worth · Identify strengths and assets

 

· Engage in social interaction · Participate in the trust relationship · Demonstrate ability to interact with staff and other clients within the therapeutic milieu · Assume increasing responsibility within the context of the therapeutic t herapeutic relationship · Use community support system successfully · Participate in follow-up or outpatient therapy t herapy as indicated  NUR SING INTERVENTIONS 

RATIONALE

* denotes collaborative interventions Provide attention in a sincere, interested manner.

Flattery

Support

Sincere

any successes or o r responsibilities fulfilled, projects, interactions with staff  members and other clients, and so forth. Avoid trying to convince the client verbally of his or her own worth. wo rth. Teach the client social skills. Describe and demonstrate specific skills, such as eye contact, attentive listening, and so forth. Discuss the type of topics that are appropriate for casual social conversation, such as the weather, local events, and so forth. Help

the client improve his or her  grooming; assist when necessary in  bathing, doing laundry, and so forth.

can be interpreted as belittling belittling by the client. and genuine praise that the client c lient has earned can improve self-esteem. The client will respond to genuine genu ine recognition of a concrete behavior rather  than to unfounded praise pra ise or flattery.

The client may have li little ttle or no knowledge of social interaction skills. Modelin Mode ling g  provides a concrete example of o f the desired skills.

Good physical grooming can enhance confidence in social soc ial situations.

E. Nursing Diagnosis: Noncompliance   Assessment

data 

· Objective tests indicating noncompli nonco mpliance, ance, such as low neuroleptic blood levels · Statements from the client or significant others describing noncompliant behavior  · Exacerbation of symptoms sympto ms · Appearance of o f side effects or complications

 

· Failure to keep appointments · Failure to follow through throug h with referrals Outcomee Identification  Outcom

· Identify barriers to compliance · Recognize the relationship between noncompliance and undesirable consequences (i.e., increased symptoms, hospitalization · Verbalize acceptance of o f illness · Identify risks of noncompliance · Adhere to therapeutic recommendations independently · Inform care provider of need for changes in therapeutic recommendations Films on Schizophrenia  A beautiful Mind (1949)  The

Fisher King  (1991)

 Birdy The

(1984)

Madness of King George

(1994)

 Promise (1986) T axi axi

Driver  (1976)

References 

1.  Reddy MV,

Chandrashekar  CR.

Prevalence of mental and behavioural disorders in India:

A meta-analysis.  I ndian ndian Journal of Psychiatry 1998;40(2):149±157. 2.  Gelder M., Gath

D.,

Mayou R., owen P. Oxford Textbook of Psychiatry. Third Edition.

Oxford University Press. New delhi 2000. 3.  Ahuja,N. A short Textbook of Psychiatry. 5 Edition Jaypee Brothers New Delhi 2002. th

4.  Videbeck, SL. Psychiatric Mental heath Nursing 2 nd edition. LWW Philadelphia 2004. 5. 

Schultz,

JM., Videbeck,

SL.

Psychiatric Nursing

Care

Plans. 7th Edition.

LWW

Philadelphia 2004 Schizophrenia

is a severe, lifelong lifelong brain disorder. P People eople who have it may hear voices, see things

that aren't there or believe that t hat others are reading or controlling their minds. In men, symptoms usually start in the late teens and early 20s. 20 s. They include hallucinat hallucinations, ions, or seeing things, and

 

delusions such as hearing voices. vo ices. For women, they start in the mid-20s to early 30s. Other  symptoms include        

y y y y

Unusual thoughts or perceptions Disorders of movement Diffi ifficulty culty speaking and expressing emotion Problems with attention, memory and organization org anization

 No one is sure what causes schizophrenia, but your genetic makeup and brain chemistry  probably play a role. Medicines can relieve many of o f the symptoms, but it can take several tries  before you find the right drug. You can reduce relapses re lapses by staying on your medicine for as long as your doctor recommends. reco mmends. With With treatment, many people improve enough to lead satisfying lives.  NIH:  N ational  ational  I nstitute nstitute of Mental  H ealth  ealth 

Causes For Schizophrenia  Schizophrenia

may result from a combination of o f genetic, biological, cultural, and psycho psychological logical factors with genetic and environmental insults most associated. For example, some evidence supports a genetic predisposition to this disorder. Close relatives of schizophrenic patients are up to 50 times more likely to develop schizophrenia; the closer the degree o off biological relatedness, the higher the risk. The most widely accepted biochemical hypothesis holds that schizophrenia results from excessive activity at dopaminergic synapses. Other neurotransmi neurotransmitter tter alterations may also contribute to schizophrenic symptoms.  Numerous psychological and sociocultural causes, such as disturbed family and interpersonal  patterns, also have been proposed pro posed as possible causes. Schizophrenia has a higher incidence among lower socioeconomic groups, gro ups, possibly related to downward social drift or lack of upward socioeconomic mobility, and to high stress levels, possibly induced by poverty, social failure, illness, and inadequate social resources. Gestational and birth complications, co mplications, such as Rh factor  incompatibility, prenatal exposure to influenza during the second seco nd trimester, and prenatal nutritional deficiencies, have been associated.

Assessment Nursing Schizophrenia

Care Plans For Schizophrenia 

is associated with a wide variety variet y of abnormal behaviors; therefore, assessment findings vary greatly, depending on both the type and phase of the illness. The individual may exhibit a decreased emotional expression, impaired impaired concentration, co ncentration, and decreased social functioning, loss of function, or anhedonia. Individuals with these particular symptoms (present in one-third of the schizophrenic population) popu lation) are associated with poor response to drug treatment and poor outcome.

 

Although behaviors and functional deficiencies can vary widely among patients and even in the same patient at different times, watch for the following following characteristic signs and symptoms sympto ms during the assessment interview: 1.  ambivalence coexisting strong positive and negative feelings, leading to emotional conflict 2.  apathy so und alike used in an illogical, nonsensical 3.  clang associations words that rhyme or sound manner; for instance, It's the rain, train, pain. 4.  concrete thinking inability to form or understand abstract thoughts 5.  delusions false ideas or beliefs accepted as real r eal by the patient. Delusi elusions ons of grandeur,  persecution, and reference (distorted belief be lief regarding regarding the relation re lation between events and one's self; for example, a belief that television t elevision programs address the patient on a personal level) are common in schizophrenia. Also common co mmon are feelings of being controlled, somatic illness, and depersonalization. depersonalizat ion. 6.  echolalia meaningless repetition of words or phrases 7.  echopraxia involuntary repetition of movements observed in others 8.  flight of ideas rapid succession of incomplete inco mplete and poorly connected ideas 9.  hallucinations false sensory perceptions with no basis in reality. Usually visual or  auditory, hallucinations may also be olfactory o lfactory (smell), gustatory (taste), or tactil tactilee (touch). 10. illusions²false sensory sensory perceptions percept ions with some basis in reality; for example, a car   backfiring might be mistaken for a gunshot. 11. loose associations not connected or related by logic or rationality 12. magical thinking belief that thoughts t houghts or wishes can control other people or events 13. neologisms bizarre words that have meaning only o nly for the patient 14. poor   poor interpersonal relationships 15. regression return to an earlier developmental stage 16. thought blocking sudden interruption in the patient's train of thought 17. withdrawal disinterest in objects, people, or surroundings 18. word salad illogical word groupings; for example, She had a star, barn, plant. p lant. It's the extreme form of loose associations.

Diagnoses Nursing

Care Plans For Schizophrenia 

                   

Anxiety Bathing or hygiene self-care deficit Disabled family coping Disturbed body image Disturbed personal identity Disturbed sensory perception (auditory, visual, kinesthetic) k inesthetic) Disturbed sleep pattern Disturbed thought processes Dressing or grooming self-care deficit def icit Fear 

 

Hopelessness

y y y y y y y y y

y

y

 

             

y y y y y y y

       

y y y y

Imbalanced nutrition: Less than body requirements Impaired home maintenance Impaired social interaction Impaired verbal communication Ineffective coping Ineffective role performance Powerlessness Risk for injury Risk for other-directed violence Risk for self-directed violence Social isolation

Interventions

Nursing

Care Plans For Schizophrenia  

1.  Assess the patient's ability to carry out the activi act ivities ties of o f daily living, paying special attention to his nutritional status. Monitor his weight if he isn't eating. If he thinks that his food is poisoned, allow him to fix his own food when possible, or offer him foods in closed containers that he can open. If you give liquid medication in a unit-dose container, the apatient to open the container. 2.  allow Maintain safe environment, minimizing stimuli. Administer medication to decrease symptoms and anxiety. Use physical restraints according acco rding to your facility's policy to ensure the patient's safety and that t hat of others. 3.  Adopt an accepting and consistent approach with the patient. Don't avoid or overwhelm him. Keep in mind that short, repeated contacts are best until trust has been established. 4.  Avoid promoting dependence. Meet the patient's needs, but only do for the patient what he can't do for himself. himself. 5.  Reward positive behavior to help the patient improve his level of functioning. 6.  Engage the patient pat ient in reality-oriented activities that involve human contact: inpatient social skills training groups, outpatient day care, and sheltered workshops. Provide reality-based explanations for distorted body images or o r hypochondriacal complaints. pat ient that Clarify private language, autistic inventions, or neologisms, explaining to the patient what he says isn't understood by others. o thers. If necessary, set limits on inappropriate behavior. 7.  If the patient is hallucinating, explore the t he content of the hallucinations. If he has aud auditory itory hallucinations, determine if they're command hallucinations that place the patient or  others at risk. Tell the patient you don't hear the voices but you know they're real to him. Avoid arguing about the hallucinations; if possible, change the subject. 8.  Don't tease or joke with the patient. Choose words and phrases that are unambiguous and clearly understood. For instance, a patient who's told, That procedure will be done on the floor, may become frightened, thinking he is being told to lie down on the floor. 9.  Don't touch the patient pat ient without telling him first exactly what you're going to do. For  example, clearly explain to him, I'm going to put this cuff on your arm so I can take your   blood pressure. If necessary, postpone procedures pro cedures that require physical contact with facility personnel until the patient is less suspicious or agitated. 10. Remember, institutionalization may produce new symptoms sympto ms and handicaps in the patient pat ient that aren't part of his diagnosed illness, so evaluate symptoms carefully.

 

11. Mobilize community resources to provide a support system for the patient and reduce his vulnerability to stress. Ongoing support is essential to his mastery of soc social ial skills. 12. Encourage compliance with the medication regimen to prevent relapse. Also monitor the  patient carefully for adverse effects of drug therapy, including drug-induced  parkinsonism, acute dystonia, akathisia, tardive dyskinesia, and malignant neuroleptic syndrome. Make sure you document d ocument and report such effects promptly.