Schizophrenia 1: Definition, Signs, and Symptoms

Schizophrenia is a group of mental disorders characterized by abnormalities in perception, content of thought, and thought processes (hallucinations and delusions) and by extensive withdrawal of interest from other people and the outside world, with excessive focusing on one's own mental life.

Schizophrenia is the most prevalent psychosis, affecting some 2 million Americans. The annual cost of the disease to the U.S. economy is estimated at $65 billion, of which $46 billion reflects lost productivity of patients and their caregivers

The term of schizophrenia was coined by Bleuler, synonymous with and replacing dementia praecox. This disorder disturbances in affect, mood, behavior, and though process.

Signs and Symptoms of Schizophrenia:

POSITIVE SYMPTOMS

• Excess or distortion of normal functions
• Delusions (persecutory or grandiose)
• Conceptual disorganization
• Hallucinations (visual, auditory, or other sensory mode)
• Excitement or agitation
• Hostility or aggressive behavior
• Suspiciousness, ideas of reference
• Pressurized speech
• Bizarre dress or behavior
• Possible suicidal tendencies

NEGATIVE SYMPTOMS

• Diminution or loss of normal functions
• Anergia (lack of energy)
• Anhedonia (loss of pleasure or interest)
• Emotional withdrawal
• Poor eye contact (avoidant)
• Blunted affect or affective flattening
• Avolition (passive, apathetic, social withdrawal)
• Difficulty in abstract thinking
• Alogia (lack of spontaneity and flow of conversation)
• Dysfunctional relationship with others

DISORGANIZED SYMPTOMS

• Cognitive defects/confusion
• Incoherent speech
• Disorganized speech
• Repetitive rhythmic gestures (such as walking in circles or pacing)
• Attention deficits

Diagnostic Characteristics:

• Evidence of two or more of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms
• Above symptoms present for a major portion of the time during a 1-month period
• Significant impairment in work or interpersonal relations, or self-care below the level of previous function
• Demonstration of problems continuously for at least a 6-month interval
• Symptoms unrelated to schizoaffective disorder and mood disorder with psychotic symptoms and not the result of a substance-related disorder or medical condition

Continued to Schizophrenia 2

Bipolar Disorder

Bipolar disorder is an affective disorder characterized by the occurrence of alternating periods of euphoria (mania) and depression.

Signs and Symptoms Of Mania:

• Becomes angry quickly.
• Distracted by environmental stimuli.
• Extroverted personality
• Flights of idea
• Delusional self-confidence.
• Grandiose and persecutory delusions
• Inability to eat or sleep.
• High and unstable affect.
• Inappropriate dress.
• Inappropriate affect.
• Initiation of activity
• Restlessness
• Pressured speech
• Sexually promiscuous
• Unlimited energy
• Urgent motor activity
• Significant decrease in appetite

Signs and Symptoms Of Depression:

• Decreased emotion and physical activity
• Decrease in activities of daily living
• Easily fatigue
• Inability to make decisions
• Introverted personality
• Internalizing hostility
• Lack of initiative
• Lack of energy
• Lack of self-confidence
• Lack of sexual interest
• Withdrawn from groups

Interventions for maniac patients:

• Remove hazardous objects from the environment
• Assess the client closely for fatigue
• Promote sleep
• Provide rest periods
• Provide private room
• Hypnotic or sedative medication as prescribed
• Encourage the patient to ventilate feeling
• Calm and slow interaction
• Encourage patient to focus on one topic during conversation
• Ignore and distract patient from grandiose thinking
• Present reality to patient
• Do not argue with patient
• Provide high-calorie finger foods and fluids
• Reduce environmental stimuli
• Set limits on inappropriate behaviors
• Provide physical activities and outlets for tension
• Avoid competitive games
• Provide gross motor activities such as walking and writing
• Provide structured activities with nurse
• Provide simple and direct explanations for routine procedures
• Supervise the administration of medication

Deal With Aggressive Behavior Patients:

• Assist patient to identify feeling of frustration and aggression
• Encourage patient to talk out instead of acting out
• Assist patient in identifying precipitating events or situations lead to aggressive behavior
• Describe the consequences of the behavior on self and others
• Assist in identifying previous coping mechanism
• Assist in problem solving techniques.

Deal With De-escalation Techniques:

• Maintain safety for the patient, others and self
• Maintain a large personal space and use non-aggressive posture
• Calm in approaching and communicating
• Clear tone of voice, be assertive not aggressive
• Avoid verbal struggles
• Assist the patient with problem-solving and decision making
• Provide the patient with clear option

Deal With Manipulative Behaviors:

• Set clear, consistent, realistic and enforceable limits
• Communicate the expected behaviors
• Be clear with the consequences associated with exceeding limits
• Discuss the patient’s behavior in non-judgmental and non-threatening manner
• Avoid power struggles with the patients

Dissociative Disorder

Dissociative disorder is a group of mental disorders characterized by disturbances in the functions of identity, memory, consciousness, or perception of the environment. It is associated with exposure to an extremely traumatic event.

Dissociative disorder includes dissociative amnesia, dissociative fugue, dissociative identity (multiple personality) disorder, and depersonalization disorder.

Dissociative Amnesia
Dissociative amnesia is the inability to recall important personal information because it is anxiety provoking. Memory impairment may be partial or almost complete.
There are three types of dissociative disorder:

1. Localized: block out all memories about specific period.
2. Selective: recalls some but not all memories about a specific period.
3. Generalized: loss of all memory about past life.

Dissociative Fugue

Dissociative fugue is a disorder in which client assumes a new identity in a new environment. It may be suddenly. The client may drift from place to place and develops few social relationships.

Dissociative Identity (Multiple Personality)
Two or more fully developed distinct and unique personalities exist within the person and may take full control of the client one at a time. This disorder is used as a method of distancing and defending self from anxiety and traumatic experiences. The transition from one personality to the other is related to stress and is sudden.

Depersonalization Disorder
Depersonalization disorder is an altered self perception in which client’s reality is temporally lost or changed. The client will have feelings of detachment and intact reality testing.

Specific Intervention for Dissociative Disorder Client:

• Develop a trust with the client.
• Encourage verbal expression of anxiety and concerns.
• Encourage client to explore methods of coping.
• Orient the client and identity sources of conflicts.
• Focus on the client’s strengths and skills.
• Use stress reduction techniques.
• Allow the client to progress at his or her own pace.
• Plan for individual, group, and family psychotherapy.

Somatoform Disorders

Somatoform disorders are group of disorders in which physical symptoms suggesting physical disorders for which there are no demonstrable organic findings or known physiologic mechanisms. There is a strong presumption that the symptoms are linked to psychological factors. The client focuses on the physical signs and symptoms and is unable to control the signs and symptoms. The signs and symptoms increase with psychosocial stressors.

There are three types of somatoform disorders: conversion disorder, hypchondriasis, and somatization disorder.

Conversion Disorder
Conversion disorder is a mental disorder in which an unconscious emotion conflict is expressed as an alteration or loss of physical functioning without any organic causes. The most common conversion symptoms are blindness, deafness, paralysis, and the inability to talk.


Clients with conversion disorder will have physical limitation or disability, feeling of guilt, anxiety, or frustration, low self esteem, feeling of inadequacy, unexpressed anger or conflict, and secondary gain.

Hypochondriasis
Hypochondriasis is a delusion that one is suffering from some disease for which no physical basis is evident. Hypochondriasis can cause impaired social and occupational functioning.

Clients with hypochondriasis will have frequent somatic function, complaints of fatigue and insomnia, preoccupation with physical function, anxiety, difficulty expressing feelings, extensive use of remedies or nonprescription medications, repeatedly visiting doctors, and secondary gain.

Somatization Disorder
Somatization disorder is a mental disorder characterized by complicated medical history and multiple physical complains involving multiple body systems without any organic basis. Somatization disorder can result from anxiety, fear, depression, worry or repressed anger. The client may use somatization for secondary gains such as increased attention or decreased responsibilities.

Clients with somatization disorder will have physical complaints of pain, signs of anxiety, fear and low self esteem, psychosocial symptoms, and secondary gains.

Specific Interventions for somatiform disorders:

• Assess nursing history and physical problems
• Do not reinforce the sick role and discourage verbalization about physical symptoms.
• Allow specific time period to discuss physical complaints.
• Assist client to identify alternative ways of meeting needs.
• Convey understanding that the physical symptoms are real to the client and assure that physical illness has been ruled out.
• Explore the source of anxiety and encourage verbalization of anxiety.
• Use relaxation techniques as the anxiety increases.
• Encourage diversional activities to decrease the focus on self.
• Report and assess any new physical complaint.
• Positive feedback for accomplishments.
• Establish a written contract with the client.
• Administer anti-anxiety medication as prescribed.

Obsessive Compulsive Disorder

Obsessive compulsive disorder is a type of anxiety disorder whose essential feature is recurrent obsession, persistent, intrusive ideas, thoughts, impulses or images, or compulsion. Compulsion means repetitive, purposeful and intentional behaviors performed in response to an obsession. The person may have both obsession and compulsions that can disrupt normal activities. An example of this disorder is excessive and repeated hand washing to ward off infection.

A person act compulsive behavior patterns can decrease the anxiety that associated with the obsessive thoughts and during stressful time, the ritualistic behavior will be increased. Most of the patient with obsessive compulsive disorder has variety of defense mechanism include repression, displacement, and undoing.


Cause of obsessive compulsive disorder was rare. Some reports have linked obsessive compulsive disorder to head injury and infections and about 20% of those with this disorder have motor tics related to tourette syndrome.

Intervention:

• Try to identify the situation that precipitates the behavior.
• Do not interrupt the compulsive behavior.
• Allow time for the patient to perform the compulsive rituals.
• Keep the client safety
• Make a schedule for patient that can distracts from the ritual.
• Set limit on the ritual.
• Encourage the patient to verbalize concerns.
• Establish the written contract that can assist to decrease the frequency of compulsive behavior.