Schizophrenia Nursing Care and Management

What is Schizophrenia?

Schizophrenia is a psychiatric disorder in which the patients develop symptoms such as hallucinations, delusions, decreased emotional expression, and disordered thinking. These symptoms affect the patient’s ability to live a fulfilling life, and, in most cases, it causes disability and distress.

Schizophrenia patients record low levels of interpersonal relationships, functionality at work, and self-care since the beginning of the symptoms. Experience difficulties differentiating between fantasy and reality, and their behavior and speech may mystify people around them.

Schizophrenia Incidences

Schizophrenia incidences are relatively constant and may occur in all societies worldwide across different cultures and ethnicity. Globally, Schizophrenia is estimated to affect about 51 million people above 18 years, about 1.1% of the global population. For instance, in the United States, it is estimated that 2 million people are affected by Schizophrenia.

Typically, the onset of Schizophrenia in both men and women occurs during the late teenage years or early adulthood. However, the onset age and presentation of symptoms can differ. Schizophrenia prevalence is higher than Alzheimer’s, disease, diabetes, and multiple sclerosis.

Causes of Schizophrenia

Genetic factors: research shows that Schizophrenia runs in families; thus, the disease has a vital genetic component.
Prenatal stress and complications: exposure to complications and stress during pregnancy, such as viral infection and malnutrition, increases the chances of developing Schizophrenia.
Biochemical factors: neurotransmitter imbalances, a chemical that transmits signals in the brain, and structural abnormalities in the brain are believed to cause Schizophrenia.
Substance abuse: psychoactive drugs like LSD and Marijuana are believed to trigger or worsen Schizophrenia symptoms.

Signs and symptoms of Schizophrenia

Schizophrenia signs and symptoms are not universal and can differ from one patient to another. Typically, the signs and symptoms are either cognitive, negative, or positive.

Positive symptoms of Schizophrenia

Hallucinations: hearing, feeling, or seeing things that are not there.
Disordered thinking and speech: there are no logical connections between thoughts and difficult speech to understand.
Delusions: false beliefs that are against social and cultural norms.
Persecutory delusion: Schizophrenia patients think they are being followed, spied on, tricked, or tormented.

Negative symptoms of Schizophrenia

Anhedonia: it is a loss of interest or pleasure in previously enjoyed activities.
Flat affect: limited emotional expression or minimal response to stimuli.
Alogia: poverty of speech where the patient cannot express thoughts or reduced speech.
Asociality: reduced interest in relationships and social interactions.
Avolition: lack of motivation and face challenges in initiating goal-oriented behavior.

Cognitive symptoms of Schizophrenia

Processing speed: reduced ability to carry out different cognitive tasks effectively.
Visual and memory learning: compromised visual and memory recall.
Verbal learning and memory: compromised verbal and memory recall.
Executive function: compromised decision-making, planning, and problem-solving.
Working and attention memory: problems in retaining information and sustaining attention.

Phases of Schizophrenia

Schizophrenia is a chronic mental disease that typically progresses into three stages

· Prodromal Phase of Schizophrenia

In the prodromal phase, the patient may experience slight changes in behavior, mood, increased anxiety, strange beliefs, social withdrawal, and thinking.

· Active Phase of Schizophrenia

In this stage, Schizophrenia patients experience the full-blown symptoms of the disorder, such as delusion, reduced motivation, hallucination, and disorganized speech and behavior.

· Residual Phase of Schizophrenia

At this point of Schizophrenia, the patient continues to show some less severe symptoms. There are some noticeable improvements in functioning, like returning to school or work; however, they require ongoing support and treatment.

Types of Schizophrenia

Residual Schizophrenia

Residual Schizophrenia patients show symptoms such as declined positive symptoms like hallucinations and delusion but persistent negative symptoms like motivation, social withdrawal, and emotions. People with this kind of Schizophrenia experience difficulties functioning in their daily activities. However, they do not experience intense symptoms related to other sorts of Schizophrenia.

Undifferentiated Schizophrenia

This is a type of Schizophrenia where the patient experiences a mixture of symptoms like motor, disorganized speech and behavior, delusion, and hallucinations.

Disorganized Schizophrenia

The characteristic of disorganized Schizophrenia patients includes disorderly behavior and speech, hallucinations, and delusion. People with disorganized Schizophrenia experience difficulties handling basic tasks, and their speech may be incoherent or jumbled.

Catatonic Schizophrenia

Motor symptoms like lack of movement or excess movement distinguish catatonic Schizophrenia. In addition, Catatonic Schizophrenia patients may experience resistance to movement and unusual posture.

Paranoid Schizophrenia

Paranoid Schizophrenia is characterized by auditory hallucinations and delusion, primarily perceiving fear of conspiracy or persecution. Paranoid Schizophrenia patients also experience some suspiciousness and paranoia and struggle to relate with others.

Diagnosis of Schizophrenia

Diagnosis of Schizophrenia is based on examination of mental status, clinical observations, and psychiatry history of the patient, such as hallucinations, delusion, negative symptoms, and disordered thinking and speech.

Physical exam: involves eliminating other problems that cause similar symptoms and checking for associated complications.
Test and screening: include tests that help exclude conditions posing similar symptoms and screen for drugs and alcohol. CT scans and MRIs are significant in the diagnosis of Schizophrenia.
Psychiatric examination: this involves the assessment of the client’s mental status via monitoring demeanor and appearance and examining mood, thoughts, delusion, drug abuse, hallucinations, and potential for suicide and threats. In addition, the family and the patient’s history are discussed.
Diagnostic criteria for Schizophrenia: DSM-5, established by American Psychiatric Association

Medical management of Schizophrenia Nursing Care

The management of Schizophrenia may include:

Drug therapy: Schizophrenia is primarily treated using antipsychotic drugs, which help prevent worsening symptoms. Before the patient receives the treatment for the first time, Schizophrenia symptoms must be present in the last 12 to 24 months. The drugs used in managing Schizophrenia may include atypical and typical or conventional antipsychotic chlorpromazine.
Electroconvulsive Therapy: this Schizophrenia management method is rarely used but is suitable for acute Schizophrenia patients or those with low medication response. It is essential in minimizing depression and catatonic symptoms.
Other management methods: psychosocial treatment, Compliance with promotional programs, vocational counseling, rehabilitation, and supportive psychotherapy.

Nursing management of Schizophrenia

Nursing management of Schizophrenia patients includes:

Nursing assessment of Schizophrenia

Recognizing Schizophrenia. Record all signs and symptoms of Schizophrenia like poor social interactions, thought distortion, and speech abnormalities.
Maximize level of function. Examine the ability of the patient to carry out various activities like ADLs
Determine trust and rapport. Introduce your name to the patient and clearly explain your purpose. Don’t joke or tease the patient and be prepared to undergo vigorous testing.
Determine positive symptoms. Examine the patient for command hallucinations and explore for answers. Determine if the patient has well-organized, fragmented, poorly organized, and unsupported beliefs.
Assess the support system. Examine whether the patient’s family has the basic information about the disease. Assess if the family understands the importance of adherence to the medication.
Examine medication history. Determine if the patient is under medication, what they are, and therapy adherence.
Establish negative symptoms. Establish the negative symptoms of Schizophrenia.

Nursing diagnosis of Schizophrenia

Injury risk. Associated with delusion and hallucinations.
Suicide risk. Linked to marked changes and impulsiveness in behavior.
Compromised physical mobility. Associated with reluctance to move and depressive mood status.
Compromised social interactions. Associated with speech and thought problems
Risk for uneven nutrition. Self-neglect and minimal self-care leads to less nutrition than typical body requirements.
Low cardiac output. Associated with effects of the orthostatic drug.

Nursing Care Planning and Goals for Schizophrenia

Elevate patient Compliance with nursing and treatment plans.
Aid the patient in obtaining optimum function level.
Minimize the harshness of Schizophrenia symptoms.
Stop the reoccurrence of acute episodes
Address both the psychosocial and physical needs of the patient.

Nursing interventions for Schizophrenia

Promote social skills. Provide the patient with the support needed to learn social skills.
Ensure enough nutrition. Observe the patient’s nutritional requirements and let them fix their food if they think it is poisoned or supply them with food in closed containers.
Keep it real. The patients should be engaged in reality-oriented activities involving human contact, like workshops.
Ensure safety. provide the patient with a safe environment and reduce stimulation.
Increase functionality level. Work with patients to maximize their sense of responsibility and reward positive behavior.
Establish rapport and trust. First, ask the client what you intend to do before touching them. Ensure you establish trust via a consistence approach and repeated contact. Use precise language that the patient understands and always convey a sense of hope for improvement.
Presenting reality to deal with hallucination. Explore hallucination and don’t argue about it. Tell the patient you don’t smell, feel or hear it but that you know what they hear, see, or think is real to them.
Increase family involvement. Engage the family in the treatment plan and make them aware of impending relapse.
Monitor drug therapy and increase Compliance. Encourage the patient to comply with prescribed drugs.

Evaluation of Schizophrenia

Determine the mental status of the patient via checking orientation to reality.
Evaluate adherence to health instructions like timely intake of drugs, family involvement, and increased activity independence.
Assess the efficiency of the medication therapy by measuring the presence and absence of acute episodes of Schizophrenia.
Evaluate the social functioning of the patient and their ability to associate with others.

Documentation of Schizophrenia

Note the identified symptoms, both negative and positive.
Document patient behavior during the execution of suicide safety precautions.
Note the client’s statement during the execution of homicide precautions. Notify the potential targets and the doctor.
Keep a record of start and end times when utilizing the restraint.