Andrew Solomon “Depression, The Secret We Share” Watch a Video http :// www.ted.com/talks/andrew_solomon_depression_the_secret_we_share.html Video Link
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Slide 1
Slide 2
http://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share.html
Video Link
Slide 3
PVN 123 Mental Health Nursing
Slide 4
Identify common subjective and objective evidence associated
with common mental health disorders Anxiety Disorders Depression
Bipolar Disorders Schizophrenia Personality Disorders Cognitive
Disorders Substance and other dependencies Eating Disorders
Identify nursing interventions, therapies, screening tools, that
may be utilized in the safe care, management, and health promotion,
for individuals who experience these disorders. Determine desired
outcomes associated with these disorders
Anxiety Response to stress High levels result in behavior
changes Tends to be persistent (often disabling) Levels of anxiety
Mild (restless/irritable/increased motivation) Moderate
(agitated/muscles tighten) Severe (unable to function / ritualistic
behaviors / unresponsive) Panic (distorted perception /
hallucinations / loss of rational thought / immobility)
Slide 7
Anxiety Disorders Panic Disorder Recurrent panic attacks
Phobias Unreasonable fear of objects or situations
Obsessive-Compulsive Disorder (OCD) Unrealistic obsessions
(thoughts) Compensated for with compulsive behaviors Ex: repeatedly
cleaning an object or constant hand washing Generalized Anxiety
Disorder (GAD) Excessive worry (more than 6 months) Stress-related
Disorders Acute Stress Disorder After exposure to traumatic event
Causes numbing, detachment, amnesia about the event (no more than 4
weeks) Posttraumatic Stress Disorder (PTSD) Caused by a traumatic
event Fear, horror, flashbacks, detachment, foreboding, restricted
affect Impairment lasts longer than one month and can last for
years
Slide 8
Coping and Defense Mechanisms Anxiety Disorders: Displacement
Undoing, reaction formation Intellectualization Isolation
Repression *** If you dont remember these from last class look them
up!!!
Slide 9
Risk Factors Anxiety Disorders: Much more likely in women
(except OCD) Precipitated by exposure to traumatic event or
experience Experiencing smells or sounds associated with the event
Can trigger panic attack Can be due to acute medical condition
Always rule out a physical cause Can be related to current use or
withdrawal from a chemical substance (ex: alcohol)
Slide 10
Subject/Objective Data Panic Disorder Panic episodes last 15 to
30 minutes Four or more of the following: Palpitations SOB Choking
/ sense of smothering Chest pain Nausea Feelings of
depersonalization Fear of dying / insanity Chills and hot flashes
Behavior changes / persistent worries about next attack Agoraphobia
(fear of being in places or situations of previous attacks)
Slide 11
Subjective/Objective Data Phobias: Social Phobia (fear of
embarrassment) Unable to perform in front of others Dread social
situations Believe others are judging them negatively Impaired
relationships Agoraphobia (fear of being outside) Impaired ability
to work or perform duties Other Phobias (ex: fear of strangers,
flying, the dark) Fear specific objects, experiences or
situations
Slide 12
Subjective/Objective Data OCD Ritualistic behaviors Difficulty
meeting self care needs If performing constant hand washing Skin
damage Infection
Slide 13
Subjective/Objective Data GAD Impairment in one or more areas
of functioning Ex: work-related duties, self care At least three of
the following manifestations Fatigue Restlessness Trouble
concentrating Irritability Muscle tension Sleep disturbance
Slide 14
Subjective/Objective Data Stress-Related Disorders
Slide 15
Standardized Screening Tools Anxiety Disorders Hamilton Rating
Scale for Anxiety Modified Spielberger State Anxiety Scale (see
handouts)
Slide 16
Nursing Care Anxiety Disorders Structured interview keep client
focused During Crisis or in Acute Anxiety: Provide safety and
comfort for client and staff Do not reinforce teaching unable to
problem-solve Remain with client and provide reassurance THEN
Slide 17
Nursing Care (continued) Anxiety Disorders Provide Milieu
Therapy Structured environment Monitor/protect from harm Daily
activities / focus on cooperation and sharing Use therapeutic
communication skills Open ended questions Help client to express,
validate, and acknowledge feelings Allow client to participate in
decision making Encourage relaxation techniques Mild to moderate
anxiety Instill hope for good outcomes (no false reassurance)
Enhance self-esteem Encourage positive statements Discuss past
achievements Assist to identify interfering defense mechanisms
Client Education
Slide 18
Other Therapies Anxiety Disorders Cognitive Reframing
Behavioral Therapies Relaxation Training Modeling Systematic
desensitization Flooding Response prevention Thought stopping Eye
Movement Desensitization Therapy (EMDR) Unfreezes fragments or
trauma Group/Family Therapy (PTSD)
Slide 19
Medications Anxiety Disorders Antidepressants Zoloft, Elavil
Sedative hypnotic anxiolytics Valium Serotonin Norepinephrine
reuptake inhibitors Effexor Non-barbiturate anxiolytics Buspar
Other Medications ***( used as mood stabilizers) Beta Blockers
Antihistamines Anticonvulsants Remeron (serotonin norepinephrine
dis-inhibitor) Used to help clients rest when panic attack occurs
during sleep
Slide 20
Client Outcomes! Anxiety Disorders Will verbalize decreased
anxiety Will be rested upon awakening Will develop realistic goals
for the future Will regularly attend support group Will demonstrate
appropriate use of relaxation techniques
Slide 21
Quick Quiz! (answers in your book!) OCD Panic Disorder Acute
Stress Disorder Agoraphobia Social Phobia PTSD Traumatic event
causing symptoms for months after event takes placeA Exposure to a
traumatic event, resulting in numbing, detachment, and amnesia
about the event for up to 4 weeksB Fear of speaking with or
interacting with others C Clinical findings including chest pain,
palpitations, feelings of impending doomD Fear of being out in open
spaces E Ritualistic compulsions and recurrent thoughts F
Slide 22
Quick Quiz! A client being evaluated in her providers office
tells the nurse, I remove my old makeup and apply new makeup every
hour or so because I look horrible. The nurse should understand
that this behavior is characteristic of which of the following
disorders? A.GAD B.Agoraphobia C.OCD D.PTSD
Slide 23
Quick Quiz! When collecting data from a client who states that
she has been dealing with constant anxiety for the past few weeks,
the nurse should use which of the following communication
techniques? _____Ask open ended questions _____Provide reassurance
_____Discuss the clients past achievements _____Offer advice about
how to reduce anxiety _____Invite the client to participate in
decision making
Slide 24
Dysthymic Disorder Major Depressive Disorder
Slide 25
I Had A Black Dog http://youtu.be/XiCrniLQGYc Watch the
Video!
Slide 26
About Depression Mood (affective) disorder Widespread issue
Ranks high among causes of disability Can be comorbid with: Anxiety
disorders Schizophrenia Substance abuse Eating disorders
Personality disorders Client may be at risk for suicide Personal or
family history of suicide attempts Comorbid anxiety or panic
attacks Comorbid substance abuse or psychosis Poor self esteem Lack
of social support Chronic medical condition
Slide 27
Depressive Disorders - MDD Major Depressive Disorder (MDD)
Single or recurrent episodes of unipolar depression Not associated
with mood swings (unipolar) Change in normal functioning Social,
occupational and self care deficits Plus. At least 5 of the
following occurring nearly every day (for most of the day) for a
minimum of 2 weeks: Depressed mood Difficulty with or excessive
sleeping Indecisiveness Decreased concentration Suicidal ideation
Changes in motor activity Unable to feel pleasure Increase or
decrease in weight ( 5% of total body weight over one month)
Slide 28
Dysthymic Disorder Milder and more chronic form of depression
Onset is early Childhood and adolescence Lasts at least 2 years
(adults) 1 year in children At least three clinical findings of
depression May become MDD later in life Clinical manifestations
less severe than with MDD
Slide 29
MDD Specific Classifications Psychotic Features Auditory
hallucinations, delusions Atypical Features Changes in appetite,
wt. gain, excessive daytime sleeping Postpartum Onset Begins within
4 weeks of childbirth May include delusions Mother and infant may
be at high risk Seasonal Characteristics Seasonal Affective
Disorder (SAD) Occurs during winter Can be treated with light
therapy Chronic Features Episode lasting more than 2 years
Slide 30
Phases of Depression
Slide 31
Depression Risk Factors Family history / previous personal
history of depression Twice as common among females 15 40 years
Very common among elderly More difficult to recognize May go
untreated May look like dementia Memory loss Confusion Behavioral
problems May seek help for somatic symptoms Other Risk Factors:
Stressful events Medical illness Postpartum female Poor social
network Comorbid substance abuse *May be primary disorder or
response to another mental or physical disorder
Slide 32
Subjective Data Depression Anergia (lack of energy) Anhedonia
(lack of pleasure in normal activities) Anxiety Sluggish (most
common) or unable to relax or sit still Change in eating patterns
Usually anorexia in MDD Increased intake with Dysthymia Change in
bowel habits (usually constipation) Sleep Disturbances Decreased
interest in sexual activity Somatic complaints (fatigue, GI
symptoms, pain)
Slide 33
Objective Data Depression Sad with blunted affect Poor grooming
/ lack of hygiene Slowed physical movement / slumped posture
Agitation (pacing/finger tapping) can also occur Little or no
effort to interact / socially isolated Slowed speech Decreased
verbalization Delayed responses
Medications - Depression Classification / Medication
ExampleNursing Considerations Selective Serotonin Reuptake
Inhibitors (SSRIs) Celexa (citalopram) Prozac (Fluoxetine) Zoloft
(Sertraline) Side effects include Nausea Headache CNS stimulation
(agitation/insomnia/anxiety) Sexual dysfunction may occur Weight
gain with long term use (follow healthy diet) Tricyclic
Antidepressants Elavil (Amitriptyline) Orthostatic hypotension
Dizziness change positions slowly Monoamine Oxidase Inhibitors
(MAOIs) Nardil (Phenelzine) Anticholinergic effects Sugarless gum
High-fiber foods Increase fluid intake (2-3L/day) Avoid foods with
tyramine! Ripe avocados Figs Fermented/smoked meats Liver Dried or
cured fish Most cheeses Some beer and wine Protein dietary
supplements **Combinations of medication and foods can cause
hypertensive crisis / death Sedative Hypnotic Anxiolytics
(Benzodiazepines) Valium (Diazepam) Ativan (Lorazepam) Watch for
CNS Depression Avoid using other CNS Depressants Avoid hazardous
activities Avoid caffeine (interferes with effect of medication)
Serotonin norepinephrine reuptake inhibitors Effexor (Venlafaxine)
Side effects include: Nausea Weight gain Sexual dysfunction
Nonbarbiturate Anxiolytics Buspar (Buspirone) Therapeutic effects
onset may take 2 to 4 weeks
Slide 36
Nursing Care Depression Milieu Therapy Self-Care Monitor
abilities to perform ADLs Encourage independence Encourage
participation in decision making Communication Relate
therapeutically Make time to be with client Make observations
rather than asking questions I notice that you were at group today
Give simple concrete directions Give client time to respond
Maintain a safe environment
Slide 37
Client Teaching for Anti-Depressant Medications Do not
discontinue medications suddenly May take time for therapeutic
effect 1 3 weeks for initial effect Up to 2 months for maximal
response Avoid hazardous activities Driving Operating heavy
equipment / machinery
Slide 38
Serotonin Syndrome Watch the video
http://www.youtube.com/watch?v=egfXW74LMi8
Slide 39
Other Treatments Psychotherapy Problem solving Increasing
coping abilities Changing negative thinking Increasing self-esteem
Assertiveness training Using community resources Alternative
Therapies St. Johns Wort Side effects (photosensitivity, skin rash,
rapid heart rate, GI distress, abdominal pain) Can increase or
reduce levels of medications being taken Serotonin Syndrome may
occur if taken with SSRIs, MAOIs, atypical antidepressants,
tricyclic antidepressants. Light Therapy First line treatment for
SAD Inhibits nocturnal secretion of melatonin Expose face to
10,000-lux light box for 30 min/day Electroconvulsive Therapy (ECT)
Specially trained nurse monitors the client before and after
procedure Watch for cardiovascular disease, neuromuscular
disorders, complicated pregnancy prior to treatment Transcranial
Magnetic Stimulation (TMS) Electromagnets stimulate the brain Vagus
Nerve Stimulation (VNS) Implanted device stimulates vagus
nerve
Slide 40
Electroconvulsive Therapy (ECT) Watch the video Sherwin Nuland:
How Electro-shock Therapy Changed Me
http://www.ted.com/playlists/9/all_kinds_of_minds.html
Slide 41
Client Education and Outcomes Education after discharge Review
clinical manifestations with clients and family Helps to identify
relapse Reinforce intended effects and side effects of meds Explain
importance and benefits of adherence to therapies Encourage Regular
exercise (30 min/day 3 to 5 days/wk) Shorter intervals are helpful
Outcomes The client will express increase in mood. The client will
adhere to the medication regimen. The client will remain safe and
notify provider of any thoughts of suicide.
Slide 42
Quick Quiz! A nurse is interviewing a 25 year-old client
diagnosed with dysthymia. Which of the following findings should
the nurse expect? A.There are wide fluctuations in mood. B.There is
no evidence of suicidal ideation. C.The symptoms last for at least
two years. D.There is an inflated sense of self-esteem.
Slide 43
Quick Quiz! A client is prescribed the SSRI paroxetine (Paxil),
but wants to continue taking St. Johns Wort. What should the nurse
tell the client and spouse about taking this medication
concurrently with St. Johns Wort?
Slide 44
Bipolar I Disorder Bipolar II Disorder Cyclothymia
Slide 45
Watch a Movie! - EXCELLENT!! "Up/Down" Bipolar Disorder
Documentary FULL MOVIE (2011) About 1 hours long Make some popcorn
and get comfy! Put up the Big Screen Enjoy and learn lots!!
http://www.youtube.com/watch?v=eyiZfzbgaW4
Slide 46
Bipolar Disorders Mood disorders Recurrent episodes of
depression and mania Usually emerge in late adolescence and early
adulthood Can be diagnosed in school age children Side effects of
medication and clinical manifestations of bipolar disorders mimic
symptoms of ADHD Children not usually diagnosed until after age 7
Periods of normal functioning alternating with illness Some clients
maintain occupational and social function Care mimics the phase of
the disease experienced
Slide 47
Bipolar Disorders and Comorbidities Bipolar Disorders Bipolar I
Disorder At least one episode of mania alternating with depression
Bipolar II Disorder More than one or more hypomanic episodes
alternating with MDD. Differs from Bipolar I Clients do not have
manic phases Cyclothymia 2 years of repeated hypomanic episodes
alternating with MINOR depressive episodes Comorbidities Substance
abuse More rapid cycling of mania Used for self-medication Direct
impact on onset of mental health disorder Anxiety Disorders Eating
Disorders ADHD
Slide 48
Watch a Video Laura Bain - Living with Bipolar Type II
http://www.youtube.com/watch?v=8Ki9dgG3P5M
Slide 49
Watch a Video Understanding Bipolar Disorder
http://www.youtube.com/watch?v=CDK50WQEOJc
Slide 50
Phases, Characteristics and Treatment Bipolar Disorders
Slide 51
Bipolar Behaviors Mania Abnormal elevated mood Described as
expansive or irritable Normally requires inpatient treatment
Hypomania Less severe than mania Lasts at least 4 days Accompanied
by 3 to 4 clinical findings of mania Hospitalization may not be
necessary Client is less impaired Mixed Episode Manic and major
depression experienced simultaneously Impaired functioning May
require hospitalization (self harm or other violence) Rapid Cycling
Four or more episodes of mania in 1 year
Slide 52
Data Collection Bipolar Disorders Risk Factors Physical illness
Substance abuse (cocaine / methamphetamine) Relapse Substance use
(alcohol, drugs, caffeine) May lead to manic episode Sleep
disturbances Before, associated with, or brought on by manic
episode Standardized Screening Tool Mood Disorders Questionnaire
(see handout)
Slide 53
Clinical Manifestations Bipolar Disorders Manic
CharacteristicsDepressive Characteristics Persistent elevated mood
(euphoria) Agitation and irritability Dislike of interference
Intolerant of criticism Increased talking and activity Flight of
Ideas rapid/continuous speaking with frequent topic changes
Grandiose view of self and abilities Impulsive Demanding /
manipulative Distracted easily Poor judgment Attention-seeking
behavior Impaired social and occupational function Decreased sleep
Neglect ADLs Possible delusions / hallucinations Denial of illness
Flat/blunted affect Tearful Lack of energy Anhedonia (loss of
pleasure/lack of interest) Discomfort or pain Difficulty
concentrating / problem solving / focusing Self-destructive
behavior Loss or increase of appetite Loss or increase of sleep
Disturbed sleep Psychomotor retardation / agitation
Slide 54
Nursing Care Bipolar Disorders Based on the phase of mania
clients are experiencing Acute Phase Focused on safety and
maintaining physical health Therapeutic Milieu (in acute care
setting) Provide safe environment Evaluate for suicidal thoughts,
escalating behavior Decrease stimulation Follow protocols for
restraints/observations/seclusion 1:1 if threat of self-injury or
harm to others Frequent rest periods Provide physical outlets Short
activities No high level concentration or detailed instructions
Monitor and maintain self-care needs Monitor sleep / fluid intake /
nutrition Provide nutritious foods to eat on the run Supervise
clothing choices Give step-by-step reminders Encourage independence
Communication Use calm and specific approach Give concise
instructions and explanations Provide consistency among staff
members Avoid power struggles Dont react personally to clients
comments List and act on legitimate grievances Reinforce
non-manipulative behaviors
Slide 55
Medications (examples) Bipolar Disorders Mood Stabilizers
(Lithium carbonate - Eskalith) Narrow therapeutic range = potential
for toxicity! (requires regular lab draws and testing) What is a
safe, effective dose for one person may be toxic to another.
According to the US Food and Drug Administration (FDA), in general
the desirable level is 0.6 to 1.2 mEq/L. However, they point out,
"Patients unusually sensitive to Lithium may exhibit toxic signs at
serum levels below 1 mEq/L. Antiepileptic Agents (Depakote,
Klonopin, Lamictal, Neurontin, Topamax) Act as mood stabilizers
Benzodiazepine (Ativan) Short term for addressing sleep impairment
related to mania Antidepressant (Prozac) Manage MDD Antipsychotic
(Risperdal) Manage psychotic disturbances during mania
Slide 56
Other Treatment / Discharge Care Bipolar Disorders ECT Used to
subdue extreme manic behavior Particularly used when medications
have not worked Can also be used for suicidal client or for rapid
cycling *See nursing actions related to ECT in prior slide Care
after Discharge Management of continuation and maintenance phases
Recommend case management to follow client Encourage group, family,
and individual psychotherapy Improve problem-solving and
interpersonal skills Reinforce teaching regarding Chronic nature of
the disorder Need for long-term pharmacological and psychological
support Factors of relapse Importance of maintaining sleep,
nutrition and activity pattern Medication administration and
adherence to regimen
Slide 57
Outcomes and Complications Bipolar Disorders Outcomes Client
will refrain from self harm Client will rest 4 to 6 hours / night
Client will maintain adequate fluid and nutrition intake Client
will use appropriate communication skills to meet needs Client will
participate in self-care Client will not experience relapse
Complications True manic episode client will not stop moving, does
not want to eat, drink, or sleep Episodes can last for weeks to
months Greater risk for psychotic episodes when manic Can become a
medical emergency Nursing actions include: Prevent harm to client
or others Decrease physical activity Promote fluid and food intake
Ensure 4 6 hours of sleep / night Manage medication
Slide 58
Quick Quiz! A client who has Bipolar I disorder is in the acute
phase and unable to eat or sleep. The clients moods change rapidly
from elated to agitated. If this client threatens to hit a staff
member or another client, which of the following verbal response by
the nurse is appropriate? A. You will be put in seclusion and kept
there if you make any more threats. B. Do not hit him or me. If you
cannot control yourself, we will help you. C. Thats enough! You
know we do not tolerate this type of behavior. D. That will only
make things worse. Why would you want to hurt someone?
Slide 59
Quick Quiz! A client who has Bipolar I Disorder is standing
with a group of clients in the mental health unit. The client is
talking excitedly and at great length about a variety of topics.
The nurse can see that the other clients are becoming anxious and
restless, but do not know what to do to stop the conversation.
Which of the following is the first action the nurse should take?
A. Give honest feedback B. Administer a sedative C. Set limits D.
Use distraction
Schizophrenia Group of psychotic disorders Affect thinking,
behavior, emotions, and ability to perceive reality May result from
combination of genetic and non-genetic factors Brain injury at
birth Nutritional factors Viral infection Hormonal imbalances
Typical onset in late teens/ early 20s Has occurred in young
children Diagnosis should not be made for children < 7 years
Rule out ADHD with violent tendencies May begin later in adulthood
Becomes problematic when clinical manifestations interfere with
relationships, self-care, ability to work
Slide 62
Categories / Taxonomies Schizophrenia Type of
SchizophreniaCommon Symptoms Paranoid Characterized by suspicion
toward others Hallucinations (auditory hearing voices) Delusions
(false/fixed beliefs) Other directed violence may occur
Disorganized Characterized by o Withdrawal from society o Very
inappropriate behaviors (poor hygiene / mutter to self) o
Frequently seen in homeless population Loose associations Bizarre
mannerisms Incoherent speech Hallucinations and delusions o Less
organized than in paranoia Catatonic Characterized by abnormal
motor movements Stages o Withdrawn o Excited Withdrawn Stage
Psychomotor retardation may appear comatose Waxy flexibility Often
have extreme self-care needs o Tube feeding unable to eat Excited
Stage Constant movement / unusual posturing/ incoherent speech
Self-care needs may predominate May be danger to self or others
Residual Active clinical manifestations no longer present Two or
more residual findings Anergia/ Anhedonia / Avolition Withdrawal
from social activities Impaired role function Speech problems
(Alogia) Odd behaviors (strange walking) Undifferentiated Clinical
manifestations of schizophrenia but do not meet criteria for any
other types Any positive or negative symptoms may be present
Slide 63
Other Psychotic Disorders Schizoaffective Disorder Criteria for
Schizophrenia plus one of the affective disorders Depression /
mania / mixed disorder Client often in acute phase of Bipolar I
with psychosis characteristics Brief Psychotic Disorder Clinical
manifestations last between 1 day and 1 month Schizophreniform
Disorder Clinical manifestations of Schizophrenia Duration 1 to 6
months Social dysfunction may or may not be present Sometimes Dx
used until further evaluation can be made Shared Psychotic Disorder
One person begins to share beliefs of another with psychosis. Also
called folie a`deux Secondary (induced) Psychosis Brought on by
medical disorder (Ex: Alzheimers) Can be caused by use of chemical
substances
Slide 64
Watch a Video What It's Like to Hear Voices (Schizophrenia) use
headphones for best experience
http://www.youtube.com/watch?v=0vvU-Ajwbok
Slide 65
Watch a Video I Hear Voices - A Story on Schizophrenia
http://www.youtube.com/watch?v=KBRAC4acr70
Slide 66
Characteristics and Behaviors Schizophrenia
CharacteristicsExamples of Behaviors Positive Symptoms Easily
identified clinical manifestations Hallucinations Delusions Speech
alterations Bizarre behavior (ex: walking backward constantly)
Negative Symptoms Manifestations more difficult to treat than
positive symptoms Affect (blunted) Algoia (may only respond vaguely
or mumble) Avolition (lack of motivation) o Can complete a task and
unable to start the next one without prompting Anhedonia (lack of
pleasure or joy) Anergia (lack of energy) Cognitive Symptoms
Problems thinking Makes independent living difficult Disordered
thinking Unable to make decisions Poor problem-solving Difficulty
concentrating Memory deficits Depressive Symptoms Hopelessness
Helplessness Suicidal Ideation
Slide 67
Types of Delusions DelusionsExamples Ideas of Reference
Misconstrue trivial events Attach personal significance to events
Believing others are talking about them Persecution Feeling singled
out for ham by others Grandeur Believe they are all powerful and
important Somatic Delusions Believe that body is changing in
unusual way o Growing a third arm Jealousy Feel spouse is involved
with someone else Being Controlled Believe outside forces control
them Thought Broadcasting Believe their thoughts are heard by
others Thought Withdrawal Believe thoughts have been removed from
their mind by someone/something else Religiosity Obsessed with
religious beliefs
Slide 68
Examples of Alterations in Speech, Perception, Behavior
Schizophrenia Flight of ideas Associative looseness May say
sentence after sentence Sentences may relate to several topics
Listener is unable to follow Neologisms Made up words Words only
have meaning to the client Ex: I trangled and flitted Echolalia
Repeating words spoken to them Clang Association Meaningless
rhyming words (often forceful) Ex: Oh fox, box, and lox Word Salad
Words jumbled together Little meaning or significance Ex: Hip
hooray, the flip is cast and wide- sprinting in the forest
Alterations in Speech Alterations in Perception Hallucinations
Auditory (hearing things) Visual (seeing things) Olfactory
(smelling odors) Gustatory (tasting things) Tactile (feeling
sensations) Alterations in Behavior Extreme agitation Stereotyped
Behaviors Automatic Obedience Wavy Flexibility Stupor Negativism
Echopraxia (imitates movements of others) Personal Boundary
Difficulties Depersonalization feeling of losing identity
Derealization feeling the environment has changes
Slide 69
Screening Tools Schizophrenia Global Assessment of Function
(GAF) Scale Helps determine ability to perform ADLs and function
independently Scale for Assessment of Negative Symptoms (SANS)
Simpson Neurological Rating Scale *** See Handouts!
Slide 70
Nursing Care Schizophrenia Use Milieu Therapy Promote
therapeutic communication Establish trusting relationship Encourage
development of social skills and friendships Encourage
participation in group work and psychotherapy Determine discharge
needs Relate wellness to symptom management Collaborate with client
Symptom management techniques Encourage medication compliance
Reinforce teaching regarding medications Communication Ask client
directly about hallucinations and delusions Dont argue or agree May
say: I dont hear anything, but you seem frightened (hallucination)
May say: I cant imagine that the President would have a reason to
kill a citizen, but it must be frightening for you to believe that
(delusion) Provide safety Focus on reality based subjects Identify
symptom triggers Be genuine and empathetic
Slide 71
Internet Moment Search this! Extrapyramidal Side Effects What
did you find? Write it down and bring it to class for
discussion
Slide 72
Medications Schizophrenia
Slide 73
Care after Discharge and Client Outcomes Schizophrenia After
Discharge Client Outcomes Recommend case manager to follow
Encourage group, family, and individual psychotherapy Improve
problem-solving / interpersonal skills Reinforce teaching Need for
self care to prevent relapse Medication Effects Side effects
Compliance Importance and resources for support groups Drug and
alcohol abstinence Journaling Monitor effectiveness of meds Journal
feelings and changes in behavior Client will regularly attend
support groups Client will maintain an appropriate level of
self-care Client will maintain medication adherence
Slide 74
Quick Quiz! Positive symptoms of Schizophrenia include which of
the following? _____Auditory hallucinations _____Lack of motivation
_____Minimal to no energy _____Delusions of persecution _____Motor
agitation _____Flat affect
Slide 75
Quick Quiz - Matching Answer Schizophreniform
DisorderAPsychotic symptoms caused by abuse of chemical substances
or physical illness Schizoaffective DisorderB An absence of active
symptoms of schizophrenia with two or more persistent or lingering
symptoms Shared Psychotic DisorderC Psychotic behavior lasting
between 1 and 6 months that may not impair the clients ability to
function at work or in social situations Residual
SchizophreniaDSymptoms of schizophrenia along with symptoms of
mania or major depression Induced PsychosisEOne person sharing the
delusional beliefs of a person who has psychosis