[Mental] Schizophrenia

1. Clinical Features

Positive/Psychotic symptoms

Pathologic excess ( Hallucinations, Delusions, Disorganized thought/incoherent speech, Disorganized/agitated behavior )

Disorganized thought/incoherent speech (Loose associations: derailment, no locial flow, Neologisms:New words, Tangentiality: diverges from the main topic, word salad: jumbling with no meaning, Echo...)

Negative symptoms

Pathologic deficit: ( Apathy-lack of motivation, poor hygiene, eating, sleeping and elimination-, Asociality, Affective flattening-emotional flattening/monotone speech, Anhedonia-inability to experience pleasure )

Catatonia(immobility, peculiar postures, and unresponsiveness)

Psychomotor slowing or agitation

 

Hallucinations: False sensory perception in the absence of stimuli

-Auditory:Hearing voices or noises

-Visual:Seeing things or people

-Tactile: Feeling bodily sensations

-Olfactory: smelling

 

Delusions: believes the idea.

-Paranoid (persecutory) delusions : The aliens are trying to posion me with the tap water.

-Grandiose delusions

-Delusion of reference :That song is a message sent to me in secret code.

: Delusion of reference cause clients to feel as if songs, newspaper articles and other events are personal to them. 

-Delusion of control

 

 

2. Antipsychotics

-first generation (typical): haloperidol

-2nd generation (atypical): aripiprazole, olanzapin, quetiapine, risperidone.

They mainly help positive/psychotic symptions.

-Long-acting injectables improve adherence and outcomes.

 

3. NRS action

General :

i) Bulid client trust

-Be honest and consistent in interactions

-Frequent and short interaction times

-Sit calm in client's room, if needed

ii) Avoid touching the client without informing

iii) Maintain a balanced neutral approach (not overly warm)

iv) Explain precedures step by step

v) Initiate activities on a one-on-one basis -> then small groups

 

Hallucinations

i) Monitor cues

ii) Ask client directly about content of halluciation: what are you hearing? what are you seeing?

iii) Monitor for worsening anxiety ot agitation

iv) Decrease stimuli or assist the client to another area

v) Provide distraction (eg. music with headphones) auditory halluciation이 있다면 굿

vi) Explain verbally what is real and unreal; do not joke or judge

vii) Engage the client's attention through structured small acticities

viii) Check for suicidal/homicidal ideation due to commend hallucinations. 

(목소리가 들린다는 환자한테 Don't pay any attention to the voice라고 강압적으로 하지 말고, What are the voices saying to you? 라 하며, Explore the content of the hallucinations. )

 

 

Delusions

-Active listening and empathy

-Do not argue or try to convince the client that the delusions are false

-Shift conversation on reality-based topic, rather than on the delusion

-Canned or prepackaged foods.

-Open medication package in front of the client

:check mouth and palms after medication administration .

-positive reinforcement

 

Negative symptoms

-Social skill training

-Measure client readiness to engage with others 

 : Praise pregress towards increased interaction

-Assist with activities of daily living. (Small steps make acomplishment!)

 

Catatonic type

-Fluid and nutrition is a priority.