Schizophrenia

Schizophrenia and comorbidities

• Hypertension, obesity, and diabetes -> death from cardiac disease is higher than in the
• Atypical medications create weight gain, worsening cholesterol and triglycerides levels and diabetes
• Tobacco use, smoking -> heart disease

The Negative Impact of Severe Mental Illness

• Impairment – hallucination, depression
• Dysfunction – lack of work adjustment skills, social skills, or ADL skills
• Disability – unemployment, homelessness
• Disadvantage – discrimination, poverty

Nurse’s feelings & self-assessment

• Pt’s anxiety, loneliness, dependence, distrust -> N’s uncomfort
• Feelings of helplessness -> anxiety -> defensive behaviors ie denial, withdrawal, avoidance -> burnout
• Peer group supervision can be helpful
• Periodic reassessment of Tx goals,

Family/care taker education

• Teaching about the disease –S/S
• Medication teaching and side-effect management
• Cognitive & social skills enhancement
• Identifying signs of relapse
• Attention to deficit in self-care, social and work functioning
• Exploration of community resources

Signs of Potential Relapse

• Feeling of tension
• Difficulty concentrating
• Trouble sleeping
• Increased withdrawal
• Increased bizarre/ magic thinking

Schizophrenia - overview

• Diagnosis - criteria
• Prevalence - age and gender
• Course of illness - phases, warning signs
• Medication management - side effect, coping
• Psychosocial rehabilitation - ind, gr, fam…
• Community resources
• Stress management

Review of antipsychotics

• Typical & atypical med/ type I & II S/S
• Clozaril – arrhythmia, agranurocytosis
• Anticholinergic drugs -> memory impaired
• High-potency -> EPSEs, NMS
• Low-potency drugs -> anticholinergic symptoms
• Half-life of the medication – safety, elderly
• Reduced rate of relapse (about 2.5 times less)

Care of Hallucinations & Delusions

• Hallucinations
• Content of hallucination – commanding H
• -> suicidal or homicidal
• N’s attitude – nonjudgmental, nonthreatening
• Eye contact, louder voice, call the person by name
• Delusion
• Be empathic - Clarify the reality of the pt’s intent
• Clarify misinterpretations of the environment
• No argument

• Great wall, China