CHAPTER 12:
Schizophrenia:
● Positive s/s: “add-ons” behaviors that shouldn’t be there
○ Alterations in reality: delusions (false, fixed beliefs). Common:
persecutory, grandiose, referential, & somatic
○ Alterations in speech: associative looseness (disorganized thinking),
word salad, clang associated (rhyming), & neologisms (made-up
words)
○ Alterations in perception: hallucinations (auditory most common) &
illusions
○ Alterations in behavior: catatonia, motor agitation/retardation, & waxy
flexibility
● Negative s/s: absence of human qualities; impair quality of life & function
○ “A” s/s: apathy (lack of interest), avolition (no motivation), anhedonia
(no pleasure), asociality, affective flattening
● Nursing care:
○ Phases:
1. Prodronal: subtle s/s like anxiety, distressing thoughts, & concentration
issues
2. Acute: focus on pt & med stabilization
3. stabilization/maintenance: help pt understand the illness, adhere to Tx,
prevent relapse, & become independent
● Safety: regularly assess for suicide/violence & monitor fluid intake
(polydipsia is a s/e of most meds)
● Med adherence: address anosognosia & educate family & pt
● Psychosocial support: for family & pt on relapse prevention, coping
skills, & community resources (NAMI)
● Nursing interventions for psychosis:
○ Hallucinations: watch for indicators & ask abt the content w/o
validating them as real. Also encourage competing stimuli like
listening to music or humming
○ Delusions: build trust, be blunt, never debate/argue w/delusional
content, focus on reality-based activities in the present
Schizophrenia:
● Positive s/s: “add-ons” behaviors that shouldn’t be there
○ Alterations in reality: delusions (false, fixed beliefs). Common:
persecutory, grandiose, referential, & somatic
○ Alterations in speech: associative looseness (disorganized thinking),
word salad, clang associated (rhyming), & neologisms (made-up
words)
○ Alterations in perception: hallucinations (auditory most common) &
illusions
○ Alterations in behavior: catatonia, motor agitation/retardation, & waxy
flexibility
● Negative s/s: absence of human qualities; impair quality of life & function
○ “A” s/s: apathy (lack of interest), avolition (no motivation), anhedonia
(no pleasure), asociality, affective flattening
● Nursing care:
○ Phases:
1. Prodronal: subtle s/s like anxiety, distressing thoughts, & concentration
issues
2. Acute: focus on pt & med stabilization
3. stabilization/maintenance: help pt understand the illness, adhere to Tx,
prevent relapse, & become independent
● Safety: regularly assess for suicide/violence & monitor fluid intake
(polydipsia is a s/e of most meds)
● Med adherence: address anosognosia & educate family & pt
● Psychosocial support: for family & pt on relapse prevention, coping
skills, & community resources (NAMI)
● Nursing interventions for psychosis:
○ Hallucinations: watch for indicators & ask abt the content w/o
validating them as real. Also encourage competing stimuli like
listening to music or humming
○ Delusions: build trust, be blunt, never debate/argue w/delusional
content, focus on reality-based activities in the present
