Paranoid Schizophrenia

Nicole Lemermeier
Natalie Stottlemyer
Katie Wharton
Nicole McNamee-Nelan
Britney Yousif
 Schizophrenia: Disturbance in thought
process perception and affect in variable
result in a severe deteriation of social and
occupational functioning

Developmental Process of
Schizophrenia
Most current theory is
schizophrenia is a biologic
based disease
Influenced by external or
internal environment
There are 7 theories of
paranoid schizophrenia
Theory of Genetics
Theory of Family relationship
The Biological Theory
The Physiological Theory
The Physical Theory
The Environmental Theory
Theory of Stressful life Events

Developmental Process of
Schizophrenia
Schizophrenia has been around since the
ancient Egyptians
The term Schizophrenia is Greek and
means split mind
In 1908 Swiss psychiatrist Eugen Bleuler
coined the phrase schizophrenia

History of Schizophrenia
Cliniciansbelieve there will never be one
treatment for schizophrenia
It is now widely believed that many
factors cause schizophrenia
In psychology, schizophrenia is the most
widely studied disorders to date

History of Schizophrenia
Suicideis the primary cause of premature
death among schizophrenics
40%-55% of schizophrenics experience
some form of suicidal ideation
20%- 50% have made at least one
attempt at suicide

History of Schizophrenia
About 1% of the entire population of the
United States is schizophrenic
Even thought the cause is unknown
genetics are believed to play a large role
in the disorder
Siblings are 5%- 10% more likely to
become schizophrenic
Twins are 50 times more likely than any
other group

History of Schizophrenia
Symptomatology
One of the most damaging of all mental
disorders
Causes its victims to lose touch with
reality
Begin to hear, see, or feel things that
aren't really there (hallucinations)
Become convinced of things that simply
aren't true (delusions
Symptoms begin in late 20’s to late 30’s
Develops gradually, although onset can be
sudden
Confusion
Inabilityto make decisions
Hallucinations
Changes in eating or sleeping habits, energy level, or weight
Delusions
Nervousness
Strange statements or behavior
Withdrawal from friends, work, or school
Neglect of personal hygiene
Anger
Indifference to the opinions of others
A tendency to argue
A conviction that you are better than others, or that people are out
to get you

Symptomatology
Less likely to be affected by mood and
thinking problems, concentration and
attention
Most affected by positive symptoms
Indicate the presence of unusual thoughts
and perceptions that often involve a loss
of contact with reality
Delusions and hallucinations are
considered positive symptoms

Symptomatology
Symptomatology
Negative symptoms effect social interactions
Less predominate symptoms of
schizophrenia
Associated with loss or reduction in
emotions, motivation, and pleasures
May show social withdrawal, lack of
conversation, indifference to appearance,
and safety
 Inability to change facial expressions
according to mood, monotone voice, and
disinterest with their surroundings
J.H. is a 24 y/o male who was brought in
to the ED by the local police. He had
attacked his sister with a knife. She was
trying to convince him that the voices he
was hearing were not telling him to kill
himself. His family claims he has not been
taking his medications. In the ED, he tells
the nurse “I see secret agents watching
me at night. They want to implant chips in
me. The voices told me if I kill myself then
they will fail.”
Case Study
Nursing Diagnosis
Risk for injury to self and
others.
R/T
 Auditory
hallucinations
 Command
hallucinations
 Visual hallucinations
 Paranoid delusions
 Suicidal ideations
 Homicidal ideations
S: “I see secret agents
watching me at night. They
want to implant chips in me.
The voices told me if I kill
myself then they will fail.”
O: At home patient attacked
his sister with a knife. Patient
was threatening to kill
himself because the voices
told him to.
Short Term & Long Term
Goals
STG:
By day five of hospitalization
patient will report a
decrease in auditory and
visual hallucinations,
delusions, suicidal ideations
and homicidal ideations.
LTG:
Patient will remain free from
harming self and others
during length of hospital
stay.
Interventions
STG
1) Use distraction or
redirection of patient’s
attention when agitated.
2) Ask what the voices are
telling the patient
3) Administer antipsychotic
medications as prescribed.
LTG
1) Remove items such as
belts, scarves, razor blades,
shoelaces, scissors- anything
that could be used for self-
harm. Check all items
brought into the unit by
patient. Instruct family
members to avoid bringing
into the unit any hazardous
items.
2) Routinely check
environment for hazards and
ensure environmental safety.
3) Intervene at earliest signs
of agitation. Use direct
commands to bring about
positive behavior in patient.
Rationales Evaluation
STG
1) Using patients distractibility STG
avoids confrontation and By day five from admission
maintains safety (Swearingen, patient states “ I don’t see
2008, p.754) people at night, I still hear
2) It is essential to know if voices sometimes but not as
“voices” are command
much, and I know there are
hallucinations that tell the
still people out to get me. I
patient to harm self or others.
This question also
know if I keep taking my
communicates that the nurse medications the voices will
does not hear the voices while go away hopefully.”
at the same time validates Continue with plan and
presence of the voices in the reevaluate in two days.
patient’s reality. (Swearingen, LTG
2008, p.771) Patient was discharged in ten
3) Antipsychotic medications
days from admission and
reduce psychotic symptoms
including hallucinations.
remained free from any self
(Swearingen, 2008, p.771 induced injuries or injuries
LTG towards others.
1) This provides environmental
safety and removes potential
suicide weapons. (Swearingen,
2008, p.764)
2) Minimizing opportunities for
self-harm is an ongoing concern
requiring constant vigilance.
(Swearingen, 2008, p.764)
3) Early intervention assists
patient in regaining control,
defuses a difficult situation,
prevents violence, and enables
treatment to continue in least
restrictive manner.
(Swearington, P. 746)
Nursing Diagnosis Short Term & Long Term Interventions Rationales Evaluation
Goals
STG: 1) It is essential to know if “voices” are
Disturbed sensory STG: 1) Ask what the voices are command hallucinations that tell STG: By day five from
perception Patient will report a telling the patient patient to harm self or others. This admission patient states “I
R/T decrease in hallucinations 2) Assure patient that you will question also communicates that the don’t see people at night, I
nurse does not hear the voices while at
 Auditory by day four of taking provide safety for him still hear voices sometimes
the same time validates presence of
hallucinations antipsychotic medications regardless of what the voices but not as much, and I know
the voices in the patient’s reality.
 Visual as scheduled. say will happen. (Swearingen, 2008, p.771) there are still people out to
hallucinations LTG: 3) Avoid touching patient 2) This provides an anchor to reality get me. I know if I keep
S: By discharge patient will LTG: and decreases patient’s fear that harm taking my medications the
“I see secret agents recognize hallucinations 1) Administer antipsychotic will occur based on what voices say. voices will go away
watching me at night. are not part of reality. medications as prescribed. (Swearingen, 2008, p.771) hopefully.”
They want to implant 2) Evaluate and observe for 3) Distortion of reality may lead patient Continue with plan and
chips in me. The voices hallucinations. Redirect back to misinterpret physical touch which reevaluate in two days.
told me if I kill myself to reality by distracting along with excessive environmental LTG: Patient states “I know
stimuli can increase anxiety and that the hallucinations are
then they will fail.” patient with conversation. precipitate hallucinations or aggressive
O: 3) Investigate with patient part of my schizophrenia and
response. (Swearingen, 2008, p.771)
Patient is talking to sources of stress and explain 1) Antipsychotic medications reduce not part of other people’s
himself. He appears to the relationship of anxiety psychotic symptoms including lives”
turn towards stimuli and stress to hallucinations. hallucinations. (Swearingen, 2008,
unseen by others. p.771)
2) Early assessment enables evaluation
of patient’s response for hallucinations
and how much time patient focuses on
them. It also enables the nurse to
assess if hallucinations place patient or
others at risk and permits early
intervention to protect patient as well
as others.
3) Providing information about the
relationship of anxiety and stress to
hallucinations gives the patient
increased control over the occurrence
of hallucinations. (Swearingen, 2008,
p.772)
 Nursing Diagnosis Short Term and Long Interventions
Term Goals
Noncompliance STG: 1) Assess patient’s
medication therapy Patient will willingly take understanding of the
R/T all prescribed disease process, medical
 Perceived medications in one week management, and
negative from admission. treatment plan. Explain
consequences of LTG: or clarify information as
the treatment. By discharge patient will indicated.
 Exacerbation of state reasons for taking 2) Assess for causes of
psychotic medications and nonadherence, such as
thinking and commitment to taking all financial constraints,
behavior. scheduled medications at inconvenience,
S: Patient refused to home. forgetfulness or memory
answer questions problems, medication
regarding why he has not side effects,
been taking his misunderstanding of
medications. instructions, or difficulty
O: Family notes patient making significant
has not been taking his lifestyle changes or
medications. following medication
schedule.
3) Promote patient’s
expression of feelings. In
addition, evaluate
patient’s perception of
effectiveness or
ineffectiveness of
treatment.
1) Confront myths and
stigmas. Provide realistic
assessment of risks, and
counter misconceptions.
2) Assess patient’s
support systems.
3)After the reason for
nonadherence is found,
intervene accordingly. If
it appears that changing
medical treatment plan
may promote adherence,
discuss this possibility
with health care provider.
Provide patient with
information about
interventions that can
minimize drug side
effects.
Rationale Evaluation
1) This assessment enables nurse STG:
to explain or clarify information as By day four patient is willingly
indicated and facilitates taking all medications
development of an individualized prescribed.
care plan that promotes LTG:
adherence. By discharge, patient is able to
(Swearingen, 2008, p.330) state “I know my medications
2) Once causes are identified, the will help my schizophrenia so I
nurse can then focus the care plan don’t have hallucinations and I
accordingly. (Swearingen, 2008, plan to take them the way they
p.330) are prescribed at home.”
3) This will help clarify patient’s
perception of vulnerability to the
disease process and signs of
denial of the illness. (Swearingen,
2008, p.330)
1) This will help determine if a
value, cultural conflict, or spiritual
conflict is causing nonadherence.
(Swearingen, 2008, p.330)
2) This will help determine if a
family disruption pattern is
making adherence difficult and
“not worth it”. (Swearingen, 2008,
p.331)
3) All my help facilitate
adherence. (Swearingen, 2008,
p.331)
Individual Psychotherapy
◦ 1 on 1 therapy.
◦ Primary Focus: decrease anxiety, increase trust.
◦ Can be difficult because they can become defensive and
suspicious.

Group Therapy
◦ Useful when combined with medication therapy.
◦ Primary Focus: real life plans, problems, and relationships.
◦ Reduces social isolation.
◦ More effective for out patient treatment once their medications
are effective.

Psychological Treatment
Milieu Therapy
◦ Focused on group/social interactions.
◦ Goal oriented, clear communication.
◦ More effective when used with psychotropic meds.

Family Therapy
◦ Some therapist believe that in order to treat a paranoid schizophrenic, they must treat the
entire family.
◦ Educate family on illness and how to help treatment with family communication and problem
solving.
◦ Extremely positive results because it helps build a support system for the client.

Assertive communication Treatment

◦ Involves a team of health care professionals: Psychiatrist, Nurses, Social Workers, Vocational
Rehabilitation Therapist, and Substance Abuse Counselors.
◦ “Individually tailored to basic living skills, helping clients work with community agency, and
assisting clients in developing a social support network.

Social Treatment
Psychopharmacology:
◦ Antipsychotics- very effective treatment.
◦ “Without drug treatment, 70%-80% of people who have experienced
a schizophrenic episode will relapse over the next 12 months”
◦ Works best when combined with psychosocial therapy.
◦ Takes several weeks for medications to take effect.
Meds used:
◦ Cholorpromazine ( Thorazine)
◦ Thiothixene (Navane)
◦ Italoperidol (Haldol)
◦ Clozapine (Clozaril)
◦ Aripiprazole (Abilify)

Organic Treatment
Common Side Effects:
◦ Nausea
◦ Skin rash
◦ Sedation
◦ Orthostatic hypotension
◦ Tachycardia
◦ Photosensitivity
◦ Decreased libido
◦ Weight gain
◦ EPS
◦ Tardive dyskinesia
◦ NMS

Organic Treatment
 Kennard, J. (December 12, 2007). Positive and negative symptoms: a
helpful concept. Retrieved from
http://www.healthcentral.com/schizophrenia/c/674/17705/concept
 Mayo clinic staff (December 16, 2008). Paranoid schizophrenia. Retrieved
from
http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862/DSE
CTION=symptoms
 Swearingen, P. L. (2008). All-in-one care planning resource. St. Louis,
Missouri: Mosby Elsevier.
 Townsend, M. (2008). Essentials of psychiatric mental heakth nursing.
Philadelphia, PA: F.A. Davis Company.

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