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Psychotic Disorders (Nursing Care (communication to address hallucinations…
Psychotic Disorders
Nursing Care
milieu therapy (safe structured environment)
Program of Assertive Community Treatment (PACT)
promote therapeutic communication
establish a trusting relationship
encourage development of social skills and friendships
Encourage participation in group work
communication to address hallucinations and delusions
ask directly about hallucinations, do not argue or agree but offer comment "I do not hear anything"
do not argue with delusions but focus on feelings and offer reasonable explanations
assess for paranoid delusions (risk for violence)
if experiencing command hallucinations provide safety
focus conversation on reality-based subjects
identify symptom triggers
be genuine and empathetic
assess discharge needs (ADL's)
promote self-care by modeling and teaching
relate wellness to symptom management
encourage medication compliance and provide teaching
incorporate family when possible in all aspects of care
Types
Schizophrenia
psychotic thinking or behavior for longer than 6 months
Schizotypal Personality Disorder
impairments of personality, not as severe
Delusional Disorder
delusional thinking for at least a month
Brief Psychotic Disorder
psychotic manifestations last one day to one month in duration
Schizophreniform Disorder
similar to schizophrenia but duration is one to six months
Schizoaffective Disorder
meets criteria for schizophrenia and depressive or bipolar disorder
Substance-induced Psychotic Disorder
psychosis due to substance intoxication or wtihdrawal
Psychotic or Catatonic Disorder
psychotic features (bizarre behavior=psychotic, change in motor activity=catatonic), does not meet criteria for diagnosis with another specific psychotic disorder
Expected Findings
Characteristic Deminsions
Positive Symtpoms
Hallucinations, Delusions, Alertations in Speech, bizarre behavior
Cognitive Symptoms
disordered thinking, inability to make decisions, poor problem-solving ability, difficulty concentrating to perform tasks, memory deficits, working memory (inability to follow direction to find address).
Affective Symptoms
hopelessness, suicidal ideation
Negative Symptoms
affect: blunted, alogia: poverty of thought or speech, anergia: lack of energy, anhedonia: lack of pleasure or joy, avolition: lack of motivation in activities and hygiene
Alterations in Thought
ideas of reference, persecution, grandeur, somatic delusions, jealousy, being controlled, thought broadcasting, thought insertion, thought withdrawal, religiosity, magical thinking
Alterations in Speech
flight of ideas, neologisms, echolalia, clang association, word salad
Alterations in Perception
auditory, command, visual, olfactory (smelling odors), gustatory (tastes), tactile (sensations)
Personal Boundary Difficulties
depersonalization, derealization
Alterations in Behavior
extreme agitation, stereotyped behaviors, automatic obedience, waxy flexibility, stupor, negativism (doing opposite), echopraxia
Medications
First-generation/conventional antipsychotics
haloperidol, loxapine, chlorpromazine, fluphenazine
chew sugarless gum (reduce anticholinergic effects) eat foods high in fiber, drink 2-3L of fluid a day: get up slowly (orthostatic hypotension) and educate on postural hypotension (sit or lie down)
Second-generation/atypical antipsychotics
risperidone, olanzapine, quetiapine, ziprasidone, clozapine
follow healthy low calorie diet regular exercise and monitor weight to minimize weight gain, report side effects (agitation, dizziness, sedation, sleep disruption), blood tests needed to monitor for agranulocytosis
Third-generation antipsychotics
Aripiprazole
decreased risk of tardive dyskinesia, weight gain, and anticholinergic effects
Antidepressants
paroxetine
used temporarily, monitor for suicidal ideation, notify provider of adverse effects (deepened depression) and avoid abruptly stopping medication to avoid withdrawal effects
Mood Stabilizing Agents/Benzodiazepines
valproate, lamotrigine, lorazepam
inform about sedative effects, use with caution in older adults
Client Education
case management-follow up care
psychoeducation-improve problem solving and interpersonal skills
social skills training-social and ADL skills
health promotion: understanding the disorder, need for self-care to prevent relapse, medication effects, importance of attending support groups, abstinence from use of alcohol/substances, keeping a log/journal of feelings and changes
Standardized Screening Tools
Abnormal Involuntary Movement Scale (AIMS)
World Health Organization Disability Assessment Schedule (WHODAS)