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wk14 Schizophrenia精神分裂症 - Coggle Diagram
wk14 Schizophrenia精神分裂症
def: a devastating brain disease that affects the person's emotions, thinking, language, social behaviour, occupational functioning, and the ability to perceive reality accurately.
cause: genetic, biochemical dysfunction, psychosocial distress, peri-natal围产期 stress, family theories
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Core symptoms
Cognitive symptoms: impaired attention, impaired memory
Mood symptoms: depression, suicidal ideation, hopelessness
Negative symptoms (Deficit of behaviours): affect-flattening压扁, apathy冷漠-lack of interest, avolition意志-lack of initiative or motivation, attention deficit
Social/ Occupational Dysfunction: unable to work, poor interpersonal relationship, neglect self care
Positive symptoms (Additional behaviours): delusion, hallucination, bizarre behaviours奇怪的行为
Treatments
Pharmacological
anti psychotics, anti-depressants
Non-pharmacological
1.Therapeutic Milieu Therapy: pt learn vocational and social skills & how to resolve conflicts in a controlled environment
- Reality-oriented individual therapy: to reduce anxiety & establish trust through truthfulness and demonstration of respect toward the individual
3.Group Therapy: social interaction...(for long-term course)
4.Behaviour Modification Therapy: reduce disturbing, aggressive behaviours
5.Social Skills Training: to improve social skills by role play with immediate feedback from the therapist
6.Family therapy: treat the family as a resource, focusing on problem solving and helping behaviours for coping with stress, teach family to reshape patterns of communication and problem solving
7.Electroconvulsive Therapy(ECT): trigger a brief seizure to cause changes in brain chemistry that can quickly reverse depressive symptoms
Nursing Management
RISK FOR VIOLENCE: SELF-DIRECTED OR OTHER-DIRECTED related to extreme suspiciousness, panic anxiety, command hallucinations or active aggressive suicidal acts
- Maintain low level of stimuli in pt's environment such as low lighting, few people and low noise level.
(R) A suspicious, agitated pt may perceive individuals as threatening in a stimulating environment.
- Observe pt's behaviour frequently while carrying out routine activities.
(R) observation during routine activities avoids creating suspiciousness of the pt and allows early interventions to ensure the pt and other's safety.
- Remove all dangerous objects from pt's environment.
(R) Prevents the pt, in an agitated, confused state, from using them to harm self or others.
- Maintain a calm attitude and offer empathetic response toward pt with increases anxiety level & offer some alternatives such as punching bag/ physical exercise.
(R) Give him or her a feeling of some control over the situations.
- If the pt is not calmed by "talking down" or by medication, use of mechanical restraints only as a last resort.
(R) The "least restrictive alternative" must be selected when planning interventions for a violent pt who is clearly at risk of ham to self or others.
SOCIAL ISOLATION related to inability to trust, panic anxiety, weak ego development as evidenced by withdrawal, dull affect and reoccupation with own thoughts and expression of feelings of rejection
- Convey an accepting attitude by making brief, frequent contacts to establish a therapeutic nurse-patient relationship (TNPR)
(R) An accepting attitude increases patient's feelings of self-worth and facilitates trust.
- Show unconditional positive regard.
(R) This conveys a belief in the patient as a worthwhile human being.
- Offer to be with the patient during group activities that he/she finds frightening/ difficult.
(R) The presence of a trusted individual provides emotional security for the patient.
- Give recognition and positive reinforcement for the pt's voluntary interactions w/ others.
(R) enhances self-esteem and encourages repetition of acceptable behaviours.
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