Question

Scenario 1 -

You are working on a mental health inpatient unit and just finished admitting a patient with schizophrenia who stopped taking his medications three weeks ago. The patient is hallucinating but is not aggressive. The patient appears disheveled with poor hygiene. The hospitalist asks you to participate in treatment planning and has a few questions for you. Using the information from your textbook, develop appropriate answers regarding the assessment and treatment options for this patient.

1. List three positive symptoms and three negative symptoms this patient might exhibit and describe them.  (You may select any from the book)
2. What questions might you ask to assess for hallucinations?
3. What is a priority nursing intervention for this patient?
4. What first and second generation anti-psychotics would you recommend? Please include how these medications work and list one name from each group.
5. What are some dangerous side effects for first and second-generation medications?

Answer 1

Ans 1. Positive and negative symptoms are medical terms for two groups of symptoms in schizophrenia.

Positive symptoms add. Positive symptoms include hallucinations (sensations that aren’t real), delusions (beliefs that can’t be real), and repetitive movements that are hard to control.

Negative symptoms take away. Negative symptoms include the inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships.

There is also a third group of symptoms, usually called cognitive symptoms. This includes anything related to thinking, such as disorganized thoughts, memory problems, and difficulties with focus and attention.

Ans 2. Ask questions such as, "Do you ever hear things that other people don't hear or see things that other people don't see?

Do you feel that someone is watching you or trying to hurt you?

Do you have any special abilities or power.

Ans 3. Patient experiencing hallucinations may also have disturbed thoughts and may become disinterested in others and their surroundings. They may also find it difficult to maintain interpersonal skills and form relationships.

An assessment of a patient’s needs is essential and must consider the following:

- Ensure physical needs are met - these include nutritional needs, sleep and self-care needs;

- Maintain safety - a risk assessment must be undertaken as patients may become a risk to themselves or to others;

- Monitor for withdrawn behaviour;

- Assess for disturbances in thought processes.

Nurses need to listen to clients with acute mental illness to begin to understand their communication difficulties and to observe for abnormal behaviour. It is important to show kindness, compassion and patience and to report any new problems. Clients with schizophrenia may have strong positive and negative experiences that cause emotional conflict. Many clients with mental health problems suffer from acute psychotic episodes that have a major impact on their own lives and their families. Some people diagnosed with schizophrenia experience auditory and visual hallucinations.

Ans 4. First generation 'typical' antipsychotics are an older class of antipsychotic than second generation 'atypical' antipsychotics. First generation antipsychotics are used primarily to treat positive symptoms such as hallucinations and delusions. Second generation antipsychotics are also effective for the positive symptoms of schizophrenia, and it is sometimes claimed that they are more effective than first generation antipsychotics in treating the negative symptoms of schizophrenia. Negative symptoms include a lack of ordinary mental activities such as emotional expression, social engagement, thinking and motivation. High potency first generation antipsychotics usually have high affinity for the dopamine receptor and therefore induce extrapyramidal side effects by the blockade of these dopamine receptors. Extrapyramidal side effects include dyskinesias (repetitive, involuntary, and purposeless body or facial movements), Parkinsonism (cogwheel muscle rigidity, pill-rolling tremor and reduced or slowed movements); akathisia (motor restlessness, especially in the legs, and resembling agitation), and dystonias (muscle contractions causing unusual twisting of parts of the body, most often in the neck). Second generation antipsychotics generally have a lower affinity for the dopamine receptor and also block serotonin receptors, so may be associated with lower risk of these side effects.

Newer or atypical antipsychotics. These are sometimes called second-generation antipsychotics and include: amisulpride, aripiprazole, clozapine, olanzapine, quetiapine and risperidone.

Older typical well-established antipsychotics

Ans 5. General: extrapyramidal side effects, weight gain, agitation, constipation, sedation, elevated cholesterol, adverse events related to prolactin elevations, galactorrhea/bloody galactorrhea, weight gain, hypotension, and metabolic changes (including changes in glucose levels, triglycerides, lipids, and the risk of developing diabeties.