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Psychopathology Paper

Written by kimmel52 on November 8, 2008 – 5:42 am


Psychopathology Paper 2
H.F.C.C. Psychiatric Nursing 150
By Nancy Taji

Definition of Medical Diagnosis: According to the DSM-IV-TR, the criteria for Schizophrenia can be summed up as follows:
Two or more of the following symptoms during a one month period, such as delusions, hallucinations, disorganized speech,
Grossly disorganized or catatonic behavior and negative symptoms such as affective flattening, avolition and or alogia. In regards
to personal, interpersonal/social and self care, the client falls short of being able to maintain normal functioning. The duration of
the illness persists for at least six months with at least one month that meets the positive symptoms of the disease. (Varcarolis,
2002, p. 529)
“Schizophrenia is a devastating disease of the brain that affects a person’s thinking, language, emotions, social behavior and ability to accurately perceive reality.” (Varcarolis, 2002, p. 524)
Psychodynamics: The psychodynamics of the disease process can be classified using the four A’s. The four A’s are:
1. Affect, usually blunted or inappropriate and or bizarre.
2. Associative looseness, which refers to a incoherent stringing together of words that have no meaning.
3. Autism, refers to the world in which the person lives in within their head. It is an imaginary world that only they live in and sometimes respond to with speaking to inner voices. This is referred as responding to internal stimuli.
4. Ambivalence, is the polarization of feelings coexisting within the individual. Such as holding love and hate simultaneously and not being able to express either. This can be paralyzing for the individual. They usually withdraw and can become catatonic. (Varcarolis, 2002, p. 526)
Generally the disease has been found to be genetically transmitted and there have been abnormal findings on PET scans. Some of the abnormal findings include frontal lobe inactivity, cortical enlargement and well as third ventrical enlargement. With later onset of positive symptoms such as delusions and hallucinations the prognosis seems to respond with greater success to medications than with a earlier onset of the negative symptoms such as Autism. As the case in any disease, the symptoms are treated for life, since there is no cure at the present time. The drugs for the treatment of schizophrenia are termed antipsychotics of which there are the typical and atypical variety. Currently the atypical variety treat the positive as well as the negative symptoms of the disease but without as drastic extrapyramidal side effects as the typicals.
Case Presentation: The client is a male Caucasian in his early thirties. He was dressed in a red sweatshirt and jogging pants. He was well groomed. He displayed a crew cut and was clean shaven. His nails appeared appropriately short and clean. The client expressed great sorrow as he explained how he was involved in an accident in which a child on a bike was killed. He spoke in depth about the deaths he had seen in his life. His expression was appropriate. He did not display any signs or symptoms of schizophrenia. He explained that he was on prolixin, and this atypical antipsychotic kept the voices away. The client explained that he had been hearing voices for many years and that he had used and currently uses alcohol when the voices wouldn’t go away. He stated that the voices consisted of the devil, although the voice would not identify himself as such, but the client said he knew it was him, a little boy and a women. He said that the voices tell him that he is next to die, and that they are more audible at night than in the daytime. He stated that he was able to hold down a successful job as a brick
layer, married and fathered two children. However, the marriage ended in divorce and the wife took the children to Texas. He has not seen his children for a while and expressed a great desire to be reunited with them. The client stated that he was afraid to get close to anyone for fear that something bad would happen to them. He stated that he felt free of the debilitating symptoms of the disease at the present, which is why he sought treatment initially.

1. Associative looseness 1. Not noted
2. Affective flattening 2. Slightly blunted, possibly due to medication
3. Alogia 3. Client stated thoughts were jumbled at times
4. Avolition-apathy 4. Client stated that it is only the thought of seeing his children again that keeps him going. None noted.
5. Anhedonia 5. Client states that is it is hard to find the will to continue living and with the thoughts of dying make it difficult to find joy in life.
5a. Asociality 5a. Afraid to make friends for fear they will die
6. Hallucinations 6. None at the present while on medication
7. Delusions 7. Client states that he hears voices telling him he will die
8. Bizarre behavior 8. Client did not exhibit any bizarre behavior, very pleasant.
(Varcarolis, 2002, p. 533)

Nursing Interventions For Client
1. Associative looseness: “Tell the client what you do understand and reinforce clear communication and accurate expression of needs, and thoughts.” (Varcarolis, 2002, p. 534)
2. Affective flatness: “All people with schizophrenia are uniquely different and all have unique personal strengths and disease-associated deficits. Ideally, outcomes should reflect enhancing the person’s strengths and minimizing the effects of the client’s deficits.” (Varcarolis, 2002, p. 536)
3,4. Alogia and Anhedonia: Encourage participation in activity groups, (only if client’s anxiety level allows for such participation). Such actions help to: “decrease withdrawal, promote motivation, modify unacceptable aggression and increase social competence.”
(Varcarolis, 2002, p. 540)
“Encourage drawing pictures, reading poetry, and listening to music.” (Varcarolis, 2002, p. 541)
5. Asociality: Encourage client to groom self and give praise. Supportive teaching in regards to the understanding and acceptance of the illness. Encourage group and family therapy.
6. Hallucinations: “Approach client in a nonthreatening and nonjudgmental manner. Maintain eye contact, speak simply in a louder voice than usual, and call the person by name.” (Varcarolis, 2002, p. 541)

7. Delusions: “Clarify the reality of the client’s experience, and empathize with the client’s apparent experience, the feelings of fear.” (Varcarolis, 2002, p. 542)
8. Bizarre behavior: Ensure the safety of the client. Gently assist client to a less stressful and quiet area. Make sure that there are no objects that the client can hurt themselves or others with. Speak in a calm clear voice and try to bring the client back to reality.

Medical Interventions for Schizophrenia
1. Antipsychotic medication 1. Client is currently on Prolixin 2.5mg T.I.D.
2. Group Therapy 2. Client participates in RT and OT daily
3. Psychotherapy 3. Client meets Psychologist and Psychiatrist regularly in hospital during stay.
4. Client teaching 4. Client receives one on one education on illness with nurse daily.
5. Antianxiety and or antidepressants used concurrently 5. Client receives Ativan 1mg q. h.s.

Lehne, R. (2004). Pharmacology for Nursing Care. Missouri: Saunders
Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing: A Clinical approach. Pennsylvania: Saunders

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