MH | Schizophrenia

1. Core Concept & Presentation Schizophrenia alters thought, perception, and behavior. It stems from genetic and neurochemical imbalances, primarily excess dopamine and serotonin. • Positive Symptoms: Additions to normal behavior, including delusions (fixed false beliefs), hallucinations (false sensory perceptions), and disordered speech like word salad or echolalia. • Negative Symptoms: Deficits in behavior, including flat affect, anhedonia (lack of joy), alogia (poverty of speech), and avolition (lack of motivation). These symptoms are major barriers to daily functioning.2. Must-Know Safety Red Flags (Psychiatric Emergencies) • Command Hallucinations: Voices demanding the patient harm themselves or others. The nurse must explicitly ask what the voices are saying to initiate safety precautions. • Neuroleptic Malignant Syndrome (NMS): A fatal antipsychotic reaction causing muscle rigidity, high fever, leukocytosis, and increased CPK. The absolute priority is to stop the medication immediately and notify the physician. • Agranulocytosis: Clozapine can cause a fatal drop in white blood cells. Monitor Absolute Neutrophil Count (ANC) weekly; immediately report fever, malaise, or sore throat. • Extrapyramidal Symptoms (EPS): Includes acute dystonia (airway-compromising muscle spasms), pseudoparkinsonism, and akathisia (severe restlessness). Treat emergently with intramuscular benztropine or diphenhydramine. • Tardive Dyskinesia (TD): Late, irreversible involuntary movements like lip-smacking or tongue protrusion. Assess routinely using the AIMS (Abnormal Involuntary Movement Scale) tool. • Suicide Risk: 10% of people with schizophrenia die by suicide; assessing suicidal ideation is a top priority.3. Must-Know Pharmacology • Conventional (Typical): Haloperidol, Chlorpromazine. Target only positive symptoms by blocking dopamine. High risk of EPS. • Atypical: Risperidone, Olanzapine, Clozapine. Target both positive and negative symptoms. • Long-Acting Injections (LAIs): Used for chronic medication nonadherence, but never used for acute psychotic episodes because they take weeks to reach stable dosing.4. Therapeutic Communication & Interventions • For Delusions: Never argue with, openly confront, or validate the false belief. Present reality simply ("I have seen no evidence of that") and use distraction techniques. • For Hallucinations: Do not pretend the hallucination is real. Say, "I don't see anything, but you must be frightened". Engage the patient in reality-based activities (like playing cards) to compete with the hallucinations. • For Bizarre Behavior: Redirect the patient matter-of-factly away from public areas to protect their dignity without scolding. Give agitated patients ample personal space to avoid escalating fear.5. NCLEX Exam Logic • Priority Action: Safety is always first. If a patient is hallucinating, first ask what the voices are commanding. • Medication Alerts: NMS = rigidity + fever (Stop med); EPS = spasms (Give benztropine); Clozapine = sore throat (Check ANC).