Wednesday, August 10, 2022

A Newly Admitted Patient Diagnosed With Schizophrenia Is Hypervigilant

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Sexual Hallucinations In Schizophrenia Spectrum Disorders And Their Relation With Childhood Trauma

Mental Health: Schizophrenia
  • 1Parnassia Psychiatric Institute, The Hague, Netherlands
  • 2Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
  • 3Department of Psychiatry, University of Groningen, Groningen, Netherlands

Background: Sexual hallucinations are probably the most neglected types of hallucination, even in psychiatric settings. They are often multimodal in nature, and their prevalence rate is unknown. For other types of hallucination, notably auditory hallucinations, childhood trauma is an important risk factor. However, whether this also applies to sexual hallucinations is unexplored.

Objective: To establish the prevalence rate of sexual hallucinations in a clinical sample of patients diagnosed with a schizophrenia spectrum disorder, to describe their phenomenological characteristics, and to estimate their relationship with childhood trauma.

Methods: After screening 778 patients diagnosed with a schizophrenia spectrum disorder, 42 were considered eligible for inclusion by their treating physician or psychiatrist. Thirty of these patients were interviewed to assess the presence of sexual hallucinations, using a tailor-made questionnaire and the short form of the Childhood Trauma Questionnaire.

Question : Multiple Choice1 A Person Has Had Difficulty Keeping A Job Because : 1499688

MULTIPLE CHOICE

1. A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, Theyre all plotting to destroy me. Isnt that true? Select the nurses most therapeutic response.

a.Everyone here is trying to help you. No one wants to harm you.

b.Feeling that people want to destroy you must be very frightening.

c.That is not true. People here are trying to help you if you will let them.

d.Staff members are health care professionals who are qualified to help you.

2. A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, I saw two doctors talking in the hall. They were plotting to kill me. The nurse may correctly assess this behavior as:

a.echolalia.c.a delusion of infidelity.

b.an idea of reference.d.an auditory hallucination.

3. A patient diagnosed with schizophrenia says, My co-workers are out to get me. I also saw two doctors plotting to kill me. How does this patient perceive the environment?

a.Disorganizedc.Supportive

b.Dangerousd.Bizarre

4. When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The patient now says, I stopped taking those pills. They made me feel like a robot. What are common side effects the nurse should validate with the patient?

a.Sedation and muscle stiffness

c.Mild fever, sore throat, and skin rash

d.Headache, watery eyes, and runny nose

Question : Multiple Choice1 A Newly Admitted Patient Has The Diagnosis Of : 1490325

MULTIPLE CHOICE

1. A newly admitted patient has the diagnosis of catatonic schizophrenia. Which behavior observed in the patient supports that diagnosis?

a.Uses a rhyming form of speech

b.Refuses to eat any unwrapped foods

c.Laughs when watching a sad movie

d.Maintains an immobilized state for hours

2. What would be an appropriate short-term outcome for a patient diagnosed with residual schizophrenia who exhibits ambivalence?

a.Decide their own daily schedule.

b.Decide which unit groups they will attend.

c.Choose which clinic staff member to work with.

d.Choose between two outfits to wear each morning.

3. What is the priority nursing diagnosis for a catatonic patient?

a.Ineffective coping

c.Impaired social interaction

d.Risk for deficient fluid volume

4. Which nursing diagnosis is appropriate for a patient who insists being called Your Highness and demonstrates loosely associated thoughts?

a.Risk for violence

c.Impaired memory

d.Disturbed thought processes

5. Which initial short-term outcome would be appropriate for a patient who was admitted expressing delusional thoughts?

a.Accept that delusion is illogical.

b.Distinguish external boundaries.

c.Explain the basis for the delusions.

d.Engage in reality-oriented conversation.

6. Which of the following interventions should the nurse plan to use to reduce patient focus on delusional thinking?

a.Confronting the delusion

b.Refuting the delusion with logic

c.Exploring reasons the patient has the delusion

a.Derealization

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References:

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A Case Of Schizophrenia In A Young Male Adult With No History Of Substance Abuse: Impact Of Clinical Pharmacists Interventions On Patient Outcome

Josephine Mensah

1Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology , PMB, U.P.O., Kumasi, Ghana

2Department of Surgery, Pharmacy Unit, Korle Bu Teaching Hospital, P.O. Box 77, Accra, Ghana

3Department of Psychiatry, Korle Bu Teaching Hospital, P.O. Box 77, Accra, Ghana

Abstract

1. Introduction

Schizophrenia is a chronic and severe mental disorder affecting more than 21 million people worldwide which is characterized by distortions in thinking, perception, emotions, language, sense of self, and behaviour. Common experiences include hallucinations mostly involving hearing voices or seeing things that are not there and delusions which involve having fixed, false beliefs .

Since schizophrenia is a chronic illness that influences virtually all aspects of life of affected persons, treatment planning has three goals which are to reduce or eliminate symptoms, to maximize quality of life and adaptive functioning, and to promote and maintain recovery from the debilitating effects of illness to the maximum extent possible .

Medications are invaluable in the management of patients with mental illnesses. Pharmacists are therefore indispensable in improving the quality of service rendered to patients with mental illnesses such as schizophrenia which contributes to reduction of the numerous problems associated with and faced by patients with mental disorders .

2. The Case

3. Discussion

Abbreviations

Limitations And Future Directions

A single case study is described here therefore, it limits the number of issues that can be examined, and thus the generalizability of the methods and strategies employed. The study is qualitative in nature however, it is anchored in real-life situations and provides a complete clinical picture of shared decision-making. There exists a need for future clinical trials with shared decision-making tools. Attention should be focused on identifying barriers and facilitators to the implementation of shared decision-making. Studies assessing the impact of shared decision-making on medication adherence would be very informative. Efforts should be made to facilitate the shared decision-making process by providing educational intervention to patients as well as in-service training to staff at health care centers. Further research is warranted to delineate nurses engagement in implementation of shared decision-making in mental health care.

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Treatment Decision And Follow

Before discussing new treatment options and making a treatment decision, Sam was queried about the degree of involvement he would like in making decisions about treatment and services. Sam indicated that he would like to be involved in most decisions, but he also wants some assistance and reassurance as requested when making decisions.

Because Sam is socially isolated and does not have family or other social support to encourage him to maintain his oral antipsychotic treatment regimen, he and his care team discussed switching to an LAI antipsychotic. Sam was concerned that the injections would be painful, but he also welcomed the opportunity to be relieved of remembering to take multiple pills every day.

Various strategies exist for switching clients from oral to LAI antipsychotics. In general, gradual overlapping is less likely to result in rebound and withdrawal effects compared with abrupt discontinuation of the old and initiation of the new antipsychotic . This strategy may be particularly relevant to maintain therapeutic levels during the initial weeks of LAI therapy .

Sam agreed to weekly phone calls from his nurse to monitor his well-being and to remind him to return in two weeks for his follow-up appointment. After he is stabilized on his new medication regimen, he would like to consider receiving fewer follow-up phone calls so that he can learn to manage his illness more independently.

Chapter 1: Schizophrenia Spectrum Disorders

Psychiatric Interviews for Teaching: Psychosis

MULTIPLE CHOICE1. A person diagnosed with schizophrenia has had difficulty keeping a job because of arguing with co-workersand accusing them of conspiracy. Today the person shouts, Theyre all plotting to destroy me. Select thenurses most therapeutic response.a. Everyone here …

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Working Diagnosis And Initial Treatment Plan

Sam met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for schizophrenia .

After discussing different features, particularly common side effects of antipsychotic medications, Sam and his provider together decided that olanzapine would be the best treatment choice for him based on his goals and stated preferences. He initiated oral olanzapine and was titrated up to 20 mg twice daily with oral haloperidol 0.5 mg at night.

In follow-up visits, he noted that he sometimes forgets to take his medications. He reported that his symptoms had improved since beginning the medication, but he still heard voices and found this distressing. He was also distressed by a weight gain of 15 kg since initiating the medication. He continued to use marijuana approximately once per week. He was very socially isolated, but desired more social interaction. He was not currently participating in any psychosocial interventions.

Who Response

WHO’s Mental Health Gap Action Programme , launched in 2008, uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. Currently mhGAP is being implemented in more than 100 WHO Member States.

The WHO QualityRights Project involves improving the quality of care and human rights conditions in mental health and social care facilities and to empower organizations to advocate for the health of people with mental disorders.

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