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Undifferentiated Schizophrenia
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UNDIFFERENTIATED SCHIZOPHRENIA
NCM 117
What is Schizophrenia?
INTRODUCTION
It is a mental disorder characterized by disturbances in thought and sensory perception, and deterioration in psychosocial functioning. It is characterized by a weak ego.
Undifferentiated Schizophrenia
What is Undifferentiated Schizophrenia?
Occurs when a patient displays general signs and symptoms of schizophrenia such as hallucinations, but collectively, the signs and symptoms do not meet the standards for a specific type of schizophrenia disorder (Keogh, 2014).
ETIOLOGY
There is no known cause of undifferentiated schizophrenia disorder. USD, like other forms of schizophrenia disorder, can run in families. Some researches believe there is a neurobiologic connection related to excessive levels of dopamine.
PROGNOSIS
Patients with early-onset USD have a poor prognosis related to increased rate of brain abnormalities. Patients with late onset undifferentiated schizophrenia disorder have the most positive prognosis if the patient complies with treatment. Increased stress and intense emotional family environments tend to increase relapses.
HALLMARK SIGNS AND SYMPTOMS
• Hallucinations
• Thought withdrawal
• Delusions
• Thought insertion
- Schizophrenia affects 20 million people worldwide (Global Burden of Disease, 2017).
- Schizophrenia is one of the top 15 leading causes of disability worldwide (Global Burden of Disease, 2016).
- The WHO estimated that 154 million Filipinos suffer from depression, 1 million from schizophrenia, and 15.3 million from substance use disorders, while 877, 000 die due to suicide every year (Department of Health, 2018).
- Typically presents in males between their late teens and early 20's and females in their 20's or 30's.
The prevalence of schizophrenia among U.S adults is estimated to be 1.5 million people per year. (National Alliance on Mental
Illness, 2019)
Epidemiology
Assessment
Common/Interpreting Test Results
ASSESSMENT
There is no test that is used to diagnose undifferentiated schizophrenia disorder.
The initial step is to rule out physiologic and other mental disorders causing the symptoms before reaching a psychiatric diagnosis. The psychiatric diagnosis of USD requires:
Delusion
Hallucinations
Disorganized behavior
Two or more of the following symptoms during a period of 1 month:
Disorganized speech
Catatonic behavior
Negative symptoms
Social functioning
Interpersonal functioning
In the last 6 months, the patient must display disturbed behavior.
There is decrease in:
Assessment
Occupational functioning
DIAGNOSIS
NURSING DIAGNOSES
Risk for social isolation related to disorganized behavior.
Disturbed thought process related to disintegration of thinking process.
Self - care deficit related to perceptual and cognitive impairment.
Impaired verbal communication related to incoherent communication.
Ineffective coping related to unrealistic perceptions.
Risk for injury related to disorganized behavior.
PLANNING
Expected outcomes or patient goals
The client will identify causes and actions to correct isolation
The client will meet physical and psychosocial needs.
The client will gain optimum level of functioning.
The client will increase compliance to treatment and nursing plan.
P
L
A
N
N
I
N
G
The client will reduce severity of psychotic symptoms
The client will be able to prevent acute episodes from recurrence.
4 Important S's of Schizophrenia
Stimulation
Structure
• Create a safe environment for the patient.
• Prevent the patient from self-injuring behavior.
• Remain calm.
• Do not argue with the patient.
• Redirect the patient using clear short statements.
• Supplement daily activities that the patient is unable to do by themselves.
• Give the patient hope by encouraging them to perform as many activities
of daily living as possible
INTERVENTION
Socialization
Support
There is no cure for schizophrenia. However, with medication, family support, and psychosocial rehabilitation therapies, many people can reduce and manage their symptoms.
Antipsychotic Drugs
Chlorpromazine (Thorazine)
Rehabilitation
Perphenazine (Trilafon)
Psychosocial Treatments
Clozapine (Clozaril)
- emphasizes social and vocational training (vocational counseling, job training, problem solving and money management skills, use of public transportation and social skills training.)
Risperidone (Risperdal)
Individual psychotherapy
- involves regularly scheduled talks between the patient and a mental health professional (psychiatrist/psychologist/nurse).
- Sessions focuses on current or past problems, experiences, thoughts, feelings or relationships to be able to understand more the patient and their problems.
- Through this, patient will be able to learn to sort out the real from the unreal and distorted.
Psychoeducation
- briefing the patients about their illness, problem solving training, communication training, and self-assertiveness training, whereby relatives were also included.
- involves teaching the family various coping strategies and problem solving skills.
- Learning how to recognize distorted thinking and reevaluate it logically
- Developing a better understanding of the behavior of others
- Using problem-solving skills for coping in difficult scenarios
- Developing a sense of confidence
- Facing fears instead of avoiding them
- Learning to calm the mind and relax the body
In cognitive behavioral therapy, patients essentially learn to be their own therapist. By participating in exercises, developing tools, and learning coping skills, individuals are able to change their thinking patterns and prevent problematic feelings and behaviors for the long-term without extensive therapy.
Cognitive Behavioral Therapy
- CET is for those who are symptomatically stable yet continue to lack social and vocational abilities.
- Consists of weekly computer-based neurocognitive training to in attention, memory and problem-solving and small-group sessions to address social-cognitive deficits that limit functional recovery from schizophrenia.
Cognitive Enhancement Therapy
EVALUATION
Provides data to determine whether the client's individual outcome were achieved. The client's perception of the success of treatment also plays a part in evaluation. The nurse must ask if the client is comfortable or satisfied with the quality of life.
EVALUATION
- The client identified causes and actions to correct isolation
- The client met physical and psychosocial needs.
- The client gained optimum level of functioning.
- The client increased compliance to treatment and nursing plan.
- The client reduced severity of psychotic symptoms
- The client prevented acute episodes from recurrence.