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Rock Street 34, San Francisco State

What is the DSM-V diagnosis of the main character?
Paranoid Schizophrenia
What are the criteria for this diagnosis?
-they have to meet 2 or more of these:

– Delusion
– Hallucination
– Disorganized speech
– abnormal psychomotor behavior
– negative symptoms
– on a scale of 0-4
– disturbances of affect, votation and speech
– persecutory beliefs of various kinds

How does the character meet these criteria?
What positive and negative symptoms of Schizophrenia did the main character exhibit?
– POSITIVE: paranoid, agitated, hallucinations, thinking people are following him, delusions

– NEGATIVE: rigidity, expressionless face

Discuss your perceptions of what was real and what was a delusion or hallucination?
– The moments never happened when they think they did. Finding this out would be devastating.
– The little girl that calls him uncle john NEVER GETS OLD
– When no one else sees what you are seeing.
– Imaginary roommate named Charles
-Imaginary William Parcher
– The psychiatrist is a Russian spy
– thinking he works for a government classified project
– digging in his arm to find the implant
– the little girl
– it means its not in your head, someone else can see what you are seeing also
– a false belief or opinion

– Delusions of….
control or influence
somatic Delusions
medical thinking

– seeing or experiencing feelings that aren’t real (inside the mind) you make up.
– perceptual experiences without actual external sensory stimuli
– usually auditory
– command hallucinations
What would be the priority nursing assessment and diagnosis for Mr. Nash?
– mental health
– Depression
– safety
– thought content
– medication adherence
What interventions (both medical and nursing) were helpful or would be helpful for this character?
– establish trust & rapport
– maximize level of functioning
– promote social skills
– ensure safety
– deal with halluincations by presenting reality
– encourage family involvement
– ensure adequate nutrition
– promotes compliance with drug therapy
– Journaling everyday before bed
– therapy
– social activities that are small
– not feeding into the delusions
– cognitive behavioral psychotherapy
– support groups
– rehabilitation to help with social skills and other things
What medications would you anticipate the patient to be on?
Side effects you observe?
– Typical antipsychotic- Thorazine-
Haldol (haloperidol)

– Atypical antipsychotic- Clozaril
Abilify (aripiprazole)
Risperdal (risperidone)
Geodon (ziprasidone)
Zyprexa (olanzapine)

– shuffling gait
– rigity
– decreased libido
– lethargic
– unresponsive
– anticholinergic
– orthostatic hypotension

List and describe therapeutic communications and non- therapeutic communications techniques that you observed in the movie?
– When the wife acts out and breaks mirror
– Rejecting
– Disapproving
– Why questions- requesting an explanation

– offering general leads
– presenting reality
– silence

Movie portray the mental health system correctly?
treatment on?
– insulin shock therapy but we no longer do it anymore
– meds we still use but have more that work better
What is Schizophrenia caused by?
– a combination of factors such as
— including
– genetic predisposition
– biochemical dysfunction
– psychosocial stressors
Risk factors for Schizophrenia?
– genetics
– excess of dopamine dependent neuronal activity in the brain
– environmental influences
– physiological influences
Four phases of Schizophrenia
1. the premorbid phase
2. prodromal phase
3. Schizophrenia phase
4. residual phase
the premorbid phase
– the schizoid personality
– indifferent
– cold
– aloof
– loners
prodromal phase
– begins with a change from premorbid functioning and extends until unset of psychotic symptoms

– sudden withdrawal, peculiar behavior, eccentric, role functioning is impaired, personal hygiene is neglected, disturbances in communication, ideation and perception

Schizophrenia phase
– active phase of the disorder
– psychotic symptoms are prominent, delusions, hallucinations, impairment in work, social relationships and self-care
Residual Phase
– similar to prodromal phase with flat affect and impairment in tole functioning are prominent
– periods of remission and exacerbations
– acute illness
– stabilization
– maintenance and recovery
– relapses- frequent, longer periods of time to recover, non- compliance with medications
disorganized thinking and speech
– loose associations
– neologisms
– clang associations
-word salad
– pressured speech
– preservation

disorganized behavior
– agression
– agitation
– cataonia
– regression
– waxy flexibility

– apathy
– affect is flat or bunted
– alogia- poverty of speech
– poor social functioning
– anhedonia- no pleasure
– social withdrawal
– avolition (no motivation)
– recovery model
– group, family, and individual therapy
– socail skills training
– milieu therapy
– behavioral therapy
– case management pact
– medications
Side effects to meds
– sedation
– photosensitivity
– orthostatic hypotension
– decreased libido
– increased prolactin
– ECG changes
– agranulocytosis
– EPS- parkinson, akinesia, dystonic, akathisia
– Anti- cholinerigic
– metabolic syndrome
Nursing measure
– do not reach out and touch a person
– avoid challenging the delusion
– decrease anxiety with empathy
– preventing relapse
– patient teaching
– family education
– promoting medication compliance
– promoting adequate communication
– assistance with self care
Schizophrenia caused by
a combination of factors

– genetics predisposition
– biochemical dysfunction – dopamine (need serotonin as well to get rid of negative symptoms
– physiological factors
– psychosocial stressors

Schizophrenia risk factors
– genetics
– 10 times higher risk in first degree relatives
– twin studies 4 times higher in monozygotic- 50 times that of gen population
– children of schizophrenic parents

– excess of dopamine dependent neuronal activity in the brain
** older meds hit our positive symptoms
** hit all the pathways with our meds

– environmental influences
— lower socio economic status
— probity a result of the disease

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Post Author: Arnold

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