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Nursing Assessment for Schizophrenia

Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social or occupational dysfunction. The onset of symptoms typically occurs in young adulthood, with a global lifetime prevalence of about 0.3–0.7%. Diagnosis is based on observed behavior and the patient's reported experiences.

Schizophrenia is associated with a wide variety of abnormal behaviors; therefore, assessment findings vary greatly, depending on both the type and phase of the illness. The individual may exhibit a decreased emotional expression, impaired concentration, and decreased social functioning, loss of function, or anhedonia. Individuals with these particular symptoms (present in one-third of the schizophrenic population) are associated with poor response to drug treatment and poor outcome.

Although behaviors and functional deficiencies can vary widely among patients and even in the same patient at different times, watch for the following characteristic signs and symptoms during the assessment interview:

  1. ambivalence coexisting strong positive and negative feelings, leading to emotional conflict
  2. apathy
  3. clang associations words that rhyme or sound alike used in an illogical, nonsensical manner; for instance, It's the rain, train, pain.
  4. concrete thinking inability to form or understand abstract thoughts
  5. delusions false ideas or beliefs accepted as real by the patient. Delusions of grandeur, persecution, and reference (distorted belief regarding the relation between events and one's self; for example, a belief that television programs address the patient on a personal level) are common in schizophrenia. Also common are feelings of being controlled, somatic illness, and depersonalization.
  6. echolalia meaningless repetition of words or phrases
  7. echopraxia involuntary repetition of movements observed in others
  8. flight of ideas rapid succession of incomplete and poorly connected ideas
  9. hallucinations false sensory perceptions with no basis in reality. Usually visual or auditory, hallucinations may also be olfactory (smell), gustatory (taste), or tactile (touch).
  10. illusions—false sensory perceptions with some basis in reality; for example, a car backfiring might be mistaken for a gunshot.
  11. loose associations not connected or related by logic or rationality
  12. magical thinking belief that thoughts or wishes can control other people or events
  13. neologisms bizarre words that have meaning only for the patient
  14. poor interpersonal relationships
  15. regression return to an earlier developmental stage
  16. thought blocking sudden interruption in the patient's train of thought
  17. withdrawal disinterest in objects, people, or surroundings
  18. word salad illogical word groupings; for example, She had a star, barn, plant. It's the extreme form of loose associations.