Disorganized Schizophrenia

• Is marked by incoherent, disorganized speech and behaviors and by blunted or inappropriate affect.
• May have fragmented hallucinations and delusions with no coherent theme.
• Usually includes extreme social impairment.
• This type of schizophrenia may start early and insidiously, with no significant remissions.

Signs and Symptoms

• Incoherent, disorganized speech, with markedly loose associations.
• Grossly disorganized behavior.
• Blunted, silly, superficial, or inappropriate affect.
• Grimacing
• Hypochondriacal complaints.
• Extreme social withdrawal.

Diagnosis

• Ruling out other causes of the patients symptoms.
• Meeting the DSM-IV-TR criteria.

Treatment

• Treatments described for other types of schizophrenia.
• Antipsychotic drugs and psychotherapy.

Nursing Interventions

1. Spend time with the patient even if he’s mute and unresponsive, to promote reassurance and support.
2. Remember that, despite appearances, the patient is acutely aware of his environment, assume the patient can hear – speak to him directly and don’t talk about him in his presence.
3. Emphasize reality during all patient contacts, to reduce distorted perceptions (for example, say, “The leaves on the trees are turning colors and the air is cooler, It’s fall”)
4. Verbalize for the patient the message that his behavior seems to convey, encourage him to do the same.
5. Tell the patient directly, specifically, and concisely what needs to be done; don’t give him choice (for example, say, “It’s time to go for a walk, lets go.”)
6. Assess for signs and symptoms of physical illness; keep in mind that if he’s mute he won’t complain of pain or physical symptoms.
7. Remember that if he’s in bizarre posture, he may be at risk for pressure ulcers or decreased circulation.
8. Provide range-of-motion exercises.
9. Encourage to ambulate every 2 hours.
10. During periods of hyperactivity, try to prevent him from experiencing physical exhaustion and injury.
11. As appropriate, meet his needs for adequate food, fluid, exercise, and elimination; follow orders with respect to nutrition, urinary catheterization, and enema use.
12. Stay alert for violent outbursts; if these occur, get help promptly to intervene safely for yourself, the patient, and others.

Paranoid Schizophrenia
Catatonic Schizophrenia

Schizophrenia Case Study

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