Paranoid Schizophrenia

• Is characterized by persecutory or grandiose delusional thought content and, possibly, delusional jealousy.
• Some patients also have gender identity problems, such as fears of being thought of as homosexual or of being approached by homosexuals.
• Stress may worsen the patient’s symptoms.
• Paranoid schizophrenia may cause only minimal impairment in the patient’s level of functioning – as long as he doesn’t act on delusional thoughts.
• Although patients with paranoid schizophrenia may experience frequent auditory hallucinations (usually related to a single theme), they typically lack some of the symptoms of other schizophrenia subtypes – notably, incoherent, loose associations, flat or grossly inappropriate affect, and catatonic or grossly disorganized behavior.
• Tend to be less severely disabled than other schizophrenia.
• Those with late onset of disease and good pre-illness functioning (ironically, the very patients who have the best prognosis) are at the greatest risk for suicide.

Signs and Symptoms

• Persecutory or grandiose delusional thoughts
• Auditory hallucinations
• Unfocused anxiety
• Anger
• Tendency to argue
• Stilted formality or intensity when interacting with others
• Violent behavior

Diagnosis

• Ruling out other causes of the patient’s symptoms.
• Meeting the DSM-IV-TR criteria.

Treatment

• Antipsychotic drug therapy.
• Psychosocial therapies and rehabilitation, including group and individual psychotherapy.

Nursing Interventions

1. Build trust, and be honest and dependable, don’t threaten or make promises you can’t fulfill.
2. Be aware that brief patient contacts may be most useful initially.
3. When the patient is newly admitted, minimize his contact with the staff.
4. Don’t touch the patient without telling him first exactly what you’re going to be doing and before obtaining his permission to touch him.
5. Approach him in a calm, unhurried manner.
6. Avoid crowding him physically or psychologically; he may strike out to protect himself.
7. Respond neutrally to his condescending remarks; don’t let him put you on the defensive, and don’t take his remarks personally.
8. If he tells you to leave him alone, do leave- but make sure you return soon.
9. Set limits firmly but without anger, avoid a punitive attitude.
10. Be flexible, giving the patient as much control as possible.
11. Consider postponing procedures that require physical contact with hospital personnel if the patient becomes suspicious or agitated.
12. If the patient has auditory hallucinations, explore the content of the hallucinations (what voices are saying to him, whether he thinks he must do what they command) tell him you don’t hear voices, but you know they’re real to him.

Disorganized Schizophrenia
Catatonic Schizophrenia

Schizophrenia Case Study

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