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
- Spend time with the patient even if he’s mute and unresponsive, to promote reassurance and support.
- 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.
- 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”)
- Verbalize for the patient the message that his behavior seems to convey, encourage him to do the same.
- 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.”)
- 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.
- Remember that if he’s in bizarre posture, he may be at risk for pressure ulcers or decreased circulation.
- Provide range-of-motion exercises.
- Encourage to ambulate every 2 hours.
- During periods of hyperactivity, try to prevent him from experiencing physical exhaustion and injury.
- As appropriate, meet his needs for adequate food, fluid, exercise, and elimination; follow orders with respect to nutrition, urinary catheterization, and enema use.
- Stay alert for violent outbursts; if these occur, get help promptly to intervene safely for yourself, the patient, and others.
Paranoid Schizophrenia
Catatonic Schizophrenia
