General Objectives This case study aims to identify and determine the general health problems and needs of the patient with an admitting diagnosis of Undifferentiated Schizophrenia. This study also intends to help us promote health and medical understanding of such condition through the application of the nursing skills. Specific Objectives After the completion of this case study, the students will be able to: Define Schizophrenia (Undifferentiated) Trace the Psychopathology Enumerate the different signs and symptoms Identify and understand different types of medical treatment Formulate and apply nursing care plan utilizing nursing process
Transcript
General Objectives
This case study aims to identify and determine the general health problems and needs
of the patient with an admitting diagnosis of Undifferentiated Schizophrenia. This study
also intends to help us promote health and medical understanding of such condition
through the application of the nursing skills.
Specific Objectives
After the completion of this case study, the students will be able to:
Define Schizophrenia (Undifferentiated)
Trace the Psychopathology
Enumerate the different signs and symptoms
Identify and understand different types of medical treatment
Formulate and apply nursing care plan utilizing nursing process
Introduction
Schizophrenia
The word "schizophrenia" comes from the Greek roots schizo (split) and phrene
(mind) to describe the fragmented thinking of people with the disorder.
It is a psychotic disorder (or a group of disorder) marked by severely impaired
Thinking
Perception
Emotions or feelings
Behavior
Schizophrenic patients are typically unable to filter sensory stimuli and may have
enhanced perception of sounds, colors, and other features of their environment. Most
schizophrenics, if untreated, gradually withdraw from interactions with other people, and
lose their ability to take care of personal needs.
The course of schizophrenia in adults can be divided into three phases or
stages. In the acute phase, the patient has an overt loss of contact with reality (psychotic
episode) that requires intervention and treatment. In the second or stabilization phase, the
initial psychotic symptoms have been brought under control but the patient is at risk for
relapse if treatment is interrupted. In the third or maintenance phase, the patient is
relatively stable and can be kept indefinitely on anti-psychotic medications. Even in the
maintenance phase, however relapses are not unusual and patients do not always return
to full functioning
Types of schizophrenia
1.Disorganized schizophrenia- characterized by:
Impaired ADL Disorganized speech, thinking and behavior Somatic delusions Flat or inappropriate affect
2. Paranoid schizophrenia – characterized by:
Extreme suspiciousness Delusion of persecution Unpredictable violence Ideas of reference Auditory hallucination
3. Catatonic schizophrenia – characterized by:
Catatonic stupor:
Stupor or rigidity Bizarre mannerism Automatism Sudden onset of mutism Waxy flexibility
Catatonic excitement:
Have dangerous periods of agitation Impulsive and explosive behavior
4. Undifferentiated schizophrenia – characterized by symptoms of more than one type of schizophrenia but does not meet the criteria for paranoid, disorganized or catatonic type.
5. Residual schizophrenia – history of at least one psychotic episode but curently without or limited overt psychotic behavior.
Theories of Etiology
1. Biological factors
Genetic Predispositon Neurochemical factor Neuroanatomic or structural dysfunctions
2. Social factors
Decrease financial status Family and caregiver stress Homelessness Stigma and community isolation
3. Psychological factors
Difficulties in relating Difficulties with decision making Decreased stress response and coping Affective blunting Self concept changes Loss of family relationships
Epidemiology
Affects 1% of the total population. 8% in siblings of affected subjects. 12% in offsprings of one affected parents 40% in offsprings of two affected parents 47% in subjects of affected monozygotic twins
Treatment
Institutional care Antipsychotic drugs Psychotherapy The community approach
Nursing History
Patient’s Profile
Patient’s name: Ms. X Informant: Patient herself and neighbor
Gender: Female Reliability: 80%
Birth date: September 16, 1964 Admitting diagnosis: F20.3
Civil status: single undifferentiated schizophrenia type
Age: 50 y/o Occupation: housekeeper
Hospital #: 8363 educational attainment: Grade VI
Religion: Catholic Address: #508 Paete St. Mandaluyong
Citizenship: Filipino City
Place of Birth: Pangasinan
Height: 5’2”
Weight: 170 lbs
Date of admission: December 13, 20145:06 pm
Chief Complaint:
According to the informant:“nangugulat, sumisigaw, nananakot.”
According to the patient: “parang susumpungin ako, gusto ko mag-pa admit.”
History of present illness:
The HPI started when the patient was 16 y/o, she was diagnosed to have mental illness and was admitted at NCMH, she is compliant to unrecalled medication which she took every night. She was then discharged.
She was apparently well, compliant to her medications until 2005 wen she had recurrence of mental illness, hence she was admitted.
She was apparently well, functional at home, compliant to chlorpromazine 200mg 2 tablets every night until 1 month prior to admission when the patient had a feeling of despair and suicidal ideation. She channeled her thoughts in doing household chores.
Few hours prior to admission, she was noted to have shouting episodes, “nanggugulat, naninigaw, nananakot nanaman sya.” as verbalized by the informant. Patient also verbalized “ parang susumpungin ako, gusto ko mag-pa admit.” she was then accompanied by her neighbor to NCMH ER and was subsequently admitted.
Past medical history:
(-) HPN
(-) DM no check-up
(-) PTB
(+) measles, mumps, unknown immunization
(-) surgery, accidents, trauma
Physical Examination
General Apperance: Patient is coherent, conscious, ambulatory, non-febrile and with VS BP: 150/100 HR: 91bpm RR: 19cpm Temp: 36.7 degree Celsius
HEENT: Anicteric sclerae, pink palpabral conjunctiva, no naso-aural discharged, no tonsillopharingeal congestion, no cervical lymphadenopathy with mole right upper lip
Lungs: Symmetrical chest expansions, no lagging, no retractions, vesicular breath sounds with scar at the upper right back
Heart: Adynamic precordium with normal heart rate and regular rhythm, no murmurs
Abdomen: Flabby abdomen, hormoactive bowel sounds, non-tender upon light and deep palpation
Extremeties: Grossly normal extremeties with 2x2 cm skin tags at the left lateral thigh, no edema, no cyanosis, pull and equal pulses on extremeties with scar just below the skin tags
Neurological Exam
Cerebrum: conscious, alert, coherent, oriented to time, place and person. Able to follow simple commands.
Cerebellar: not assessed (patient is restrained)
Cranial Nerves
CN I- can smell
CN II- 2mm pupils equally reactive to light and accommodation
CN III, IV, VI- intact EOM
CN V- able to feel pain prick at forehead, able to clench teeth
CN VII- no facial asymmetry, able to raise eyebrows
CN VIII- able to hear
CN IX, X- intact gag reflex, uvula at the midline
CN XI- able to shrug shoulder against resistance
CN XII- tongue is at the midline
Motor strength: Sensory strength:
5 5 5 5 100% 100%
5 5 5 5 100% 100%
(-) nuchal rigidity
(-) kernigs
(-) Brudzinski
Mental Status Examination
General appearance:
Patient is female, old looking, looking appropriate at her age, with average height, black hair with some white hair, wearing floral house dress, brown in complexion, groomed with good eye contact, good posture, no, mannerism, no signs of agitation, no unusual gestures, cooperative
Speech:
Patient answers cues spontaneously in moderate tone in normal pace, no neologism, no resistance and talks appropriately
Mood and Affect:
Euthymic mood with appropriate affect
Thought Process:
Patient is coherent, comprehensive and goal oriented
Thought Content:
Patient has no delusions, she is not preoccupied, she denies suicidal idea, no intention to hurt others and no phobias
Perception:
Patient has no aunditory and visual hallucination. She denies illusions and depersonalization
Cognition and Sensorium:
Patient is alert, conscious and coherent. She is attentive, oriented to time, and person. She can do simple calculation with intact immediate, recent and remembering memory. She is able to differentiate banana and apple by differentiating the two
Insight:
Patient understands and has true emotional insight of her illness
Judgment:
Patient has good judgment when asked what she’ll do id she found a wallet with full of money, she answered that if the wallet has an addressed on it she will return it to the owner.
Emergency Room
General Survey:
Conscious, coherent, disoriented to time and place. Oriented to person, not in distress, restrained to bed
VS:
BP: 120/180 RR: 18
HR: 80 TEMP: 37.2 degree Celsius
Skin: brown, soft, good skin turgor, capillary refill less than 2 seconds
HEENT: no neck vein distension (no corvicolynphedenopathy)
(no cervical lymphadenopathy)
Chest and Lungs: symmetric chest, well expansion, vesicular smooth sounds, no lagging, no retraction
Heart: adynamic pericardium, no heaves, no thrills, normal note, regular rhythm, no murmur
Abdomen: flabby, soft, non-tender with normal active bowel sounds
Extremeties: grossly normal extremities, no cyanosis, no edema
Neurological Exam
Cerebrum: conscious, coherent, hypoproductive speech, disoriented to time and place, oriented to person, able to do simple commands
Cerebellum: restrained to bed, unable to perform other cerebellar test
Cranial Nerves
CN I- unable to assess
CN II- pupils equally round and reactive to light
CN III, IV, VI- intact EOM
CN V- can clench teeth
CN VII- no facial asymmetry
CN VIII- not assessed
CN IX, X- uvula at the midline
CN XI- shrugs shoulders
CN XII- tongue is midline, no atrophy
Motor strength: Cannot assess motor function
Sensory strength:
100% 100%
100% 100%
Daily Activities
Day 2
Dance Aerobic Activity
Definition- Dance is the most fundamental of the arts, involving direct expression through the body. Dance movement therapy effects changes in feelings, cognition, physical functioning, and behavior.
Title of the dance song: Break Free
Facilitators are in the front, dancing different steps, enabling the patients to follow the dance steps.
Goals:
To encourage the patients to release or express their emotions To let the client learn on how to dance in simple steps To increase the physical activity of the patients To enhance the memory of the patients To communicate/receive a satisfying sense of social engagement
Role of Nurse:
Lead and explain the different dance aerobic steps. Participate and cooperate in dance activity. Facilitate the whole activity.
Day 3
Dance Aerobic Activity
Definition- Dance is the most fundamental of the arts, involving direct expression through the body. Dance movement therapy effects changes in feelings, cognition, physical functioning, and behavior.
Title of the dance song: Break Free
Facilitators are in the front, dancing different steps, in able for the client to follow easily the facilitators.
Goals:
To encourage release or express clients emotions To let the client learn on how to dance in simple steps To increase the physical activity of the patients To enhance the memory of the patients To communicate/receive a satisfying sense of social engagement
Role of Nurse:
Lead and explain the different dance aerobic steps. Participate and cooperate in dance activity. Facilitate the whole activity.
Recreational Activity
Definition- A form of psychotherapy used to help them express or act out their experiences, feelings, and problems by playing group games. The purpose of recreational therapy in the field of mental health is to provide clients with opportunities to explore health leisure choices that enable the development of a variety of skills they can transfer into their day-to-day lives.
Goals:
Enhance memory. Encourage participation and cooperation. Enhance positive personal growth.
Role of Nurse:
Facilitator in the activity. Provide the needed materials. Leader in positive personal independency of the patients
Name of the Game 1: Pantomime
Procedure: Participants stand in a circle, arms distance apart. Ask each person to think of a verb and action which starts with same letter as the person’s first name e.g. “jumping James.”
The person does the action and yells out their action-name. Everyone then repeats the action and the action-name.
This requires high level of energy from the instructor. People are shy to start with, you must encourage everyone to join in and say the name and action of everyone else.
For participants who verbalize “I can’t think of anything,” just respond “keep thinking, we’ll come back to you.” If they still do not come up with anything. I ask the group to help.
Name of Game 2: Human Chain
Materials: Yarn
Procedure: Form a group of two with equal amount of players. Form a line facing left side with arm sideward and hold the hand of the member to your left and right. A yarn that is tied at the ends will be given to the first player. The yarn should pass the body of all the players up to the last without the use of their hands.
Name of Game 3: Banana Relay
Materials: Banana
Procedure: Form a group of two with equal amount of players. A banana will be given to the first player, she will put it to her body with the exception of the hands and runs through the designated point and goes back. She then will pass it to the next player. Note you cannot repeat the same body parts that had been used.
Music and Art Therapy
Description- The use of art materials for self-expression and reflection.
Materials: Crayons, Bond Paper, and relaxing instrumental music
Procedure: Patients are provided with crayons and one piece of bond paper each. They are then asked to draw an interpretation of what they are feeling at that moment; while the instrumental music is playing. After each patient is done drawing, they are asked one by one to explain their individual drawings.
Goals:
To encourage patient’s ability to think and reflect regarding their experiences. To encourage patient’s participation and cooperation. To let and encourage the patient to express their emotions and feelings.
Role of Nurse:
Explain the procedure. Provide needed materials to be use. Facilitate on the activity Leader of positivity
Day 4
Dance Aerobic Activity
Definition- Dance is the most fundamental of the arts, involving direct expression through the body. Dance movement therapy effects changes in feelings, cognition, physical functioning, and behavior.
Title of the dance song: Break Free
Facilitators are in the front, dancing different steps, in able for the client to follow easily the facilitators.
Goals:
To encourage release or express clients emotions To let the client learn on how to dance in simple steps To enhance memory to follow simple steps given.
Role of Nurse:
Lead and explain the different dance aerobic steps. Participate and cooperate in dance activity. Facilitate the whole activity.
Recreational Therapy
Goals:
Enhance memory. Encourage participation and cooperation. Enhance positive personal growth.
Role of Nurse:
Explain the procedure. Provide needed materials to be use. Facilitate on the activity. Leader of Positive personal growth.
Name of Game: Musical Instruments
Procedure: Get a partner and will be assigned of a group number. The game starts with a song “ sumisikat na ang araw sagisag ng bagong buhay, Gawain ay naghihintay halina’t ating simulant. Nasaan and group…” a group will be dcalled and say “narito ang group…tumutugtog ng…” will say a musical instrument and mimic its sound and how to play it. The song ends to the last group to perform its musical instrument.
Name of Game: Fruit Salad
Procedure: Let the patient form a line , then when the student nurse says “banana” they must lean their hips forward, when the student nurse says “apple” they must lean their hips backwards, when the student nurse says “mango” they must move their hips to the left, when the student nurse says “orange” they must move their hips to the right, lastly when the student nurse says “fruit salad’ they must rotate their hips.
Occupational Therapy:
Name of Activity: Making of Graham Balls
Definition: Any activity, mental or physical, prescribed and guided to aid an individual’s recovery from diseases or injury. This activity excludes competition and pressure. There is opportunity for creativeness and produce something tangible out of patient’s own thinking and imagination. Self-confidence and personal achievements are also experienced.
Materials:
Crushed Grahams, Marshmallows, Condensed Milk, Disposable Plastic Gloves, Paper Plates.
Procedure:
Each of patients were given the materials and instructed on how to incorporate the marshmallows with the condensed milk. They were then instructed to place crushed grahams on the marshmallows that were covered in condensed milk.
Goals:
To promote positive personal growth. To give patient extra income when they are to be discharge. To encourage cooperation and participation.
Role of the Nurse:
Explain the procedure of the activity. Facilitate the activity successfully. Assist the patient in doing the activity.
ANATOMY AND PHYSIOLOGY
Structure and function of the nervous system
I. Structures
A. The neurologic system consists of two main divisions, the central nervous system (CNS) and the peripheral nervous system (PNS). The autonomic nervous system (ANS) is composed of both central and peripheral elements.
1. The CNS is composed of the brain and spinal cord.
2. The PNS is composed of the 12 pairs of the cranial nerves and the 31 pairs of the spinal nerves.
3. The ANS is comprised of visceral efferent (motor) and the visceral afferent (sensory) nuclei in the brain and spinal cord. Its peripheral division is made up of visceral efferent and afferent nerve fibers as well as autonomic and sensory ganglia.
B. The brain is covered by three membranes.
1. The dura matter is a fibrous, connective tissue structure containing several blood vessels.
2. The arachnoid membrane is a delicate serous membrane.
3. The pia matter is a vascular membrane.
C. The spinal cord extends from the medulla oblongata to the lower border of the first lumbar vertebrae. It contains millions of nerve fibers, and it consists of 31 nerves – 8 cervical, 12 thoracic, 5 lumbar, and 5 sacral.
D. Cerebrospinal fluid (CSF) forms in the lateral ventricles in the choroid plexus of the pia matter. It flows through the foramen
of Monro into to the third ventricle, then through the aqueduct of Sylvius to the fourth ventricle. CSF exits the fourth ventricle by the foramen of Magendie and the two foramens of Luska. It then flows into the cistema magna, and finally it circulates to the subarachnoid space of the spinal cord, bathing both the brain and the spinal cord. Fluid is absorbed by the arachnoid membrane.
II. Function
A. CNS
1. Brain
a The cerebrum is the center for consciousness, thought, memory, sensory input, and motor activity; it consists of two hemispheres (left and right) and four lobes, each with specific functions.
i The frontal lobe controls voluntary muscle movements and contains motor areas, including the area for speech; it also
contains the centers for personality, behavioral, autonomic and intellectual functions and those for emotional and cardiac responses.
ii The temporal lobe is the center for taste, hearing and smell, and in the brain’s dominant hemisphere, the center for interpreting spoken language.
iii The parietal lobe coordinates and interprets sensory information from the opposite side of the body.
iv The occipital lobe interprets visual stimuli.
b The thalamus further organizes cerebral function by transmitting impulses to and from the cerebrum. It also is responsible for primitive emotional responses, such as fear, and for distinguishing between pleasant and unpleasant stimuli.
c Lying beneath the thalamus, the hypothalamus is an automatic center that regulates blood pressure, temperature, libido, appetite, breathing, sleeping patterns, and peripheral nerve discharges associated with certain behavior and emotional expression. It also helps control pituitary secretion and stress reactions.
d The cerebellum or hindbrain, controls smooth muscle movements, coordinates
sensory impulses with muscle activity, and maintains muscle tone and equilibrium.
e The brain stem, which includes the mesencephalon, pons, and medulla oblongata, relays nerve impulses between the brain and spinal cord.
2. The spinal cord forms a two-way conductor pathway between the brain stem and the PNS. It is also the reflex center for motor activities that do not involve brain control.
B. The PNS connects the CNS to remote body regions and conducts signals to and from these areas and the spinal cord.
C. The ANS regulates body functions such as digestion, respiration, and cardiovascular function. Supervised chiefly by the hypothalamus, the ANS contains two divisions.
1. The sympathetic nervous system serves as an emergency preparedness system, the “flight-for-fight” response. Sympathetic impulses increase greatly when the body is under physical or emotional stress causing bronchiole dilation, dilation of the heart and voluntary muscle blood vessels, stronger and faster heart contractions, peripheral blood vessel constriction, decreased peristalsis, and increased perspiration. Sympathetic stimuli are mediated by norepinephrine.
2. The parasympathetic nervous system is the dominant controller for most visceral effectors for most of the time. Parasympathetic impulses are mediated by acetylcholine.
S: “Nakakahiya naman, mabaho na yata kili kili ko, wala kasing deodorant eh. Tapos wala ring shampoo ang kati tuloy ng ulo ko.” As verbalized by the patient.
Disturbed body image related to unrealistic perception of appearance as evidenced by verbalization of perception and feeling towards one’s own appearance.
Within 8 hours, the client will be able to have a clean and good appearance.
Determine whether condition is permanent with no suspection for resolution.
Recognize behaviour indicative of overconcern with body and it’s process.
Have a client describe self, noting what is negative. Be aware of how client believes others see self.
Health teaching.
After 8 hours, the client was able to perform good hygiene and will cooperate to the procedure of proper grooming.
S:Disturbed thought process related to increased dopaminergic as manifested by disorganized thoughts.
Within 2-3 weeks of nursing intervention the client will have maintain reality orientation and identify intervention to deal effectively with the situation.
Tested ability to receive, send and appropriately interpret communications.
Maintain reality oriented relationship and environment.
Present reality concisely and briefly and do not challenge logical thinking.
Encouraged participation in resocialization activities.
Determine ability to participate in planning and executing care.
Client may respond with anxious or aggressive behaviours if started or over stimulated
Client may feel threatened and may withdraw or rebel.
To maintain gains and continue progress if tables
After 2-3 weeks of nursing interventions, the client identifies and understands interventions to improve behaviors and maintains reality orientation.
S: " Minolestya ako ngstepfather ng stepmotherko pero wala akong ginawa.Sinarili ko lang lahat."
O:-Decrease use of social support-Sleep disturbance-Crossing of arms-use of forms of coping that impede adaptive behaviour
Ineffective coping related to dysfunctional familysystem as evidence byinappropriate use ofdefense mechanism.
Within 2weeks ofnursing intervention, the client will be able to:
short term goal:-will develop trust in at least one staff member within 2 weeks.
Long term goal:-will demonstrate use of more adaptive coping skills
-encourage same staff to work with client as much as possible-avoid laughing, whispering, or talking quietly where client can see but not hear what is being said.-be honest and keep all promises-determine previous methods of dealing with life problems-encourage client to verbalize true feelings. The nurse should avoid becoming defensive when angry feelings are directed at him or her.--confront client when behavior is inappropriate, pointing out difference between words and actions
- it reinforce the paranoid feelings.-honesty and dependability promote a trusting relationship.-to identify successful techniques that can be used in current situation.-verbalization of feelings in a non-threatening environment may help client come to terms with long unresolved issues.-provides external locus of control, enhancing safety.-enhances therapeutic
After 2 weeks of nursing intervention, the client was able to:
-assess the current situation accurately-verbalize awareness of own coping abilities.-verbalize feelings congruent with behaviour.
-converse at client's level, providing meaningful conversation while - in order to promote development of trusting relationshipperforming care.-provide for gradual implementation and continuation of necessary behsvior/Lifestyle changes
relationship-enhances commitment to plan.
NAME CLASSIFICATION INDICATION ADVERSE EFFECTS CONTRAINDICATION NURSING CONSIDERATION
Generic Name:Biperiden
Brand Name:Akineton
Dosage &Frequency:2 mg tab OD
Route of Administration: Oral
Anticholinergic drug
Action:Synthetic anticholinergic drug, blocks cholinergic responses in the CNS
Parkinsonian syndrome especially to counter act muscular rigidity and tremor; extrapyramidal symptoms
Fatigue Untreated narrow angle glaucoma, intestinal stenosis or obstruction, mega colon, prostatic hypertrophy.
*Assess for Parkinsonism, EPS.*Assess for mental status.
*Assess patient response if anticholinergics are given.
*Assess for tolerance over long term therapy, dosage may have to be increased or changed.
*Avoid activities that require alertness, may cause dizziness, drowsiness and blurring of vision.
Drug Study
NAME CLASSIFICATION INDICATION ADVERSE EFFECTS CONTRAINDICATION NURSING CONSIDERATION
Generic name: risperidone
Brand Name: Risperdal
Dosage&Frequency: 2mg tab OD
Route of Administration: Oral
Antipschotic
Action: Blocks dopamine and serotonin receptors inthe brain,
Treatment of schizophrenia
Delaying relapse in long-term treatment of schizophrenia
Unlabeled uses: Bipolar disorder; treatment of patients with dementia-relatedpsychotic symptoms
Insomnia Contraindicated with hypersensitivity to risperidone.
Use cautiously with cardiovascular disease, pregnancy, renal or hepaticimpairment, hypotension
Monitor patient for tardive dyskinesia, which may occur after prolonged use. It may not appear until months or years later and may disappear spontaneously or persist for life, despite stopping drug.
Life-threatening hyperglycemia may occur in patients taking atypical antipsychotics. Monitor patients with diabetes regularly.
Periodicallyreevaluatedrug’srisks and benefits, especially during prolonged use.
Monitor patient for weight gain.
NAME CLASSIFICATION INDICATION ADVERSE EFFECTS CONTRAINDICATION NURSING CONSIDERATION
Generic Name:Diphenhydramine hydrochloride
Brand Name:Benadryl
Frequency&Dosage50mg cap OD
Route of administration: Oral
Antihistamine
Action: Blocks the effect of histamine at the H1 receptor sites, and is used for a wide range of effects, ranging from allergy and itching relief, to sleep aids, to nausea relief.
Diphenhydramine is used for its antimiscarinic properties in the control of parkinsonism and drug-induced extrapyramidal disorders
Insomnia Increased Pressure in the Eye, Closed Angle Glaucoma, Chronic Difficulty having a Bowel Movement, High Blood Pressure, Stenosing Peptic Ulcer, Blockage of Urinary Bladder, Enlarged Prostate, Cannot Empty Bladder, Overactive Thyroid Gland
Take as prescribed; avoid excessive dosage.
Take with food if GI upset occurs.
Report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual disturbances, irregular heartbeat.
Discharge Planning
AFTER YOU LEAVE:
Medicines:Antipsychotics
Antianxiety
Mood stabilizers
Tranquilizers
Antidepressants
ENVIRONMENTProvide a safe and secure environment.
Treatment SettingsCrisis residential program: This is a program where you live in a home-care facility. Caregivers work in these homes just like in hospitals. This program is helpful especially when you are having a relapse (your symptoms return).
Day treatment program: This program provides a chance to learn and practice skills. This also provides long-term support so you may have an improved quality of life.
Partial care program: A partial care program is also called day hospitalization or partial hospitalization. This is group therapy and lasts 4 to 6 hours a day, 3 to 5 days a week. It may help you avoid going into the hospital or help you get out of the hospital sooner. It may also help you get symptoms under control and avoid a relapse.
Health Teaching:Do not stop taking your medicines: Tell your primary healthcare provider or psychiatrist if you have any problems with or questions about your medicines.
Do not stop your therapies: It is normal to have doubts about or feel discomfort with your therapy. Tell your primary healthcare provider or psychiatrist if you are not comfortable or have questions about your therapies.
Get regular sleep: Try to get 6 to 8 hours of sleep each night. Tell your primary healthcare provider or psychiatrist if you are not able to sleep, or if you are sleeping too much.
Do not drink alcohol: Alcohol interacts with medicine used to treat schizophrenia.
Contact your primary healthcare provider or psychiatrist if:You feel that you are having symptoms of schizophrenia.
You are not able to sleep well, or are sleeping more than usual.
You cannot eat or are eating more than usual.
You have questions or concerns about your condition or care.
Seek care immediatelyYou think about killing yourself or someone else.
You have a rash, swelling, or trouble breathing after you take your medicine.
OutpatientAn outpatient program is when you meet regularly with your therapist. You may meet one-to-one with your therapist, or you might meet with your therapist in a group.
DIET AND NUTRITIONBalance your blood sugar and avoid stimulantsYour intake of sugar, refined carbohydrates, caffeine, alcohol and cigarettes, as well as stimulant drugs, all affect the ability to keep one’s blood sugar level balanced. On top of this common antipsychotic medication may also further disturb blood sugar control. Stimulant drugs, from amphetamines to cocaine, can induce schizophrenia. The incidence of blood sugar problems and diabetes is also much higher in those with schizophrenia.Therefore it is strongly advisable to reduce, as much as possible, your intake of sugar, refined carbohydrates, caffeine and stimulant drugs and eat a low glycemic load diet.
