Case Study: Schizophrenia and Schizoaffective Disorder

Case Study 1: Patient with New-Onset Schizophrenia Q1. Which findings are consistent with schizophrenia?

• Auditory hallucinations

• Disorganized speech

• Elated mood

• Flat affect

• Memory loss due to trauma

Answer explanation

Auditory hallucinations, disorganized speech, and flat affect are core symptoms of schizophrenia, indicating disturbances in thought and perception. Elated mood and memory loss due to trauma are not typical of schizophrenia.

Case Study 1: Patient with New-Onset Schizophrenia Q2. Choose the most appropriate priority nursing intervention for a patient experiencing auditory hallucinations:

• Redirect the patient to reality-based activities

• Encourage the patient to listen to the voices and follow their instructions

• Leave the patient alone to process the hallucinations

• Confront the patient about the unreality of the voices

Answer explanation

Redirecting the patient to reality-based activities helps distract from hallucinations and promotes engagement with the real world, which is crucial for their safety and well-being.

Highlight all signs of positive symptoms of schizophrenia:

• Delusions, Hallucinations, Disorganized behavior

• Affective flattening, Alogia, Anhedonia

• Social withdrawal, Poor grooming, Lack of motivation

• Memory loss, Impaired attention, Reduced IQ

Answer explanation

The correct choice highlights positive symptoms of schizophrenia, which include delusions, hallucinations, and disorganized behavior. These symptoms reflect an excess or distortion of normal functions.

Case Study 2: Schizoaffective Disorder Q5. Which medication is commonly used to treat schizoaffective disorder due to its effect on both mood and psychosis?

Answer explanation

The medication commonly used to treat schizoaffective disorder is often an atypical antipsychotic, such as olanzapine or quetiapine, which address both mood symptoms and psychosis. Sertraline is primarily an antidepressant.

The nurse is educating a patient starting risperidone. Which side effects should be included?

• Weight gain

• Extrapyramidal symptoms

• Bradycardia

• Elevated prolactin levels

• Cough

Answer explanation

Risperidone can cause weight gain, extrapyramidal symptoms (like tremors), and elevated prolactin levels, which can lead to issues like galactorrhea. Bradycardia and cough are not common side effects associated with this medication.

Which of the following lists the correct order of interventions when approaching a patient having a psychotic episode?

• Ensure safety, establish rapport, assess symptoms, provide reassurance

• Assess symptoms, provide reassurance, ensure safety, establish rapport

• Provide reassurance, ensure safety, assess symptoms, establish rapport

• Establish rapport, assess symptoms, provide reassurance, ensure safety

Answer explanation

The correct order prioritizes safety first, then rapport to build trust, followed by assessing symptoms for appropriate intervention, and finally providing reassurance to the patient. This approach ensures effective management of the psychotic episode.

The nurse suspects neuroleptic malignant syndrome (NMS). Which action is most appropriate?

• Stop the antipsychotic medication immediately and notify the provider

• Administer another dose of the antipsychotic medication

• Encourage the patient to rest and monitor for improvement

• Apply warm blankets and observe for shivering

Answer explanation

Stopping the antipsychotic medication immediately is crucial in suspected NMS to prevent further complications. Notifying the provider ensures timely intervention and management of this potentially life-threatening condition.

Symptoms associated with NMS include:

• Muscle rigidity, hyperthermia, altered mental status, autonomic dysfunction

• Bradycardia, hypothermia, weight gain, insomnia

• Rash, cough, diarrhea, blurred vision

• Tremor, headache, hypotension, dry mouth

Answer explanation

Neuroleptic Malignant Syndrome (NMS) is characterized by muscle rigidity, hyperthermia, altered mental status, and autonomic dysfunction. The other options do not align with the symptoms of NMS.

Which strategies support medication adherence in schizophrenia?

• Use of long-acting injectables

• Psychoeducation

• Changing medications weekly

• Involving family in care

• Simplified medication regimen

Answer explanation

Strategies like long-acting injectables, psychoeducation, involving family, and simplifying regimens enhance adherence by ensuring consistent medication use and support, while changing medications weekly can disrupt adherence.

A patient stabilized on clozapine needs routine monitoring of which lab value?

• Liver enzymes

• White blood cell count

• Serum potassium

• INR

Answer explanation

Clozapine can cause agranulocytosis, making regular monitoring of the white blood cell count essential to ensure patient safety and detect any potential blood dyscrasias early.