Assess for positive symptoms of schizophrenia. These symptoms reflect aberrant mental activity and are usually present early in the first phase of the schizophrenic illness.
Alterations in Thinking
* Delusion: false, fixed belief that is not amenable to change by reasoning. The most frequent elicited delusions include:
o Ideas of reference.
o Delusions of grandeur.
o Delusions of jealousy.
o Delusions of persecution.
o Somatic delusions.
* Loose associations: the thought process becomes illogical and confused.
* Neologisms: made-up words that have a special meaning to the delusional person.
* Concrete thinking: an overemphasis on small or specific details and an impaired ability to abstract.
* Echolalia: pathologic repeating of another’s words.
* Clang associations: the meaningless rhyming of a word in a forceful way.
* Word salad: a mixture of words that is meaningless to the listener.
Alterations in Behavioral Responses
* Bizarre behavioral patterns
o Motor agitation and restlessness
o Automatic obedience or robotlike movement
o Autonomic obedience or robotlike movement
o Negativism
o Stereotyped behaviors
o Stupor
o Waxy flexibility (allowing another person to reposition extremities)
* Agitated or impulsive behavior
* Assess for negative symptoms of schizophrenia that reflect a deficiency of mental functioning
o Alogia (lack of speech)
o Anergia ( inability to react)
o Anhedonia ( inability to experience pleasure)
o Avolition (lack of motivation or initiation)
o Poor social functioning
o Poverty of speech
o Social withdrawal
o Thought blocking
* Assess for associated symptoms of schizophrenia
o Substance use, abuse, or dependence
o Depression
o Fantasy
o Violent or aggressive behavior
o Water intoxication
o Withdrawal
Common nursing diagnosis found in Nursing Care Plans for Delusional Disorder
* Disturbed Thought Processes related to perceptual and cognitive distortions, as demonstrated by suspiciousness, defensive behavior, and disruptions in thought
* Social Isolation related to an inability to trust
* Activity Intolerance related to adverse reactions to psychopharmacologic drugs
* Ineffective Coping related to misinterpretation of environment and impaired communication ability
* Risk for Self-directed or Other-directed Violence related to delusional thinking and hallucinatory experiences
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