The Nurse's Notes: Tuesday, RN

NOTES ABOUT MENTAL STATUS EXAMINATION
(Excerpts from NURSE’S NOTES: Reviewer’s Edition)

Maritess Manalang-Quinto, RN, MAN(c)
Nurse Educator/Nurse Instructor/Resource Speaker
Reviewer V for Local and International Nurse Licensure Examinations
Certified Foreign Graduate Nurse
Registered Nurse, Vermont State, USA
Registered Nurse, Republic of the Philippines

SCHIZOPHRENIA

: Characterized by individuals who exhibits manifestations which are considered bizarre and inappropriate
Etiology:
1. Psychoanalytic
2. Genetics
3. Dopamine hypothesis
4. Other neurotransmitters
Classic Signs of Schizophrenia:
(Bleuler’s Concept of Schizophrenia)
o Looseness of Associations
o Autism
o Inappropriate Affect
o Ambivalence

Confirmatory symptoms:
• Hallucinations
• Delusions

TYPES OF SCHIZOPHRENIA
o Paranoid
o Disorganized
o Catatonic
o Undifferentiated
o Residual

Types of Symptoms:
1. Hard
o Hallucinations
o Delusions
o Echopraxia
o Flight of Ideas
o Perseveration
o Associative looseness
o Ideas of Reference
o Ambivalence

2. Soft
o Apathy
o Alogia
o Flat affect
o Blunt affect
o Anhedonia
o Catatonia
o Lack of volition

Hallucinations Common to Schizophrenic Clients:
o Auditory Hallucination (most common and should be validated)
o Command Hallucination
o Tactile Hallucination
o Olfactory Hallucination
o Gustatory Hallucination
o Cenesthetic Hallucination
o Kinesthetic Hallucination

Delusions Common to Schizophrenic Clients:
o Paranoid Delusions
o Ideas of Reference
o Grandiose Delusions
o Somatic Delusions
o Religious Delusions

Prognosis of the disease process
1. Good
o Late onset
o Positive Symptoms
o Obvious precipitating Factos
o Good premorbid, sexual and work histories
o Mood disorders
o Married
o Family history of mood disorders
o Good support systems
2. Poor
o Young onset
o Sudden onset
o No precipitating factors
o Poor work, sexual or social histories
o Withdrawn, autistic
o Single, divorced, widow
o Family history of schizophrenia
o Poor support systems
o Negative symptoms
o Neuro symptoms
o No remissions in 3 years
o No relapses
o History of assault

Nursing Interventions:
1. Safety
2. Set limits
3. Present Reality
4. Depends on the manifestations of the client
5. Psychopharamcology
6. Behavioral Therapy
7. Milieu Therapy

Medications:
a. Typical b. Atypical
Chlorpromazine (Thorazine) Clozapine (Clozaril)
Trifluoperazine (Trilafon) Risperidone (Risperdal)
Fluphenazine (Prolixin) Olanzapine (Zyprexa)