Patients who are diagnosed with schizophrenia should be treated with antipsychotics (neuroleptics) to help improve their quality of life. These medications; however, have several side effects, so you should always be aware of extrapyramidal symptoms and neuroleptic malignant syndrome in these patients.
Often these patients are delusional, so it is important to built trust and rapport amongst the patient. It is through this relationship that you can better help the patient.
Schizophrenic patients often forgo hygiene and self-care, as they are distracted with their symptoms. Thus, assisting patients with their self-care can improve mental status and social functioning. We want these patients to be able to perform their ADLs independently.
Often, it is important to follow up patients who have schizophrenia with reality testing. This helps conclude whether treatment is effective, or if delusions and hallucinations are persisting.
Patients taking antipsychotic medications can develop neuroleptic malignant syndrome, which is a severe side effect. This syndrome is composed of rigidity of muscle ("lead-pipe"), fever, encephalopathy, and unstable vital signs. Treat patients with cooling blankets and pharmacologic intervention. Mild cases are treated with bromocriptine (Parlodel), while severe cases are treated with dantrolene (Dantrium).
A very common side effect of antipsychotic medications is tardive dyskinesia. This is described as stereotypic oral-facial (lip-smacking) and other motor movements. These are potentially irreversible. You can track involuntary movements using the AIMS (abnormal involuntary movement scale) test.
Educating the family on recognizing schizophrenic symptoms, as well as signs of drug toxicity are very important. Goals of family therapy are to develop trust among the patient and family, and allow the family to participate in support groups, if needed.
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