SCHIZOPHRENIC question

GOMER42 · Jan 11, 2009

Is this homework?

caringkay RN · Jan 11, 2009

no it's not. the answer is confusing, i found it in a book.

Psyched Out RN · Jan 11, 2009

My guess is 4 because I'd want to know what the voices are telling the patient to do (could be a situation where pt. is a danger to him/herself or others).

What is the answer and why are you confused?

caringkay RN · Jan 11, 2009

but then auditory hallucination is also a sign of schizophrenia and that is why am confused

Atheos · Jan 11, 2009

I am only guessing but I would assume the answer would be #2 'I can read the mind of everyone here.'

The obvious choice of hearing voices really doesn't mean much. The voices could say anything. They could just be telling him the sky is purple.

By the patient thinking he can read everyone's mind he may pose a greater threat because if he thinks he can read your mind he may be apt to ascribe some thought to you and ACT on it.

Of course. I am just guessing based on my experience with mental illness NOT anything else.

What was the answer in the book.

BabyLady, BSN, RN · Jan 11, 2009

but then auditory hallucination is also a sign of schizophrenia and that is why am confused

It's more than a sign of schizophrenia, that alone can confirm a diagnosis of schizophrenia, assuming it lasts for more than 6 months.

I think you just answered your own question.

#1 may or may not be schizophrenia...but it can occur with other disorders.

#2 is a grandiose thought process or just someone making the statement for attention..not enough to tell.

#3 may be depression or bipolar.

That leaves 4 as your answer.

so alive LPN · Jan 11, 2009

ok. Been a while, and I'm not 100%, but " I have voices that tell me what to do" would be my choice. I personally would assess what the voices were saying, suicidal idealations, homocidal idealations, etc.

Mr Ian · Jan 11, 2009

The question states the pt has schizophrenia. (well it says they're "a schizophrenic" - but that's just their condition)

The correct answer is - they all do as they all evoke as need.

However, for purposes of the question posed - it is seeking something specific and I'm unfortunately drawn to the conclusion they are seeking to assess your ability to assess risk in mental disorder; which would be 4. (I say unfortunate as more time is spent assessing and managing 'risk' than is actually understanding and supporting the individual when it comes to psychoses. The stats show that ppl with only schizophrenia are only slightly more likely than average Jo to act aggressively - and in fact they are more likely to hurt themselves before someone else. Those with Scz and illicit drug use are, however, 3 times more likely than average Jo to be aggressive)

So why 4? Because it is a "command hallucination", it's telling the person how to behave and you need to find out:

a) the nature of the command - is it harm related? Is there a need to make an immediate safety plan? (It could be - I need to kiss the president or - I have to rip your eyeballs out: There are immediate differences in opportunity and consequences).

b) the person's capacity to self-regulate or self-restrain - depending on the intensity, nature and duration of the voice. Working out how far pushed they feel gives you indication how close or far they are to/from breaking point. This will also give you an indication of how the person is likely to respond:

a) cope

b) act out - eg trash room

c) act out - eg hurt self

d) act out - eg hurt others

e) act out - kill self

f) act out - kill other(s)

c) what opportunity is there to reduce any imminent risk? While assessing the risk; assess the person's perception and likely ability to either; self-maintain, trust the care team to support them, accept the care team applying coercive mesures or having lost the capacity to engender any of these, the process and people needed to preserve safety by necessary means.

My only other consideration is #3 - as it gives rise to risks of suicide. But #4 is risk of suicide or harm to others.

What book was it and was there a contextual slant to the question? eg it was a chapter on risk to self?

jadzcare · Jan 11, 2009

answer #4..highest priority...SAFETY

RN BSN 2009 · Jan 11, 2009

yup.. I'm going with #4... if the voices are telling him/her to harm themselves or others.

caringkay RN · Jan 11, 2009

waoh thanks everyone, i guess am wrong then, cause i chose the no.3 since answer no 4 is expected in a client with this kind of diagnosis. It is a review book i saw in the library(prentice hall's i think) today and because this question has been bothering me i had to post it. Thanks once aga