Psychiatric Mental Health Nursing by Videbeck

is used to screen for symptoms of movement disor-
ders. The client is observed in several positions, and
the severity of symptoms is rated from 0 to 4. The
AIMS can be administered every 3 to 6 months. If the
nurse detects an increased score on the AIMS, indi-
cating increased symptoms of tardive dyskinesia, he
or she should notify the physician so that the client’s
dosage or drug can be changed to prevent advance-
ment of tardive dyskinesia. The AIMS examination
procedure is presented in Box 14-1.

Seizures.Seizures are an infrequent side effect as-
sociated with antipsychotic medications. The inci-
dence is 1% of people taking antipsychotics. The no-
table exception is clozapine, which has an incidence
of 5%. Seizures may be associated with high doses of
the medication. Treatment is a lowered dosage or a
different antipsychotic medication.

Neuroleptic Malignant Syndrome. Neuroleptic
malignant syndrome(NMS) is a serious and fre-
quently fatal condition seen in those being treated
with antipsychotic medications. It is characterized by
muscle rigidity, high fever, increased muscle enzymes
(particularly CPK), and leukocytosis (increased leuko-
cytes). Estimates are that 0.1% to 1% of all clients tak-
ing antipsychotics develop NMS (O’Connor, 1998).
Any of the antipsychotic medications can cause NMS,
which is treated by stopping the medication. The
client’s ability to tolerate other antipsychotic med-
ications after NMS varies, but use of another anti-
psychotic appears possible in most instances.

Agranulocytosis. Clozapine has the potentially fatal
side effect of agranulocytosis (failure of the bone mar-
row to produce adequate white blood cells). Agranulo-
cytosis develops suddenly and is characterized by

fever, malaise, ulcerative sore throat, and leukopenia.

This side effect may not be manifested immediately

but can occur as long as 18 to 24 weeks after the initi-

ation of therapy. The drug must be discontinued im-

mediately. Clients taking this antipsychotic must have

weekly white blood cell counts. Currently, clozapine is

dispensed every 7 days only, and evidence of the white

cell count is required before a refill is furnished.

Psychosocial Treatment

In addition to pharmacologic treatment, many other

modes of treatment can help the person with schizo-

phrenia. Individual and group therapy, family ther-

apy, family education, and social skills training can

be instituted for clients in both inpatient and com-

munity settings.

Individual and group therapy sessions are often

supportive in nature, giving the client an opportunity

for social contact and meaningful relationships with

other people. Groups that focus on topics of concern

such as medication management, use of community

supports, and family concerns also have been benefi-

cial to clients with schizophrenia (Adams, Wilson, &

Bagnell, 2000).

Clients with schizophrenia can improve their so-

cial competence with social skills training, which

translates into more effective functioning in the com-

munity. Bustillo et al. (2001) describe three forms

of social skills training: the basic model; the social

problem-solving model; and the cognitive reme-

diation model. The basic model involves breaking

complex social behavior into simpler steps, practicing

through role-playing, and applying the concepts in

the community or real-world setting. The social

problem-solving model focuses on improving impair-

ments in information processing that are assumed

14 SCHIZOPHRENIA 305

Table 14-3

EFFICACY OFDRUGSUSEDTOTREATEXTRAPYRAMIDALSIDEEFFECTS ANDNURSINGINTERVENTIONS

Generic Trade Name Akathisia Dystonia Rigidity Tremor Nursing Interventions

Benztropine (Cogentin)

Trihexyphenidyl (Artane)

Biperiden (Akineton)

Procyclidine (Kemadrin)

Amantadine (Symmetrel)

Diphenhydramine (Benadryl)

Diazepam (Valium)

Lorazepam (Ativan)

Propranolol (Inderal)

2 2 1 1 3 2 2 2 3

2

3

3

3

2

2–3

1–2

1–2

0

3 3 3 3 3 1

1–2

1–2

0

2 3 3 3 2 2

0–1

0–1

1–2

Increase fluid and fiber intake to

avoid constipation; use ice chips

or hard candy for dry mouth;

assess for memory impairment

(another side effect).

Use ice chips or hard candy for dry

mouth; assess for worsening psy-

chosis (an occasional side effect).

Use ice chips or hard candy for dry

mouth; observe for sedation.

Observe for sedation; potential for

misuse or abuse.

Observe for sedation; potential for

misuse or abuse.

Assess for palpitations, dizziness,

cold hands and feet.