MOOD AND AFFECT
Clients with schizophrenia report and demonstrate
wide variances in mood and affect. They often are de-
scribed as having flat affect(no facial expression) or
blunted affect(few observable facial expressions).
The typical facial expression often is described as
mask-like. The affect also may be described as silly,
characterized by giddy laughter for no apparent
reason. The client may exhibit an inappropriate ex-
pression or emotions incongruent with the context
of the situation. This incongruence ranges from mild
or subtle to grossly inappropriate. For example, the
client may laugh and grin while describing the death
of a family member or weep while talking about the
weather.
The client may report feeling depressed and hav-
ing no pleasure or joy in life (anhedonia). Conversely
he or she may report feeling all-knowing, all-powerful,
and not at all concerned with the circumstance or sit-
uation. It is more common for the client to report ex-
aggerated feelings of well-being during episodes of
psychotic or delusional thinking and a lack of energy
or pleasurable feelings during the chronic or long-
term phase of the illness.THOUGHT PROCESS AND CONTENT
Schizophrenia often is referred to as a thought disor-
der because that is the primary feature of the dis-
ease: thought processes become disordered, and the
continuity of thoughts and information processing is
disrupted (Cancro & Lehman, 2000). The nurse can
assess thought process by inferring from what the
client says. He or she can assess thought content by
evaluating what the client actually says. For exam-
ple, clients may suddenly stop talking in the middle
of a sentence and remain silent for several seconds to
1 minute (thought blocking). They also may state
that they believe others can hear their thoughts
(thought broadcasting); that others are taking
their thoughts (thought withdrawal); or that oth-
ers are placing thoughts in their mind against their
will (thought insertion).
Clients also may exhibit tangential thinking,
which is veering onto unrelated topics and never an-
swering the original question:
Nurse:“How have you been sleeping lately?”
Client:“Oh, I try to sleep at night. I like to listen
to music to help me sleep. I really like country-western
music best. What do you like? Can I have something to
eat pretty soon? I’m hungry.”
Nurse:“Can you tell me how you’ve been
sleeping?”
Circumstantiality may be evidenced if the client
gives unnecessary details or strays from the topic but
eventually provides the requested information:ent and make no sense to the listener) and echolalia
(repetition or imitation of what someone else says).
Speech may be slowed or accelerated in rate and vol-
ume: the client may speak in whispers or hushed tones
or may talk loudly or yell. Latency of response
refers to hesitation before the client responds to
questions. This latency or hesitation may last 30 or
45 seconds (Cancro & Lehman, 2000) and usually in-
dicates the client’s difficulty with cognition or thought
processes. Box 14-2 lists and gives examples of these
unusual speech patterns.
308 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
Box 14-2
➤ UNUSUALSPEECHPATTERNS OFCLIENTS
WITHSCHIZOPHRENIA
Clang associationsare ideas that are related to
one another based on sound or rhyming rather
than meaning.
Example: “I will take a pill if I go up the hill but
not if my name is Jill, I don’t want to kill.”
Neologismsare words invented by the client.
Example: “I’m afraid of grittiz. If there are any
grittiz here, I will have to leave. Are you a grittiz?”
Verbigerationis the stereotyped repetition of
words or phrases that may or may not have
meaning to the listener.
Example: “I want to go home, go home, go
home, go home.”
Echolaliais the client’s imitation or repetition of
what the nurse says.
Example: Nurse:“Can you tell me how you’re
feeling?” Client:“Can you tell me how you’re
feeling, how you’re feeling?”
Stilted languageis use of words or phrases that
are flowery, excessive, and pompous.
Example: “Would you be so kind, as a represen-
tative of Florence Nightingale, as to do me the
honor of providing just a wee bit of refreshment,
perhaps in the form of some clear spring water?”
Perseverationis the persistent adherence to a sin-
gle idea or topic and verbal repetition of a sen-
tence, phrase, or word, even when another per-
son attempts to change the topic.
Example: Nurse:“How have you been sleeping
lately?” Client:“I think people have been fol-
lowing me.” Nurse:“Where do you live?”
Client:“At my place people have been follow-
ing me.” Nurse:“What do you like to do in your
free time?” Client:“Nothing because people
are following me.”
Word saladis a combination of jumbled words
and phrases that are disconnected or incoherent
and make no sense to the listener.
Example: “Corn, potatoes, jump up, play games,
grass, cupboard.”