schizophrenia syndrome – many varieties disordered & bizarre thoughts disordered & bizarre...

Schizophrenia

Syndrome – many varietiesDisordered & bizarre thoughtsDisordered & bizarre perceptions

Bizarre behaviors and movements Flat or blunted emotions Impaired communication & social

functioning Impaired cognition

Brain & Behavior Research Foundation - ART

Schizophrenia

Onset usually late adolescence or early adulthood

About 1% of population Onset abrupt or slow Clinical course varies; can be

debilitating Earlier onset = poor prognosis Inheritability estimated 80%

Inheritability of schiz as high as 80% Identical Twin studies

About 50% chance both will develop schiz why don’t both get the disease?

Over 1000 genes examined as candidate genes – heterogeneity

“Alleles of very small effect and rare mutations interact with environmental factors to confer risk” ( Journal of Nursing Scholarship, 2013)

Positive symptoms Hallucinations Delusions & illusions Echopraxia/echolalia Flight of ideas & loose associations Perseveration Ideas of reference Ambivalence Symptoms related to changes in subcortical

limbic circuits

Auditory hallucinations 53% schizophrenics 28% MDD 27% incest survivors Non-psychiatric

Left temporal lesions Psychoactive substances Other somatic conditions Stress/bereavement/spiritual

Negative symptoms Apathy Alogia Flat or blunted affect Anhedonia Absence of will Poor hygiene Social isolation/socially inappropriate Changes in the medial & orbital prefrontal

cortex

Cognitive functioning Working memory – ability to retain & use data Executive function – decision making

Context “If the farmer wants to keep chickens

she needs a pen” Changes in dorsolateral prefrontal cortex

In both those with schiz & those at risk for! Newer antipsychotics MAY be especially

beneficial Early evidence – may be able to treat early and

prevent psychosis from developing

Person with schizophrenia – Elyn Saks, PhD

http://www.ted.com/talks/elyn_saks_seeing_mental_illness

This is about 15 minutes long so I recommend viewing on your own time.

Nursing assessment History Presenting problem

Include suicide/homicide risk Appearance and behaviors

Speech patterns Mood and affect

Flat or blunted inappropriate

Nursing assessment

Thought process Thought content

Hallucinations Delusions Judgment and insight Self concept, relationships, self care

Nursing diagnosesfor positive symptoms

Risk for violence (self or other directed)

Altered thought processes Sensory/Perceptual alterations Personal identity disturbance Impaired verbal communication

Nursing diagnosesfor negative symptoms

Self-care deficit Social isolation Altered health maintenance Ineffective management of

therapeutic regime Diversional activity deficit

Schizophrenia case study

http://www.youtube.com/watch?v=H_jYqSA_fJk

Mindyourmind.co

Antipsychotic medications

Phenothiazines & Haldol (conventional) Decrease dopamine

Atypical antipsychotics More specific blocking of dopamine

receptors as well as increasing serotonin & norepinephrine

Dopamine system stabilizers (new generation – Abilify)

Neuroleptic Malignant Syndrome

Depletion of dopamine Muscle rigidity Hyperthermia Hypertension Diaphoresis Confusion – mutism Elevated CPK and WBC

Extrapyramidal Symptoms

Dystonia Torticollis Opisthonis Oculogyric crisis Pseudoparkinsonism Akathesia NMS Tardive dyskonesia

Anticholinergic symptoms

Dry Mouth Constipation Orthostatic Hypotension

Other side effects Weight gain &

metabolic syndrome

Sexual side effects

Clozaril/Clozapine

Potential fatal side effect of agranulocytosis

Sudden fever, sore throat, malaise

Leukopenia Weekly WBC

Non-pharmacological interventions Cognitive behavioral

therapy Support groups Social skills and

lifeskills training Cognitive

remediation Techniques for

dealing with hallucinations

Case study

Sam is a 19 yr old who has been admitted to a psychiatric evaluation unit. You are assigned as nurse. When you first see him you note he has long shaggy unwashed hair; he is relatively thin; he makes no eye contact. He tells you in a soft voice that Mary was supposed to care for him because he was nice to her, but she disappointed him by moving away. Something is keeping them apart; maybe because other people are reading his thoughts. “My thoughts are very loud and bump into the sides of my head. Can you hear them?”

Case study continued Sam moved back to his parent’s home after

living in a college dorm. He is not sure if he is still in school. “I haven’t gone to class in months because they won’t help me make Mary understand. They want me to fail and the teachers wink at me to tell me I am stupid. I don’t need school. I don’t want a job because people will make sure I would get fired.” He shows little emotion. It seems difficult for him to find the words to explain. He is easily distracted; stares off into the corner, and is restless. After a few minutes he gets up and leaves.

Preventing recidivism

Medication teaching and effective medication management

Community follow-up Effective self-care and stress

reduction Teaching pt & significant others Recognizing trigger events and early

symptoms

Recovery model

Accepts that mental illness is often a life-long illness with remissions, exacerbations, and set backs

Borrowed from substance abuse fields Focus on treating mental illness like

any other chronic illness http://www.youtube.com/watch?v=Zn6y

w2KUIwc

A beautiful mind John Nash

B.1928 Nobel prize 1994 2 sons Alicia:

1 son: Married 2X

Second son by Eleanor Stier