ch 31 schizophrenia and other psychoses
TRANSCRIPT
![Page 1: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/1.jpg)
Ch 31
Schizophrenia and Other Psychoses
![Page 2: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/2.jpg)
http://www.npr.org/programs/atc/features/2002/aug/schizophrenia/
http://www.medicalview.com/Topic.asp?ProgID=62&CatID=0#
![Page 4: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/4.jpg)
Psychoses
• The inability to recognize reality, relate to others or cope with life’s demands
![Page 5: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/5.jpg)
Schizophrenia
• Most common psychosis• Group of related disorders characterized
by disordered thinking, perceptions and behaviors
• Other psychotic disorders– Delusional disorder– Drug related psychosis– Brief psychotic disorder
![Page 6: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/6.jpg)
Continuum of Neurobiological Responses
• Adapting to environment – able to use logical thought, have clear perceptions and able to socially relate in appropriate ways
• Not adapting (middle)-function within reality but have emotional overreactions, distorted thoughts or odd behaviors
• Maladaptive- hallucinations, inability to experience emotions
![Page 7: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/7.jpg)
Psychoses in Childhood• Processing or combining information is a
near impossible task.• FTT-related to neglect, environmental
problems or severe family stress• Psychosis can occur as young as 5• Etiology unknown – 3 risk factors
– Genetics – parents,siblings, relatives– Complications during pregnancy or birth – flu
virus exposure during 2nd trimester– Biochemical influences - dopamine
![Page 8: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/8.jpg)
• Signs and Symptoms vary• Core behaviors
– Lack of contact with reality– Withdrawal into world of their own– Impaired ability to process visual information, regulate
attention and sort out incoming info– Affect changes– Language and communication disturbances– Problems with motor control, emotional control and
expression
![Page 9: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/9.jpg)
Psychoses in Adolescence• Ups and downs intensified• Family members may note changes in behavior• Poor hygiene , grooming habits poor• Strange vague speech and lack of interest lead
to social withdrawal• Hoarding, talking to self• Thoughts and beliefs may be bizarre• Unusual superstitions• Belief in telepathy• Belief one is remotely controlled• Self injury and self destructive behaviors arise
![Page 10: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/10.jpg)
• First treatment is inpatient for assessment, monitoring and controlled
• Interventions focus on– Decreasing acute symptoms– Improving relationships– Education
![Page 11: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/11.jpg)
Psychoses in Adulthood
• Onset often men middle 20s• Women late 20’s• Men endure longer before seeking help• 1/3 persons improve with treatment• 1/3 improve without treatment• 1/3 progress into chronic course with or
without treatment
![Page 12: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/12.jpg)
• Prognosis – outlook is better if adaptive interpersonal relationships, school performance and work histories were present before the onset of symptoms
• Outlook better for women• Men have higher relapse rates and spend
more time inpatient
![Page 13: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/13.jpg)
• Length of stays are shorter – individuals with schizophrenia return home while still psychotic requiring observation and support
• Parents struggle with guilt and frustration attempting to understand “why”
• Grieve losing the ‘normal child’
![Page 14: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/14.jpg)
Older Adulthood
• Seldom diagnosed at this age• Possible onset 40s and 50s• Many elders suffer irreversible side effects from
long term antipsychotic use• Hallucinations/delusions of younger years often
disappear• Become more withdrawn or paranoid• Frequently homeless• End of life in nursing facilities
![Page 15: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/15.jpg)
Biological Theory
• Brain disorder evidence rising• Neurochemical production and transmission
problems are being investigated • Stress/disease/trauma- effects of stress during
prenatal period, viral infection, severe malnutrition
• Birthing difficulty contributes-long labor, difficult birth, umbilical cord prolapse
• Cocaine use
![Page 16: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/16.jpg)
Psychological model
• Character flaw with poor family relationships
• Overprotective or anxious mothers• Cold, uncaring fathers• Couples who stayed together for the sake
of the children• Failure to accomplish task trust or intimacy
![Page 17: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/17.jpg)
Sociocultural theory
• Effects of environment• Poverty, homelessness, unstable families
![Page 18: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/18.jpg)
Subtypes
• Catatonic• Disorganized• Paranoid• Undifferentiated• Residual
![Page 19: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/19.jpg)
Signs and Symptoms
• Physical appearance- – Unkempt– Focus on inner matters– Personal hygiene is poor – Body images are distorted– Motor activity ranges agitated to immobile
![Page 20: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/20.jpg)
• Hallucinations-false sensory inputs with no external stimuli– Olfactory– Auditory– Gustatory– Visual– Tactile– Feelings of altered internal workings of the
body• Illusions- false perceptions of real stimuli• Agnosia-inability to recognize familiar
objects or people is common
![Page 21: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/21.jpg)
• Problems with attention, memory and use of language
• Delusions-fixed false ideas not based in reality
• Ideas of reference-people or media are talking about oneself
• Derealization-loss of ego boundaries with inability to tell where one’s body ends nad the environment begins
![Page 22: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/22.jpg)
• Speech-– Clang associations– Concrete thinking– Echolalia– Flight of ideas– Loose associations– Ideas of reference– Mutism– Neologisms– Verbigerations– Word salad
![Page 23: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/23.jpg)
• Perseveration-repeating of the same idea in response to different questions
• Poverty of thought-lack of ability to produce new thoughts or follow a train of thought
• Little insight into illness, poor judgment• General decline in intellectual abilities as
the disorder progresses
![Page 24: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/24.jpg)
s
• Blunted or flat affect• Alexithymia- difficulty in identifying and
describing emotions• Apathy- lack of concern interest , feelings • Anhedonia- inaibility to experience
pleasure in life• Little impulse control• Anger management is poor
![Page 25: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/25.jpg)
• Avolition- lack of energy or motivation• Substance abuse – dual diagnosis• Unable to establish or maintain
relationships with others• Self esteem is low and gender identity
confusion may exist• Social behaviors are inappropriate
![Page 26: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/26.jpg)
• Positive symptoms- r/t maladaptive thoguhts and behaviors– Hallucinations, speech problems, bizarre
behaviors• Negative Symptoms-lack of adaptive
mechanisms– Flat affect, poor grooming, withdrawal, poverty
of speech
![Page 27: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/27.jpg)
Phases of Disorganization• Prodromal- withdrawal, lack of energy, little
motivation, complain about multiple physical problems– Ideas beliefs and become odd , unusual– Hygiene ignored – Agitated and angry
• Prepsychotic phase- quite , passive and obedient– Hallucinations, delusions may be present– Slip away
![Page 28: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/28.jpg)
• Acute – disturbances in thought, perception, behavior and emotion
• Residual phase- lack of energy, no interest in goal directed activities
• Remission-manage basic ADLs, relief from some distresses of psychosis
![Page 29: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/29.jpg)
Other• Brief psychotic disorder-lasts more than one day
but less than a month
• Delusional Disorder- more than one month of nonbizarre reality based fixed ideas
• Shared Psychotic-disturbance that develops in an individual who is influenced by someone else who has an established delusion with similar content
• Schizoaffective-diagnosed when depression and mania are present
![Page 30: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/30.jpg)
Treatment and Therapies
• Combination therapy and medications• Stress reduction• Family education• Early intervention
![Page 31: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/31.jpg)
Pharmacological Therapy
• Antipsychotics – slow the CNS system– Emotional quieting, sedation, slowed motor
responses– Interrupt dopamine
• Neuroleptics
![Page 32: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/32.jpg)
Nursing Process
• Basic goal- assist clients in controlling their symptoms and achieving highest possible level of functioning
• EPS- abnormal involuntary movement disorder
![Page 33: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/33.jpg)
• Akathisia- inability to sit still, nervous and jittery, lots of nervous energy
• Akinesia-absence of movement • Bradykinesia-slowing of body movement, do not
try to move or speak• Dyskinesia-involuntary skeletal muscle
movements, jerking, affect gait• Dystonia-impaired muscle tone, rigidity
– Oculogyric – eye rolls into back of head– Torticollis-force face and neck into twisted position
![Page 34: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/34.jpg)
• Laryngeal-pharyngeal dystonia- muscles of neck and throat become rigid , client begins to gag, choke and become cyanotic
• Treated with anticholinergic drugs
![Page 35: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/35.jpg)
NMS
• Neuroleptic malignant syndrome• Death can occur from resp. failure, renal
failure, aspiration pneumonia, PE• Cardinal sign is high body temp• Tachycardic, changes in BP, incr.
perspiration, incontinence, rapid labored respirations
![Page 36: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/36.jpg)
TD
• Irreversible side effect of long term treatment
• Involuntary repeated movements of muscles of the face, trunk, arms and legs
![Page 37: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/37.jpg)
Anticholinergic Effects
• Hypotension• Protect from falls
![Page 38: Ch 31 Schizophrenia and Other Psychoses](https://reader035.vdocuments.us/reader035/viewer/2022062504/5a4d1b947f8b9ab0599c3146/html5/thumbnails/38.jpg)
Nursing Responsibilities
• Oil vs water based injectables• Monitor client responses to meds• Client and family education