SCHIZOPHRENIA

Janice A. Aloi, DMH,RN,CNE

INTRODUCTIONSCHIZOPHRENIA PROBABLY CAUSES MORE LENGTHY HOSPITALIZATIONS, MORE CHAOS IN FAMILY LIFE, MORE EXORBITANT COSTS TO INDIVIDUALS AND GOVERNMENTS, AND MORE FEARS THAN ANY OTHER MENTAL DISORDER.

NATURE OF THE DISORDER-results in disturbances in thought processes, perception, and affect-severe deterioration in social and occupational functioning-will affect 1 percent of the population-premorbid behavior

PREMORBID PHASES1. Phase 1 The Schizoid Personality2. Phase 2 Prodromal-withdrawn-peculiar behavior-impaired role functioning-neglected hygiene-disturbance in ideation, perception, communication

PREMORBID 3. Phase III Schizophrenia-psychotic symptoms (delusions, hallucinations, disorganized speech or behavior, negative symptoms, impairment in work, social relations and self-care)At least 6 months4. Phase IV Residual-similar to prodromal phase with flat affect and impairment in role functioning being prominent

ETIOLOGY-BIOLOGICAL INFLUENCES-GENETICS-BIOCHEMICAL-PHYSIOLOGICAL

ETIOLOGYPSYCHOLOGICAL INFLUENCES-POOR EARLY MO-CHILD RELATIONSHIP-DYSFUNCTIONAL FAMILY SYSTEM-DOUBLE-BIND COMMUNICATION

ETIOLOGYENVIRONMENTAL-LOWER SOCIOECONOMIC STATUS-STRESSFUL LIFE EVENTS

-Most likely the result of a combination of biological, psychological, and environmental influences.

POSITIVE AND NEGATIVE SYMPTOMS

POSITIVE-DEVIANT-PRESENT BUT SHOULD BE ABSENT-PSYCHOTIC-OUT OF REALITY-EX. DELUSIONS, HALLUCINATIONSNEGATIVE-ABSENCE OF NORMAL CHARACTERISTICS-EX. APATHY, AFFECT, SPEECH, ANHEDONIA

TYPES

The DSM 5 identifies a spectrum of psychotic disorders from least to most severe.

GENERAL APPEARANCE-CHRONIC-REGRESSED-FLAT OR GROSSLY INAPPROPRIATE AFFECT-BIZARRE MANNERISMS-SOCIAL IMPAIRMENT EXTREMENEGLECT OF HYGIENE & APPEARANCE

SCHIZOTYPAL PERONALITY DISORDERA MORE SEVERE SCHIZOID PERSONALITYODDALOOFMAGICAL THINKINGDEPERSONALIZATIONSPEECH SOMETIMES BIZARRE

DELUSIONAL DISORDER-EROTOMANIC-GRANDIOSE-JEALOUS-PERSECUTORY-SOMATICMIXED

BRIEF PSYCHOTIC DISORDER-SUDDEN ONSET

-PSYCHOTIC SYMPTOMS (LESS THAN ONE MONTH)

MAY OR MAY NOT BE PRECEDED BY A SEVERE STRESSOR

EVENTUAL RETURN TO PREMORBID LEVEL OF FUNCTIONING

SUBSTANCE-INDUCED PSYCHOTIC DISORDERMAY BE:SUBSTANCE INTOXICATIONWITHDRAWALMEDSTOXINSSYMPTOMS SEVERE

PSYCHOTIC DISORDER DUE TO ANOTHER MEDICAL CONDITION

HALLUCINATIONSDELUSIONSEX. Epilepsy, neuro trauma, thyroid disease

CATATONIC DISORDER DUE TO ANOTHER MEDICAL CONDITION

Symptoms of catatoniaEx. Metabolic disorders, tumors

SCHIZOPHRENIFORM DISORDERSYMPTOMS OF SCHIZOPHRENIAAT LEAST ONE MONTHLESS THAN 6 MONTHSPROVISIONAL DIAGNOSIS

SCHIZOAFFECTIVE DISORDERSCHIZOPHRENIC BEHAVIORSDISTURBANCE OF MOOD

CATATONIA (specifier)-A. STUPORMOTOR RETARDATION, MUTE,POSTURING, WAXY FLEXIBILITY

-B. EXCITEMENTAGITATION, PURPOSELESS MOVEMENTS, POSSIBLE INJURY TO SELF

ASSESSMENTPOSITIVE SYMPTOMS

-content of thought-delusions-religiosity-paranoia-magical thinking-form of thinking-associative looseness-neologisms-concrete thinking-clang associations-word salad-circumstantiality-tangentiality-mutism-perseveration

ASSESSMENT (pos)PERCEPTION

-HALLUCINATIONS

-ILLUSIONS

ASSESSMENT (pos)SENSE OF SELF-ECHOLALIA-ECHOPRAXIA-IMITATION-DEPERSONALIZATION

ASSESSMENT NEGATIVE SYMPTOMSVOLITION-IMPAIRMENT OF THE ABILITY TO INITIATE GOAL-DIRECTED ACTIVITY

DETERIORATED APPEARANCE

AMBIVALENCE-POS & NEG FEELINGS ABOUT THE SAME PERSON OR THING. CANT MAKE A DECISION.

ASSESSMENT (-)SOCIAL IMPAIRMENT

AFFECTInappropriateFlatApathy

ASSESSMENT (-)PSYCHOMOTOR BEHAVIOR-ANERGIA-WAXY FLEXIBILITY-POSTURINGPACING AND ROCKING

ASSOCIATED FEATURES-ANHEDONIA-REGRESSION

NURSING DIAGNOSES-alteration in thought processes-sensory-perceptual alteration-social isolation-risk for violence-impaired verbal communication-self-care deficit-ineffective family coping-altered health maintenance

KEY COMPONENTS OF PSYCHOSOCIAL TREATMENT-client and family teaching-collaborative decision-making-monitoring drug therapy-assistance obtaining drugs-supervision of financial resources-activities of daily living-self-help groups-psychotherapy

GENERAL NURSING INTERVENTIONS-establish trust and rapport; use same staff, if possible; keep all promises-avoid physical contact, crowding-calm, unhurried manner-maintain an assertive, genuine, matter-of-fact approach-intervene at the first sign of escalation-maximize level of functioning

GENERAL NURSING INTERVENTIONS-remove all dangerous objects from the clients environment-check the level of stimuli in the environment; may be to high for some clients-promote social skills-ensure safety

GENERAL NURSING INTERVENTIONS-avoid laughing and whispering where the client can see but cannot hear what is being said-do not tease or joke-keep it real focus on reality-offer simple, matter of fact explanations; avoid cliches and abstract phrases (concrete thinking)-deal with hallucinations distraction voice dismissal -respond to feelings, themes-connect hallucinations with increased anxiety-convey acceptance of clients need for false belief, but indicate that you do not share the belief-do not argue or deny the belief use reasonable doubt

GENERAL NURSING INTERVENTIONS-encourage compliance with drug therapy-look for adverse drug reactions-mouth checks may be necessary-encourage family involvement

DRUG THERAPY

Antipsychotic drugs control symptoms adequately in most schizophrenics. The wide choice of drug treatment options available today has improved clients chances for remission and recovery.

PROGNOSIS-1/3 Improve

-1/3 Intermittent relapses

-1/3 Severe incapacity

ANTIPSYCHOTIC DRUGS-also called neuroleptics are effective in the treatment of schizophrenia

TWO TYPES:Typical (Traditional) reduce mostly positive symptomsAtypical effective against both positive and negative symptoms, less likely to produce EPS

ACTION OF TYPICALS-not really known-might block dopamine receptors leading to the inhibition of transmission of neural impulses at the synapsesEx. Thorazine, Prolixin, Haldol, Stellazine, Navane, Trilafon, Mellaril

ACTION OF ATYPICALSBlock dopamine and serotonin receptorsSimultaneous blocking may account for their increased successDecreased incidence of long-term side effectsEx. Clozaril, Risperdal, Seroquel, Zyprexa

SIDE EFFECTS1. Anticholinergic effects dry mouth, blurred vision, constipation, urinary retention2. Nausea 3. Skin rash4. Sedation5. Orthostatic hypotension6. Photosensitivity7. Hormonal effects

SIDE EFFECTS8. ECG changes9. Reduction of seizure threshold10.Agranulocytosis (Clozapine)11.Hypersalivation (Clozapine)12.Extrapyramidal symptoms-pseudoparkinsonism-akinesia-akathisis-oculogyric crisis-dystonia

SIDE EFFECTS13. Tardive dyskinesia (bizarre facial and tongue movements, stiff neck, difficulty swallowing-potentially irreversible-stop drug at the first sign

SIDE EFFECTS14. Neuroleptic Malignant Syndrome (severe muscle rigidity, fever up to 107, tachycardia, BP fluctuations, diaphoresis, mental status deterioration to stupor and coma-onset hours or years-stop drug-monitor vital signs15. Hyperglycemia and Diabetes

ANTIPARKINSONIAN DRUGS-GIVEN FOR THE RELIEF OF PARKINSONIAN SYMPTOMS-Cogentin-Parlodel-SIDE EFFECTS-anticholinergic-nausea-drowsiness-psychotic symptoms-orthostatic hypotension

CLIENT EDUCATION-CAUTION WHEN DRIVING-CONTINUE MEDS-SUNSCREEN-KNOW SYMPTOMS AND REPORT IF OCCUR-ORAL CARE-NO ALCOHOL-NO OTC DRUGS WITHOUT APPROVAL

*Psychosis/ thought disorderNo single cause/tx

Late aldosecentsChild hood schizopernia 4rth leading cause of disability

*************Has some sym of szhiopernia and mood disorder thing going on *Very severe/***********************