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SCHIZOPHRENIA

Janice A. Aloi, DMH,RN,CNE

INTRODUCTION
SCHIZOPHRENIA 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 PHASES
1. Phase 1 The Schizoid Personality
2. 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-withdrawn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 months
4. Phase IV Residual
-similar to prodromal phase with flat affect and
impairment in role functioning being prominent

ETIOLOGY
-BIOLOGICAL INFLUENCES

-GENETICS
-BIOCHEMICAL
-PHYSIOLOGICAL

ETIOLOGY
PSYCHOLOGICAL INFLUENCES

-POOR EARLY MO-CHILD RELATIONSHIP


-DYSFUNCTIONAL FAMILY SYSTEM
-DOUBLE-BIND COMMUNICATION

ETIOLOGY
ENVIRONMENTAL

-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, HALLUCINATIONS
NEGATIVE
-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 EXTREME
NEGLECT OF HYGIENE &
APPEARANCE

SCHIZOTYPAL
PERONALITY DISORDER
A MORE SEVERE SCHIZOID
PERSONALITY
ODD
ALOOF
MAGICAL THINKING
DEPERSONALIZATION
SPEECH SOMETIMES BIZARRE

DELUSIONAL DISORDER

-EROTOMANIC
-GRANDIOSE
-JEALOUS
-PERSECUTORY
-SOMATIC
MIXED

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 DISORDER
MAY BE:

SUBSTANCE INTOXICATION
WITHDRAWAL
MEDS
TOXINS
SYMPTOMS SEVERE

PSYCHOTIC DISORDER
DUE TO ANOTHER
MEDICAL CONDITION

HALLUCINATIONS
DELUSIONS
EX. Epilepsy, neuro trauma, thyroid
disease

CATATONIC DISORDER
DUE TO ANOTHER
MEDICAL CONDITION
Symptoms of catatonia
Ex. Metabolic disorders, tumors

SCHIZOPHRENIFORM
DISORDER

SYMPTOMS OF SCHIZOPHRENIA
AT LEAST ONE MONTH
LESS THAN 6 MONTHS
PROVISIONAL DIAGNOSIS

SCHIZOAFFECTIVE
DISORDER
SCHIZOPHRENIC BEHAVIORS
DISTURBANCE OF MOOD

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

-B. EXCITEMENT
AGITATION, PURPOSELESS MOVEMENTS,
POSSIBLE
INJURY TO SELF

ASSESSMENT
POSITIVE 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 SYMPTOMS
VOLITION
-IMPAIRMENT OF THE ABILITY TO INITIATE GOALDIRECTED ACTIVITY
DETERIORATED APPEARANCE
AMBIVALENCE
-POS & NEG FEELINGS ABOUT THE SAME
PERSON OR THING. CANT MAKE A DECISION.

ASSESSMENT (-)
SOCIAL IMPAIRMENT
AFFECT
Inappropriate
Flat
Apathy

ASSESSMENT (-)

PSYCHOMOTOR BEHAVIOR
-ANERGIA
-WAXY FLEXIBILITY
-POSTURING
PACING 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, matterof-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
symptoms
Atypical 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 synapses
Ex. Thorazine, Prolixin,
Haldol, Stellazine,
Navane, Trilafon, Mellaril

ACTION OF ATYPICALS
Block dopamine and serotonin receptors
Simultaneous blocking may account for
their increased success
Decreased incidence of long-term side
effects
Ex. Clozaril, Risperdal,
Seroquel, Zyprexa

SIDE EFFECTS
1. Anticholinergic effects dry mouth, blurred
vision, constipation, urinary retention
2. Nausea
3. Skin rash
4. Sedation
5. Orthostatic hypotension
6. Photosensitivity
7. Hormonal effects

SIDE EFFECTS

8. ECG changes
9. Reduction of seizure threshold
10.Agranulocytosis (Clozapine)
11.Hypersalivation (Clozapine)
12.Extrapyramidal symptoms

-pseudoparkinsonism
-akinesia
-akathisis
-oculogyric crisis
-dystonia

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

SIDE EFFECTS
14. 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 signs
15. 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