1 / 28

Schizophrenia

Schizophrenia. Syndrome – many varieties Disordered & bizarre thoughts Disordered & bizarre perceptions Bizarre behaviors and movements Flat or blunted emotions Impaired communication & social functioning Impaired cognition. Brain & Behavior Research Foundation - ART. Schizophrenia.

williamsonr
Download Presentation

Schizophrenia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Schizophrenia Syndrome – many varieties Disordered & bizarre thoughts Disordered & bizarre perceptions • Bizarre behaviors and movements • Flat or blunted emotions • Impaired communication & social functioning • Impaired cognition

  2. Brain & Behavior Research Foundation - ART

  3. 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%

  4. 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)

  5. 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

  6. Auditory hallucinations • 53% schizophrenics • 28% MDD • 27% incest survivors • Non-psychiatric • Left temporal lesions • Psychoactive substances • Other somatic conditions • Stress/bereavement/spiritual

  7. 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

  8. 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

  9. 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.

  10. Nursing assessment • History • Presenting problem • Include suicide/homicide risk • Appearance and behaviors • Speech patterns • Mood and affect • Flat or blunted • inappropriate

  11. Nursing assessment • Thought process • Thought content • Hallucinations • Delusions • Judgment and insight • Self concept, relationships, self care

  12. Nursing diagnosesfor positive symptoms • Risk for violence (self or other directed) • Altered thought processes • Sensory/Perceptual alterations • Personal identity disturbance • Impaired verbal communication

  13. Nursing diagnosesfor negative symptoms • Self-care deficit • Social isolation • Altered health maintenance • Ineffective management of therapeutic regime • Diversional activity deficit

  14. Schizophrenia case study • http://www.youtube.com/watch?v=H_jYqSA_fJk • Mindyourmind.co

  15. 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)

  16. Neuroleptic Malignant Syndrome • Depletion of dopamine • Muscle rigidity • Hyperthermia • Hypertension • Diaphoresis • Confusion – mutism • Elevated CPK and WBC

  17. Extrapyramidal Symptoms • Dystonia Torticollis • Opisthonis • Oculogyric crisis • Pseudoparkinsonism • Akathesia • NMS • Tardive dyskonesia

  18. Anticholinergic symptoms • Dry Mouth • Constipation • Orthostatic Hypotension

  19. Other side effects • Weight gain & metabolic syndrome • Sexual side effects

  20. Clozaril/Clozapine • Potential fatal side effect of agranulocytosis • Sudden fever, sore throat, malaise • Leukopenia • Weekly WBC

  21. Non-pharmacological interventions • Cognitive behavioral therapy • Support groups • Social skills and lifeskills training • Cognitive remediation • Techniques for dealing with hallucinations

  22. 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?”

  23. 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.

  24. 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

  25. 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=Zn6yw2KUIwc

  26. A beautiful mind • John Nash • B.1928 • Nobel prize 1994 • 2 sons • Alicia: • 1 son: • Married 2X • Second son by Eleanor Stier

More Related