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Schizophrenia and Other Psychotic Disorders. Chapter 14. Schizophrenia http://www.youtube.com/watch?v=H_jYqSA_fJk Schizophrenia Part 1 - ABC 20/20 coverage http://www.youtube.com/watch?v=moP_e-gx5hk Schizophrenia Part 2 - ABC 20/20 coverage http://www.youtube.com/watch?v=QPXkwYM9G-s

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slide2

Schizophrenia

  • http://www.youtube.com/watch?v=H_jYqSA_fJk
  • Schizophrenia Part 1 - ABC 20/20 coverage
  • http://www.youtube.com/watch?v=moP_e-gx5hk
  • Schizophrenia Part 2 - ABC 20/20 coverage
  • http://www.youtube.com/watch?v=QPXkwYM9G-s
  • What is Schizophrenia? (Schizophrenia #1)
  • http://www.youtube.com/watch?v=KnoTwOUb0aQ
  • Diagnosing and Treating Schizophrenia (Schizophrenia #2)
  • http://www.youtube.com/watch?v=WwlM1pxIbaI
introduction
Introduction
  • The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind).
  • Schizophrenia is probably caused by a

combination of factors, including:

  • Of all mental illnesses, schizophrenia probably causes more
    • Lengthy hospitalizations
    • Chaos in family life
    • Exorbitant costs to people and governments
    • Fears
nature of the disorder
Nature of the Disorder
  • Schizophrenia disturbs

Thought processes, Perception and Affect

  • With schizophrenia, there is a severe deterioration of social and occupational functioning

* In the United States, the lifetime prevalence of schizophrenia is about 1 percent.

slide5

Premorbid behavior of the patient with schizophrenia can be viewed in four phases.

  • First Phase: Schizoid Personality
    • Indifferent, cold, and aloof, these people are loners. They do not enjoy close relationships with others.
  • Second Phase: Prodromal Phase
    • These people are socially withdrawn and show evidence of peculiar or eccentric behavior.
    • Neglect of personal hygiene and grooming
    • Blunted or inappropriate affect
    • Disturbances in communication
    • Bizarre ideas
    • Lack of initiative
  • Third Phase: Schizophrenia
    • In the active phase of the disorder, psychotic symptoms are prominent
      • Delusions
      • Hallucinations
      • Impairment in work, social relations, and self-care
  • Fourth Phase: Residual Phase
    • Symptoms similar to those of the prodromal phase
    • Flat affect and impairment in role functioning are prominent
predisposing factors
Predisposing Factors
  • Various physical conditions
    • Epilepsy
    • Huntington’s chorea
    • Birth trauma
    • Head injury in adulthood
    • Alcohol abuse
    • Cerebral tumor
    • Cerebrovascular accident
    • Systemic lupus erythematosus
    • Myxedema
    • Parkinsonism
    • Wilson’s disease
characteristic symptoms
Characteristic Symptoms

Positive symptoms:

Negative symptoms:

Affective Flattening

Alogia

Apathy

Anhedonia

Social isolation

  • Delusions
  • Hallucination
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
types of schizophrenia and other psychotic disorders
Types of schizophrenia and other psychotic disorders
  • Paranoid
  • Disorgainzed
  • Catatonic
  • Residual
  • Undifferentiated
  • Schizoaffective disorder
  • Brief psychotic disorder
  • Schizophreniform disorder
  • Delusional Disorder
  • Shared psychotic disorder
  • substance-Induced psychotic disorder
content of thought
Content of Thought

Delusions

Form

Associative Looseness

Neologisms

Concrete thinking

Clang associations

Word salad

Circumstantialities

Tangentiality

Mutism

Perseveration

  • Of Persecution
  • Of Grandeur
  • Of Reference
  • Of control or influence
  • Somatic
  • Nihilistic
  • Religiosity
  • Paranoia
  • Magical thinking
slide10
Perception

Affects

Inappropriate affect

Bland or flat affect

Apathy

  • Hallucination
  • Auditory
  • Visual
  • Tactile
  • Olfactory
conventional antipsychotics
Conventional Antipsychotics

Generic

Haloperidol

Chlorpromazine

Fluphenazine

Thiothixene

Trifluoperazine

Thioridazine

Perphenazine

Loxapine

Brand

Haldol

Thorazine

Prolidixin

Navane

Stelazine

Mellari

Trilafon

Loxitane

conventional antipsychotics1
Conventional Antipsychotics
  • Advantage

-Effective for positive

symptoms of

schizophrenia

- Available in IM

formulation for acute

psychosis/agitation

- Cheap

  • Disadvantage
  • Could worsen

cognitive function

  • Minimally effective for

negative symptoms

of schizophrenia

  • Higher incidence of

side effects (EPS, NMS,

tardivedyskinesia, etc.

atypical antipsychotics
Atypical Antipsychotics
  • Generic

Clozapine

Olanzapine

Risperidone

Quetiapine

Ziprasidone

Aripiprazole

Paliperidonen

  • Brand

Clozaril, FazaClo

Zyprexa (Aydis)

Risperdal (Consta, M-tab)

Seroquel, Seroquest XR

Geodon

Abilify

Invega (newest)

atypical antipsychotics1
Atypical Antipsychotics
  • Advantage
  • Effective for positive

of symptoms of

schizophrenia

  • May improve negative

symptoms of

schizophrenia

  • Lower incidence of

side effects compared to conventional antipsychotics

  • Disadvantage
  • Higher incidence of

weight gain

  • Higher incidence of

diabets

- Expensive

side effects
Side Effects
  • Neuroleptic malignant syndrome (NMS)
    • Potentially life threatening
    • High fever, unstable BP, myoglobinemia
  • Extrapyramidal symptoms (EPS)
    • Involuntary muscle symptoms similar to those of Parkinson’s disease
    • Akathisia (distressing muscle restlessness)
    • Acute dystonia (painful muscle spasms)
    • Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)
  • Tardive dyskinesia (TD)
    • Involuntary contractions of oral and facial muscles
    • Choreoathetosis (wavelike movements of extremities)
    • Occurs with continuous long-term antipsychotic therapy
nursing process
Nursing Process
  • Nursing Assessment
  • Nursing Diagnosis
  • Related to
  • Evidenced by
  • Interventions
  • Education
conventional antipsychotics2
Conventional Antipsychotics

Generic

Haloperidol

Chlorpromazine

Fluphenazine

Thiothixene

Trifluoperazine

Thioridazine

Perphenazine

Loxapine

Brand

Haldol

Thorazine

Prolidixin

Navane

Stelazine

Mellari

Trilafon

Loxitane

conventional antipsychotics3
Conventional Antipsychotics
  • Advantage

-Effective for positive

symptoms of

schizophrenia

- Available in IM

formulation for acute

psychosis/agitation

- Cheap

  • Disadvantage
  • Could worsen

cognitive function

  • Minimally effective for

negative symptoms

of schizophrenia

  • Higher incidence of

side effects (EPS, NMS,

tardivedyskinesia, etc.

atypical antipsychotics2
Atypical Antipsychotics
  • Generic

Clozapine

Olanzapine

Risperidone

Quetiapine

Ziprasidone

Aripiprazole

Paliperidonen

  • Brand

Clozaril, FazaClo

Zyprexa (Aydis)

Risperdal (Consta, M-tab)

Seroquel, Seroquest XR

Geodon

Abilify

Invega (newest)

atypical antipsychotics3
Atypical Antipsychotics
  • Advantage
  • Effective for positive

of symptoms of

schizophrenia

  • May improve negative

symptoms of

schizophrenia

  • Lower incidence of

side effects compared to conventional antipsychotics

  • Disadvantage
  • Higher incidence of

weight gain

  • Higher incidence of

diabets

- Expensive

antipsychotics
Antipsychotics

Background Assessment Data

  • Indications: Treatment of acute and chronic psychoses; selected agents are also used as antiemetics in the treatment of intractable hiccoughs and for control of tics and vocal utterances in Tourette’s disorder
  • Actions: Unknown; thought to block postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla. Newer antipsychotics may block action on receptors specific to dopamine, serotonin, and other neurotransmitters.
slide22

Contraindications/precautions

    • Contraindicated with known hypersensitivity; with CNS depression; when blood dyscrasias exist; in clients with Parkinson’s disease; or those with liver, renal, or cardiac insufficiency
    • Caution with elderly, debilitated, or diabetic clients or those with respiratory insufficiency, prostatic hypertrophy, or intestinal obstructio
  • Interactions
    • Additive anticholinergic effects with other drugs that produce these properties
    • Additive hypotensive effects with beta-blockers
    • Decreased absorption of antipsychotics with antacids and antidiarrheals
    • Decreased effectiveness of antipsychotics with barbiturates
    • Additive CNS depression with alcohol, antihistamines, antidepressants, sedative-hypnotics, and anxiolytics
nursing diagnosis
Nursing Diagnosis
  • Risk for other-directed violence
  • Risk for injury
  • Risk for activity intolerance
  • Noncompliance
neuroleptic malignant syndrome
Neuroleptic Malignant Syndrome
  • Signs and symptoms of NMS are: muscle rigidity, hyperthermia, decreased ventilation, cardiovascular collapse, and an elevate CPK
side effects1
Side effects
  • Neuroleptic malignant syndrome (NMS)
    • Potentially life threatening
    • High fever, unstable BP, myoglobinemia
  • Extrapyramidal symptoms (EPS)
    • Involuntary muscle symptoms similar to those of Parkinson’s disease
    • Akathisia (distressing muscle restlessness)
    • Acute dystonia (painful muscle spasms)
    • Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)
  • Tardive dyskinesia (TD)
    • Involuntary contractions of oral and facial muscles
    • Choreoathetosis (wavelike movements of extremities)
    • Occurs with continuous long-term antipsychotic therapy
slide26

A 29 year old woman is being discharged in 2 days form the hospital after her first psychotic break (paranoid schizophrenia). She is recently divorced and has been working as a legal secretary, although her work had become erratic, and her suspicious behavior was calling attention to herself at work. She will be discharged in her mother’s care until she is able to resume working. Her mother is overwhelmed and asked the nurse how she is going to cope. “She has become so distant and she always takes thing the wrong way. I can hardly say anything to her with her misconstruing everything. She is very mad at me because I called 911 and had her admitted after she told me she was going to get justice back in the world by blowing up evil forces that have been haunting her life and then proceeded to try to run over her ex-husband, thinking he was the devil. She told me there is nothing wrong with her and I am concerned she won’t take her medication once she is discharge.

slide27

What are some of the priority concern that nurse could address in the hospital setting before she is discharge?

  • How would you explain to the mother some of the symptoms that she is experience in? What suggestion could you give her to handle some of the immediate concerns?
  • What issues could you bring up to the staff about her medication compliance? What would be some ways to deal with this issue?

4. What do you think of the prognosis for her? Support your hypothesis with data regarding influences on the course of schizophrenia.