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Schizophrenia

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Discuss about schizophrenia, types, management and others

Discuss about schizophrenia, types, management and others

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  • 1. SCHIZOPHRENIA 2nd most frequent diagnosis of patients 14-64 y/o Pamela M. Veroy RN, MAN Retrieved sources from: CRH (2008)
  • 2. Last update 6/25/09 ajj In this module we will cover • What is schizophrenia • Symptoms of schizophrenia • Types of schizophrenia • Some of the more common treatments for schizophrenia
  • 3. What is schizophrenia? • A chronic severe brain disorder; often they hear voices, believe media are broadcasting their thoughts to the world or may believe someone is trying to harm them. • In men it usually develops in teen years and early 20s; in women it usually develops in 20s and 30s.
  • 4. Diagnosis • Currently there is no physical or lab test that can absolutely diagnose schizophrenia. • A psychiatrist usually comes to the diagnosis based on clinical symptoms.
  • 5. Misdiagnosis • This is a common problem since schizophrenia shares a significant number of symptoms with other disorders. • Per the Nat’l Depression & Bipolar Support Alliance there is an average of 10 years from onset to correct diagnosis & tx.
  • 6. Disorders that may appear like Schizophrenia • Schizoid personality • Schizophreniform disorder • Schizotypal personality • Bipolar Disorder • Asperger’s syndrome
  • 7. Symptoms of Schizophrenia • Profound disruption in cognition and emotion, affecting the most fundamental human attributes: – Language – Thought – Perception – Affect – Sense of self
  • 8. Positive Symptoms • Those that appear to reflect an excess or distortion of normal functions.
  • 9. Positive Symptoms • Delusions. Those where the patient thinks he is being followed or watched are common; also the belief that people on TV, radio are directing special messages to him/her.
  • 10. Positive Symptoms • Hallucinations. Distortions or exaggerations of perception in any of the senses. • Often they hear voices within their own thoughts followed by visual hallucinations.
  • 11. Positive Symptoms • Disorganized thinking/speech. • AKA loose associations; speech is tangential, loosely associated or incoherent enough to impair communication.
  • 12. Positive Symptom • Grossly disorganized behavior. • Difficulty in goal directed behavior (ADLs), unpredictable agitation or silliness, social disinhibition, or bizarre behavior. • There is a purposelessness to behavior.
  • 13. Positive Symptom • Catatonic behavior. • Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.
  • 14. Other Positive Symptoms • Inappropriate response to stimuli • Unusual motor behavior (pacing, rocking) • Depersonalization • Derealization • Somatic preoccupations
  • 15. Summary of Positive Symptoms • Delusions • Hallucinations • Disorganized thinking • Disorganized behavior • Catatonic behavior • Inappropriate responses
  • 16. FYI: Positive Symptoms • Positive symptoms are those that have a positive reaction from some treatment. • In other words, positive symptoms respond to treatment.
  • 17. Negative Symptoms • Those that appear to reflect a decline or loss of normal functions. • May be difficult to evaluate because they are not as grossly abnormal as positive symptoms.
  • 18. Negative Symptoms • Affective flattening. • Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.
  • 19. Negative Symptom • Alogia (poverty of speech) • Lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts; often manifested as short, empty replies to questions.
  • 20. Negative Symptom • Avolition • The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.
  • 21. Examples of Avolition • No longer interested in going out with friends • No longer interested in activities that the person used to show enthusiasm • No longer interested in anything • Sitting in the house for hours or days doing nothing
  • 22. Disorganized Symptoms • This one is somewhat new and may not be considered valid. • It is thought disorder, confusion, disorientation and memory problems.
  • 23. Summary of Negative Symptoms • Lack of emotion • Low energy • Lack of interest in life • Affective flattening • Alogia • Inappropriate social skills • Inability to make friends • Social isolation
  • 24. Cognitive Symptoms • Difficulties in concentration and memory: – Disorganized thinking – Slow thinking – Difficulty understanding – Poor concentration – Poor memory – Difficulty expressing thoughts – Difficulty integrating thoughts, feelings, behaviors
  • 25. FYI: Negative Symptoms • Currently there is no treatment that has a consistent impact on negative symptoms.
  • 26. Types of Schizophrenia • Paranoid • Hebephrenic • Catatonic • Residual • Schizoaffective • Undifferentiated
  • 27. Paranoid Schizophrenia • Persons are very suspicious of others and often have grand schemes of persecution at the root of their behavior. • During this phase they may have hallucinations and frequent delusions.
  • 28. Hebephrenic Schizophrenia • AKA disorganized schizophrenia; characterized by emotionless, incongruous, or silly behavior, intellectual deterioration, frequently beginning insidiously during adolescence. • May be verbally incoherent and may have moods and emotions that are not appropriate to the situation. • Hallucinations not usually present.
  • 29. Catatonic Schizophrenia • Person is extremely withdrawn, negative and isolated. • May have marked psychomotor disturbances.
  • 30. Residual Schizophrenia • Lacks motivation and interest in day-to- day living. • Person is not usually having delusions, hallucinations or disorganized speech.
  • 31. Schizoaffective Disorder • There will be symptoms of schizophrenia as well as mood disorder (depression, bipolar, mixed mania).
  • 32. Undifferentiated Schizophrenia • Conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the previous types. • Exhibits more than one of the previous types without a clear dominance of one.
  • 33. Summary • Before a diagnosis the psychiatrist must make a thorough evaluation including a physical/medical exam, a mental status exam, appropriate labs, and a full history. • History includes changes in thinking, behavior, movement, mood, etc. as seen by the family.
  • 34. Medications • In general it may take up to 6 months for medications to show consistent effects. • The newest medication is Invega. • Meds include atypicals: Abilify, Geodon, Clozapine, Risperidone, Seroquel, Zyprexa. – [Remember: a giraffe can really see a zebra]
  • 35. • These medications may have such intolerable side effects that the patient will stop the drugs. • One study showed the average time the meds were taken regularly was 3 months.
  • 36. Treatments • Psychotherapy - an adjunct to meds and is very useful to keep the patient on the meds. • Group therapy • Family therapy • Community support groups
  • 37. • Early detection and treatment has the best results/response to treatment. • Per patients, once you have schizophrenia you have it for life. The best you can hope for is control.
  • 38. Psych Definitions • Delusion = fixed beliefs that usually involve a misinterpretation of experience. “Client believes someone is reading his thoughts” • Several types: grandiose, nihilistic, persecutory, somatic
  • 39. Psych Definitions • Hallucinations = perceptual experiences that occur in absence of actual sensory stimuli; involves the 5 senses.
  • 40. Psych Definitions • Illusions = person misperceives or exaggerates stimuli that actually exist in the external environment.
  • 41. Defense Mechanism • Affiliation = Turning to others for help or support; sharing problems with others without implying that someone else is responsible. Ex: An individual has a fight with spouse and turns to their best friend for emotional support.
  • 42. Defense Mechanism • Devaluation = Attributing exaggerated negative qualities to self or others. Ex: A boy has been rejected by his long time girlfriend. He tells his friends that he realizes that she is stupid and ugly.
  • 43. Defense Mechanism • Displacement = Transferring a feeling about, or a response to, one object onto another (usually less threatening) substitute object Ex: A child is mad at her mother for leaving for the day, but says she is really mad at the sitter for serving her food she does not like.
  • 44. Communication Technique • Confrontation = Presenting the patient with a different reality of the situation. Ex: My best friend never calls. She hates me. Nurse ‘I was in the room yesterday when she called.’
  • 45. Communication Technique • Doubt = Expressing or voicing doubt when a patient relates a situation. Ex: My best friend hates me. Nurse ‘From what you have told me, that does not should like her. When did she last call you?’
  • 46. Thank you...