Schizophrenia
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Schizophrenia

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Schizophrenia Schizophrenia Presentation Transcript

  • Schizophrenia History
    • 19th Century
      • Kraepelin- Dementia Praecox
    • 20th Century
      • Bleuler
      • autism-apathy-ambivalence-anhedonia
      • Arieti
      • associative looseness, auditory
      • hallucinations
  • Current theories
    • Genetic
    •  1% of population
    • 10 % of 1st degree relatives
    • 35-55% concordance rate in monozygotic
    • twins (genetically identical)
    • 15-17% concordance rate in dizygotic
    • twins (share half their genes)
    • Slightly more men than women
    • Early 20s age of first psychotic break
    • 75% of people have permanent disability
    • Cultural component on relapse
    • Developing countries have better prognosis than developed countries
    View slide
    • Neurotransmitter imbalance
    • Dopamine system hyperactivity
    • Norepinepherine elevation
    • Serotonin elevation
    • Diminished levels of GABA
    • Decreased co-enzyme for conversion of PKU to tyrosine
    View slide
    • Central Nervous System Anomaly
    • Type 2 enlarged ventricles
    • negative symptoms resistant to medication
    • Type 1 positive symptoms respond to medication
  • Positive Symptoms
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Bizarre or disorganized behavior
  • Negative Symptoms
    • Flat Affect
    • Avolition
    • Alogia
    • Anhedonia
    • Attention Impairment
  • History of Therapy
    • Psychoanalytic
    • Sullivan/Peplau
    • Interpersonal Communication
    • Somatic
    • Insulin Coma
    • Electroconvulsive Therapy
    • Psychosurgery
    • Psychopharmacology
    • 1950s phenothiazines
    • 1990s D1-D2 receptor medications
    • Community Mental Health
    • Milieu
    • Therapeutic Community
    • De-institutionalization
  • Typology of Thought Disorder
    • Paranoid
    • Catatonic
    • Disorganized
    • Undifferentiated
    • Residual
  • Paranoid
    • Delusions- especially persecutory
    • Auditory Hallucinations
    • No loose associations
    • No marked affective problem
    Paranoid
  • Catatonic
    • Stupor or mutism
    • Negativism
    • Rigidity
    • Excitement
    • Posturing (waxy flexibility)
  • Disorganized
    • Marked looseness of associations
    • Grossly inappropriate affect
    Disorganized
    • Undifferentiated
    • Prominent delusions
    • Hallucinations or grossly disorganized behavior
    • Residual
  • Diagnosis
    • Presence of 1,2, or 3 for more than 1 week
    • 1. Two of the following:
    • delusions, prominent
    • hallucinations, marked
    • associative looseness
    • catatonic behavior
    • flat or silly affect
    • 2. Bizarre delusions
    • 3. Prominent hallucinations
    • Continuous signs of disturbance  6 months
    • 18 years if age or more
    • Downward course
  • Nursing Process- Assessment
    • 1. Perceptual changes:
    • illusions, hallucinations
    • 2. Thought disorder:
    • loose associations, clanging, delusions
    • 3. Communication changes:
    • thought disorganization,
    • blocking, tangential, circumstantial
    • 4. Motor Changes:
    • catatonia-excited, posturing, waxy
    • flexibility
    • 5. Family:
    • enmeshed, family burden
  • Nursing Diagnosis
    • Impaired communication
    • poverty of speech
    • blunt emotions
    • Self-care deficits
    • Activity intolerance
    • Social isolation
    • Decisional conflict
    • Sensory alterations
    • Body image distortion
    • Altered thought processes
    • delusions, magical thinking
    • thought insertions, withdrawal
    • thought broadcasting
    • Altered emotional response
    • blunted or flat affect
    • anhedonia
    • Altered family function
  • Nursing Planning & Intervention
    • Adequate communication
    • Grooming & hygiene
    • Social skills
    • Intervene with delusions
    • Family understanding
    • Medication usage
    • Organize behavior
    • Reality based perceptions
    • Congruent emotional responses
    • Community contacts
  • Nursing Planning & Intervention
    • Adequate communication
    • Grooming & hygiene
    • Social skills
    • Intervene with delusions
    • Family understanding
    • Medication usage
    • Organize behavior
    • Reality based perceptions
    • Congruent emotional responses
    • Community contacts
  • Nursing Implications with Neuroleptic Medications
    • 1. Phenothiazines
    • Thorazine (Chlorpromazine)
    • Mellaril (Thiorizidine)
    • Stelazine (Trifluoperazine)
    • Prolixin (Fluphenazine)
    • Prolixin Decanoate
    • 2. Butyrophenes
    • Haldol (Haloperidol)
    • Haldol LA
    • 3. Low potency D1-D2 medications
    • Clozaril (Clozapine)
    • Risperdol (Resperidone) & Risperdol E
    • Zyprexa (Olanzapine)
    • Abilify (Ariprazole)
    • Geodon (Ziprasidone)
  • Side Effects
    • Nervous system E xtra P yramidal S ymptoms
    • A kathisia
    • D ystonia
    • A kinesia
    • P seudo parkinsonism
    • T ardive dyskinesia
    Tardive Dyskinesia
  • Other Side Effects
    • Photophobia
    • Leukocytosis
    • Orthostatic hypotension
    • Anti-cholinergic effects
  • D1 and D2 effects
    • Weight gain
    • Impotence
    • Risk for development of Diabetes Mellitus (Geodon)
    • Gallactarhea
  • Neuroleptic malignant syndrome
    • Possibly fatal side effect of neuroleptics
    • Non-dose related
    • Fever
    • Confusion
    • Convulsions
    • Death
    • Rx-stop neuroleptic- emergency care
      • Amantadine 200-400 mgmpo/day in divided doses
  • Side Effect Treatment
    • Anti-parkinson medications:
    • Cogentin (Benztropine)
    • Artane (Trihexyphenidyl)
    • Symmetrel (Amantadine)
  • Atropine Psychosis
    • Mad as a hatter confused
    • Red as a beet fever
    • Dry as a bone anticholinergia
    • Blind as a bat diplopia
    • Rx. Hold medication and re-hydrate
  • Laboratory Values for Schizophrenia
    • White blood cell count
      • Leukopenia (WBC 2,000 – 3,000)and agranulocytosis (granulocytes less than 1,000) with certain psychotropic mendiations, such as phenothiazines , carbamazepine, and CLOZARIL
      • Leukocytosis with neuroleptic malignant syndrome
  • Assessment Tools for Schizophrenia
    • Abnormal Involuntary Movement Scale (AIMS) (public)
    • Brief Psychiatric Rating Scale (Psychological Reports, 1962 10:799)
    • Schedule for Affective Disorders and Schizophrenia (SADS) (Archives of General Psychiatry, 1978 35:837)
    • Scale for the Assessment of Negative Symptoms (SANS) (University of Iowa Press, 1983)
    • Scale for the Assessment of Thought, Language, and Communication (TLC) (University of Iowa Press, 1978)
    • Thought Disorder Index (TDI) (Archives of General Psychiatry, 1983 40:1281)
    • Quality of Life Scale (QLS) (Schizophrenia Bulletin, 1984, 10: 383
    • Chestnut Lodge Prognastic Scale for Chronic Schizophrenia (Schizophrenia Bulletin, 1987 13:277)