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Schizophrenia online2

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  • 1. Schizophrenia History19th Century Kraepelin- Dementia Praecox20th Century Bleuler autism-apathy-ambivalence-anhedonia Arieti associative looseness, auditory hallucinations
  • 2. Current theoriesGenetic ↓ 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)
  • 3. Slightly more men than womenEarly 20s age of first psychotic break75% of people have permanent disabilityCultural component on relapse
  • 4. Neurotransmitter imbalance Dopamine system hyperactivity Norepinepherine elevation Serotonin elevation Diminished levels of GABA Decreased co-enzyme for conversion of PKU to tyrosine
  • 5. Central Nervous System Anomaly Type 2 enlarged ventricles negative symptoms resistant to medication Type 1 positive symptoms respond to medication
  • 6. Positive SymptomsDelusionsHallucinationsDisorganized speechBizarre or disorganized behavior
  • 7. Negative SymptomsFlat AffectAvolitionAlogiaAnhedoniaAttention Impairment
  • 8. History of TherapyPsychoanalytic Sullivan/Peplau Interpersonal CommunicationSomatic Insulin Coma Electroconvulsive Therapy Psychosurgery
  • 9. Psychopharmacology 1950s phenothiazines 1990s D1-D2 receptor medicationsCommunity Mental Health Milieu Therapeutic Community De-institutionalization
  • 10. Typology of Thought DisorderParanoidCatatonicDisorganizedUndifferentiatedResidual
  • 11. ParanoidDelusions- especially persecutoryAuditory HallucinationsNo loose associationsNo marked affective problem Paranoid
  • 12. CatatonicStupor or mutismNegativismRigidityExcitementPosturing (waxy flexibility)
  • 13. DisorganizedMarked looseness of associationsGrossly inappropriate affect Disorganized
  • 14. UndifferentiatedProminent delusionsHallucinations or grossly disorganized behavior Residual
  • 15. DiagnosisPresence of 1,2, or 3 for more than 1 week1. Two of the following: delusions, prominent hallucinations, marked associative looseness catatonic behavior flat or silly affect
  • 16. 2. Bizarre delusions3. Prominent hallucinationsContinuous signs of disturbance ↑ 6 months18 years if age or moreDownward course
  • 17. Nursing Process- Assessment1.Perceptual changes: illusions, hallucinations2. Thought disorder: loose associations, clanging, delusions3. Communication changes: thought disorganization, blocking, tangential, circumstantial echolalia, echopraxia
  • 18. 4. Motor Changes: catatonia-excited, posturing, waxy flexibility5. Family: enmeshed, family burden
  • 19. Nursing DiagnosisImpaired communication poverty of speech blunt emotionsSelf-care deficitsActivity intoleranceSocial isolationDecisional conflict
  • 20. Sensory alterationsBody image distortionAltered thought processes delusions, magical thinking thought insertions, withdrawal thought broadcasting
  • 21. Altered emotional response blunted or flat affect anhedoniaAltered family function
  • 22. Nursing Planning & InterventionAdequate communication Medication usageGrooming & hygiene Organize behaviorSocial skills Reality based perceptionsIntervene with delusions Congruent emotionalFamily understanding responses Community contacts
  • 23. Nursing Planning & InterventionAdequate communication Medication usageGrooming & hygiene Organize behaviorSocial skills Reality based perceptionsIntervene with delusions Congruent emotionalFamily understanding responses Community contacts
  • 24. Nursing Implications with Neuroleptic Medications1. Phenothiazines Thorazine(Chlorpromazine) Mellaril (Thiorizidine) Stelazine (Trifluoperazine) Prolixin (Fluphenazine) Prolixin Decanoate (Fluphenazine D)
  • 25. 2. Butyrophenes Haldol (Haloperidol) Haldol LA3. Low potency D1-D2 medications Clozaril (Clozapine) Risperdol (Resperidone) & Risperdol C Zyprexa (Olanzapine)
  • 26. Abilify (Ariprazole)Geodon (Ziprasidone)
  • 27. Side EffectsNervous system Extra Pyramidal Symptoms Akathisia--restelessness Dystonia– muscle contractions Opisthotonis—tongue sticking out Occulogryic Crisis- eye rolling Akinesia– muscle heaviness Pseudo parkinsonism- mask like fascies and other symptoms Tardive dyskinesia—tongue movements Tardive Dyskinesia
  • 28. Other Side EffectsPhotophobiaLeukocytosisOrthostatic hypotensionAnti-cholinergic effects
  • 29. D1 and D2 effectsWeight gainImpotenceRisk for development of Diabetes Mellitus (Geodon)Gallactarhea
  • 30. Neuroleptic malignant syndromePossibly fatal side effect of neurolepticsNon-dose relatedFeverConfusionConvulsionsDeathRx-stop neuroleptic- emergency care
  • 31. Side Effect TreatmentAnti-parkinson medications: Cogentin (Benztropine) Artane (Trihexyphenidyl) Symmetrel (Amantadine)
  • 32. Atropine PsychosisMad as a hatter confusedRed as a beet feverDry as a bone anticholinergiaBlind as a bat diplopia