Schizophrenia History19th Century Kraepelin- Dementia Praecox20th Century Bleuler    autism-apathy-ambivalence-anhedonia A...
Current theoriesGenetic ↓ 1% of population 10 % of 1st degree relatives 35-55% concordance rate in monozygotic     twins (...
Slightly more men than womenEarly 20s age of first psychotic break75% of people have permanent disabilityCultural comp...
Neurotransmitter imbalance Dopamine system hyperactivity Norepinepherine elevation Serotonin elevation Diminished levels o...
Central Nervous System Anomaly Type 2    enlarged ventricles         negative symptoms resistant to     medication Type 1 ...
Positive SymptomsDelusionsHallucinationsDisorganized speechBizarre or disorganized behavior
Negative SymptomsFlat AffectAvolitionAlogiaAnhedoniaAttention Impairment
History of TherapyPsychoanalytic Sullivan/Peplau Interpersonal CommunicationSomatic Insulin Coma Electroconvulsive Therapy...
Psychopharmacology 1950s     phenothiazines 1990s     D1-D2 receptor medicationsCommunity Mental Health Milieu Therapeutic...
Typology of Thought DisorderParanoidCatatonicDisorganizedUndifferentiatedResidual
ParanoidDelusions- especially persecutoryAuditory HallucinationsNo loose associationsNo marked affective problem Paranoid
CatatonicStupor or mutismNegativismRigidityExcitementPosturing (waxy flexibility)
DisorganizedMarked looseness of associationsGrossly inappropriate affect     Disorganized
UndifferentiatedProminent delusionsHallucinations or grossly disorganized behavior                    Residual
DiagnosisPresence of 1,2, or 3 for more than 1 week1. Two of the following:      delusions, prominent      hallucinations,...
2. Bizarre delusions3. Prominent hallucinationsContinuous signs of disturbance ↑ 6 months18 years if age or moreDownward c...
Nursing Process- Assessment1.Perceptual changes:      illusions, hallucinations2. Thought disorder:      loose association...
4. Motor Changes:     catatonia-excited, posturing, waxy            flexibility5. Family:      enmeshed, family burden
Nursing DiagnosisImpaired communication poverty of speech blunt emotionsSelf-care deficitsActivity intoleranceSocial isola...
Sensory alterationsBody image distortionAltered thought processes delusions, magical thinking thought insertions, withdraw...
Altered emotional response blunted or flat affect anhedoniaAltered family function
Nursing Planning & InterventionAdequate communication     Medication usageGrooming & hygiene         Organize behaviorSoci...
Nursing Planning & InterventionAdequate communication     Medication usageGrooming & hygiene         Organize behaviorSoci...
Nursing Implications with Neuroleptic                 Medications1. Phenothiazines  Thorazine(Chlorpromazine)  Mellaril   ...
2. Butyrophenes  Haldol    (Haloperidol)  Haldol LA3. Low potency D1-D2 medications  Clozaril (Clozapine)  Risperdol (Resp...
Abilify (Ariprazole)Geodon (Ziprasidone)
Side EffectsNervous system Extra Pyramidal Symptoms Akathisia--restelessness Dystonia– muscle contractions      Opisthoton...
Other Side EffectsPhotophobiaLeukocytosisOrthostatic hypotensionAnti-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Dea...
Side Effect TreatmentAnti-parkinson medications: Cogentin (Benztropine) Artane         (Trihexyphenidyl) Symmetrel      (A...
Atropine PsychosisMad as a hatter              confusedRed as a beet                feverDry as a bone                anti...
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Schizophrenia online2

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Schizophrenia online2

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