This project compares FTD and schizophrenia, specifically the physical anatomy, symptoms and differences in nursing practice to ultimately improve quality nursing care.
2. 1
Myth Fact
Dementia is a natural part of
aging. Only the elderly get
dementia.
It’s a genetic illness. If you have
a relative with schizophrenia,
you will get it too.
Frontotemporal
Dementia
----------------------
Schizophrenia
On average people living with
schizophrenia are twice as
likely to die earlier than the
general population.
(World Health Organization, 2015)
3. What is it?
Frontotemporal Dementia (FTD)
• Degeneration of the frontal
and temporal lobes that can
lead to changes in behavior,
emotion, language and/or
muscle disturbances1.
• Types: Behavioral Variant,
Primary Progressive Aphasia
(semantic variant and non-
fluent variant)2.
• Onset at 40-60 years of age1
Schizophrenia
• Characterized by distortions
in thinking, perception,
emotions, language, sense
of self and behavior3.
• Symptoms4
– Positive & Negative
– Affective & Cognitive
• Onset4
– Late teens for men
– Late twenties for women
21. (Kurz, Kurz, Ellis, & Lautenschlager, 2014) 2. (Shinagawa et al., 2015) 3. (WHO, 2015) 4. (Shah, Qureshi, Jawaid, & Schulz, 2011)
4. Symptoms
FTD
• Behavioral Changes
• Aphasia
• Motor Function
Disturbance
Schizophrenia
• Positive
• Negative
• Affective
• Cognitive
• Consequences
3(Shinagawa et al., 2015)
5. CT Scans of the Brain
FTD
Schizophrenia
4
(Groves, 2015) (Mehta, 2014)
6. Nursing Interventions
Decrease Anxiety Levels
Decrease sensory stimulation
Directing patient to a quiet place
Remain calm
Be conscious of patient’s personal space
Remain at the same eye level as the patient
Listen carefully
Summarize discussion to patient
Schizophrenia
Non-pharmacological Approach to Combat
Medicinal Side Effects
Psychological Symptoms
Allowing patient time to
process/respond
Encourage list making
Minimize anxiety
Extrapyramidal Symptoms
Passive range of motion exercises
Reduce anxiety
Other
Education on diet and exercise
Lifestyle changes
Decrease Social Misconduct
Old hobbies/games
Routine care
Create homelike environment
Including patient’s portrait in room
Frontotemporal Dementia (FTD)
Enhance Attention
Repetitive rehearsal
Procedural learning
Demonstrating the steps of eating
to a patient
Increase Food Consumption
Contrasting colors
Incorporating more visually appealing food
items with bright colours
Sweet Foods
Apple sauce
Increased lighting in dining area
Family style dining
Allow patients to interact with co-patients
during mealtime
7. Lack of Medication Adherence - Schizophrenia
6
PSYCH
MOTOR
OTHER
• Difficulty concentrating
• Trouble remembering
• Difficulty staying awake
• Slowing of movements
• Muscle stiffness
• Shakiness
• Muscle spasms
• Weight gain
• Weight loss
Side Effects of Medication
• Allow time to
process/respond
• Encourage list making
• Encourage active
engagement in tasks
• Minimize Anxiety
• Passive range of motion
exercises
• Reduce anxiety
• Education on diet, exercise
and lifestyle changes
What We Can Do?
(Chiang, Klainin-Yobas, Ignacio, & Chng, 2011)
8. Elyn Saks: A Tale of Mental Illness - from the Inside
• TED TALK
7
“The stigma against mental health is so powerful that I
didn't’t feel safe with people knowing” - Elyn Saks
9. References
Chiang, Y., Klainin-Yobas, P., Ignacio, J., & Chng, C. (2011). The impact of antipsychotic side effects on
attitudes towards medication in people with schizophrenia and related disorders. Journal of Clinical
Nursing, 15-16(20), 2172-2182. doi:10.1111/j.1365-2702.2010.03659.
Folsom, D., Lebowitz, B., Lindamer, L., Palmer, B., Patterson, T., & Jeste, D. (2006). Schizophrenia in
late life: Emerging issues. Dialogues in Clinical Neuroscience, 8(1), 45-52.
Goldberg, T., & Green, M. (2002). Neurocognitive functioning in patients with schizophrenia: An
overview. In Neuropsychopharmacology: The fifth generation of progress (pp. 657-662).
Philadelphia: Lippincott Williams & Wilkins.
Groves, S. (2015, January 22). Rare dementia ravages people in midlife. The Delphos Herald.
Retrieved from http://www.delphosherald.com/Content/Social/Social/Article/Rare-dementia-
ravages-people-in-midlife/-2/-2/190626
Kurz, A., Kurz, C., Ellis, K., & Lautenschlager, N. T. (2014). What is frontotemporal dementia?
Maturitas, doi:10.1016/j.maturitas.2014.07.001
Mehta, N. (2014, April 1). The mystery of schizophrenia. Live Mint: e- Newspaper. Retrieved from
http://www.livemint.com/Specials/jgAURoNbTXxWPfa5uJD4vI/The-mystery-of-schizophrenia.html
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10. References Cont’d
Mendez, M., Licht, E., & Shapira, J. (2008). Changes in dietary or eating behavior in frontotemporal
dementia versus alzheimer's disease. American Journal of Alzheimer's Disease and Other
Dementias®, 23(3), 280-285. doi:10.1177/1533317507313140
Saunders, J. C. (2009). Perioperative nursing care of patients with schizophrenia. AORN Journal,
89(5), 893-897. doi:10.1016/j.aorn.2009.04.010
Shah, J., Qureshi, S., Jawaid, A., & Schulz, P. (2011). Is There Evidence for Late Cognitive Decline in
Chronic Schizophrenia? Psychiatr Q Psychiatric Quarterly, 127-144
Shinagawa, S., Nakajima, S., Plitman, E., Graff-Guerro, A., Mimura, M., Nakayama, K., & Miller, B.
(2015). Non-pharmacological management for patients with frontotemporal dementia: A systematic
review. Journal of Alzheimer Disease, 45, 283-293.
World Health Organization. (2015). WHO: Schizophrenia. Retrieved from
http://www.who.int/mediacentre/factsheets/fs397/en/
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Editor's Notes
Dementia is not a natural part of aging. Worldwide 47.5 million people have been diagnosed with dementia. In 2010, it was estimated that 524 million people are aged sixty five and older. Dementia is not a natural part of ageing. Only the elderly get dementia this is not true, frontotemporal dementia affects people between 40-60 years of age. Dementia is common amongst the elderly but they are not the only population that can be affected by the illness
If you have a relative with schizophrenia you will get it too. Schizophrenia has a strong hereditary component. Individuals with a first-degree relative have a ten percent chance of developing the disorder, as opposed to the one percent chance of the general population.
This is often due to physical illnesses, such as cardiovascular, metabolic and infectious diseases (world health organization, 2015)
Have you heard of any myths regarding dementia and schizophrenia? I am sure many of you have been working for CAMH for many years, how have you views changed?
Behavioral Variant: Alteration in personality and social conduct
Loss of empathy: selfish behavior, what they want to talk about and what they want to do
Loss of judgment
Loss of foresight
Primary Progressive Aphasia: Difficulty expressing and understanding language (Speaking, writing and comprehension)
There are two types: Semantic Variant and Non-fluent Variant
Semantic Variant- inability to comprehend for example the inability to form sentences and understand others.
Non-Fluent Variant- inability to express for example when a persons speech is hesitant and jumbled.
Disturbance of motor function can accompany all types of FTD.
Disturbance of Motor Function
Amyotrophic lateral sclerosis (ALS), which causes muscle weakness or wasting
Corticobasal syndrome, which causes arms and legs to become uncoordinated or stiff.
Progressive supranuclear palsy (PSP), which causes muscle stiffness, difficulty walking and changes in posture. It also affects eye movements.
Schizophrenia:
Positive Symptoms
Hallucination: Auditory- command hallucination, olfactory (smell), visual, gustatory (tasting), tactile (touch)
Delusions: depersonalization (doesn’t believe their arm is their arm), derealization (believes that one’s surrounding is not real)
Disorganized Speech: circumstantiality, Tangentiality, Neologisms, Echolalia, word salad
Bizarre Behavior: Echopraxia, Stilited, Rigid, Rituals
Negative Symptoms
Blunted Affect: decrease in expression
Poverty of Though (alogia)
Loss of Motivation
Inability to experience pleasure (anhedonia)
Cognitive Symptoms
Inattention & Distactibility
Impaired Memory
Poor problem solving/decision making
Illogical Thinking (reality testing, concrete thinking)
Impaired Judgment
Affective Symptoms
Dysphoria: state of dissatisfaction
Suicidality
Hopelessness
Computed tomography (CT) scanDegeneration of the frontal and temporal lobes
-Shrinks (atrophy): brain cell death due to protein filled structures (pick bodies) that are toxic to brain cells
A person living with schizophrenia
-Larger cerebral ventricles
-Less blood flow to frontal lobe
Psych Effects: For psychic side effects, patients may have attributed them to other factors and under-reported them to their clinicians. Thus, clinicians should enquire directly when assessing for the presence of psychic side effects.
Brings light to the challenges and stigma associated with mental health illnesses and the way you as CAMH employees are transforming lives.