This document discusses schizophrenia and its symptoms, classifications, causes, and treatment options. It describes Bleuler's 4 A's of schizophrenia symptoms. Positive symptoms include hallucinations and delusions, while negative symptoms involve a lack of emotion and motivation. Schizophrenia progresses through prodromal, acute, and chronic phases. Antipsychotic medications work by blocking dopamine and serotonin receptors. Nursing diagnoses for schizophrenia patients include noncompliance, risk for violence, impaired social interactions, and risk for suicide. Nursing interventions aim to address symptoms, promote medication adherence, and ensure safety and self-care.

1. Unit 4: Thought Disorders and Medications Schizophrenia in Focus

2. Schizophrenia: Bleuler’s 4-A’s AFFECT: flat, blunted, inappropriate or bizarre affect AMBIVALENCE: holding opposing opinions or attitudes at the same time ASSOCIATIVE LOOSENESS: Jumbled, illogical thinking AUTISM: living in one’s own fantasy world—turned in to the self

3. Classifying Symptoms: Positive Symptoms “What’s there that shouldn’t be there” Hallucinations Delusions Bizarre Behavior Disorganized speech, word salad, echolalia

4. Thought Alterations Ideas of reference Persecutory, grandiose, somatic delusions Thought blocking, insertion, withdrawl, broadcasting Command/control hallucinations

5. Classifying Symptoms: Negative Symptoms “ What’s not there that should be there” Lack of Feeling and affect including positive emotion (anhedonia) Poverty of thought (alogia) Loss of motivation (avolition)

6. Classifying Symptoms:Cognitive Symptoms Thinking and Decision-making Impaired memory Poor problem solving and poor judgment Illogical thinking Inattention, distractability

7. Phases of Schizophrenia Prodromal: isolation, behavior change, often in adolescence or y. adult Acute/Active Phase: Evident psychosis. Periods of fluctuation, but symptoms are evident Chronic/Residual: Long term outcome is that the intensity of the psychosis may diminish, leaving more of the negative symptoms

8. Theories of Causation Many of the psychological theories are now doubted as evidence of a brain disease is more clear. Genetic transmission is evident Dopamine theory—excess dopamine (does not explain all) Glucomate theory—regulation of glucomate (NMDA) receptor in brain r/t PCP psychosis

9. Neuroanatomical Changes Enlarged lateral cerebral ventricles Cortical and cerebellum atrophy Third ventricle dilation and asymmetry Changes in blood flow and glucose metabolism patterns

10. Mechanism of Action of Antipsychotics Phenothiazines: block post-synaptic dopamine receptors giving a decreased dopamine response. Works on + symptoms only Atypical antipsychotics: Antagonizes both serotonin and dopamine receptors giving a decreased dopamine and serotonin response. Works on + and – symptoms both See supplemental info on Oncourse

11. Side effects of antipsychotics Extrapyramidal (see H/O in syllabus) Tardive dyskinesia: can be permanent, See AIMS test, don’t raise dose of med Anticholinergic side effects (go over) Blood dyscrasias Photosensitivity, excess prolactin

12. Neuroleptic Malignant Syndrome Life threatening: increased temp, decreased consciousness, severely increased muscle tonicity, HTN, tachycardia, drooling sweating Stop the antipsychotic, treat symptoms in a monitored setting (ICU), fluids, cooling blanket, dantrolene, parlodel (a dopamine agonist)

13. Nursing Diagnosis: Non compliance Not taking meds or attending therapy is a big factor leading to rehospitalization Why? Denial, hate being in sick role, lack of judgment, side effects of meds

14. Nursing Diagnosis: Potential for violence Usually related to paranoia/perceived threat

15. Nursing Diagnosis: Impaired social interaction Related to negative symptoms, hard to change!

16. Nursing Diagnosis: self care deficit No motivation to bathe, lack of recognition of problem, paranoia

17. Nursing Diagnosis: altered nutrition/FVE Paranoia about eating and drinking Excess fluid intake

18. Nursing diagnosis: risk for suicide About 10% schizophrenics commit suicide

19. Paranoid Schizophrenia Intense, strongly defended irrational suspicions Ideas of reference Behaving with anger, sarcasm, hostility Projection of feelings Often paranoid ideas are intricate and complex

20. Nursing Tactics with Paranoia Calm, matter of fact approach—don’t smother or hover Respect personal territory Verbal indication of nursing measures before intervention Be honest, trustworthy, consistent Don’t feed delusions or challenge directly—cast reasonable doubt and focus on reality Look at underlying themes in delusions

21. More nursing interventions in Paranoia Help client manage anger and fear through consistent limits, appropriate diversion, and not taking bx personally “ When in doubt, check it out” strategy Talk about dealing with food and med. paranoia

22. Disorganized Schizophrenia Regression, increased social impairment, bizarre affect/behavior, incoherent speech Nursing measures: help with grooming, eating. Routine, consistent and structured. Understanding milieu. Plus all the general nsg measures.

23. Catatonia: abnormal motor behavior Withdrawn: posturing, waxy flexibility, stupor, mute, unaware of environment Nsg care in Withdrawn state: complete hygiene, nutrition, mobility, bathroom assist Excited: Gross hyperactivity-running striking out Nsg with Excited: preserve milieu, keep client safe

24. Other categories of Schizophrenia Undifferentiated – means doesn’t fit a specific othre group Residual—means most of the active symptoms are gone (mostly negative symptoms remaining)