Schizophrenia

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Schizophrenia

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

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