Schizophrenia Ch. 26

Treatment
-Comprehensive
-Multidisciplinary effort
-Pharmacotherapy
-Pyschosocial care (living and social skills, rehab, and family therapy)

Psychosis Characterisitcs
Disturbances in thought processes, perception, and affect invariably result in a severe deterioration of social and occupational functioning

Phase I: The Premorbid Phase
-Irritability
-Antagonistic thoughts and behavior
-Very shy and withdrawn
-Having poor peer relationships/ Antisocial
-Doing poorly in school

Phase II: The Prodromal Phase
-Last a few weeks to 5 years
-Substanial functional impairment
-Sleep disturbance
-Anxiety
-Irritability
-Depressed mood
-Poor concentration
-Fatigue
-Social withdrawal

Phase III: Schizophrenia
-Delusions
-Hallucinations
-One or more major areas of functioning, such as work, inerpersonal relaionships, or self care, are markedly below the level achieved before onset

Phase IV: Residual Phase
-Flat affect and impairment
-Symptoms of acture stage or no longer prominent

Biological Influences
-Genetics
-Biochemical (too many dopamine receptors)
-Phsiological (Viral, Physical Conditions)
-Environmental Influences: Sociocultural

Environmental
-Sociocultural
-Stressful Life Events

Downward Drift Hypothesis
Individuals with Schizophrenia have difficulty maintaining gainful employment and “drift down” to a lower socioeconomic level (or fail to rise out of a lower socioeconomic group)

Disorganized Schizophrenia
-Behavior is markedly regressive and primitive
-Affect is flat or grossly inappropriate
-Periods of silliness and incongruous giggling

Catatonic Schizophrenia
Catatonic stupor: Extreme psychomotor retardation
Catatonic excitement: Extreme psychomotor agitation; frenzied and purposely movements; continuous incoherent verbalizations and shoutings

Paranoid Schizophrenia
-Deulsions of persecution or grandeur
-Auditory Hallucinations related to a single theme
-Tense, suspicious, and guarded
-May be argumentative, hositle, and aggressive

Undifferentiated Schizophrenia
-Do not meet the criteria for any of the subtypes
-Evidence of delusions, hallucinations, incoherence, and bizzare behavior

Residual Schizophrenia
History of at least one previous episode of schizophrenia with prominent psychotic symptoms

Schizoaffective Disorder
Associated with mood disorders

Brief Psychotic Disorder
-Sudden onset of psychotic symptoms
-Symptoms last at least 1 day but less than one month

Schizophreniform Disorder
-Identical to Schizophrenia
-Symptoms last as least 1 month, but less than 6 months

Delusional Disorder: Erotomanic Type
Believes everyone (usually of higher status) is in love with them

Delusional Disorder: Grandiose Type
-Irriational ideas regarding their own worth
-Believes they are Marilyn Monroe

Delusional Disorder: Jealous Type
Centers on ideas that the person’s sexual partner is unfaithful

Delusional Disorder: Persecutory Type
Beleive they are being malevolently treated in some way (different than others)

Delusional Disorder: Somatic Type
Believe they have some physical defect, disorder, or disease

Shared Psychotic Disorder
Folie a duex (relationship with someone else with the same disorder)

Substance-Induced Psychotic Disorder
Alcohol (the room spinning)

Delusion of Persecution
-Positive Symptom
-Believes FBI has bugged them, or someone is after them

Delusion of Grandeur
-Positive Symptom
-Has exaggerated feeling of importance, power, knowledge, or idenity
-I am God

Delusion of Reference
-Positive Symptom
-Someone is trying to get a message through me through this article in a magazine
-Events within the environment are reffered by the psychotic person to himself

Delusion of Control or Infulence
-Positive Symptom
-Believes certain objecs or persons have control over their behavior
-Filling in tooth controls what I think or do

Somatic Delusion
-Positive Symtom
-Physical
-The doctor says i’m not pregnant, but I know I am (70 year old)

Nihilistic Delusion
-Positive symptom
-Individual has false idea about the self
-I have no heart; The world no longer exists

Religiosity
-Positive symptom
-Excessive obsession with religious ideas and behavior

Paranoia
-Positive symptom
-Extreme suspiciousness of others and of their actions
-I wont eat this food, I know it has been poisoned

Magical Thinking
-Positive symptom
-Believes his thoughts or behaviors have control over specific situations or people
-It’s raining, the sky is sad

Associative looseness
-Positive symptom
-Ideas shift from one unrelated subject to another
-We wanted to take the bus, but the airport took all the traffic.

Neologisms
-Positive symptom
-Person makes new words

Concrete Thinking
-Positive symptom
-Literal interpretation of the environment, represents a regression to an earlier level of cognitive development
-Can’t describe the meaning “It’s raining cats and dogs”

Clang association
-Positive symptom
-Rhyming
-It’s very cold. I am cold and bold

Word Salad
-Positive symptom
-Words randomly put together
-Most forward action grow life double.

Circumstantiality
-Positive symptom
-Person delays in reaching the point of communication because of tedious details

Tangentiality
-Positive symptom
-Unrelated topics are introduced
-Focus of original discussion is lost

Perservation
-Positive symptom
-Person repeats the same word or idea in response to different questions
-“Bam”

Hallucinations
-Positive symptom
-Auditory, Visual, Tactile, Gustatory, and Olfactory

Illusions
-Positive symptom
-Misperceptions or misinterpretations of real external stimuli

Echolalia
-Positive symptom
-Repeat words that he or she hears
-Parrot talk

Echopraxia
-Positive symptom
-Purposelessly imitate movements made by others

Identifications
-Positive symptom
-Unconscious
-Take on behavior of someone else

Imitation
-Positive symptom
-Conscious
-Take on behavior of someone else

Depersonalization
-Positive symptom
-Feelings of unreality
-Feeling that one’s extremities have changed in size

Inappropriate Affect
-Negative symptom
-Emotional tone is incongruent with the circumstances

Bland or Flat Affect
-Negative symptom
-Emotional tone is very weak or void

Apathy
-Negative symptom
-Indifference to or disinterest in the environment

Volition
-Negative symptom
-Not having a goal for the day

Emotional Ambivalence
-Negative Symptom
-Coexistence of opposite emotions toward the same object, person, or situation

Autism
-Negative Symptom
-Focuses inward on a fantasy world, while distorting or excluding the external environemnt

Deteriorated Appearance
-Negative Symptom
-Physical grooming is neglected

Anergia
-Negative Symptom
-Deficiency of energy

Waxy Flexibility
-Negative Symptom
-Allowing body parts to be placed in bizarre or uncomfortable positions (involuntary)

Posturing
-Negative Symptom
-Voluntary assumption of inappropriate or bizarre posturing

Pacing and Rocking
-Negative Symptom
-Pacing back and forth and body rocking

Anhedonia
-Negative Symptom
-Inability to experience pleasure

Regression
-Negative Symptom
-Retreating to an earlier level of development

Disturbed Thought Processess related to inability to trust, panic anxiety, or possible hereditary or biochemical factors
Priority Nursing Intervetion

Altered mood and thought disturbances
A client is admitted with a diagnosis of schizoaffective disorder. Which symptoms are characteristic of this diagnosis?

Loose association
The client hears the word “match.” The client replies, “A match. I like matches. They are the light of the world. God will light the world. Let your light so shine.” Which communication pattern does the nurse identify?

Identify with the person speaking
A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech?

Distract the client’s attention
To deal with a client’s hallucinations therapeutically, which nursing intervention should be implemented?

“I find that hard to believe.”
A client, diagnosed with paranoid schizophrenia, states, “My roommate is plotting to have others kill me.” Which is the appropriate nursing response?

Antipsychotic Medication Side Effects
Anticholinergic effects
Nausea; GI upset
Skin rash
Sedation
Orthostatic hypotension
Photosensitivity
Hormonal effects
ECG changes
Hypersalivation
Weight gain
Hyperglycemia/diabetes
Increased risk of mortality in elderly clients with dementia
Reduction in seizure threshold
Agranulocytosis
Extrapyramidal symptoms
Tardive dyskinesia
Neuroleptic malignant syndrome

Akinesia
-Muscular Weakness
-Extrapyramidal symptom

Psuedoparkinsonism
-Tremor, Shuffling gait, Drooling, Ridgidity
-Extrapyramidal symptom

Akathisia
-Continuous restlessness and fidgeting
-Extrapyramidal symptom

Dystonia
-Involuntary muscular movements of the face
-Extrapyramidal symptom

Oculogyric crisis
-Uncontrolled rolling back of the eyes
-Extrapyramidal symptom

Benztropine (Cogentin)
A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order?

Anticholinergics
-Treat extrapyramidal symptoms
-Benztropine (Cogentin), Atropine