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Lifetime risk of being affected by any mental illness:
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Schizophrenia disord
Schizophrenia
| Question | Answer |
|---|---|
| In any given year | 26.2 % of the U.S. population is affected by a mental illness 5.8% is categorized as having a Severe Mental Illness 1.1% of population is categorized as having Schizophrenia 2 (3?) million Americans affected in any given year |
| Lifetime risk of being affected by any mental illness: | 46.4% |
| In 2002, 100 Billion Dollars was spent on | mental Health expenditures. |
| Images of the aggressive, sadistic “schizophrenic” are widespread in the media | These stereotypes further the STIGMA attached to this debilitating disorder and leads to discrimination, exclusion and fear |
| Facts of Schizophrenia | Cannot be defined as a single illness, more like a syndrome or disease process Usually diagnosed in late adolescence or early adulthood With comprehensive, multi-disciplinary treatment many patients can successfully live in the community with strong sup |
| Schizophrenia is a group of chronic, disabling psychiatric disorders that affects brain functioning and behavior and are characterized by: | Disturbed thinking Disorganized speech Possibly having difficulty distinguishing fantasy from reality |
| Estimated 50% of schizophrenia patients are substance abusers | Leads to poor compliance with medications Complicates treatment: Repeated Relapses Compounds difficulties with impaired perceptions Complicates abilities to maintain self care or independent living Frequent hospitalization Loss of Social support |
| Suicide and Schizophrenia | A major Concern 1/3rd of people with schizophrenia attempt suicide and about one in 10 die from the attempt Suicidal ideation is in the range of 40-55 % of individuals with schizophrenia |
| Diagnostic and Statistical Manual of Mental Disorder, 5th Edition, (DSM-V) Diagnostic Criteria Symptoms divided into two major categories | Positive or “hard” symptoms Negative or “soft” symptoms |
| Positive symptoms | can be controlled through medication but frequently the negative symptoms are persistent and difficult to manage. Disorganized Symptoms include bizarre behavior ( childlike laughing) inappropriate hygiene or conduct, agitation |
| Symptoms of Schizophrenia: Delusions | False ideas or beliefs accepted as real by the patient |
| Symptoms of Schizophrenia: Hallucinations | False Sensory perceptions with no basis in reality |
| Symptoms of Schizophrenia: Disorganized speech | (frequent incoherence/derailment) |
| Symptoms of Schizophrenia: Clang associations: | Words that rhyme, used illogically |
| Symptoms of Schizophrenia: Echolalia: | Meaningless repetition of words or phrases |
| Symptoms of Schizophrenia: Word Salad: | Illogical word groupings (She was a big star,Barn,Mall) |
| Symptoms of Schizophrenia: Thought blocking: | Sudden interruption in train of thought |
| Symptoms of Schizophrenia: (Hard or Positive Symptoms - Magical thinking | Belief that thoughts can control other events and people |
| Symptoms of Schizophrenia: (Hard or Positive Symptoms - persivaration: | Persistent adherence to a single idea or topic |
| Symptoms of Schizophrenia: (Hard or Positive Symptoms - Ideas of reference: | False belief that external events have a Special meaning for the person |
| Symptoms of Schizophrenia: (Hard or Positive Symptoms - Flight of ideas: | Jumps rapidly from one topic to another |
| Symptoms of Schizophrenia: (Hard or Positive Symptoms - Echopraxia: | Involuntary repetition of movements observed in others |
| Symptoms of Schizophrenia: (Hard or Positive Symptoms - Ambivalence: | Holding contradictory beliefs about something |
| Symptoms of Schizophrenia (Soft or Negative Symptoms)Flat affect: | Absence of any facial expression that indicates mood or emotion |
| Symptoms of Schizophrenia (Soft or Negative Symptoms)Avolition: | Lack of will, ambition or drive |
| Symptoms of Schizophrenia (Soft or Negative Symptoms)Social withdrawal or discomfort | withdraw with society and public activity |
| Symptoms of Schizophrenia (Soft or Negative Symptoms)Apathy: | Feelings of indifference toward people, activities, events |
| Symptoms of Schizophrenia (Soft or Negative Symptoms)Anhedonia: | Feeling no joy or pleasure from life, activities or relationships |
| Symptoms of Schizophrenia (Soft or Negative Symptoms)Alogia | Tendency to speak very little or to convey little substance of meaning (poverty of content) |
| Symptoms of Schizophrenia: DSM-V Criterion B | For significant portion of time since onset level of functioning in one or more major areas is markedly below the level achieved prior to the onset of disorder - work, Interpersonal relationships, Self-care |
| Symptoms of Schizophrenia: DSM-V Criterion C Continuous signs of the disturbance persist for at least 6 months | Must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A May include periods of prodromal or residual symptoms. During prodromal/residual period only signs may be negative symptoms or by two or more symptoms listed |
| Symptoms of Schizophrenia: DSM-V Criterion D: | Schizoaffective disorder and depressive/bipolar disorder with psychotic features has been ruled out. |
| Symptoms of Schizophrenia: DSM-V Criterion E: | Physiological disturbances are not attributable to drug use or another medical condition |
| Symptoms of Schizophrenia: DSM-V Criterion F: | If hx of autism disorder present additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms are present. |
| Sub-types of Delusional Disorders Persecutory type | Hallucinations, Delusional Thought May have a consistent theme May believe someone is reading their thoughts Persecutory or Grandiose delusions Suspicious Possible excessive religiosity delusional religious focus Possible hostile and aggressive be |
| Sub-types of Delusional Disorders Erotomanic type | Belief that someone, usually of a higher status, is in love with them (often a famous figure) May follow, contact, or stalk the object of their delusion |
| Sub-types of Delusional Disorders Catatonic | marked psychomotor disturbance, Fixed Stupor for long periods of time Rapid swings between stupor and excitement extreme negativism; mutism Bizarre mannerisms and postures peculiarities of voluntary movement (echolalia, echopraxia) |
| Sub-types of Delusional Disorders Mixed type | mixed schizophrenic symptoms along with disturbances of thought, affect, and behavior. No single theme |
| Sub-types of Delusional Disorders Jealous type | Delusion that the persons partner is unfaithful. Irrational and without cause. Partner is confronted, possibly attacked. “Lover” or perceived other “person” may also be confronted |
| Sub-types of Delusional Disorders somatic type | Delusion of some type of general medical condition ( I have no heart… I have a worm in my brain…) |
| Sub-types of Delusional Disorders Grandiose type | Irrational ideas regarding their own worth, talent, knowledge, or power. May believe they have a special relationship with famous person May assume the identity of a famous person (believing actual person is an imposter) May assume the identity of a de |
| Disease Onset and Progression Premorbid Phase | Social maladjustment, withdrawal, irritability and antagonistic thoughts and behavior. |
| Disease Onset and Progression Prodromal Phase | May last a year or so Shows clear decline from previous level of functioning Loss of interest in work, school, activities Neglected hygiene and appearance possible Psychosis, delusions, hallucinations begin to emerge |
| Disease Onset and Progression Active Phase | Commonly triggered by stressful event and patient has acute psycotic symptoms. Functional deficits worsen and prognosis worsens with each acute episode |
| Disease Onset and Progression Residual Phase | Stabilization of the disease, rarely full remission Symptoms resemble prodromal with persistence of some psychotic symptoms |
| Most clients experience a slow and gradual onset of symptoms | Those who experience gradual onset of disease (about 50%) tend to have poorer immediate and long term outcomes than those with sudden/acute onset) |
| Schizophrenia onset | Younger age of onset associated with poorer outcomes In first years after diagnosis, client may have relatively symptom-free periods between psychotic episodes or fairly continuous psychosis with some shift in severity of symptoms |
| Schizophreniform disorder | symptoms of schizophrenia are experienced for less than the 6 months required for a diagnosis of schizophrenia |
| Brief psychotic disorder | one psychotic symptoms lasting 1 day to 1 month may or may not have an identifiable stressor, such as childbirth |
| Shared psychotic disorder (folie à deux) | similar delusion shared by two people, one of whom has psychotic delusions |
| Schizoaffective disorder: | symptoms of psychosis and thought disorder along with all the features of a mood disorder |
| Genetic factors | Identical Twins have 50% risk of developing if one gets Fraternal twins 15% Child with one parent with disease: 15% Child with both parents with disease: 35% |
| Neuroanatomic theories | Less brain tissue and cerebrospinal fluid Enlarged ventricles, cortical atrophy Abnormal brain function in frontal and temporal areas |
| Neurochemical theories | Consistent abnormalities documented: Dopamine (Excess can cause psychosis, paranoia) serotonin (modulates/controls dopamine) Glutamate/glycine (research currently in progress… possible target of new drugs |
| Possible Physical Factors | Birth trauma, head injury, epilepsy, Huntington’s, cerebral tumor, stroke, SLE |
| Immunovirologic factors | Waves of schizophrena have occurred a generation after influenza epidemics |
| Primary treatment involves antipsychotic (neuroleptic) medication conventional antipsychotics | Delusions Hallucinations Disturbed thinking Other psychotic symptoms but have no observable effect on the negative signs |
| Primary treatment involves antipsychotic (neuroleptic) medication atypical antipsychotics | diminish positive symptoms lessen the negative signs Social withdrawal Anhedonia |
| Conventional Antipsychotics | Chorpromazine (Thorazine) Perphenazine (Triafon) Haloperidol (Haldol) Fluphenazine (Prolixin) Mesoridazine (Serentil) Loxapine (Loxitane) Molindone (Moban) Trifluoperazine (Stelazine) |
| Atypical Antipsychotics | Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Paliperidone (Invega) Aripiprazole (Abilify) |
| Extrapyramidal Side Effects Reversible - Dystonic Reactions: | Spasms in muscle groups (neck muscles, eye muscle, tongue protrusion, dysphagia, laryngeal/pharyngeal spasms) |
| Extrapyramidal Side Effects Reversible - Psuedoparkinsonism | Shuffling gait, mask-like face, stiffness, cogwheeling, drooling, akinesia |
| Extrapyramidal Side Effects Reversible - Akathisia | Restless movements, pacing, inability to remain still (uncomfortable) |
| Antipsychotic Medications - irreversible - Tardive Dyskinesia | Late appearing side effect, irreversible Abnormal, involuntary movements Lip smacking, tongue protrusion, chewing, blinking |
| Antipsychotic Medications - irreversible - Choreiform movements | moving legs and arms uncontrollably |
| Antipsychotic Medications - irreversible - Seizures | seizure activity |
| Antipsychotic Medications - irreversible Neuroleptic Malignant Syndrome | consists of muscle rigidity, fever, autonomic instability,[1] and cognitive changes such as delirium, and is associated with elevated plasma creatine phosphokinase.[ |
| Antipsychotic Medications - irreversible - Agranulocytosis: | Fatal side effect, failure of blood to produce WBC |
| Two antipsychotics are available in depot injection forms for maintenance therapy: | Fluphenazine (Prolixin) in decanoate and enanthate preparations Haloperidol (Haldol) in decanoate |
| Group therapies | Supportive, medication management, use of community supports |
| Cognitive adaptation training | Using environmental supports to improve functioning at home (signs, calendars, hygiene supplies, and pill containers) |
| Cognitive enhancement therapy (CET) | Computer based cognitive trainging with groups sessions |
| Family therapy | Support groups (see NAMI website!) |
| Application of the Nursing Process: Assessment | Previous history with schizophrenia Previous suicidal ideation Current support system Client’s perception of current situation |
| Application of the Nursing Process: Assessment | General appearance, motor behavior, and speech Mood and affect: flat or blunted affect, anhedonia Thought processes and content: disordered Delusions Sensorium and intellectual processes: hallucinations, disorientation, concrete or literal thinking |
| Application of the Nursing Process: Assessment | Roles and relationships: often socially isolated, have difficult fulfilling life roles Physiologic and self-care considerations may have multiple self-care deficits inattention to hygiene, nutrition, sleep needs; polydipsia occasionally seen in long |
| Common nursing diagnoses for positive symptoms include: | Risk for other-directed violence Risk for suicide Disturbed thought processes Disturbed sensory perception Disturbed personal identity Impaired verbal communication |
| Common nursing diagnoses for negative symptoms and functional abilities include: | Self-care deficits Social isolation Deficient diversional activity Ineffective health maintenance Ineffective therapeutic regimen management |
| Outcome identification Expected outcomes for the acute, psychotic phase; the client will: | Not injure self or others Establish contact with reality Interact with others Express thoughts and feelings in a safe and socially acceptable manner Participate in prescribed therapeutic interventions |
| Expected outcomes for continued care; the client will: | Participate in the prescribed regiment (including medication and follow-up appointments) Maintain adequate routines for sleeping and food and fluid intake Be independent in self-care activities Communicate effectively with others in the community to me |
| Promote safety of clients and others | Safe environment with minimal stimulation If patient expresses homicidal or suicidal thoughts, institute the proper precautions |
| Establish a therapeutic relationship | Establish trust and rapport. Accepting, consistent approach Don’t touch patient without first telling him exactly what you are going to do. |
| Interventions for delusional thoughts | Avoid being confrontational, arguing or Reinforcing delusion Present and maintain reality through simple statements, “I see no evidence of that” (presenting reality) or “It doesn’t seem that way to me” (casting doubt) |
| Use therapeutic communication | Speak in clear unambiguous language Convey a sense of hope for possible improvement |
| Provide reality based activities and explanations | Make sure to include activities that involve human contact. |
| Interventions for hallucinations | Tell him you don’t hear the voices, but you know they’re real to him Avoid confrontation or arguing about the hallucinations |
| Protecting the client who has socially inappropriate behaviors | Redirect the patient to appropriate activities, provide privacy if appropriate, factual statements without casting shame or ridicule |
| Client and family teaching | Teach patient and family about importance of adhering to medication regimen and side effects to notify physician of Encourage family involvement and how patient and family can recognize an impending relapse. |
| Elderly people with schizophrenia experience a variety of long-term outcomes: | 20% to 30% of clients experience dementia, resulting in a steady, deteriorating decline in health 20% to 30% experience a reduction in positive symptoms, somewhat like a remission 40% to 60% remain mostly unchanged |
| Community-Based Care | Assertive community treatment (ACT) Behavioral home health Community support programs Case management |
| Mental Health Promotion | Psychiatric rehabilitation has the goal of recovery for client, more than just symptom control and medication management Early identification and aggressive treatment of psychotic symptoms maximizes recovery and quality of life Studies identifying at-ri |
| Self-Awareness Issues | Providing Care May be challenging if client is suspicious or mistrustful or nurse is frightened Nurse may become frustrated if client is noncompliant Nurse must not take client’s success or failure personally; the client’s remarks and behavior or noncom |
| Awareness | Focus on client’s strengths and time OUT of the hospital, not just on symptoms and need for acute care |
| The nurse understands that schizophrenia can be differentiated from psychosis by which assessment? | Negative symptoms. |
| Which finding depicts negative symptoms of schizophrenia? | Flat affect and social inattentiveness. |
| Which nursing problem has priority? | Disturbed thought processes. |
| What is the reason that Prolixin is prescribed for this client? | Disorganized thoughts. |
| The nurse understands that a client with schizophrenia will experience which benefit from fluphenazine decanoate (Prolixin) if it is administered intramuscularly? | Maintain long-term medication compliance. |
| Which client behavior validates the need for involuntary hospitalization? | Violence towards father. |
| If a client who has voluntarily chosen to be hospitalized should want to leave the hospital, which assessment would be most important in deciding to release the client against medical advice (AMA)? | Potential danger to self or others. |
Created by:
hajet