Schizophrenia
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| show | 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
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| Lifetime risk of being affected by any mental illness: | show 🗑
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| In 2002, 100 Billion Dollars was spent on | show 🗑
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| show | These stereotypes further the STIGMA attached to this debilitating disorder and leads to discrimination, exclusion and fear
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| show | 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
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| show | Disturbed thinking
Disorganized speech
Possibly having difficulty distinguishing fantasy from reality
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| Estimated 50% of schizophrenia patients are substance abusers | show 🗑
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| Suicide and Schizophrenia | show 🗑
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| Diagnostic and Statistical Manual of Mental Disorder, 5th Edition, (DSM-V) Diagnostic Criteria Symptoms divided into two major categories | show 🗑
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| Positive symptoms | show 🗑
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| Symptoms of Schizophrenia: Delusions | show 🗑
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| Symptoms of Schizophrenia: Hallucinations | show 🗑
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| show | (frequent incoherence/derailment)
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| show | Words that rhyme, used illogically
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| Symptoms of Schizophrenia: Echolalia: | show 🗑
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| show | Illogical word groupings (She was a big star,Barn,Mall)
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| show | Sudden interruption in train of thought
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| show | Belief that thoughts can control other events and people
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| Symptoms of Schizophrenia: (Hard or Positive Symptoms - persivaration: | show 🗑
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| show | False belief that external events have a Special meaning for the person
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| show | Jumps rapidly from one topic to another
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| Symptoms of Schizophrenia: (Hard or Positive Symptoms - Echopraxia: | show 🗑
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| show | Holding contradictory beliefs about something
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| show | Absence of any facial expression that indicates mood or emotion
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| Symptoms of Schizophrenia (Soft or Negative Symptoms)Avolition: | show 🗑
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| Symptoms of Schizophrenia (Soft or Negative Symptoms)Social withdrawal or discomfort | show 🗑
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| Symptoms of Schizophrenia (Soft or Negative Symptoms)Apathy: | show 🗑
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| show | Feeling no joy or pleasure from life, activities or relationships
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| Symptoms of Schizophrenia (Soft or Negative Symptoms)Alogia | show 🗑
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| Symptoms of Schizophrenia: DSM-V Criterion B | show 🗑
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| show | 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
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| show | Schizoaffective disorder and depressive/bipolar disorder with psychotic features has been ruled out.
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| Symptoms of Schizophrenia: DSM-V Criterion E: | show 🗑
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| show | 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.
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| show | 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
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| show | 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
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| Sub-types of Delusional Disorders Catatonic | show 🗑
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| show | mixed schizophrenic symptoms along with disturbances of thought, affect, and behavior. No single theme
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| Sub-types of Delusional Disorders Jealous type | show 🗑
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| show | Delusion of some type of general medical condition ( I have no heart… I have a worm in my brain…)
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| show | 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
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| show | Social maladjustment, withdrawal, irritability and antagonistic thoughts and behavior.
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| Disease Onset and Progression Prodromal Phase | show 🗑
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| Disease Onset and Progression Active Phase | show 🗑
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| Disease Onset and Progression Residual Phase | show 🗑
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| Most clients experience a slow and gradual onset of symptoms | show 🗑
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| show | 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
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| Schizophreniform disorder | show 🗑
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| show | one psychotic symptoms lasting 1 day to 1 month
may or may not have an identifiable stressor, such as childbirth
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| show | similar delusion shared by two people, one of whom has psychotic delusions
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| show | symptoms of psychosis and thought disorder along with all the features of a mood disorder
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| show | 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%
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| show | Less brain tissue and cerebrospinal fluid
Enlarged ventricles, cortical atrophy
Abnormal brain function in frontal and temporal areas
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| Neurochemical theories | show 🗑
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| show | Birth trauma, head injury, epilepsy, Huntington’s, cerebral tumor, stroke, SLE
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| show | Waves of schizophrena have occurred a generation after influenza epidemics
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| Primary treatment involves antipsychotic (neuroleptic) medication conventional antipsychotics | show 🗑
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| Primary treatment involves antipsychotic (neuroleptic) medication atypical antipsychotics | show 🗑
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| Conventional Antipsychotics | show 🗑
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| Atypical Antipsychotics | show 🗑
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| show | Spasms in muscle groups (neck muscles, eye muscle, tongue protrusion, dysphagia, laryngeal/pharyngeal spasms)
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| Extrapyramidal Side Effects Reversible - Psuedoparkinsonism | show 🗑
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| show | Restless movements, pacing, inability to remain still (uncomfortable)
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| Antipsychotic Medications - irreversible - Tardive Dyskinesia | show 🗑
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| show | moving legs and arms uncontrollably
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| Antipsychotic Medications - irreversible - Seizures | show 🗑
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| show | consists of muscle rigidity, fever, autonomic instability,[1] and cognitive changes such as delirium, and is associated with elevated plasma creatine phosphokinase.[
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| show | Fatal side effect, failure of blood to produce WBC
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| Two antipsychotics are available in depot injection forms for maintenance therapy: | show 🗑
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| show | Supportive, medication management, use of community supports
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| Cognitive adaptation training | show 🗑
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| Cognitive enhancement therapy (CET) | show 🗑
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| Family therapy | show 🗑
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| Application of the Nursing Process: Assessment | show 🗑
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| show | 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
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| show | 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
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| show | Risk for other-directed violence
Risk for suicide
Disturbed thought processes
Disturbed sensory perception
Disturbed personal identity
Impaired verbal communication
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| show | Self-care deficits
Social isolation
Deficient diversional activity
Ineffective health maintenance
Ineffective therapeutic regimen management
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| Outcome identification Expected outcomes for the acute, psychotic phase; the client will: | show 🗑
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| show | 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
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| show | Safe environment with minimal stimulation
If patient expresses homicidal or suicidal thoughts, institute the proper precautions
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| show | Establish trust and rapport.
Accepting, consistent approach
Don’t touch patient without first telling him exactly what you are going to do.
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| show | 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)
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| Use therapeutic communication | show 🗑
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| Provide reality based activities and explanations | show 🗑
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| show | Tell him you don’t hear the voices, but you know they’re real to him
Avoid confrontation or arguing about the hallucinations
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| Protecting the client who has socially inappropriate behaviors | show 🗑
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| Client and family teaching | show 🗑
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| Elderly people with schizophrenia experience a variety of long-term outcomes: | show 🗑
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| Community-Based Care | show 🗑
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| show | 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
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| show | 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
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| show | Focus on client’s strengths and time OUT of the hospital, not just on symptoms and need for acute care
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| show | Negative symptoms.
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| show | Flat affect and social inattentiveness.
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| show | Disturbed thought processes.
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| show | Disorganized thoughts.
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| show | Maintain long-term medication compliance.
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| Which client behavior validates the need for involuntary hospitalization? | show 🗑
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| 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)? | show 🗑
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Created by:
hajet