Schizophrenia
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| In any given year | show 🗑
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| show | 46.4%
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| In 2002, 100 Billion Dollars was spent on | show 🗑
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| Images of the aggressive, sadistic “schizophrenic” are widespread in the media | show 🗑
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| Facts of Schizophrenia | show 🗑
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| Schizophrenia is a group of chronic, disabling psychiatric disorders that affects brain functioning and behavior and are characterized by: | show 🗑
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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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| show | Positive or “hard” symptoms
Negative or “soft” symptoms
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| Positive symptoms | show 🗑
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| show | False ideas or beliefs accepted as real by the patient
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| Symptoms of Schizophrenia: Hallucinations | show 🗑
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| Symptoms of Schizophrenia: Disorganized speech | show 🗑
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| show | Words that rhyme, used illogically
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| show | Meaningless repetition of words or phrases
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| Symptoms of Schizophrenia: Word Salad: | show 🗑
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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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| Symptoms of Schizophrenia: (Hard or Positive Symptoms - Ideas of reference: | show 🗑
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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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| Symptoms of Schizophrenia (Soft or Negative Symptoms)Flat affect: | show 🗑
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| show | Lack of will, ambition or drive
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| show | withdraw with society and public activity
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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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| show | Tendency to speak very little or to convey little substance of meaning (poverty of content)
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| show | 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
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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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| show | Physiological disturbances are not attributable to drug use or another medical condition
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| Symptoms of Schizophrenia: DSM-V Criterion F: | show 🗑
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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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| Sub-types of Delusional Disorders Erotomanic type | show 🗑
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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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| Sub-types of Delusional Disorders Grandiose type | show 🗑
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| Disease Onset and Progression Premorbid Phase | show 🗑
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| show | 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
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| show | Commonly triggered by stressful event and patient has acute psycotic symptoms.
Functional deficits worsen and prognosis worsens with each acute episode
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| Disease Onset and Progression Residual Phase | show 🗑
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| show | Those who experience gradual onset of disease (about 50%) tend to have poorer immediate and long term outcomes than those with sudden/acute onset)
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| Schizophrenia onset | show 🗑
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| show | symptoms of schizophrenia are experienced for less than the 6 months required for a diagnosis of schizophrenia
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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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| Shared psychotic disorder (folie à deux) | show 🗑
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| Schizoaffective disorder: | show 🗑
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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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| Neuroanatomic theories | show 🗑
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| Neurochemical theories | show 🗑
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| Possible Physical Factors | show 🗑
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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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| show | diminish positive symptoms
lessen the negative signs
Social withdrawal
Anhedonia
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| Conventional Antipsychotics | show 🗑
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| show | Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Paliperidone (Invega)
Aripiprazole (Abilify)
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| Extrapyramidal Side Effects Reversible - Dystonic Reactions: | show 🗑
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| show | Shuffling gait, mask-like face, stiffness, cogwheeling, drooling, akinesia
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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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| show | seizure activity
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| Antipsychotic Medications - irreversible Neuroleptic Malignant Syndrome | show 🗑
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| show | Fatal side effect, failure of blood to produce WBC
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| show | Fluphenazine (Prolixin) in decanoate and enanthate preparations
Haloperidol (Haldol) in decanoate
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| Group therapies | show 🗑
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| show | Using environmental supports to improve functioning at home (signs, calendars, hygiene supplies, and pill containers)
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| show | Computer based cognitive trainging with groups sessions
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| show | Support groups (see NAMI website!)
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| show | Previous history with schizophrenia
Previous suicidal ideation
Current support system
Client’s perception of current situation
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| Application of the Nursing Process: Assessment | show 🗑
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| Application of the Nursing Process: Assessment | show 🗑
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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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| Common nursing diagnoses for negative symptoms and functional abilities include: | show 🗑
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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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| show | Speak in clear unambiguous language
Convey a sense of hope for possible improvement
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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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| show | 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
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| Community-Based Care | show 🗑
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| Mental Health Promotion | show 🗑
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| Self-Awareness Issues | show 🗑
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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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| Which finding depicts negative symptoms of schizophrenia? | show 🗑
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| Which nursing problem has priority? | show 🗑
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| What is the reason that Prolixin is prescribed for this client? | show 🗑
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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