Phase I
Premorbid phase
-Social maladjustment, withdrawal, irritability
-Antagonistic thoughts and behavior
-Being very shy, withdrawn, poor peer relations, antisocial, doing poorly in school
-Quiet, passive, and introverted
-Enjoy solitary activities. No sport t
Phase 2
Prodromal Phase
-Precedes characteristic manifestations of the illness
-Extends from premorbid end to frank psychotic symptoms
-Average length: 2-5 years
-Substantial functional impairment and nonspeficic symptoms (insomnia, depression, anxiety)
-Behavior
Phase 3
Schizophrenia
-ACTIVE PHASE OF DISORDER
-Psychotic symptoms are prominent
-Delusions, hallucinations, impairment in work, social relations and self care
Phase 4
Residual phase
-Periods of remission and exacerbation
-Follows active phase of illness
-Symptoms: are either absent or no longer prominent
-Negative symptoms may remain and flat affect and impairment in role functioning occur
-Residual impairment often in
Schizophrenia results from the combination of
Biological, psychological, and environmental factors
Dopamine and schizo
Suggested that an excess in dopamine may cause the disease
Acute manifestations
Delusions, hallucinations
Chronic manifestations
Apathy, loss of drive, poverty of ideas
Structures of the brain involved in schizo
FRONTAL CORTEX
LIMBIC SYSTEM
TEMPORAL LOBES
Endocrine correlation to schizo
Decreased prolactin levels
Conventional (typical) antipsychotics
-Phenothiazines & Haloperidol
-SE: EPS, hyperprolactemia, neuroleptic malingnant syndrome
-Provide relief in psychosis
-Improve positive symptoms
-Worsen negative symptoms
Novel (atypical) antipsychotics
-Clozapine, olanzepine, risperidone
-Provide relief of psychosis
-Improve in positive and negative symptoms
Disease prognosis
Returning to premorbid phase is not common
-Factors that help a good prognosis:
.Late onset
.Being female
.Good premorbid adjustment
.Abrupt onset
.Good inter-functioning during episode
.Brief duration of active symptoms
.Minimal residual symptoms
.No str
Genetics and schizo
Studies have shown a? strong correlation between genetics and schizo
Socioeconomics and schizo
Low socioeconomic classes have more incidence of this disease
Transactional model and schizo
Schizo is most likely a biologically based disease, with an onset influenced by factors from internal and external environment
Delusional disorder
-Presence of delusions (at least 1 month)
-No hallucinations and no bizarre behavior
-Types: erotomanic, grandiose, jealous, persecutory, somatic, mixed
Erotomanic
-Individual believes that someone of higher status is in love with him/her (ex: famous people)
Grandiose
-Have irrational ideas regarding their own worth, talent, knowledge, or power
-May believe they have a relationship with famous person or assume identity of famous person
-Assume identity of deity or religious leader
Jealous
-Sexual partner thought to be unfaithful
-Searches for evidence
-Imaginary lover attacked and partner confronted
-Attempts to restrict autonomy of partner
Persecutory
-Most common type
-Individuals believe their are being persecuted or malevolently treated
-Thing they are plotted against, cheated on, defrauded, poisoned
-Repeated complaints to authority
-Lack of satisfaction leading to violence towards object of delusi
Somatic
Think they have some general medical condition
Brief psychotic disorder
-Sudden onset of psychotic symptoms
-Last at least 1 day but less than a month
-Eventual full return to premorbid phase
-Emotional turmoil
-Overwhelming perplexity/confusion
-Impaired reality: incoherent speech, delusions, hallucinations, bizarre behavior
Substance induced psychotic disorder
-Prominent hallucinations and delusions directly attributed to substance abuse intoxication or withdrawal, or exposure to med or toxin
-Diagnosis made when symptoms are more severe than those of an intoxication or withdrawal
-Catatonic features may appear
Psychotic disorder due to medical condition
-Hallucinations and delusions due to medical condition
-Diagnosis not made if this occurs during delirium
Catatonic disorder due to medical condition
When catatonic symptoms are due to medical condition
Catatonic disorder symptoms
-Stupor (no psychomotor activity)
-Catalepsy (posture against gravity)
-Wavy flexibility (resistance to positioning) (tendency to remain in immobile posture)
-Mutism (no or very little verbal response)
-Negativism (no response to external stimuli or instr
Schizofreniform disorder
-Essential features identical to schizophrenia
-Difference: duration is less than 6 months
-Diagnosis changed to schizophrenia if this persists for more than 6 months
-Good prognosis if: individual's affect is not blunted or flat, rapid onset of psychosis
Schizoaffective
-Schizophrenic behavior + strong symptoms from mood disorders (depression or mania)
-Client may appear with: depression, psychomotor retardation, suicidal ideation, euphoria, grandiosity, hyperactivity
-Decisive factor: presence of hallucinations or delus
What are positive symptoms
Alteration or distortion of normal mental functions and associated with normal brain structures
Good responses to Tx
What are negative symptoms
Diminution or loss of normal functions
Difficult to treat and dont respond well to antipsychotics
Most destructive because they render the pt inert and unmotivated
Positive symptoms
-Content of thought: delusions, religiosity, paranoia, magical thinking
-Form of thought: neologisms, concrete thinking, clang associations, word salad, circumstantiality, tangentiality, mutism, perseveration
-Perception: hallucinations, illusions
-Sense
Delusions
False personal beliefs that are inconsistent with person's intelligence of cultural background
-Of persecution: "The FBI has bugged my room and intends to kill me"
-Of grandeur: "I am Jesus Christ"
-Of reference: "Someone is trying to get a message to me
Paranoia
Extreme suspiciousness of other and actions or perceived intentions
Neologisms
Psychotic person invents new words meaningless to others but with symbolic meaning to them
"She wanted to give me a ride in her new uniphorum
Clang associations
Choice of word governed by sounds
Rhyming
"It is very cold. I am cold and bold
Word Salad
Group of words put together randomly without logical connection
"Most forward action grows life double plays circle uniform
Circumstantiality
Person delays reaching point of communication because of tedious unnecessary details. Person eventually gets to point
Tangentiality
Same as circumstantiality except that person never gets to the point
Perseveration
Same word or idea in response to different questions
Hallucinations
False sensory perceptions not associated with real external stimuli
-Auditory: MOST COMMON. False perceptions of sound. Command--> voice that issues commands. Puts person at potentially dangerous situation
-Visual: False visual perceptions
-Tactile: False
Illusions
False interpretations or misperceptions of real external stimuli
Identification and imitation
Identification is unconscious level and imitation is conscious
Defense mechanisms
NEGATIVE SYMPTOMS
-Affect: inappropriate, bland, or flat. Apathy
-Volition: emotional ambivalence, deteriorated appearance, inability to initiate goal-directed activity
-Interpersonal and Relationships: impaired social interaction, social isolation
-Psychomotor: anergia, w
Posturing
Voluntary assumption of inappropriate or bizarre posturing
Regression
Primary defense mechanism of schizophrenia
Dysfunctional attempt to relieve anxiety
Nursing Diagnosis: disturbed sensory perception
-Impaired communication (inappropriate responses)
-Disordered thought sequencing
-Rapid mood swings
-Poor concentration
-Disorientation
-Stops talking in midsentence
-Tilts head side to side
Nursing Diagnosis: disturbed thought process
-Inability to concentrate and problem solve, abstract or conceptualize
-Impaired volition
-Extreme suspiciousness of others
-Inaccurate interpretation of environment
Nursing Diagnosis: Impaired communication
-Neologisms, word salads, clang associations, echolalia, concrete thinking, poor eye contact, inappropriate verbalization, loose association of ideas
Nursing interventions in hallucinations
-Avoid touching the client without warning to do so
-Attitude of acceptance
-DO NOT REINFORCE HALLUCINATIONS. USE "THE VOICES" INSTEAD OF "THEY"
-LET CLIENT KNOW THAT YOU DONT SHARE THE PERCEPTION
-Try to distract client from hallucination (tv, radio)
-Vo
Nursing interventions in disturbed thought process
-Use reasonable doubt as a therapeutic technique: "I understand you believe this is true, but I personally find it hard to accept"
-Use same staff as much as possible to develop trust
-Be honest and keep all promises
-Assertive, matter of fact, genuine ap
Client in restraints to be observed every
15 mins
Tx for schizo
-Individual psychotherapy: goal is to improve med compliance, enhance social and occupational functioning, and prevent relapse. REALITY-ORIENTED IS THE MOST SUITABLE
-Group therapy: reduces social isolation, increases sense of cohesiveness, improves reali