Schizophrenia
Bleuler
Schizo
6 + phren
Split. + Mind
Syndrome Symptoms
A
Think Chronic
Percieve
Behave/act
Cancer Differ from person to person
Delusions
Discover Psychosis
Hallucinations
Important to Substance abuse
manage (Dual diagnosis)
y
n
Suicide
(command hallucination)
Suffering
Symptoms
Positive Hard
Is
Ambivalence Holding seemingly contradictory beliefs or feelings
about the same person, event, or situation
my
Associative looseness
Ti
Fragmented or poorly related thoughts and ideas
Imitation of the movements and gestures of
tf
Echopraxia
s another person whom the client is observing
D
Flight of ideas
Continuous flow of verbalization in which the
es
person jumps rapidly from one topic to another
s
Ideas of reference
nil
False impressions that external events have special
meaning for the person
Perseveration Persistent adherence to a single idea or topic; verbal
is
repetition of a sentence, word, or phrase; resisting
attempts to change the topic
Bizarre behavior Outlandish appearance or clothing; repetitive or stereotyped,
3s
seemingly purposeless movements;
unusual social or sexual behavior
no
Hallucinations False sensory perceptions or perceptual experiences that do not
exist in reality
threatening and
I
is
frightening no stimulant Trigger
five senses
Pleasant
real
Illness
Hallucinations
I saw
Visual hallucinations seeing images that do not exist at all,
or
(second most common such as lights or a dead person, or distortions such as
type of hallucination). seeing a frightening monster instead of the nurse.
Auditory hallucinations, hearing sounds, most often voices, talking to or about the
no
the most common type client. There may be one or multiple voices; a familiar or
unfamiliar person’s voice may be speaking
Command are voices demanding that the client take
hallucinations action, often to harm the self or others, and
are considered dangerous.
suicide
smells or odors. They may be a specific scent such
no tend
Olfactory hallucinations
as urine or feces or a more general scent such as a
rotten or rancid odor
dementia,
to
seizures,
cerebrovascular
accidents.
Tactile hallucinations sensations such as electricity running
3s
through the body or bugs crawling on the skin
tho
Schizophrenia
alcohol withdrawal
Gustatory hallucinations taste lingering in the mouth or the sense that food
ins
tastes like something else. The taste may be metallic
or bitter or may be represented as a specific taste
nil
Cenesthetic hallucinations client’s report that he or she feels bodily functions
that are usually undetectable
e
sensation of urine forming or impulses being
transmittedthrough the brain 2
client is motionless but reports the sensation of bodily
arts
Kinesthetic hallucinations
movement. Occasionally, the bodily movement is
something unusual,
nor
floating above the ground
Interventions for hallucinations:
Help present and maintain reality by frequent contact and
communication with client
• Elicit description of hallucination to protect the client and
others. The nurse's understanding of the hallucination helps him
or her know how to calm or reassure the client.
• Engage client in reality-based activities, such as card playing,
occupational therapy.
new
Delusions Fixed false beliefs that have no basis in reality
Persecutory/paranoid involve the client’s belief that
ns.tnnd
delusions “others” are planning to harm him or her or are spying, following,
ridiculing, or belittling the client in some way.
The client may think that food has been poisoned
rooms are bugged with listening devices.
tu ou.net
Grandiose delusions are characterized by the client’s claim to
association with famous people or celebrities, or the clien
belief that he or she is famous or capable of great feats
Thus
client may claim to be engaged to a for he or she
may claim to have found a cure for cancer
generally vague and unrealistic beliefs aboutthe client’s
no
Tid
Somatic delusions health or bodily functions. Factual information or
diagnostic testing does not change these beliefs.
s
A male client may say that he is pregnant, or a client may
report decaying intestines or worms in the brain
ms
Nihilistic delusions the client’s belief that his or her organs aren’t
ing
functioning or are rotting away, or that some body part or
feature is horribly disfigured or misshapen.
Referential delusions
minus
ideas of reference involve the client's belief that television
broadcasts, music, or newspaper articles have special meaning
for him or her.
mild
The client may report that the president was speaking
directly to him on a news broadcast or that special messages are
sentthrough newspaper articles.
Interventions for delusions:
Do not openly confront the delusion or argue with the client.
• Establish and maintain reality for the client.
• Use distracting techniques
• Teach the client positive self-talk, positive thinking, and to ignore
delusional beliefs..
Negative symptom
reductions in normal emotional andbehavioral states
I
Soft
harder to recognize depression
Alogia:
no
(poverty of content)
infl
Tendency to speak little or to convey little substance of
meaning
Feeling no joy or pleasure from life or any activities or
o
Anhedonia
tms
relationships
mimes
Apathy Feelings of indifference toward people, activities, and events
mid
Asociality Social withdrawal, few or no relationships, lack of closeness
t.MS
Blunted affect: Restricted range of emotional feeling, tone, or mood
mmmm
his
Catatonia: Psychologically induced immobility occasionally marked
by periods of agitation or excitement; the client seems motionless,
as if in a trance
Flat affect:: Absence of any facial expression that would indicate
teh
emotions or mood
on nmi
Avolition or lack of Absence of will, ambition, or drive to take
volition: action or accomplish tasks
is
Inattention Inability to concentrate or focus on a topic or activity,
regardless of its importance
Onset
abrupt or insidious
slowly and
gradually Poorer
Harder to detect
social withdrawal
unusual behavior
no
loss of interest in school
neglected hygiene
no
diagnosis
mi
positive symptoms
MSW
Immediate-Term Course years immediately after the onset
mis
ongoing psychosis and never
fully recovers
pony
episodes of psychotic symptoms with
episodes of relatively complete recovery
man
Long-Term Course
Antipsychotic They do not cure the intensity of psychosis
my
medications
ins
disorder tends to diminish with age.
Try
lower relapse rates
may live independently later life improved insight,
quality of life,
social functioning
RELATED DISORDERS
ms
Schizoaffective disorder mixture of psychotic and mood symptoms
simultaneously depression
Srm
Schizophrenia Misdiagnosis
may alternate
a bipolar disorder
acute
Isn
Schizophreniform disorder
T
psychosis less than the 6 months
reactive
occupational functioning may
3
or may not be impaired
Arm
mood disorders
excessive motor activity
ins
psychomotor
On
Catatonia
a disturbance
virtual immobility and
mid
motionlessness
and
purposeless catalepsy (waxy flexibility)
stupor
no
persecutory, functioning is not
if
erotomanic, markedly impaired
i
Delusional disorder grandiose,
jealous, behavior is not
somatic obviously odd or bizarre.
sudden onset of
mW
Brief psychotic disorder
at least one psychotic 1 day to 1 month.
symptom,
No stressor
Childbirth
mg
Shared psychotic disorder close
(folie à deux) Two people
relationship
53
separated from the share a similar siblings,
dominant person
o
improve
delusion parent and child,
husband and wife
Schizotypal odd,
To
personality disorder
eeccentric behaviors transient psychotic
is
personality disorder
schizophrenia 20% I
ETIOLOGY
identical twins have a 50%
Biologic Theorie
immediate families
Fraternal twins have only a 15%
no
Genetic Factor
one biologic parent with schizophrenia
15%
both biologic parents 35%
less brain tissue and
cerebrospinal fluid
glucose metabolism and oxygen are
min
Neuroanatomic factors diminished in the frontal cortical
structures of the brain
Computed tomography scans have shown
enlarged ventricles in the brain and cortical
atrophy
decreased brain volume and
abnormal brain function in the
frontal and temporal areas
dopamine and serotonin
IS
Neurochemical Factors
clozapine (Clozaril)
serotonin
excess dopamine
block dopamine amphetamine
decreasing symptoms
ing
Immunovirologic Factors
cytokines
infections in pregnant women
children born in
crowded areas in cold weather
my
TREATMENT
Psychopharmacolog
electroconvulsive therapy,
my
Previously insulin shock therapy
psychosurgery
Now
first-generation,
positive no observable effect on
antipsychotic medications 9
signs the negative signs
Typical, classic
The second-generation positive signs
antipsychotics + negative
G Atypical symptoms
discontinue or
ng
Side effects
reduce the dosage
•
s Nonneurologic
weight gain, sedation,
photosensitivity, anticholinergic
symptoms, mouth, blurred vision,
constipation, urinary
retention, and orthostatic hypotension
for
neurologic
they
movement
Extrapyramidal Side Effects. EPSs disorders
dystonic early spasms in discrete
Z
reactions muscle groups
neck muscles (torticollis) or eye
muscles (oculogyric crisis)
Compromise
client’s airway
s
protrusion of the tongue,
dysphagia
laryngeal and pharyngeal spasms
, causing a medical emergency
bird
diphenhydramine (Benadryl) given IM ,IV
benztropine (Cogentin) given IM
shuffling gait, masklike facies, muscle
stiffness (continuous) or cogwheeling
parkinsonism, rigidity (ratchet-like,movements of joints),
Pseudoparkinsonism, or so.nu drooling,
neuroleptic-induced parkinsonism akinesia (slowness and difficulty
initiating movement)
Treatment
a
first few days 2
restless movement,
6
akathisia pacing, starting
inability to remain still, increasing the dosage
inner restlessness
mm
Beta-blockers such as propranolol
benzodiazepines
abnormal,
Nw
Tardive Dyskinesia late-appearing involuntary
2
movements
lip smacking, tongue protrusion,
socially isolated embarrassing chewing, blinking,
grimacing, choreiform
movements of the limbs and feet
irreversible decreasing or discontinuing
my
the medication
serious muscle rigidity, high fever,
_S
Neuroleptic Malignant increased muscle enzymes
Syndrome. NMS
i fatal
(particularly, creatine phosphokinase),
leukocytosis (increased leukocytes)
failure of the bone marrow to
Agranulocytosis Clozapine produce adequate white
blood cells
fever, malaise,
18 to 24
ulcerative sore throat, suddenly
weeks
leukopenia
weekly white then every 2
discontinue blood cell counts for the weeks
medication s
first 6 months
furnished. 3,500 cells/mm3 7 or 14 days only
Seizures infrequent 1%
high doses
clozapine 5%
mind lowered dosage
different antipsychotic medication
Psychosocial Treatment
stud
social contact meaningful relationships with other people
breaking complex social behavior
mins
Basic social skill training into simpler steps, practicing through role-playing,
and applying the
concepts in the community or real-world setting.
Groups focus on topics of concern such as medication
tf
management, use of community supports, and
family concerns
combines computer-based
ns.ny
cognitive training with group sessions
cognitive enhancement therapy (CET)
that allow clients to practice
and develop social skills
attention,
memory,
information processing
Unusual Speech Patterns of Clients with Schizophrenia
so
Clang associations ideas that are related to one another based on
mis
sound or rhyming rather than meaning
Sd
I will take a pill if I go up the hill but not if my
name is Jill, I don’t want to kill.
”
0
Neologisms words invented by the client.
not
I’m afraid of grittiz. If there are any grittiz
here, I will have to leave. Are you a grittiz?”
stereotyped repetition of words or phrases that
nip
Verbigeration
may or may not have meaning to the listener
nmi
I want to go home, go home, go home, go home
Echolalia
mtg
client’s imitation or repetition of what the nurse says
mind
Nurse: “Can you tell me how you’re feeling?”
Client: “Can you tell me how you’re feeling, how you’re feeling?
Perseveration the persistent adherence to a single idea or topic and
min
verbal repetition of a sentence, phrase, or word, even when
another person attempts to change the topic
Nurse: “How have you been sleeping lately?”
Client: “I think people have been following me.
” The
Nurse: “Where do you live?”
Client: “At my place people have been following me.
”
Nurse: “What do you like to do in your free time?”
Client: “Nothing because people are following me.
combination of jumbled words and phrases that are
imy
Word salad disconnected or incoherent and make no sense to the
i listener
must
Corn, potatoes, jump up, play games, grass, cupboard. ”
