Schizophrenia

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Author:
ncappadonia
ID:
114098
Filename:
Schizophrenia
Updated:
2011-11-02 22:41:19
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Shizophrenia
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Types of Schizophrenia
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  1. Causative Factors of Schizophrenia:
    - Most common onset: Late teen to early adult hood

    - Patients commonly have comorbiditys hypertension, diabetes, cardiovascular disease, and metabolic syndrome

    - Affects men and women equally

    - Onset an relapse are almost always due to stress

    - Prenatal and perinatal events associated with disease

    - Higher incidence if born in late Winter or early Spring

    - Can have a genetic predisposition

    • - Alcohol, smoking, and drugs are all high in people with schizophrenia
  2. What is Schizophrenia?
    • Diagnostic term used to describe a major psychotic disorder characterized by disturbances in:
    • Perceptions
    • Thought Processes
    • Reality Testing
    • Feelings
    • Behaviors
    • Attention
    • Motivation
  3. Brain Changes and Theories
    • Enlarged ventricles--> MOST COMMON
    • - Considered to have poorer prognosis

    - Smaller hippocampus

    - Increased number of dopamine receptors

    • - Excessive dopamine activity in limbic area
    • ^how you have positive symptoms
  4. Features of Schizophrenia
    - DETERIORATING PERSONALITY

    - Disordered thoughts

    - Language disturbance

    - Loss of function

    - Delusions

    - Hallucinations

    - Cognitive dysfunction

    - Hopelessness and suicidal ideation is very common
  5. Objective Signs of Schizophrenia
    --> Things you can see

    • -- Alterations in Personal Relationships
    • - Decreased attention to appearance and social amenities related to introspection and autism
    • - Inadequate or inappropriate communication
    • - Hostility
    • - Withdrawal

    • -- Alterations of Activity
    • - Psychomotor agitation
    • - Catatonic rigidity
    • - Echopraxia (repetitive movements)
    • - Stereotypy (repetitive acts or words)
  6. Subjective Signs of Schizophrenia:
    --> Things you cannot see

    • --Altered Perception
    • - Hallucination
    • - Illusions
    • - Paranoid thinking

    • -- Alterations of Thought
    • - Loose associations
    • - Retardation
    • - Blocking
    • - Autism
    • - Ambivalence
    • - Delusions
    • - Poverty of speech
    • - Ideas of reference
    • - Mutism

    • -- Altered Consciousness
    • - Confusion
    • - Incoherent speech
    • - Clouding
    • - Sense of "going crazy"

    • -- Alterations of Affect
    • - Inappropriate, blunted, flattened, or labile affect
    • - Apathy
    • - Ambivalence
    • - Overreaction
    • - Anhedonia
  7. Positive- Type 1 Symptoms
    • - Too much of something
    • - Most easy to identify
    • - Due to excess dopamine

    • - Hallucinations
    • - Grandiosity
    • - Agitation, tension
    • - Bizarre behavior
    • - Delusions
    • - Suspiciousness
  8. Negative- Type 2 Symptoms
    • - Lack of feelings
    • - Harder to treat
    • - More difficult to detect

    • - Flattened affect
    • - Alogia
    • - Avolition (lack of motivation)
    • - Anhedonia (lack of pleasure/joy)
    • - Communication difficulties
    • - Poor grooming
    • - Asocial behavior
    • - Attention deficitis** (hard time concentrating and paying attention)
  9. Phases of Schizophrenia:
    • -- Prodomal (before diagnosis)
    • - Start showing subtal sx
    • - Sleep disturbances, trouble thinking, most people go through this

    • -- Acute
    • - Severe psychotic symptoms
    • - Can be positive or negative symptoms

    • -- Stabilizing
    • - Getting better
    • - But symptms still getting in way of normal functioning

    • -- Stable
    • - Hallucinations/delusions not as severe; or can be asymptomatic
    • - Can still be having these problems, they just learn to ignore and function normally
  10. DSM-lV-TR Criteria:
    - Atleast 2 characteristic symptoms

    - Social- occupational dysfunction

    - Duration - atleast 6 months

    - No other causes (shizoaffective, medical, or substance abuse)
  11. Catatonic Schizophrenia:
    - Intense psychomotor disturbance

    - Stupor, posturing, vegetative condition

    - Waxy flexibility

    - Mute, negative, purposeless motor activity

    - Magical thinking

    - Responds well to meds
  12. Disorganized Schizophrenia:
    - Disintegration of personality

    - Word salad, clanging, odd behavior

    - Poor grooming

    - Poor prognosis

    - Flat innappropriate affect

    - Rhyming words over and over again

    - Many homeless have this
  13. Paranoid Schizophrenia:
    - Better prognosis

    - Less neurologic, cognitive impairments

    - Persecutory delusions, auditory hallucinations common
  14. Undifferentiated Schizophrenia:
    - Fragmented delusions, vague hallucinations, bizarre & disorganized behavior, disorientation, incoherence

    - Inappropriate affect

    - Poor prognosis
  15. Residual Schizophrenia:
    - Had at least 1 acute episode of schizophrenia, only negative symptoms

    - Unpredictable prognosis
  16. Psychosocial and Rehabilitation:
    - Trust building

    - Behavior therapy

    - Follow up

    - Group theraphy

    - Address non-compliance

    - High suicide risk***

    - Occupational therapy is very effective with them
  17. Nursing Diagnosis:
    - Impaired thought processes

    - Impaired sensory perceptions

    - Impaired verbal communication

    - Impaired role performance

    - Self-care deficit

    - Social isolation
  18. Nursing Intervention:
    - Promote trust

    - Promote positive orienation

    - Promote perceived control

    - Promote strengths

    - Meet health-oriented goals
  19. Things You Should NOT Do:
    - Reinforce hallucinations/delusions

    - Touch without warning

    - Whisper, laugh when patient can't hear conversation

    - No competing

    - Do not embarrass
  20. Psychosis Induced Polydipsia:
    - Cumpulsive H20 drinking (4-10 liters/day)

    - Occurs because of thirst and osmotic dysregulation

    • - Major concern= HYPONATREMIA
    • ---- sx: lightheadedness, weakness, lethargy, muscle cramps, n/v, confusion, convulsions, coma

    - Treatment: frequent weighings, restricted fluid intakes, sodium replacement and positive reinforcement
  21. Schizoaffective Disorder:
    - Affective & Schizophrenic symptoms

    - Severe mood swings

    - Criteria that meets schizophrenia and a mood disorder

    - Prognosis better than schizophrenia but less for just a mood disorder
  22. Delusional Disorder:
    - Display symptoms similar to schizophrenia

    - Normal behavior

    - Sx similar to schizophrenia delusions which have the basis to reality
  23. Schizophreniform Disorder:
    - Same symptoms as schizophrenia except symptoms > 1 month but < 6 months

    - Usually occurs later in life

    • - Common in elderly patients with a reaction to medication
  24. Manic Episodes:
    - Bipolar: usually less severe

    - Substance abuse, medical/neuro problems

    - Have fewer sx of bipolar
  25. Psychotic Disorders:
    - Delusions, hallucinations, disordered thoughts, bizarre behavior

    • --Late Onset Schizophrenia
    • - Late onset after 60 years old
    • - More bizarre, hallucinations, and delusions
    • - Hallucinations and delusions of all five senses
    • - Do not show negative symptoms very often
    • - Use antipsychotics
    • - Very often need long term care
  26. Alzheimers Disease:
    Agnosia: Can't recognize familiar object

    Amnesia: Loss of memory

    Aphasia: Language disturbance

    Apraxia: Inability to show motor activity
  27. Anxiety Disorders:
    - Highest of all disorders in the elderly

    - Anxiety, phobias, panic

    - Nonbenzodiazepines
  28. Depression:
    - Common; often overlooked

    - Treated with SSRI's (Prozac, Paxil)

    - BuSpar, ECT
  29. Substance Abuse:
    -ALCOHOL

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