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What is schizophrenia??
Severe disorder of the brain like epilepsy or multiple sclerosis.
It is a clinical syndrome, not just one cause
It is a NO fault illness.
Acute periods with relapses
What is off in Schizophrenia??
Perception, judgement, and emotions
Schizophrenia is not due to what the parents did wrong but it is
it is Highly Genetic
What is Not schizophrenia??
Does not mean “split personality”.
Not caused by bad parenting.
Not caused by personal weakness.
What is the disconnection in pts with schizophrenia
Disconnect btw what the pt is seeing and the outside world
(emotions not expressed congruently). Difficult time in relationships
What is a pt with schizophrenia more prone to do when taking thier medications??
When they are taking drugs they are more prone to think more clearly and able to plan a suicide
What are pts with schizophrenia less likely to commit suicide when not on their meds??
When not on meds there are so many thoughts they cant distinguish and paln and think clearly
What are the advantages to being diagnosed with schizophrenia later on in your life??
The later your diagnosed, the better level of functioning overall. Outcomes are greater if you were functional before you were diagnosed
more likely you will be able to function bc you know what is normal and what is not
What is the disadvantage of getting diagnosed with schizophrenia at a young age??
- their outcomes are worse bc they didnt have a chance to
- develop and function well before.
The earlier your diagnosed the less of a life you will have
Kids wont know the difference btw normal and not
What is the Dopamine Hypothesis
- ppl with schizo produce more excess dopamine and they dont have as good things to break it dop down so theres higher concentrations the increased doamine craving cells and a decrease in activity in antagonis (more cells want
- dopamine and less want to block it )
What are some Selected factors activate genetic vulnerability to schizophrenia
Viral infection 28th-30th week of pregnancy
Starvation during pregnancy
Oxygen deprivation at birth
What are the important test used for schizophrenia
MRI: identifies small changes in brain
PET: high activity in temporal lobe , metabolism, sugars can be seen
EEG: just shows pt is alive, and current seizure
What is the Schizophrenia DSM-IV-TR Criteria
Lasting 6 months
- Active-phase symptoms lasting at least 1 month include
- two of the following:
–Disorganized or catatonic behavior
What are the subtypes of Schizophrenia
what is the paranoid subtype
- delusional thought.
- See the enviroment as threatening and hostile.
- They can be dangerous.
- Highest functioning, most successful in recovery
What are people able to do in the Paranoid subtype
able to work and go to school, just have to manage with the voices, able to functionin life,sees life as threating and hostile enviornment (hypervigulent), want to know whattheir thoughts are (I wonder what its like for you)
can have hallucinations. Looseness of assoc. disconnection in their affect
(laughing when talking about someone who died). Harder to understand.
walking around, not really talking or have awareness of surroundings. Could be motionless, like a mannequin.
Look unaware of their environment. They say theres so much going in their head that it immobilizes them. Can be successful
What are we worried about in the Catatonic stage
- worried about DVT and eating , catatonic can be succesful
they can still hear you even though they may look like they are a maniquien
could be a combo of the other ones. Might not be as successful in recovery.
little bits and pieces of everything, lots of things going on, a mess and not able to function well
don’t have active symptoms but still difficult time in social situations
left over behaviors after treatment, no active symptom
What are the courses of schizophrenia
pre before diagnosis
–Early symptoms preceding diagnosis: social withdrawal, deterioration in function, perceptual disturbances, magical thinking, and peculiar behavior
- Usually before pt has their first break there are SOME symptoms. Start disconnecting social-wise. Magical thinking , change in behavior usually don’t act like this
- is a sign
when postive symptoms occur crack and start to be schizophrenic
Acute symptoms decrease, especially positive symptoms
When meds and treatment are given
Symptoms are in remission
Even in remission, pts will have some type of delusional thinking but it might not prevent them from functioning
Positive Symptoms of Schizophrenia-Excess or distortion of normal functions
Hallucinations-distortion of perceptions
Delusions-distortion of thought content
Grossly disorganized or catatonic behaviors
Negative Symptoms of Schizophrenia- Loss of Normal Functions
- Lack of motivation
- Blunted flat affect
- Loss of emotional warmth
- Impaired social skills
- Atypical antipsychotics-newer. They help these
thought blocking is associated with what disease
Flight of ideas is associated with what disease
What are the Thought Disturbances with Schizophrenia
- Thought blocking
- Losse association
somebody who doesn’t know what is more important.
You ask them about a movie and they tell you everything (the parking spot, etc) THE WHOLE STORY
start talking about something then going off on tangent (refocus pt)
- might not be a connection.
- They go from one topic to another.
- (random, I cant follow you)
When a pt says I Am Jesus what is that
When a person says they Hear Jesus and they Can see him what is that
What are the Objective data in the Assessment
Mental status examination
Positive and negative symptoms
–PHATS (Bp, HDL (good cholesterol), Abdominal obesity, Triglycerides, sugar) how they are reacting to the atipical drugs
Newer bc a lot of the newer drugs cause these
What happens if the pt is not doing their ADLs
Then they will not be discharged
What will the nurse do in the Planning stage of the nursing process in the Acute phase
planning strategies to ensure patient safety and stabilize symptoms
What will the nurse do i the Planning stage of the nursing process in the Maintenance phase
planning strategies to provide patient and family education
What will the nurse do in the planning stage of the nursing pocess in the stabilization phase
planning strategies to prevent relapse
If they ask you if you think they are jesus christ, you say
i find it hard to believe but i believe that you think youre jesus christ”
which diagnosis would be highest priority for client with catatonic schizophrenia?
Imbalanced nutrition:less than body requirements
Typical Antipsychotic block what
Block D2 receptors in limbic region
When a Typical Antipsychotic blocks dopamine it reduces what symptoms
What are the Typical Antiphsychotic drugs for Schizophrenia
Haldol, Prolixin, Thorazine, trilafon
What are the Major side effects with Typical Antipsychotics
dopamine blockage (EPS), noradrenergic (Alpha 1)blockage, cholinergic blockage
What are the Adverse effects to Cholinergic blockade in low-potency Typical Antipsychotics
Atropine-like Side Effects
•Treatment: Supportive measures
What are the HIGH potency Typical Antipsychotics
What are the MEDIUM potency Typical Antipsychotics
- Loxaprin (loxitane)
What are the LOW potency Typical Antipsychotics
Haldol hase a low _____affect
los sedative affect
Haldol can be given IM every
Prolixin IM can be effective when given
every 2-4 wks
Which Typical Antipsychotic drug has an increase sensitivity to the sun??
Which Typical Antipsycotic drug has the Highest sedative and hypotensive effect
What Typical Antipsychotic cna can irreversible retinitis pigmentosa at 800 mg
Adverse Side Effects Related to Alpha1 Blockade Low-Potency Typical Antipsychotics
Orthostatic hypotension-risk of falling and monitor blood pressure
Adverse Side Effects Related to D2 Blockade High-Potency Typical Antipsychotics
Extrapyramidal Side Effects
What are the Extrapyramidal Side Effects??
- Tradive Dyskinesia
(stiffness)(see this right away)
IM diphenhydramine (benadryl) or benztropine (cogentin, artane) followed by oral antiparkinsonism drug, eyes rolling back
What are the Two Typical Antipsychotics that have more EPS
Haldol and Prolixin
Change to low-potency drug
Oral antiparkinsonism (symmetrel) drug
(see this a lot. Movements uncontrolled. Pacing, moving legs) (they look agitated)
Decrease antipsychotic dose
chronic result) (involuntary movement of facial area a lot of times) tongue might be moving. feeling of caramel stuck in your mouth
Change to atypical antipsychotic make comment of what you are seeing
Other Side effect with Typical Antipsychotics
Photosensitivity( doesn’t matter what your skin color is)wear sunscreen
Poikilothermia (Temperature Regulation Affected)-body isnt telling them if theyre hot or cold. Could be sweating but wont know to take their coat off
Galactorrhea and Gynecomastia
What are the Atypical Antipsychotics??
Clozapine (Clozaril)-agranulocytosis,wt gain
•Olanzapine (Zyprexa)-wt gain
What are the Side Effect for Atypical Antipsychotic
fewer EPS, fewer anticholinergic effects, may have sedation and hypotension
Dopamine side effects much weaker
Histamine is blocked: results in weight gain, sedation
What happens metabolically with Atypical Antipsychotics
Hyperlipidemia, Hyperglycemia and weight gain may occur over time, esp. with Olanzapine
•May improve TD
What Atypical Antipsychotic may cause Agranuloctyosis??
Clozaril-requires weekly WBC counts
Clozapine takes up a high amount of what??
D4 and 5HT2
Clozapine has a risk for
What are the Side effects for Clozapine
–Neuroleptic malignant syndrome (NMS)
–Tachycardia, postural hypotension
What the side effects of Neuroleptic Malignant Syndrome Reaction to Antipsychotic Medications
•Decreased Level ofbconsciousness
•Inceased Muscle tone
•Myoglobinuria-large molecules that block your kidneys
What is the treatment for NMS
•Dantrolene- antidote for hyperthermia
What can be used for early recognition of EPS
Use Abnormal Involuntary Movement Scale (AIMS) for early recognition of EPS
What meds can be used for treatment of EPS
- Risperdal Consta atypical antipsychotic
- Fluphenazine (Prolixin)decanoate typical antipsychotic
- –IM or SC
- •Haloperidol decanoate typical antipsychotic
What things will cause relapse
•Denial of illness
•Lack of family support
•Inability to cope with health system