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In schizophrenia, these symptoms reflect an excess or distortion of normal functions. These
active, abnormal symptoms may include:
These beliefs are not based in reality and usually
involve misinterpretation of perception or experience. They are the mot common
of schizophrenic symptoms.
These usually involve seeing or hearing things that
don't exist, although they can be in any of the senses. Hearing
voices is the most common example among people with schizophrenia.
Difficulty speaking and organizing thoughts may
result in stopping speech midsentence or putting together meaningless words,
sometimes known as "word salad."
This may show in a number of ways, ranging from
childlike silliness to unpredictable agitation.
refers to a diminishment
or absence of characteristics of normal function. They may appear months or
years before positive symptoms. They include:
of interest in everyday activities
to lack emotion
ability to plan or carry out activities
of personal hygiene
Involves problems with thought processes. These symptoms may be the most
disabling in schizophrenia, because they interfere with the ability to perform
routine daily tasks. A person with schizophrenia may be born with these
symptoms, but they may worsen when the disorder starts. They include:
with making sense of information
also can affect mood, causing depression or mood swings. In addition, people
with schizophrenia often seem inappropriate and odd, causing others to avoid
them, which leads to social isolation.
Homelessness & Schizophrenia
Mental illness is one of the main contributors to homelessness.
- Schizophrenia and homelessness are dual conditions that plague nearly every
- industrialized country in the world. The crisis is compounded by the fact that
- many schizophrenics are drug addicts and/or alcoholics. Treatment is difficult,
- if not impossible, and funding is a continuing issue. With the challenges of
- treatment, increased legal issues, schizophrenics' tendency toward violence and
- the fact that mentally ill homeless remain homeless longer than the general
- homeless population , homeless schizophrenics have become modern
- society's untouchables. According to HealthMad.com, in 2007, approximately 200,000
- people were schizophrenic and homeless.
- Henry McMaster has named domestic violence as the number one crime problem
- in South Carolina. More than 36,000 victims annually report a domestic
- violence incident to law enforcement agencies around the state. Over the
- past twelve years, an average of thirty-three (33) women have been killed each
- year by their intimate partner. Currently South Carolina ranks eighth in
- the nation for the amount of homicides caused by criminal domestic violence
One in every four women will?
There were 35,894 victims of domestic violence in
South Carolina in 2005. 43% of reported domestic violence cases ended in an
In South Carolina, 36% of aggravated assaults were
domestic violence related in
1,809 forcible rapes were reported in South Carolina
28% of murders in South Carolina were domestic
violence related in
There were 32 domestic violence related homicides
The most common relationship between homicide
perpetrators and victims was boyfriend/girlfriend and the second most common
relationship was between
How long do you have to have the symptoms to classify as schizophrenia?
Symptoms X30 days for >6Months
How long for schizophrenoform DO?
Symptoms < 6 months
What is SAFD?
Schizoaffetive Disorder….Symptoms with & without mood episode
What is a delusional disorder?
Non-bizarre delusion x 1month
How long is a brief psychotic disorder?
> 1 day <1 month
What is a shared psychotic disorder?
It takes on other delusions
Some other psychotic disorders can be caused by what?
What is the diagnosis criterion for schizophrenia?
- 1. Positive or negative symptoms for 30 days for greater than 6 months
- 2. Marked social/vocational dysfunction
- 3. NOT due to:
- …….. medical
- …….. drugs
- …….. SAFD
- …….. Manic Depressive Disorder (MDD) with psychotic features
What are the 4 types of POSITIVE symptoms?
- 1. Delusions
- 2. Hallucinations
- 3. Disorganized Speech
- 4. Catatonia
Grandiosity, persecution, somatic, reference, thought insertion/withdrawal/broadcasting, ect?
auditory, visual, tactile, olfactory, gustatory?
clang, neologisms, thought block, loose assoc, perseveration?
stupor, posture, excitation?
What are the NEGATIVE symptoms of schizophrenia? *Hint-Crazy 8's*
- - Affective blunting
- - Avolition
- - Asociality
- -Attention problems
What are the subtypes of schizophrenia?
Negative symptoms that persist inspite of resolution of positive symptoms
What is the scope of schizophrenia?
- •40 % attempt suicide within 10 yrs.
- •10 % actually complete suicide
- •9thleading cause of disability
- •60-70% never marry/have children
- •Occupy 25% of all hospital beds
- •70%–80% are unemployed or underemployed
- •10% of permanently disabled Americans
- • 20%–30% of the homeless population
Schizophrenia vs. Violence
•Evidence mixed•Media sensationalized?•Schizophrenics 14% more likely to be victimrather than comit violent crime
What are the demographics of Schizophrenia?
•0.5 - 1.5 % of population•Urban > Rural•Uniform rates across racial and ethnic groupsin US, except for higher rates with racial minorities in large cities •Higher rates with maternal malnutrition
What are the gender differences of Schizophrenia?
•Male > Female (up to 20%)•Onset: male (18-25 yr); female (25-35 yr) •Second peak in onset women after 45 yrs.•Pre-morbid function females > males•Males – More positive symptoms•Females – More negative symptoms•Women have moreemotional/affectivesymptoms – misdiagnosed MDD or SAFD
What are the etiological theories concerning Schizophrenia?
•Genetic – familial ; 10% greater chance•Hormonal – onset S/P puberty, thyroid, DM•Apoptosis/Excessive pruning•Virus – selectivity; dormancy; triggered bystress/hormonal; alter cellular process without destroying cells•Neurotransmitter – drugs can either mimic or eleviatesymptoms
What is the pathology behind Schizophrenia?
•Up To 25% loss of graymatter•Enlarged ventricles •Enlarged amygdala •Neurological abnormalities•Impaired cognitive function•Decreased prefrontal brainfunction •Impaired awareness ofillness
What are the 4 stages of progression when dealing with Schizophrenia?
1. Premorbid2. Prodromal3. Psychotic4. Recovery
Asymptomatic withgenetic/environmental vulnerability.
Premorbid (0-35 yrs.)
Insidious decline inwork/school/social/adaptive functioning
Prodromal (2-5 yrs.)
Abrupt onset of (+) &significant worsening of (-) symptoms. Often hospitalized due to unable to care for self.
Exacerbations & remissionswith 80% relapse rate. Degree of illness/level of functioning plateau after 10yrs.
What are some ways to treat Schizophrenia without medications?
•Supportive psychotherapy•Family therapy•Socialization/social skills training•Cognitive Behavioral Therapy•Hospitalization
What are the two types of pharmacotherapeutics that treat Schizophrenia?
1. Typicals2. Atypicals
These Alleviate positive symptoms, have More side effects, but are Lessexpensive
These will alleviate positive symptoms, offer some help with negative symptoms, have fewer side effects, and MIGHT have neuroprotective effects????
What are the medication forms that treat Schizophrenia?
•Pill/capsule•Elixir•Orally disintegrating tabs (ODT)•IV/IM•Deaconate
What are the drug side effects for drugs that treat Schizophrenia?
•Histaminic effects – Sedation•Adrenergic effects – Orthostasis•Anticholenergic effects – Dry mouth•Hyperprolactinemia – Sexual•Metabolic effects:- Weight gain- Hyperglycemia/diabetes- Hyperlipidemia
What are the other med risks?
•Seizures•Stroke•Sudden death (dementia)•QTcProlongation (Geodon & Melaril)•Extrapyramidal symptoms (EPS)•Tardive dyskinesia(TD)•Neuroleptic malignant disorder (NMS)•Agranulocytosis (Clozaril)
What does the nurse need to monitor the patient for that is receiving treatment for Schizophrenia?
•Vital signs – include orthostatic BP (falls)•Weight & BMI•EKG•AIMS – Abnormal Involuntary Movement Scale (TD)•Labs – CBC, renal function,lipids, glucose, HgbA1C, LFTs, TFTs, prolactin•Suicidality
This syndrome is probably, in part, a genetic condition. People with this syndrome have motor tics and vocal tics. Motor tics are movements of the
muscles, blinking, head shaking, jerking of the arms, and shrugging. When a
person with this syndrome suddenly begins shrugging, he or she may not be
doing it on purpose. This may be a motor tic.
These tics are sounds that a person with Tourette syndrome might make with his or her
voice. Throat clearing, grunting, and humming are all common tics. A
person with Tourette syndrome will sometimes have more than one type of tic happening
Tics are usually worse when a person is under?
Tourette syndrome is not a psychological condition, it is a ? one
Tourette's However, psychological factors are very important in this condition. Psychological distress can make the tics worse, and kids with Tourette syndrome might feel very upset because of the tics and the problems that go with them. Counselors and Tourette syndrome organizations can help kids learn how to explain tics to others. It affects at least 1 in 1,000 to 2,000 people and maybe more. It is believed that about 100,000 Americans have Tourette syndrome.
What drugs is ADHD treated with?
- ADHD is usually treated
- with the aid of stimulant drugs like Ritalin. Concerta
- and with non-stimulant Straterra
- as well as amphetamines,
- such as Dexedrine
- and Adderall.
Stimulants are believed to
work by increasing ? levels in the brain. Stimulant medications boost
concentration and focus while reducing hyperactive and impulsive behaviors.
ADD / ADHD come in both short and long-acting dosages. Short-acting stimulants
peak after several hours, and must be taken (x) times a day. Long-acting or
extended-release stimulants last 8-12 hours, and are usually taken (y)?
- (x)= 2-3 times
- (y)= 1 time per day
The relationship between suicide risk and
sexual orientation: results of a population-based study.
There is evidence of a strong association between suicide risk and bisexuality or
homosexuality in ?
RESULTS: Suicide attempts
were reported by 28. 1
% of bisexual/homosexual males, 20.5% of bisexual/homosexual females, 14.5% of
heterosexual females, and 4.2% of heterosexual ?
Limiting access to lethal
means of self-harm is an ? strategy to prevent self-destructive
behavior, including suicide.
Some suicidal acts are
?, resulting from a combination of psychological pain or despair
coupled with easy availability of the means to inflict self-injury: firearms,
carbon monoxide, medications, sharp objects, tall structures.
By limiting the individual's ? to the
means of self-harm, a suicidal act may be prevented.
The ? is to separate in
time and space the individual experiencing an acute suicidal crisis from easy
access to lethal means of self-injury and personal harm
The hope is by making it
harder for those intent on self-harm to act on that impulse, one can buy time
for the ? to pass and for healing and recovery to occur.
? are the most common method
of completed suicides nationwide (54%), followed by suffocation (20%),
poisoning (17.5%), falls (2.3%), cut/pierce (1.8%), and drowning (1.2%) (CDC:
This is true for men, women
and adolescents who complete suicide. In New York, ? are also the
predominant means of suicide, but by a much slimmer margin
Suicide by firearms seems
to be associated with their availability in the home and with victim
Many homes contain guns and
nearly half (43%) of all homicides and suicides occur in a ?. Most victims
are shot: 67% of the homicides and 54% of the suicides in 2002 (CDC: WISQARS,
2005). In some studies, ? pose the greatest risk.
Asperger syndrome and interpersonal relationships
The lack of
demonstrated ? is possibly the most dysfunctional aspect of Asperger
with Asperger's Syndrome experience difficulties in basic elements of (1), which
may include a failure to develop friendships or to seek shared enjoyments or
achievements with others (for example, showing others objects of interest), a
lack of social or emotional reciprocity, and impaired nonverbal behaviors in areas such as (2….4 items)?
- 1= social interaction2= eye contact, facial expression, posture, and gesture
Qualitative impairment in social
interaction, as manifested by at least two of the following: (4 items)
(A) marked impairments in the use of
- multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body
- posture, and gestures to regulate social interaction
(B) failure to develop peer relationships
- appropriate to developmental level
(C) a lack of spontaneous seeking to
- share enjoyment, interest or achievements with other people, (e.g.. by a lack
- of showing, bringing, or pointing out objects of interest to other people)
(D) lack of social or emotional
(II) Restricted repetitive &
stereotyped patterns of behavior, interests and activities, as manifested by at
least one of the following: (4 items)
(A) encompassing preoccupation with one
- or more stereotyped and restricted patterns of interest that is abnormal either
- in intensity or focus
(B) apparently inflexible adherence to
- specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor
- mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body
- preoccupation with parts of objects
It is estimated that 8 million ? have an eating
disorder – seven million women and one million men
Eating disorders have the highest ? rate of any mental illness
A study by the National Association of Anorexia Nervosa and
Associated Disorders reported that 5 – 10% of anorexics die within 10 years
after contracting the disease; 18-20% of anorexics will be dead after 20 years
and only ? ever fully recover
30 – 40%
20% of people suffering from anorexia will prematurely die from
complications related to their eating disorder, including suicide and ?
co-morbid conditions include ? (50% to
75%), sexual abuse (20% to 50%), obsessive-compulsive disorder (25% with
anorexia nervosa), substance abuse (12% to 18% with anorexia nervosa,
especially the binge-purge subtype, and 30% to 37% with bulimia nervosa), and
bipolar disorder (4% to 13%). 1-4
major depressive disorder or dysthymia
Medical Complications of Anorexia?
- 1. Amenorrhea Bradycardia
- 2. Orthostatic Blood Pressure Drop
- 3. Osteoporosis
- 4. Stress fractures
Cold intolerance, constipation, cyanosis, edema, hypoglycemia, low albumin
What are the Structural and functional brain changes associated with anorexia?
What can appetite suppressant abuse cause?
Anxiety, hypertension, tremors, tachycardia, Purging type reflux, parotid abnormalities, gastrointestinal
- bleeding, hypokalemia, Dental caries, enamel erosion, dehydration, cardiac
- arrhythmias, and Renal failure
TREATING ANOREXIA involves what three components?
· The ? in anorexia treatment is to address and
stabilize any serious health issues. Hospitalization may be necessary to
prevent starvation, suicide, or a medical crisis. Dangerously thin anorexics
may also need to be hospitalized until they reach a less critical weight.
Outpatient treatment is an option when the patient is not in immediate medical
Explores the critical and
unhealthy thoughts underlying anorexia. The focus is on increasing
self-awareness, challenging distorted beliefs, and improving self-esteem and
sense of control. Also involves education about anorexia.
Promotes healthy eating behaviors
through the use of rewards, reinforcements, self-monitoring, and goal
setting. Teaches the patient to recognize anorexia triggers and deal with
them using relaxation techniques and coping strategies.
Examines the family dynamics that
may contribute to anorexia or interfere with recovery. Often includes some
therapy sessions without the anorexic patient—a particularly important
element when the person with anorexia denies having an eating disorder.
Allows people with anorexia to
talk with each other in a supervised setting. Helps to reduce the isolation
many anorexics may feel. Group members can support each other through
recovery and share their experiences and advice.
Genetic factors (nature) and childhood experiences (nurture) are predisposing causes for developing ?
combined with genetic predisposition begins to explain complexity of
development of child psychiatric illness
to roles of ? and brain development
Perhaps epigenetic mechanism
mechanisms down-regulate stress reaction after ? has passed, returning
brain to prior level of functioning
and reversible during acute stress
prolonged, severe, or repetitive stress, increased neurotransmitter activity
Resilience: ability to withstand stress ØAffected
- by individual characteristics, early life experiences
- factors in their environment
- competent, realistic, flexible, assured of their own inner resources and
- strong sense of personal control
- age-appropriate responsibility
- quickly when faced with stressors
- realistic, well-defined goals
- to complex social needs
- and advocate for child
- comprehensive treatment plan that identifies and integrates child’s needs and
- family resources
- that behavior is cultural, must be viewed from sociocultural
- goal: to establish therapeutic alliance with child and parents
- child’s verbal communications vague or unclear, ask for more explanations
- may not respond to problem-centered lines of communication
- discuss more general aspects of child’s life (family members, school, friends)
Communicating with Children
- age-related development
- respect and authenticity
- familiar vocabulary at child’s level of understanding
- child’s needs in immediate situation
- child’s capacity to cope with change
Communicating with Children
- coping skills by creative, unstructured play
- indirect age-appropriate communication techniques (storytelling, picture
- drawing, creative writing)
- alternative communication devices for children with special needs (sign
- language, computer aids)
Ego Competency Skills
Important to learn
- nursing assessment on specific skills all children need to become competent
- of medical diagnosis, assess child for mastery of these skills:
- closeness and trusting relationships
- separation/independent decision making
- joint decisions and interpersonal conflictØDealing
- with frustration/unfavorable eventsØCelebrating
- good feelings and experiencing pleasureØWorking
- for delayed gratificationØRelaxing
- and playingØCognitive
- processing through words, symbols, imagesØEstablishing
- adaptive sense of direction or purpose
•More common childhood
ADHD Depression Anxiety
Behaviors for Children
- from stressful situations
- immediate response
- more manageable situation
- (manipulating or shaping) environment
- good and bad as part of life
- toward maintaining optimal conditions of adjustment, security, comfort
- improve brain functioning
- skills training: improve socialization
- management: learn impulse control
- therapy: practice problem solving and communication
- education: integrate new behaviors and skills into child’s life
Eating Regulation Responses and Eating Disorders
Adaptive Eating Responses
- eating patterns
- caloric intake
- weight appropriate for height
- to regulate eating habits
- overuse or underuse of food
- biological, psychological, sociocultural integrity
Maladaptive Eating Responses
- associated with maladaptive eating regulation responses
–Anorexia nervosa –Bulimia nervosa
–Binge eating disorder
–Night eating syndrome
Adaptive Eating Responses
- disorders more common among females; males more reluctant to seek treatment
•Sociocultural norms result in
- distorted body image
- disorders can cause biological changes: altered metabolic rates, profound
- malnutrition, possibly death
- obsessions can cause psychological problems, e.g., depression, isolation,
- emotional lability
Eating Disorders: Anorexia
- •Anorexia nervosa in approximately 0.5%-1% of females
- •About 5%-10% of people with anorexia are male
- •Usual onset between 13-20 years but can occur in any age
Eating Disorders: Anorexia
- •Although hungry, person with anorexia refuses to eat
- because of distorted self-perception of fatness
- •Starvation ensues
- •Can become chronic illness
- •Estimated mortality from anorexia nervosa: 5% of those
- with the disorder
Eating Disorders: Bulimia
- •Bulimia nervosa more common
- –Estimated in 1%-4% of
- population, mostly females
- –4%-15% of female high
- school and college students
- •Onset usually at 15-18 years old
Eating Disorders: Bulimia
- •Uncontrolled binge eating alternating with vomiting or
- •Same patient may have bulimia and anorexia
- •Bulimia usually occurs in people of normal weight but
- people may be obese or thin
Eating Disorders: Binge Eating
- eating disorder: consuming large amounts of calories in contained amount of
- from bulimia because person does not attempt to prevent weight gain
- behaviors not used
- approximately 2%-4% of population
Eating Disorders: Night Eating
- eating syndrome: pattern of awakening during night associated with food intake
–Not yet listed as separate eating disorder in DSM-IV-TR
–Estimated 1.5% in general population
–Make up 27% of severely obese population seeking surgical treatment
Overlapping Relationships Among Eating Disorders
- biological, psychological, sociocultural evaluations
- physical examination: vital signs; weight; skin; cardiovascular system;
- evidence of laxatives, diet pills, diuretic abuse, and/or vomiting; dental
- history: dieting and substance use, family assessment, medication
Screening for Eating Disorders
•Focus specific attention on assessment of eating
- regulation responses
•Several questionnaires and rating scales screen for
- eating disorders
•Adding these two questions may be as effective as more
- extensive questionnaires to identify people with eating disorders:
–Are you satisfied with your eating patterns?
Assessment: Eating Disorders
- and desired weight, weight history, menstruation
- avoidances, restrictions, dieting, fasting patterns/unusual nutrition beliefs
- extent, timing of binge eating, and/or purging/compulsive exercise patterns
Assessment: Eating Disorders
- of laxatives, diuretics, diet pills, other methods of purging/chewing and
- spitting food
- or shape preoccupation/body image disturbances
- preferences, peculiarities
- of illness on school, work, social life
- consumption of much food in discrete period
- on patient’s perception of loss of control, perceived excessive caloric intake
- more important than total number of calories consumed, but must assess both
- binge secretively, often feel shame
- with bulimia typically average weight or slightly overweight with unsuccessful
- dieting history
- times weekly to more than 10 times/day, or occasional binges related to
- stressful situations
Behaviors: Fasting or Restricting
- with anorexia eat 500-700 calories (as few as 200) daily
- all meat, poultry, fish, dairy; do not substitute nonanimal protein, nutrients
- be obsessive-compulsive: eat same foods repeatedly, foods in predetermined
- order, bizarre food preferences, avoid fattening food, fast for days
- or prescription diuretics, diet pills, laxatives, steroids
- abuse common, inefficient way to
- lose; abuse can increase to 60 doses/week
Medical Complications of
•Central nervous system •Renal •Hematological •GastrointestinaI •Metabolic
Related to Anorexia
- 30% below ideal body weight often have life-threatening clinical, laboratory
- who vomit and use laxatives or diuretics, regardless of weight, usually have
- health problems
- and endocrine abnormalities result from malnutrition/starvation
Related to Anorexia
- see amenorrhea, osteoporosis, hypometabolic symptoms (cold intolerance, bradycardia)
- may cause hypotension, constipation, acid-base, fluid-electrolyte disturbances,
- e.g., pedal edema
Related to Bulimia
•Potassium depletion and hypokalemia from vomiting,
- laxative or diuretic abuse
•Symptoms of potassium depletion: muscle weakness,
- cardiac arrhythmias, conduction abnormalities, hypotension
•Gastric, esophageal, bowel abnormalities common in
- patients with bulimia
•May erode dental enamel, cause enlarged parotid glands
Related to Binge Eating
- weight: serious health problems
- weight: exacerbate health problems
- problems common
- weight: hypertension, cardiac problems, sleep apnea, difficulties with
- mobility, diabetes mellitus
Co-morbid Mental Illnesses
- or dysthymia in 50%-75% of people
- with anorexia and bulimia
- disorder in up to 25% of patients with anorexia nervosa
- with bulimia have increased rates of anxiety disorders, posttraumatic stress
- disorder, substance abuse, mood disorders
•Psychological: rigidity, perfectionism •Environmental: illnesses, sexual abuse, drug abuse,
- media influences
•Familial: increased risk in female relatives