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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 most common of all schizophrenic symptoms
These usually involve seeing or hearing things that don't exist. 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:
*Loss of interest in everyday activities
*Appearing to lack emotion
*Reduced ability to plan or carry out activities
*Neglect of personal hygiene
*Loss of motivation
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.
*Problems with making sense of information
*Difficulty paying attention
Schizophrenia 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.
What is the #1 crime problem in South Carolina?
One in every four women will?
experience domestic violence in her lifetime
One in 33 men have?
experienced an attempted or completed rape
There were 35,894 victims of domestic violence in South Carolina in 2005. 43% of reported domestic violence cases ended in a(n) ?
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 greater than 6Months
How long for schizophrenoform DO?
Symptoms less than 6 months
What is SAFD?
Schizoaffetive Disorder….Symptoms with & without mood episode
this is a psychiatric diagnosis denoting a psychotic mental disorder that is characterized by holding one or more non-bizarre delusions in the absence of any other significant psychopathology. Non-bizarre delusions are fixed beliefs that are certainly and definitely false, but that could possibly be plausible, for example, someone who thinks he or she is under police surveillance
Delusional Disorder (Non-bizarre delusion x 1month)
How long is a brief psychotic disorder?
Greater than a day, less than a month
What is a shared psychotic disorder?
A disorder that 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:
- *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, etc?
auditory, visual, tactile, olfactory, gustatory?
clang, neologisms, thought block, loose associations, perseveration?
stupor, posture, excitation?
What are the NEGATIVE symptoms of schizophrenia?
- -Affective blunting
- -Attention problems
What are the subtypes of schizophrenia?
Negative symptoms that persist inspite of resolution of positive symptoms
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 more emotional/affective symptoms (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 by stress/hormones; alters cellular process without destroying cells
- *Neurotransmitter – drugs can either mimic or eleviate symptoms
What is the pathology behind Schizophrenia?
- •Up To 25% loss of gray matter
- •Enlarged ventricles
- •Enlarged amygdala
- •Neurological abnormalities
- •Impaired cognitive function
- •Decreased prefrontal brainfunction
- •Impaired awareness of illness
What are the 4 stages of progression when dealing with Schizophrenia?
- 1. Premorbid
- 2. Prodromal
- 3. Psychotic
- 4. Recovery
Asymptomatic with genetic/environmental vulnerability.
Premorbid (0-35 yrs.)
Insidious decline in work/ school/ social/ adaptive functioning
Prodromal (2-5 yrs.)
Abrupt onset of (+) & significant worsening of (-) symptoms. Often hospitalized due to inability to care for self.
Exacerbations & remissions with 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
What are the two types of pharmacotherapeutics that treat Schizophrenia?
These Alleviate positive symptoms, have More side effects, but are Less expensive
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?
- •Orally disintegrating tabs (ODT)
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?
- •Sudden death (dementia)
- •QT Prolongation
- •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
- •AIMS – Abnormal Involuntary Movement Scale (TD)
- •Labs – CBC, renal function,lipids, glucose, HgbA1C, LFTs, TFTs, prolactin
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 at once.
Tics are usually worse when a person is under what?
Tourette syndrome is not a psychological condition, it is a ? one
With Tourette's 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 ? 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.
Stimulants for 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
There is evidence of a strong association between suicide risk and bisexuality or
homosexuality in ?
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%)
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. In some studies, ? pose the greatest risk.
The lack of demonstrated ? is possibly the most dysfunctional aspect of Asperger's syndrome.
Individuals with Asperger's Syndrome experience difficulties in basic elements of (A), 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 (B(4))?
- A= social interaction
- B= 1. eye contact, 2. facial expression, 3. posture 4. 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 reciprocity
(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 movements)
(D) persistent preoccupation with parts of objects
It is estimated that 8 million Americans have an ? – 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 ?
Common co-morbid conditions with eating disorders include ? (50% to 75%), sexual abuse, obsessive-compulsive disorder, substance abuse, and bipolar disorder
- 1. major depressive disorder
- 2. 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?
Common co-morbid conditions with eating disorders include ? (50% to 75%), sexual abuse, obsessive-compulsive disorder, substance abuse, and bipolar disorder
This explores the critical and unhealthy thoughts underlying anorexia. The focus is on increasing self-awareness, challenging distorted beliefs, and improving self-espteem and sense of control. Also involves education about anorexia.
This 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 (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. 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 ?
Experience combined with ? begins to explain complexity of development of child psychiatric illness
Child psychiatric illnesses can be related to roles of ? and brain development
Brain mechanisms down-regulate stress reaction after ? has passed, returning brain to prior level of functioning
*Rapid and reversible during acute stress
If prolonged, severe, or repetitive stress, increased neurotransmitter activity often ?
- Resilience: ability to withstand stress
- ØAffected by individual characteristics, early life experiences
- *Protective factors in their environment
- *Are competent, realistic, flexible, assured of their own inner resources and support
- ØHave strong sense of personal control
- ØTake age-appropriate responsibility
- ØRecover quickly when faced with stressors
Challenges for Nurses
*Derive realistic, well-defined goals
*Respond to complex social needs
*Understand and advocate for child
*Develop comprehensive treatment plan that identifies and integrates child’s needs and family resources
*Realize that behavior is cultural, must be viewed from sociocultural perspective
First goal: to establish therapeutic alliance with child and parents if child’s verbal communication is vague or unclear, ask for more explanations
- *Child may not respond to problem-centered lines of communication
- **First discuss more general aspects of child’s life (family members, school, friends)
Strategies for communicating with children
Strategies for communicating with children
*Increase coping skills by creative, unstructured play
*Use indirect age-appropriate communication techniques (storytelling, picture drawing, creative writing)
*Use alternative communication devices for children with special needs (sign language, computer aids)
Ego Competency Skills Important to learn
1. Focus nursing assessment on specific skills all children need to become competent adults
- 2. Regardless of medical diagnosis, assess child for mastery of these skills:
- *Establishing closeness and trusting relationships
- *Handling separation/independent decision making
- *Negotiating joint decisions and interpersonal conflict
- *Dealing with frustration/unfavorable events
- *Celebrating good feelings and experiencing pleasure
- *Working for delayed gratification
- *Relaxing and playing
- *Cognitive processing through words, symbols, images
- *Establishing adaptive sense of direction or purpose
More common childhood psychiatric illnesses
Effective Coping behaviors for children
- *Withdrawing from stressful situations
- *Postponing immediate response
- *Finding more manageable situation
- *Restructuring (manipulating or shaping) environment
- *Accepting good and bad as part of life
- *Working toward maintaining optimal conditions of adjustment, security, comfort
Treatment for childhood illnesses
- *Medication: improve brain functioning
- *Social skills training: improve socialization
- *Behavior management: learn impulse control
- *Cognitive therapy: practice problem solving and communication
- *Parent education: integrate new behaviors and skills into child’s life
Adaptive Eating Responses
- •Balanced eating patterns
- •Appropriate caloric intake
- •Body weight appropriate for height
- •Able to regulate eating habits
- •Resists overuse or underuse of food
- •Maintains biological, psychological, sociocultural integrity
Maladaptive eating responces
Implications of eating disorders
- *Eating disorders more common among females b/c males are more reluctant to seek treatment
- *Sociocultural norms result in distorted body image
- * Eating disorders can cause biological changes: altered metabolic rates, profound malnutrition, possibly death
- *Eating obsessions can cause psychological problems, e.g., depression, isolation, emotional lability
- •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
- •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
- •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
- •Uncontrolled binge eating alternating with vomiting or dieting
- •Same patient may have bulimia and anorexia
- •Bulimia usually occurs in people of normal weight but people may be obese or thin
- •Binge eating disorder: consuming large amounts of calories in contained amount of time
- •Differs from bulimia because person does not attempt to prevent weight gain
- •Purging behaviors not used
- •Prevalence: approximately 2%-4% of population
- *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
Assessment for Eating Disorders
- •Complete biological, psychological, sociocultural evaluations
- •Full physical examination: vital signs; weight; skin; cardiovascular system; evidence of laxatives, diet pills, diuretic abuse, and/or vomiting; dental examination
- •Psychiatric history: dieting and substance use, family assessment, medication
- •Actual and desired weight, weight history, menstruation•Food avoidances, restrictions, dieting, fasting patterns/unusual nutrition beliefs
- •Frequency, extent, timing of binge eating, and/or purging/compulsive exercise patterns
- •Use of laxatives, diuretics, diet pills, other methods of purging/chewing and spitting food
- •Weight or shape preoccupation/body image disturbances
- •Food preferences, peculiarities
- •Impact of illness on school, work, social life
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?
- –Do you ever eat in secret?
•Rapid consumption of much food in discrete period
•Emphasis on patient’s perception of loss of control, perceived excessive caloric intake more important than total number of calories consumed, but must assess both
- with bulimia typically average weight or slightly overweight with unsuccessful
- dieting history
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
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
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
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
•Biological: probable relationship to serotonin and
- dopamine levels
•Sociocultural: shifting cultural norms for young women to face
- multiple, ambiguous, often contradictory role expectations
- some cultures, thinness highly valued, culturally rewarded, associated with
- U.S. ideal woman is lean, strong, graceful, feminine with emphasis on fitness,
- adolescents, young adults living where emphasis placed on weight and size often
- develop eating disorders
- peer pressure, daily solitude, interpersonal rejection, loss
- pressures, stress if lacking self-concept, realistic body image
- on external feedback
Stuart Stress Adaptation Model: Eating Regulation
–Includes intense fear of gaining weight, disturbed body
–>15% below minimum normal weight for age/height
–Can be restrictive type or binge eating/purge type
- will identify cognitive distortions about food, weight, body shape
- nutritionally balanced menus
- describe body dimensions
- positive family interactions and successful movement toward achievement of
- separation and individuation issues
- care varies based on treatment setting of patient with maladaptive eating
- regulation responses
- affecting choice of treatment setting
–Patient’s physical and psychological condition
–Availability of treatment specialists
Care Settings for Eating Disorders
- settings: day treatment, intensive, partial hospitalization programs
- outpatient office visits
- for inpatient programs often difficult to obtain
- patient greatest opportunity for self-control, autonomy
- high patient motivation
- family’s active support, involvement
Evidence-Based Treatment for Bulimia Nervosa
- CBT is treatment of choice
- antidepressants produced short-term reductions in binge eating, purging
- effects untested
- to engage in therapeutic alliance and obtain commitment to treatment process
•Before patient admitted to eating disorder treatment
- program, obtain cooperation with nurse-patient contract
•By signing contract, patients show they understand
- treatment they will be receiving
- priority for nursing intervention
- healthy target weights
- life-threatening circumstances, malnourished patients may need refeeding interventions
Eating Disorder Program Protocols
- frequency, procedure for weighing patient and if patient may view reading
- and number of meals each day
- staff will interact with patients at mealtimes to maximize therapeutic value of
- their presence