Psych

break from reality, alteration in perceotion, includes delusions, hallucinations, disorganized speech or behavior

• affected equally but onset differs
• men between 18-25 are more affected by negative symptoms
• women between 25 and 45 have better social functioning before the diagnosis

• a predisposition for schizophrenia is inherited and something triggers it
• you are 10 times more likely to be diagnosed with schizophrenia if a first degree relative also has it
• estimate that maybe 80% of cases have this predisposition

• 4 consistant changes that occur in the brains of patients with schizophrenia
• done using post mortem studies

• most relied on theory
• positive symptoms are caused by dopamine hyperactivity in the mesolimbic tract
• associated with excessive dopamine transmission- most meds are dopamine blockers and they are able to reduce the positive symptoms

• one theory is the expressed emotion theory
• schizophrenia is more prevalent where the family environment is more hostile, highly critical, higher expressed emotions, overinvolved families

• increased risk of medical problems- as high as 80%
• they dont receive adequate medical care- many medical problems go undiagnosed
• depression and suicide- voices telling them to commit suicide, shame of having the disease
• substance abuse: 40% of patients have substance issues- may self medicate
• cigarette smoking- pts may smoke more b/c it is thought to reduce effectiveness of meds, also reduces anxiety

• must have 2 of the 5 for at least 6 months for diagnosis
• delusions
• hallucinations
• disorganized speech
• grossly disorganized or catatonic behavior
• negative symptoms

hallucinations: auditory, visual, tactile, olfactory, gustatory

others intend to hard of persecute the patient

events within environment pertain to an individual- the patient thinks the tv or radio is talking directly to them

• exaggerated feeling of importance, power, knowledge or identity
• thinking they can do anything, they have great ideas that no one else can understand

• patient thinks self, part of self, others or world doesn't exist
• " i'll never die" "i have no head"

false idea about body function

excessive demonstration of or obsession with religious ideas/behavior

belief that an individual is someone else

ideas shift from one unrelated topic to another

• group or random unconnected words that the patient puts together in a sentence
• " purple tree table rainbow"

choosing words based on the sounds, rhyming

repeating words or phrases said by another person

repetition of same word or idea in response to different questions

extreme motor agitation- unusual movements

• maintains rigid position, moveable
• if you move patient they will stay in that position, wont move on their own, even in painful positions

• voluntary assumption of bizarre position
• will stay like that for a very long time but no reason for why they are in that position

seemingly unaware of surroundings- lack of movements all together but not paralysis

pathological imitation of body movements of another person

reduced range of emotional expression

inability to experience pleasure

• inability to pursue and persist in goal-directed behavior or activities
• lack of desire, drive or motivation

• reduced fluency and production of language and thought
• poverty of speech

feelings of indifference

• florid positive symptoms, suicidality, violence, can be very frightening
• this is when hospitalizations occur, the pts are no longer able to care for themselves
• pt may not remember psychotic periods after they happen

• symptoms are still present but less evident
• this is when medication adjustment would occur

• acute symptoms have decreased, may even remit completely
• family is involved at this point, figuring out how to prevent relapse
• medication non-compliance is largest cause of relapse

• prominent delusions and/or hallucinations
• most common, best known subtype
• hallucinations may not be paranoid
• delusions and hallucinations may be linked but they dont have to be

• disorganized speech or behavior, flat or inappropriate affect
• characterized by a regression to disinhibited behavior, have trouble functioning in daily like, trouble dressing, cleaning themselves, show little to no reaction to major life events- they care but they just cant show it

• characterized by extreme psychomotor disruption
• less common in U.S

• cant clearly state that they meet criteria for the first 3 types
• used when someone has mostly negative symptoms, more relapses or episodes

• one documented episode, but no prominent positive symptoms
• can go years without episodes occurring

• meet criteria A,D and E for schizophrenia
• A. at least 2 positive and 2 negative symptoms,
• D. schizoaffective and mood disorders have been ruled out
• E. substance/ general medical condition has been excluded
• - at least 1 month, less than 6
• - usually no impairment in social/ occupational functioning

• uninterrupted period of illness during which there is major depressive, manic, or mixed episode concurrent with 2 criterion A symptoms for schizophrenia (symptoms of schizo and mood disorder at same time)
• - at risk for suicide (23-40% of pts attempt)
• - less common than schizophrenia
• - more common in women

• stable, well systemized, logical, non-bizarre delusions ( could conceivably occur) that occur in the absence of other psychiatric disorders for at least 1 month
• - function well in other areas of life not related to delusion
• - 6 types- erotomanic, jealous, unspecified, grandiose, somatic, persecutory
• goal is just symptom management, dont respond well to treatment

• believe someone is in love with them
• can lead to stalking

may think their partner is cheating on them for no reason

• one or more criterion A symptoms of schizophrenia present for at least one day but less then 1 month
• - return to prior level of functioning
• - may be due to stressful event
• - rare

• folie a deux
• - two people in a close relationship, second person begins to take on delusion of the one with the original delusion
• - may believe it completely or only partly

• block serotonin and dopamine receptors
• newer, atypical are more efficacious and safer- less EPS
• more effective for negative symptoms, can also use for bipolar
• - risperidal
• - Zyprexa
• - Seroquel
• - Geodon
• - Abilify
• - invega
• - clozaril

• second line med- requires patient to have weekly CBC with differential when they start for first 6 months
• due to high risk of agranulocytosis
• need to get WBC and complete neutrophil counts
• can move to q4week monitoring after a year of good blood tests

• older, first line, typical drugs- need 60-80% receptor blockade for efficacy
• EPS occur at 80% receptor blockade
• thorazine
• haldol
• prolixin
• trilafon
• moban
• mellaril
• Stelazine
• Navane

• Depakote: thought to reduce episodes of violence
• tegretol

• Ativan
• Klonopin
• use with caution for patients with substance abuse, can cause dependence and withdrawal issues

• ECT: indicated for patients with catatonic schizophrenia or who cant take anti-psychotic meds, not used for maintenance
• psychosurgery: limited experimental used, infrequently done

• type of EPS, due to anti-psychotic medications
• - uncontrolled hand and finger movements
• - shuffling walking, lack of arm swinging

• type of EPS, due to anti-psychotic medications
• -characterized by sustained muscle contractions that cause twisting and repetitive movements or abnormal postures

• side effect of anti-psychotic meds, EPS
• - a sensation of restlessness characterized by an inability to sit still or remain motionless

• side effect of anti-psychotics, type of EPS
• - characterized by involuntary, repetitive, purposeless movements

• sedation
• weight gain
• orthostatic hypertension
• elevated prolactin
• photosensitivity
• new-onset diabetes
• cardiac arrhythmias

• mental status
• changes in role functioning
• self-care
• substance abuse
• past and present health status
• family health history
• family issue
• environmental assessment

• disturbed thought process
• disturbed sensory perception
• risk for violence
• ineffective coping
• self-care deficit
• impaired social interaction
• ineffective role performance
• interrupted family processes