Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
Intro: Schizophrenia is probably caused by a combination of factors, including:
Genetic predisposition
Biochemical dysfunction
Physiological factors
Psychosocial factors
We still don’t know the exact cause. More predisposed for it if you have a parent with it. Definitely dysfunctional neurotransmitters. Early onset of drug use can cause more mental illness.
Treatment for schizophrenia needs to be…
Comprehensive and presented in a multidisciplinary effort
There is a sense of loss for people who have schizophrenia. We need to treat with de-stigmatization.
1/3 of people with schizophrenia die from suicide
High ongoing SI is common
Of all mental illnesses, schizophrenia probably causes more…
Lengthy hospitalizations
Chaos in family life
Exorbitant costs to people and governments
Fear
Majority of people do w/ it will be dead by age 25
Nature of schizophrenia. It can cause disturbances in:
Thought processes
Perception (often paranoid delusions)
Affect (often blunted)
There is a severe deterioration of social and occupational functioning
In the U.S. the lifetime prevalence of schizophrenia is about 1%
Psychosis: a break from reality
Sometimes a loss of abstract thinking
Four phases of schizophrenia: phase 1
Premorbid phase
Could be seen as a normal part of puberty or middle school
Social maladjustment, antagonistic thoughts and behavior, shy and withdrawn
Poor peer relationships
Doing poorly in school
Antisocial behavior
Four phases of schizophrenia: Phase Two
Prodromal phase
A distinct change
Lasts from a few weeks to a few years
Deterioration in role functioning and social withdrawal
Substantial functional impairment
Sleep disturbance, anxiety, irritability
Depressed mood, poor concentration, fatigue
Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis
Four phases of schizophrenia: Phase Three
Schizophrenia
Acute psychosis. Many have hallucinations
If one gets tx. On first break, then prognosis is better overall.
In the active phase of the disorder, psychotic symptoms are prominent
Delusions
Hallucinations
Impairment in work, social relations, and self-care
Four Phases of Schizophrenia: Phase Four
Residual phase
Symptoms similar to those off the prodomal phase
Flat affect and impairment in role functioning are prominent
One becomes more impaired with the more episodes of psychosis they have
Meds and other tx’s may help
Talk dismissal to voices can help
Pts often go off meds
Prognosis of Schizophrenia
A return to full premorbid functioning is not common
Better is later onset
More positive prognosis if there is no family history
And if they are female
Biological Predisposing factors for schizophrenia
Biological influences: genetics play an important role in development of schizophrenia.
Biochemical influences: one theory suggests that schizophrenia may be caused by an excess of dopamine activity in the brain. Abnormalities in other neurotransmitters have also been suggested.
Other biological predisposing factors for schizophrenia
Factors that have been implicated:
Viral infection
Anatomical abnormalities
Electrophysiology
Epilepsy
Huntingtons disease
Birth trauma, head injury in adulthood, alcohol abuse, cerebral tumor, cerebrovascular accident, Lupus
Psychosis. Predisposing factors of schizophrenia
These theories no longer hold credibility. Researchers now focus their studies of schizophrenia as a brain disorder.
Psychosocial theories probably developed early on out of a lack of info related to a biological connection.
Environment predisposing factors for schizophrenia
Sociocultural factors: poverty has been linked with the development of schizophrenia
Downward drift hypothesis: Poor social conditions seen as consequence of, rather than a cause of, schizophrenia.
More environment Predisposing factors for schizophrenia
Stressful life events may be associated with exacerbation of schizophrenic symptoms and increased rates of relapse
Studies of genetic vulnerability for schizophrenia have linked certain genes to increased risk for psychosis and particularly for adolescents who use cannabinoids.
Theoretical integration for schizophrenia
It is likely a biologically based disease, the onset of which is influenced by factors in the internal or external environment
Complication of Clozapine
Can cause agranulocytosis which one can die from. Rare.
It is an effective drug otherwise that can save peoples lives.
Schizophrenia and Marijuana use
Marijuana can cause schizophrenia in 1/10 people who are predisposed to it. Can be after on use, or chronic use.
Types of Schizophrenia: Delusional disorder
Must be at least one month of 1 of the following (remember this criteria)
The existence of prominent, non bizarre delusions
Erotomanic type (someone like a celebrity is in love with them)
Grandiose
Jealous
Persecutory
Somatic type or mixed type
Types of psychotic disorders: Brief psychotic disorder
Sudden onset of symptoms
May or may not be preceded by a severe psychosocial stressor
Lasts less than 1 month
Return to full premorbid level of functioning
Substance induced psychotic disorder
The presence of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal.
Can also occur with prescription meds.
Psychotic disorder associated with another medical condition
Prominent hallucinations and delusions are directly attributable to a general medical condition.
Catatonic disorder
Catatonic features may be associated with other psychotic disorders, such as brief psychotic disorder, schizophreniform disorder, schizophrenia, schism affective disorder, and substance-induced psychotic disorder.
Symptoms of catatonic disorder include: Stupor and muscle rigidity or excessive, purposeless motor activity
Also waxy flexibility, negativism, echolalia, echopraxia
Catatonic disorder associated with another medical condition
When we know the general medical condition is causing the catatonic symptoms
Schizophreniform disorder
Same symptoms as schizophrenia with the exception that the duration of the disorder has been at least 1 month but less than 6 months
1-6 months
Schizoaffective disorder
Schizophrenic symptoms accompanied by a strong element of symptomatology associated with the mood disorders either mania or depression.
Not always worse
Usually mood stabilizers are added
Assessment: Positive symptoms
They are what is “added” in schizophrenia, not what is necessarily good.
Content of thought!
Delusions: false personal beliefs
Religiosity: Excessive demonstration of obsession with religious ideas and behavior
Paranoia: Extreme suspiciousness of others
Magical thinking: Ideas that one’s thoughts or behaviors have control over specific situations
Assessment: More examples of positive symptoms
Form of thought
Associative looseness: shift of ideas from one unrelated topic to another
Neologisms: made up words that have meaning only to the person who invents them.
Concrete thinking: Literal interpretations of the environment
Clang associations: choice of words is governed by sound (often rhyming)
Assessment: More examples of positive symptoms… More form of thought
More form of thought
Word salad: group of words put together in a random fashion
Circumstantiality: Delay in reaching the point of a communication because of unnecessary and tedious details
Tangentiality: Inability to get to the point of communication due to introduction of many new topics
Mutism: inability or refusal to speak
Perseveration: persistent repetition of the same word or idea in response to different questions
Assessment: More examples of positive symptoms… perceptions…
Perception: interpretation of stimuli through the senses
Hallucinations: false sensory perceptions not associated with real external stimuli (auditory, visual, tactile, gustatory, olfactory)
Illusions/delusions: misperceptions of real external stimuli
Assessment: More examples of positive symptoms… Sense of self…
Sense of self: The uniqueness and individuality a person feels
Echolalia: repeating words that are heard
Echopraxia: Repeating movements that are observed
Identification and imitation: taking on the form of behavior one observes in another
Depersonalization: feelings of unreality
Assessment: Negative symptoms - Affect-
What they have lost.
A loss of normal functions
Affect: The feeling state or emotional tone
Inappropriate affect: emotions are incongruent with the circumstances
Bland: weak emotional tone
Flat: Appears to be void of emotional tone
Apathy: disinterest in the environment
Assessment: Negative symptoms - Avolition-
Avolition: impairment in the ability to initiate goal-directed activity.
Emotional ambivalence: coexistence of opposite emotions toward same object, person, or situation.
Deterioration in appearance: impaired personal grooming and self-care activities
Assessment: Negative symptoms - Impaired things -
Impaired interpersonal functioning and relationship to the external world
Impaired social interaction: Clinging and intruding on the personal space of others, exhibiting behaviors that are not culturally and socially acceptable
Social isolation: A focus inward on the self to the exclusion of the external environment
Assessment: Negative symptoms- Lack of insight
Anosognosia: Lack of awareness of any illness or disorder
Anergia: deficiency of energy
Anhedonia: Inability to experience pleasure
Lack of abstract honking ability
Assessment: Negative symptoms: Extra ones
Wavy flexibility: passive yielding of all movable parts of the body to any effort made at placing them in certain positions
Posturing: Voluntary assumption of inappropriate or bizarre postures
Pacing and rocking
Regression
Eye movement abnormalities
Nursing outcomes: A few examples
The client…
Demonstrates an ability to relate to others satisfactorily
Recognizes distortions of reality
Has not harmed self or others
Maintains anxiety at a manageable level
Intervention for disturbed thought process…
Do not argue or deny the belief
Reinforce and focus on reality
Interventions for patients at risk for violence
Observe client’s behavior
Maintain calm attitude
Have sufficient staff on hand
Educate client and family on:
Nature of illness and what to expect as illness progresses
Symptoms associated with illness
Ways for family to respond to behaviors associated with illness
Individual psychotherapy
Long term therapeutic approach; difficult because of client’s impairment in interpersonal functioning
Group therapy
some success if occurring over the long-term course of the illness; less successful in acute, short-term treatment
The recovery model
A concept of healing and transformation enabling a person with mental illness to live a meaningful life in the community while striving to achieve his or her full potential
Recovery after an initial schizophrenia episode (RAISE)
A program of case management that takes a team approach in providing comprehensive, community based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness
Two types of antipsychotics
Typicals: Dopaminergic blockers with various affinity for cholinergic, a-adrenergic, and histaminic receptors
Atypicals: Weak dopamine antagonists; potent 5HT2A antagonists; also exhibit antagonism for cholinergic, histaminic, and adrenergic receptors.
EPS symptoms include:
Pseudoparkinsonism
Akinesia
Akathisia
Dystonia
Oculogyric crisis
Antiparkinsonian agents may be prescribed to counteract EPS.
AIMS examination to screen for Tardive Dyskinesia
The client should…
Not stop taking the drug abruptly
Use sunscreen and protective clothing
Be aware of possible risks during pregnancy
not drink alcohol
Not consume other meds without the physician’s knowledge
