Schizophrenia Flashcards
Schizophrenia
- Coined by Swiss psychiatrist Eugen Bleuler in 1908;
from the greek word skhizo-“split” and phren-“mind” - Onset: 15-44 yo;
if before 17 - EOS,
if before 13 (rare) - VEOS
equally affecting men and women
- Affects thoughts and emotions to the point of social &
occupational functioning impairment - 9-13% of schizophrenics commit suicide
Predisposing Factors schizophrenia
Biological:
a. Genetics: Familial hx of schizophrenia
b. Biochemical: High dopamine level
c. Neuroanatomical - Dopaminergic System:
1.Mesolimbic pathway: Memory, arousal, emotion, pleasure
- Excess activity leads to development of POSITIVE SYMPTOMS
- Mesocortical pathway: Cognition, social behavior, planning
- Diminished activity leads to development of NEGATIVE SYMPTOMS - Nigrostriatal pathway: motor control; degeneration leads to PSYCHOMOTOR SYMPTOMS
Positive Symptoms
Content of Thought:
- Delusions:
● Delusion of persecution
● Delusion of grandeur
● Delusion of reference
● Delusion of control
● Somatic Delusion
● Nihilistic Delusion - Religiosity
- Paranoia
- Magical Thinking
Positive Symptoms
Form of Thought:
- Clang Associations
- Loose Associations
- Flight of Ideas
- Word Salad
- Neologism
- Concrete Thinking
- Verbigeration
- Perseveration
- Latency of Response
- Mutism
Positive Symptoms
Perceptions
- Hallucinations
- Illusions
Positive Symptoms
Sense of Self
- Echolalia
- Echopraxia
- Identification
- Imitation
- Dissociation
Negative Symptoms
Affect:
● Inappropriate
● Bland/Blunted
● Flat
● Apathy
Negative Symptoms
Volition:
● Deteriorated Appearance
Negative Symptoms
Interpersonal Functioning:
- Social Isolation
Negative Symptoms
Psychomotor Behavior:
- Anergia
- Waxy Flexibility/Catatonia/Catatonic Stupor
- Pacing and Rocking
Negative Symptoms
Associated Features:
Anhedonia, Regression
Medical Management of Schizophrenia
Positive symptoms
typical/traditional-Positive Symptom
High Potency:
(Haldol) Haloperidol - Photosensitivity; ECG
(Prolixin) FluphenAZINE - IM Q2-4 weeks
Low Potency:
(Mellaril) ThiodaZINE - don’t spill - contact derm
(Thorazine) ChlorpromAZINE - Monitor BP
Common Side Effect: Sexual Dysfunction,
Anticholinergic Symptoms (PSSS)
Medical Management of Schizophrenia
Negative Symptoms
Atypical/Non-Traditional:
Negative
CORi
(Clozaril)ClozAPINE- agranulocytosis, weekly/monthly WBC Count Monitoring
(Zyprexa)OlanzAPINE-RBS
(Risperdal)RisperiDONE-monitor blood glucose, lipid profile
Common Side Effect: Weight Gain
Side Effects of Neuroleptics
“SPONGEBOB”
Sedation- No activities that requires full alertness/concentration
Photosensitivity- sunblock, sunglasses, long sleeves, big hats
Orthostatic Hypotension-Rise gradually, monitor BP
Neuroleptic Malignant Syndrome
Glucose/Galactorrhea/Gynecomastia
Extrapyramidal Symptoms
Blurring of Vision-don’t drive until vision clears
Obesity-weight monitoring
BM (Constipation)-Increase fluid intake/fiber
Neuroleptic Malignant Syndrome
-FEVER
Fever
Encephalopathy
VS abnormal (high BP, PR, Temp)
Enzyme High (Myoglobin)
Rigidity and Hyperreflexia
Nsg Resp: Discontinue medication immediately! Notify MD.
Antidote: Dantrolene Na (Dantrium), Bromocriptine (Parlodel)
Extrapyramidal Symptoms
- Dystonic Reaction-torticollis, facial, laryngeal, pharyngeal
- Antidote: Diphenhydramine (Benadryl), Benzotropine (Cogentin) IM
- Pseudoparkinsonism-shuffling gait, cogwheel rigidity, pill-rolling tremors
- Akathisia- “ants in the pants,” usually linked to initial treatment or increase in dosage
Antidote: Amantadine (Symmetrel), Propranolol (Inderal), benzodiazepines
Nursing Managements in Schizophrenia
- Establish a trusting interpersonal relationship.
- Do not reason, argue, challenge the delusion - Identify type and content of delusion.
- Do not confirm or feed the delusion when the person
is well - Assess intensity, frequency and duration of
delusion. - Decrease environmental stimuli (media
monitoring).
more mgmts (17)
- Give client ample space to enhance sense of security.
- Move client to quiet, non-stimulating environments.
*Restraints are always a last resort! - Q15mins
* Remove restraints one at a time
- Be mindful with using touch.
- Make effort trying to understand the client’s message.
- Offering Self, Presenting Reality, Translate Feelings
- Distraction techniques, allow time for grooming
- Remove dangerous objects from the client
- Intervene at the first sign of anxiety
- Call client by name
- Encourage independence to ADLs if possible
- Use concrete explanation; establish a schedule
- Don’t take what they say personally
- Emphasize on their strengths, provide positive
reinforcement - Focus on the feelings of what they say, not the actual
facts of their story - Don’t tell them they are psychotic
If Patient is Highly Suspicious: (5)
- Use same staff as much as possible
- Avoid physical contact, warn the patient prior to
touching - Do not laugh, whisper or talk quietly where the client
can see but not hear you - Provide canned foods with complete label/foods in
sealed packaging - DO MOUTH CHECKS
