Schizophrenia

Question 1

Schizophrenia

Answer 1

• 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

Question 2

Predisposing Factors schizophrenia

Answer 2

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

2. Mesocortical pathway: Cognition, social behavior, planning
   - Diminished activity leads to development of NEGATIVE SYMPTOMS
3. Nigrostriatal pathway: motor control; degeneration leads to PSYCHOMOTOR SYMPTOMS

Question 3

Positive Symptoms

Content of Thought:

Answer 3

• Delusions:
  ● Delusion of persecution
  ● Delusion of grandeur
  ● Delusion of reference
  ● Delusion of control
  ● Somatic Delusion
  ● Nihilistic Delusion
• Religiosity
• Paranoia
• Magical Thinking

Question 4

Positive Symptoms

Form of Thought:

Answer 4

• Clang Associations
• Loose Associations
• Flight of Ideas
• Word Salad
• Neologism
• Concrete Thinking
• Verbigeration
• Perseveration
• Latency of Response
• Mutism

Question 5

Positive Symptoms

Perceptions

Answer 5

• Hallucinations
• Illusions

Question 6

Positive Symptoms

Sense of Self

Answer 6

• Echolalia
• Echopraxia
• Identification
• Imitation
• Dissociation

Question 7

Negative Symptoms

Affect:

Answer 7

● Inappropriate
● Bland/Blunted
● Flat
● Apathy

Question 8

Negative Symptoms

Volition:

Answer 8

● Deteriorated Appearance

Question 9

Negative Symptoms

Interpersonal Functioning:

Answer 9

• Social Isolation

Question 10

Negative Symptoms

Psychomotor Behavior:

Answer 10

• Anergia
• Waxy Flexibility/Catatonia/Catatonic Stupor
• Pacing and Rocking

Question 11

Negative Symptoms

Associated Features:

Answer 11

Anhedonia, Regression

Question 12

Medical Management of Schizophrenia

Positive symptoms

Answer 12

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)

Question 13

Medical Management of Schizophrenia

Negative Symptoms

Answer 13

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

Question 14

Side Effects of Neuroleptics

Answer 14

“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

Question 15

Neuroleptic Malignant Syndrome

Answer 15

-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)

Question 16

Extrapyramidal Symptoms

Answer 16

1. Dystonic Reaction-torticollis, facial, laryngeal, pharyngeal

• Antidote: Diphenhydramine (Benadryl), Benzotropine (Cogentin) IM

2. Pseudoparkinsonism-shuffling gait, cogwheel rigidity, pill-rolling tremors
3. Akathisia- “ants in the pants,” usually linked to initial treatment or increase in dosage

Antidote: Amantadine (Symmetrel), Propranolol (Inderal), benzodiazepines

Question 17

Nursing Managements in Schizophrenia

Answer 17

1. Establish a trusting interpersonal relationship.
   - Do not reason, argue, challenge the delusion
2. Identify type and content of delusion.
   - Do not confirm or feed the delusion when the person
   is well
3. Assess intensity, frequency and duration of
   delusion.
4. Decrease environmental stimuli (media
   monitoring).

Question 18

more mgmts (17)

Answer 18

• 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

Question 19

If Patient is Highly Suspicious: (5)

Answer 19

• 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