Schizophrenia and Psychotic Disorders Flashcards
Aetiology of Schizophrenia: the diathesis-stress model
individuals are exposed to stressful events in the course of their life and these events may precipitate the symptoms in some people who have predisposition to mental health
Aetiology of Schizophrenia: Biochemical theories
chemicals known as neurotransmitters responsible for the transmission of nerve impulses across synapse have also been thought to be responsible for the development of schizophrenia
Delusion
fixed false belief that are inconsistent with one’s social, cultural and religious beliefs and not amenable to change despite conflicting evidence or argumentation
Disorganised thinking
The symptoms must be severe enough to substantially impair effective communication. this is evident if:
- the person switches topids erratically (derailment or loose association)
- their response to questions are unrelated (tangentially)
- their speech is incoherent or disorganised
the ideas fail to follow one another with a logical flow and sequence; this results in shifting from one subject to another resulting in loss of significant meaning.
perceptual disturbance
vivid involuntary perceptions that are experienced as “normal” and occur without external stimuli
Affect: emotional blunting
being “flat” or inappropriate; voice is a monotone and face is imobile
Bizarre Behaviour: catatonia
a marked decrease in reactivity to the environment, behaviour induced resistance to instructions, ridgid posture
Bizarre Behaviour: Abnormal motor behaviour
can rage from agitation to childlike silliness, which leads to difficulties in performing activities of daily living
Bizarre Behaviour: Clothing and Appearence
reflects mental state: can be dishevelled, poorly groomed, quiet and immobile or screaming and agitated; may be; inappropriately dressed for the occasion, environment and temperature
Bizarre Behaviour: social or sexual behaviour
loss of ego boundaries can cause confusion in relationship with others,
positive symptoms of psychotic disorders and schizophrenia
- hallucinations, delusions, disordered speech, bizarre behaviour
negative symptoms of psychotic disorders and schizophrenia
diminished emotional expression (reduced facial expression, eyecontact, head/hand movement), avolition, alogia. anhedonia, asoslity, poverty of ideas and anergia
Schizophrenia- introduction
- prevalence, approx 1% population
- predominantly young people (18-24)
- high presence in the socially disadvantaged and homeless
- research yet to determine cause of schizophrenia
- increasingly viewed as a neurological illness rather than a disorder of the mind
- most debilitating and misunderstood disorder
Biological theories Theories
Neuroanatomical abnormalities - Genetic predisposition - Biochemical theories -
The Diathesis-stress model
- brings much of what is known into one model of understanding
- exposure to stress
- environmental and family
- expressed emotion
Schizophrenic disorder- considerations
Not just schizophrenia; psychosis is the main set of symptoms associated with schizophrenia diagnosis dependent on - specific symptoms - length of time experienced individual experience is unique needs to be contextual consider cultural identity
Psychosis
set of symptoms associated with the following disorders
- schizophrenia
- acute mania
- depression
- drug intoxication
- organic brain injury
- head injury
- delirium
presentation can and does change over time
linked to events, experiences and relationships
DSM 5 criteria for Schizophrenia
two or more of the following, each present for a significant proportion of time during a 1 month period
- delusions
- hallucinations
- disorganised speech
- grossly disorganised or catatonic behaviour
- negative symptoms
Hallucinations
when someone hears, sees, feels, or smells something that is not there. Hearing voices that others cannot hear or when there is no one else in the room is very typical for psychosis. sometimes these voices will talk about or to the affected individual
the voices sometimes command them to do things. For some, these voices can be inside their head; occasionally they may be seen to come from within their body, or from the radio or television
Thought disturbances
How an individual processes thought or have the ability to concentrate and maintain a train of thought may be affected. For example the person may feel like their thoughts are racing and friends may notice they are constantly changing the topic of conversation or that the person is easily distracted or may laugh at irrational times
speech may become quiet disorganised, and the individual may use made up words that they only understand
Mood symptoms
loss of motivation- interest or pleasure in things. everyday tasks such as washing up become difficult
mood changes- the person will tell friends there feeling great or never better. however, their behaviour will be recognised as excessive by friends or family . they may also be quite unresponsive and be unable to express joy or sadness
social withdrawal- people may notice that an individual may become very careless in dress and self-care. or have periods of seemings to do little and periods of being extremely active . other symptoms include subtle difficulties with tasks like problem solving or they may show signs of depression- commonly experienced by people with schizophrenia
Positive symptoms
- delusions (context of thought)
- hallucinations (perceptual disturbances)
- adutiotory (voices)
- visual (visions)
- olfactory (odours)
- gustory (tastes)
- tactile (feelings)
- thought disorder (severe thought process disturbance)
Negative symptoms
- Anhedonia (the inability to take pleasure in activities one would normally find enjoyable)
- Avolition ( lack of initiative or goals)
- Affective flattening (absence in mood, a decrease or a low level in individuals emotion)
- Thought disorder alogia (speaking very little or a lack of spontaneous content in conversation, called poverty of speech)
Cultural consideration
- hearing voices is not always considered a bad thing
- beliefs around tapu or makatu
- spiritual interpretation possession and demons
- spiritual enlightenment
Strategies- therapeutic relationship
- pivotal to mental health nursing
- based on trust and respect
- allow the individual to tell their story
- assume the voices are there and commenting on you
- assess and enquire about their mood
- concentrate on the individual rather than the illness
- take your time
Strategies - psychopharmacology
- anti-psychotics
- nursing strategies
- education
- side effect management
Clozapine
- commonly used to manage treatment resistant schizophrenia
- client is prescribed this having undergone unsuccessful trials of other antipsychotics (usually Olanzapine and risperidone)
- has significant side-effects that clients need to be educated on including agranulocytosis, hypersalivation, weight gain and postural hypotension.
- however, clozapine has been proven to have a significant impact upon people symptoms and quality of life
Agranulocytosis (rare but life threatening) most common with clozapine
- low white blood cell count, therefore body is unable to fight infections
- requires careful monitoring, weekly blood tests for the first 18 weeks of treatment, then monthly blood tests to monitor neutrophils
- symptoms of concern - fever, rihor, sore throat, any signs or infection and cognitive change.
person must be advised to contact doctor immediately if they develop any of these symptoms
strategies- normalisation
- focus on management of voices/ delusions rather than elimination
- examine the continuum of psychosis
- what is normal?
- remove the barrier between “sane” and “insane”
strategies - socratic questioning
- a method of interviewing that focuses on open-ended questions
- focus on the periphery of the delusions
- encourages the individual to question their own assumptions
- is individual and takes time
allows individual to tell their story - encourages the person to analyse their own assumptions
Acute effects of psychosis
- increased suspicion
- heightened anxiety
- neglect of ADL’s
- increased impulsivity
- social isolation/ withdrawal
- acute experience of psychosis can impact the individuals ability to interpret situations accurately, experience can be terrifying, and very quickly affect a person’s attachment to their environment
long term chronic effects of psychosis
- treatment resistance
- medication side effects
- exhaustion
- positive
considerations
- stigma and discrimination
- terminology
- fear and ignorance
- impact on treatment engagement
- impact of symptoms
- impact on symptom disclosure
- self-stigma
- think media portrayal, movies
- crazy, psycho, dangerous
- treatment engagement may be affected by treatment providers i.e. someone who is currently hearing voices is not as “safe: as someone who is not, patients hide symptoms to appear “well and normal”
- there is no “cure”
