Schizophrenia ppt Flashcards
Schizophrenia when is it diagnosed?
Usually diagnosed in late adolescence or early adulthood
Peak incidence of onset for schizophrenia is what for women
25 to 35 years of age for women.
Peak incidence of onset for schizophrenia is what for men
Peak incidence of onset is 15 to 25 years of age for men
What is the estimated prevalence of schizophrenia?
Prevalence is estimated at about 1% of total population
Clinical course of Schizophrenia (onset and diagnosis)
Onset: most with slow, gradual development of signs and symptoms
Diagnosis usually with more actively positive symptoms of psychosis
Clinical Course: What are the two courses
- Intermediate term course
- Long term course
Intermediate term course
two patterns
Ongoing psychosis, never fully recovering
Episodes of psychotic symptoms alternating with episodes of relatively complete recovery
Long-term course:
Long-term course: intensity of psychosis diminishes with age; disease becomes less disruptive
Etiology of Schizophrenia
Genetic factors*
Neuroanatomic and neurochemical factors (less brain tissue and cerebrospinal fluid;
Dopamine excess
Stress enhancement
Alcohol & Drugs
What is Phase I of Schizophrenia
Prodromal Phase
Prodromal Phase of Schizophrenia: How long does it last?
Lasts from a few weeks to a few years
What occurs during the Prodromal Phase?
Deterioration in role functioning and social withdrawal
Sleep disturbance, anxiety, irritability
Depressed mood, poor concentration, fatigue
Can be focused on certain topics, such as religion, the government, or a particular public figure.
Phase II of Schizophrenia
Schizophrenia
Phase II of Schizophrenia- What occurs
In the active phase of the disorder, psychotic symptoms are prominent
Delusions
Hallucinations
Impairment in work, social relations, and self-care
Phase III of Schizophrenia: what is it called
Residual Phase
Residual Phase of Schizophrenia
The more intense symptoms, like hallucinations, start to fade.
Still have some strange beliefs.
Likely to withdraw into oneself and talk less
Trouble concentrating
May become depressed* with increased awareness
Most common symptoms of schizophrenia:
Delusions
Hallucinations
Disorganized Speech
Grossly disorganized or catatonic Behavior
Negative symptoms
Positive Symptoms of Schizophrenia:
Excessive or distorted thoughts & perceptions within the individual but are not experienced by others.
Negative Symptoms of Schizophrenia
Emotions and behaviors that should be present but are diminished in persons with schizophrenia.
Target of Antipsychotic Drugs for Positive Symptoms of Schizophrenia
Target of antipsychotic medications:
Delusions
Distortions
Disorganized speech
Disorganized, catatonic or agitated behavior
Hallucinations
Delusions of Positive Symptoms
Fixed, false beliefs, despite evidence
Positive Symptoms: Types of Delusions
Persecutory
Referential have reference to the individual i.e. news
Grandiose
Somatic
Guilt
Religious
Jealousy
Control
Thought insertion *One’s thoughts are not one’s own, but rather belong to someone else and have been inserted into one’s mind
Thought broadcasting
Positive Symptoms: Content of Thought includes
Delusions:
Religiosity:
Paranoia:
Magical thinking:
Positive Symptoms (Content of Thought): Delusions
false personal beliefs
Positive Symptoms (Content of Thought): Religiosity
excessive demonstration of obsession with religious ideas and behavior
Positive Symptoms (Content of Thought): Paranoia
extreme suspiciousness of others
Positive Symptoms (Content of Thought): Magical Thinking
ideas that one’s thoughts or behaviors have control over specific situations
Positive Symptoms: Form of Thought includes:
Associative looseness
Neologisms:
Concrete thinking:
Clang associations:
Positive Symptoms: Form of Thought (Associative looseness)
A thought-process disorder characterized by a confusing connection between
Positive Symptoms: Form of Thought (Neologisms)
made-up words that have meaning only to the person who invents them
Positive Symptoms: Form of Thought (Concrete Thinking)
Literal interpretations of the environment
Positive Symptoms: Form of Thought (Clang associations)
choice of words is governed by sound (often rhyming) Click, clack, clutch”
Positive Symptoms: Word Salad
Jumble of words that is meaningless
Positive Symptoms: Perseveration:
persistent repetition of the same word or idea in response to different questions
Positive Symptoms: Mutism
inability or refusal to speak
Positive Symptoms: Circumstantial
delay in reaching the point of a communication because of unnecessary and tedious details
Positive Symptoms: Tangential:
Completely off topic that never reaches the point of the conversation.
Perception
interpretation of stimuli through the senses
Positive Symptoms: Hallucinations
false sensory perceptions not associated with real external stimuli
Positive Symptoms: Types of Hallucinations
Auditory
Visual
Tactile
Gustatory
Olfactory
Positive Symptoms: Illusions
misperceptions of real external stimuli
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:
you persistently or repeatedly have the feelingthat you’re observing yourself from outside your body
Negative Symptoms: Affect
the feeling state or emotional tone
Inappropriate affect
emotions are incongruent with the circumstances
Flat Affect
appears to be void of emotional tone
Apathy:
disinterest in the environment/Is a feeling of generalized indifference and unaffectedness
Volition:
Negative Symptoms
impairment in the ability to initiate goal-directed activity
Example of volition
Deterioration in appearance: impaired personal grooming and self-care activities
Negative Symptoms: Impaired interpersonal functioning
Impaired social interaction
social isolation
Psychomotor behavior of schizophrenia: what kind of symptoms
Anergia
Waxy flexibility
Posturing
Pacing and rocking
Anergia:
deficiency of energy
Waxy flexibility:
condition in which a patient’s limbs retain any position into which they are manipulated by another person
Posturing:
voluntary assumption of inappropriate or bizarre postures
Pacing and rocking:
pacing back and forth and rocking the body
Associated features of Negative Symptoms
Anhedonia:
Regression:
Associated feature of negative symptoms Anhedonia:
Engaging in an activity that previously brought you joy or positive feelings, but no longer elicits those feelings
Associated Feature of Negative symptoms: Regression:
retreat to an earlier level of development
Nursing Priorities of Schizophrenia
Risk to self or others*
Command hallucinations
Impaired Judgement
Does the client believe he or a loved one are being threatened or in danger?
Ability to care for oneself i.e. food, self care
Co-occurring disorders i.e. depression, substance abuse,
medical
Medication Compliance
Nursing Interventions of Schizophrenia
Establish trust and ensure a safe environment
Do not touch client without first informing client exactly what nurse is going to do.
If necessary, postpone procedures until less suspicious or agitated.
Use accepting, consistent approach, and clear, unambiguous language.
Address identified barriers to medication adherence.
Encourage the client to comply with the medication regimen to prevent relapse.
Nursing Interventions of Schizophrenia continued
Reduce external stimulation.
Monitor client’s thinking, perceptions, and associated behavior.
Ask about voices, and monitor for increased negativity of content, anxiety and agitation, or social withdrawal.
Do not argue with delusional statements but express doubt.
Address feelings reflected in delusions.
If the client expresses suicidal thoughts, institute suicide precautions.
Report increased anxiety and/or increasing risk for violence.
Nursing interventions for hallucinations suicidal or homicidal
themes require appropriate safety measures. Focus on reality based conversations “The voice your hear is part of your illness; it cannot hurt you”
Nursing interventions for associative looseness
Reflects poorly organized thinking. Place the difficulty in understanding on yourself not on the pt. “I am having trouble following what you are saying”
Nursing interventions for Delusions
It is Never useful to debate or attempt to dissuade patient regarding a delusion. Clarify misinterpretation of the environment
Acknowledge client’s concern about false belief(s) but do not agree with them.
Avoid reinforcing delusion by going along with what client says.
Focus on feelings such as fear or anxiety and offer alternative thoughts and behaviors to reduce negative feelings.
Help client minimize effects of delusional thoughts.
Schizoaffective
Major mood episode (major depression or manic) concurrent with schizophrenia
Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depression or mania)
Major mood episode are present for the majority of the total duration of the active and residual portion of the illness
What are the FGA antipsychotics - in general
Dopamine antagonists (blocks dopamine) (D2 receptor antagonists)
What do dopamine antagonists target?
Target positive symptoms of schizophrenia
Advantages of Conventional Antipsychotics (FGA)
Less expensive than atypical antipsychotics
Disadvantages of Conventional Antipsychotics (FGA)
Do not treat negative symptoms
Extrapyramidal side effects (EPSs)
Tardive dyskinesia
Anticholinergic side effects
Lower seizure threshold
List of Conventional Antipsychotics
Chlorpromazine
Trifluoperazine
Thiothixene
Pimozide
Thioridazine
Fluphenazine*
Loxapine
Perphenazine
Molindone
Haloperidol*
Which of the conventional antipsychotics come in long acting preparation?
Haloperidol (Haldol)*
Fluphenazine (Prolixin)*
Conventional Antipsychotics can cause the following Extrapyramidal Side Effects
Akathisia:
Pseudo parkinsonism:
Tardive dyskinesia:
Acute dystonia :
Akinesia:
Oculogyric crisis:
Akathisia:
Extrapyramidal Side Effect
restlessness, shuffling from one foot to another
Pseudo parkinsonism:
Extrapyramidal Side Effect
tremor, shuffling, stooped posture, rigidity
Tardive dyskinesia:
Extrapyramidal Side Effect
repetitive tic like motions in facial muscles, rapid blinking, stick out your tongue, smack or pucker your lips
Acute dystonia :
Extrapyramidal Side Effect
abnormal movements i.e. head rotated to one side
Akinesia
Extrapyramidal Side Effect
the inability to perform movement
Oculogyric crisis:
Extrapyramidal Side Effect
uncontrolled rolling back of the eyes
What medication is used to treat EPS?
Benztropine (anticholinergic) treats involuntary movements r/e FGAs.
Benzotropine
Benztropine (anticholinergic) treats involuntary movements r/e FGAs.
What does Benztropine (anticholinergic) do?
Decrease side effects such as muscle stiffness/rigidity (extrapyramidal signs-EPS)
What is Benztropine NOT helpful for?
It is not helpful in treating movement problems caused by tardive dyskinesiaand may worsen them
How long does it take Benztropine to take effect?
It may take 2-3 days before the benefit of this drug takes effect.
Anticholinergic affects
Remember! Anticholinergic effects Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter.
What are the medications used for Tardive Dyskinesia?
There are two FDA-approved medicines to treat tardive dyskinesia:
Deutetrabenazine
Valbenazine
Neuroleptic Malignant Syndrome (NMS) what is it caused by
Is fatal
Caused by medications, mainly antipsychotic, that alter dopamine levels in the brain
Either taking the medication or withdrawal of medications increase central nervous system levels of dopamine.
Signs and Symptoms of NMS
Severe muscle rigidity, elevated temperature (hyperthermia), altered consciousness, sweating, seizures and death.
“Hot, stiff and out of it”
Serum creatinine kinase (CK) elevation (kidney failure)
What is the typical serum creatinine for men:
For adult men, 0.74 to 1.35 mg/dL
(65.4 to 119.3 micromoles/L)
What is the typical serum creatinine for women:
0.59-1.04 mg/dL
(52.2 to 91.9 micromoles/L)
Treatment for NMS (nonmedicinal)
Early recognition of symptoms; withholding of antipsychotic medications, ICU
Frequent vital signs monitoring, treating fever, laboratory testing
Supportive measures and promoting safety
Treatment for NMS (medicine)
Dopamine agonists (bromocriptine);
muscle relaxants (dantrolene or benzodiazepine)
STUDY SLIDE 43 you don’t understand it
STUDY SLIDE 43 you don’t understand it
What are second generation first line treatment for schizophrenia?
Atypical Antipsychotics
What do Atypical Antipsychotics treat (what kind of symptoms)?
Treat both positive and negative symptoms
Benefits of atypical antipsychotics?
Treat both positive and negative symptoms
Minimal to no extrapyramidal side effects (EPSs) or tardive dyskinesia
Disadvantages of Atypical Antipsychotics?
Disadvantage tendency to cause significant weight gain & metabolic issues. Hyperglycemia, HTN
Examples of Atypical Antipsychotics (Serotonin-dopamine antagonists or Second Generation)
Clozapine
Risperidone *
Olanzapine*
Ziprasidone
Aripiprazole *
Lurasidone
Prolong QT
Asenapine
Paliperidone*
Quetiapine
Iloperidone
Atypical Antipsychotics (Serotonin-dopamine antagonists or Second Generation) that cause Prolong QT
Asenapine (Saphris)
Paliperidone (Invega)*
Quetiapine (Seroquel)
Iloperidone (Fanapt)
Which Atypical Antipsychotics (Serotonin-dopamine antagonists or Second Generation) that come in long acting preparation
Risperidone (Risperdal)*
Olanzapine* (Zyprexa)Metabolic effects
Aripiprazole (Abilify)*
Paliperidone (Invega)*
SLIDE 46 and 47 you don’t know study again
SLIDE 46 and 47 you don’t know study again
When is Tardive Dyskinesia seen most often?
Most often seen in FGA and can be seen when client is on the medication 3 months or more
Anticholinergic Crisis
Life-threatening condition: overdose or sensitivity to drugs with anticholinergic properties
Anticholinergic Crisis is also known as
anticholinergic delirium
Treatment for Anticholinergic Crisis
Discontinuation of medication
Physostigmine (acetylcholinesterase inhibitor)
Gastric lavage, charcoal, catharsis for intentional overdoses
