INTRODUCTION
Schizophrenia is possibly a group of psychotic
disorders that severely impairs all areas of an individuals functioning. 1 to 1.5% of US population has schizophrenia. However they make up far more than 50% of the county and long-term residents of state mental hospitals. More than 50% are homeless, and in addition may have an addiction problem. The cost of treatment and loss of revenues are estimated in the billions of dollars.
COMORBIDITY
Substance abuse disorders Nicotine dependence Depression
Suicide
Anxiety disorders
Psychosis-induced polydipsia
ETIOLOGY
Neurobiochemical
Dopamine hypothesis Serotonin Glutamate
Neuroanatomical
Structural cerebral abnormalities
Genetic
Several genes on different chromosomes interact with
environment
GENETIC PREDISPOSITION
A single gene has not been identified.
Research is focused on chromosomes 6, 13, 18 & 22. The risk of developing the disorder is as follows: One parent 12-15%+ Both parents 40%+
Course of Schizophrenia
Recurrent acute exacerbations
2. Maintenance phase
3. Stabilization phase
Anxious
Phobias Obsessions and compulsions
Difficulty concentrating
Preoccupation with religion Preoccupation with self
Bleulers 4 As of Schizophrenia
Affect Associative looseness Autism Ambivalence
reasoning Ideas of reference Persecution Grandiosity Somatic sensations Jealousy Control Thought broadcasting Thought insertion Thought withdrawal Delusion of being controlled Concrete thinking
Visual
Olfactory Tactile
Automatic obedience
Waxy flexibility Stupor Negativism
Negative Symptoms
Affective blunting
Anergia Anhedonia Avolition Poverty of content of speech
Thought blocking
Flat affect/inappropriate affect
Cognitive Symptoms
Inattention, easily distracted
Impaired memory Poor problem-solving skills Poor decision-making skills Illogical thinking Impaired judgment
Types of Schizophrenia
Subtypes Paranoid Catatonic Disorganized Undifferentiated Residual
Medical history and recent medical workup Positive, negative, cognitive, and mood
Outcome Criteria
Acute phase
Client safety and medical stabilization
Maintenance phase
Adherence to medical regimen
Understanding schizophrenia Participation of client and family in psychoeducational activities
Stabilization phase
Target negative symptoms
Anxiety control Relapse prevention
Milieu Therapy
Safety
Potential for physical violence due to hallucinations or
delusions
Priority is least restrictive safety technique
and friendships
manner Assess if messages are suicidal or homicidal Initiate safety measures if needed Client anxious, fearful, lonely, brain not processing stimuli accurately Focus on the clients feelings and present reality
Learn all you can about the illness. Develop a relapse prevention plan. Avoid alcohol and drugs. Learn ways to address fears and losses. Learn new ways of coping. Comply with treatment. Maintain communication with supportive people. Stay healthy by managing illness, sleep, and diet.
Treatment Modalities
Individual therapy
Social skills training (SST) Cognitive remediation Cognitive adaptation training (CAT) Cognitive behavioral therapy (CBT)
Psychopharmacology
Antipsychotics
Standard/ Typical Atypical
Antiparkinson
Disadvantages
Do not treat negative symptoms Extrapyramidal side effects (EPS) Tardive dyskinesia Anticholinergic effects (ACH) Lower seizure threshold
Medium potency
Loxapine (Loxitane)
Molindone (Moban) Perphenazine (Trilafon)
Antipsychotic Medications:
Traditional continued
Low potency = high sedation + high ACH + low EPSs
Chlorpromazine (Thorazine) Thioridazine (Mellaril) Mesoridazine ( Serentil)
Advantages
Diminishes negative as well as positive symptoms of schizophrenia
Less side effects encourages medication compliance Improves symptoms of depression and anxiety Decreases suicidal behavior
Disadvantages
Weight gain Metabolic abnormalities
Risperidone (Risperdal
Zipreasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify)
Orthostatic Hypotension Decreased Libido Agranulocytosis (Clozapine) Weight gain Tachycardia Edema
Blurred vision
Photosensitivity Dry eyes Inhibition of ejaculation or impotence in men
Acute Dystonia
Muscle spasms of the jaw, tongue, neck or eyes.
Akathisia
Motor restlessness, pacing, rocking, etc
chewing, tongue from side to side, etc. Involuntary tonic muscular spasms of extremities Trunk Potentially irreversible
Severe extrapyramidal
Hyperpyrexia
Autonomic dysfunction
RARE, POTENTIALLY FATAL ONSET WITHIN HOURS OR YEARS EPS REACTIONS CPK HYPERTHERMIA 102 AND ABOVE TACHYCARDIA FLUCTUATING B.P. DIAPHORESIS STUPOR AND COMA
AGRANULOCYTOSIS
Potentially fatal disorder Symptoms include:
White blood cells level <2000 mm3 or granulocyte
count <1500mm3 Sore throat Low grade fever Malaise Sores in the mouth
NURSING IMPLICATIONS
MONITOR B.P. BEFORE ADMINISTERING MEDS CHECK CBC, CPK, LIVER FUNCTIONS AND VISION REGULARLY EVALUATE FOR EFFECTIVENESS AND SIDE EFFECTS ADMINISTER 1 OR 2 HOURS BEFORE BEDTIME MIX LIQUIDS WITH 60CC FRUIT JUICE PATIENT EDUCATION
ANTIPARKINSON AGENTS
health agencies for support at the local and national level (NAMI AND NIMH). Develop a relapse prevention plan. Teach about medication and treatment compliance. Teach to avoid alcohol or drugs. Teach to keep in touch with supportive people. Teach to keep healthy stay in balance.
Thank You