Schizophrenia and Other

Psychotic Disorders
 Introduction
• The word schizophrenia is derived from the
Greek words skhizo (split) and phren (mind).
• Schizophrenia is probably caused by a
combination of factors, including:

• Of all mental illnesses, schizophrenia probably

causes more
– Lengthy hospitalizations
– Chaos in family life
– Exorbitant costs to people and governments
– Fears
 Nature of the Disorder
• Schizophrenia disturbs
Thought processes, Perception and Affect
• With schizophrenia, there is a severe
deterioration of social and occupational
functioning
* In the United States, the lifetime prevalence of
schizophrenia is about 1 percent.
• Premorbid behavior of the patient with schizophrenia can be viewed in
four phases.
• First Phase: Schizoid Personality
– Indifferent, cold, and aloof, these people are loners. They do not enjoy close relationships with
others.
• Second Phase: Prodromal Phase
– These people are socially withdrawn and show evidence of peculiar or
eccentric behavior.
– Neglect of personal hygiene and grooming
– Blunted or inappropriate affect
– Disturbances in communication
– Bizarre ideas
– Lack of initiative
• Third Phase: Schizophrenia
– In the active phase of the disorder, psychotic symptoms are prominent
• Delusions
• Hallucinations
• Impairment in work, social relations, and self-care
• Fourth Phase: Residual Phase
– Symptoms similar to those of the prodromal phase
– Flat affect and impairment in role functioning are prominent
 Predisposing Factors
– Various physical conditions
• Epilepsy
• Huntington’s chorea
• Birth trauma
• Head injury in adulthood
• Alcohol abuse
• Cerebral tumor
• Cerebrovascular accident
• Systemic lupus erythematosus
• Myxedema
• Parkinsonism
• Wilson’s disease
 Characteristic Symptoms
Positive symptoms: Negative symptoms:

• Delusions • Affective Flattening

• Hallucination • Alogia
• Disorganized speech • Apathy
• Grossly disorganized or • Anhedonia
catatonic behavior • Social isolation
 Types of schizophrenia and other
psychotic disorders
• Paranoid
• Disorgainzed
• Catatonic
• Residual
• Undifferentiated
• Schizoaffective disorder
• Brief psychotic disorder
• Schizophreniform
disorder
• Delusional Disorder
• Shared psychotic
disorder
• substance-Induced
psychotic disorder
 Content of Thought
Delusions Form
• Of Persecution • Associative Looseness
• Of Grandeur • Neologisms
• Of Reference • Concrete thinking
• Of control or influence • Clang associations
• Somatic • Word salad
• Nihilistic • Circumstantialities
• Religiosity • Tangentiality
• Paranoia • Mutism
• Magical thinking • Perseveration
Perception Affects
• Hallucination • Inappropriate affect
• Auditory • Bland or flat affect
• Visual • Apathy
• Tactile
• Olfactory
 Conventional Antipsychotics
Generic Brand
Haloperidol Haldol
Chlorpromazine Thorazine
Fluphenazine Prolidixin
Thiothixene Navane
Trifluoperazine Stelazine
Thioridazine Mellari
Perphenazine Trilafon
Loxapine Loxitane
 Conventional Antipsychotics
• Advantage • Disadvantage
-Effective for positive - Could worsen
symptoms of cognitive function
schizophrenia - Minimally effective for
- Available in IM negative symptoms
formulation for acute of schizophrenia
psychosis/agitation - Higher incidence of
- Cheap side effects (EPS, NMS,
tardive dyskinesia, etc.
 Atypical Antipsychotics
• Generic • Brand
Clozapine Clozaril, FazaClo
Olanzapine Zyprexa (Aydis)
Risperidone Risperdal (Consta, M-tab)
Quetiapine Seroquel, Seroquest XR
Ziprasidone Geodon
Aripiprazole Abilify
Paliperidonen Invega (newest)
 Atypical Antipsychotics
• Advantage • Disadvantage
- Effective for positive - Higher incidence of
of symptoms of weight gain
schizophrenia - Higher incidence of
- May improve negative diabets
symptoms of - Expensive
schizophrenia
- Lower incidence of
side effects compared to
conventional
antipsychotics
 Side Effects
• Neuroleptic malignant syndrome (NMS)
– Potentially life threatening
– High fever, unstable BP, myoglobinemia
• Extrapyramidal symptoms (EPS)
– Involuntary muscle symptoms similar to those of Parkinson’s disease
– Akathisia (distressing muscle restlessness)
– Acute dystonia (painful muscle spasms)
– Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)
• Tardive dyskinesia (TD)
– Involuntary contractions of oral and facial muscles
– Choreoathetosis (wavelike movements of extremities)
– Occurs with continuous long-term antipsychotic therapy
 Nursing Process
• Nursing Assessment
• Nursing Diagnosis
• Related to
• Evidenced by
• Interventions
• Education
A 29 year old woman is being discharged in 2 days form the hospital after her first
psychotic break (paranoid schizophrenia). She is recently divorced and has
been working as a legal secretary, although her work had become erratic, and
her suspicious behavior was calling attention to herself at work. She will be
discharged in her mother’s care until she is able to resume working. Her
mother is overwhelmed and asked the nurse how she is going to cope. “She
has become so distant and she always takes thing the wrong way. I can hardly
say anything to her with her misconstruing everything. She is very mad at me
because I called 911 and had her admitted after she told me she was going to
get justice back in the world by blowing up evil forces that have been haunting
her life and then proceeded to try to run over her ex-husband, thinking he was
the devil. She told me there is nothing wrong with her and I am concerned she
won’t take her medication once she is discharge.
1. What are some of the priority concern that nurse could address in the
hospital setting before she is discharge?
2. How would you explain to the mother some of the symptoms that she is
experience in? What suggestion could you give her to handle some of
the immediate concerns?
3. What issues could you bring up to the staff about her medication
compliance? What would be some ways to deal with this issue?
4. What do you think of the prognosis for her? Support your hypothesis with
data regarding influences on the course of schizophrenia.