Schizophrenia
Syndrome – many varietiesDisordered & bizarre thoughtsDisordered & bizarre perceptions
Bizarre behaviors and movements Flat or blunted emotions Impaired communication & social
functioning Impaired cognition
Brain & Behavior Research Foundation - ART
Schizophrenia
Onset usually late adolescence or early adulthood
About 1% of population Onset abrupt or slow Clinical course varies; can be
debilitating Earlier onset = poor prognosis Inheritability estimated 80%
Inheritability of schiz as high as 80% Identical Twin studies
About 50% chance both will develop schiz why don’t both get the disease?
Over 1000 genes examined as candidate genes – heterogeneity
“Alleles of very small effect and rare mutations interact with environmental factors to confer risk” ( Journal of Nursing Scholarship, 2013)
Positive symptoms Hallucinations Delusions & illusions Echopraxia/echolalia Flight of ideas & loose associations Perseveration Ideas of reference Ambivalence Symptoms related to changes in subcortical
limbic circuits
Auditory hallucinations 53% schizophrenics 28% MDD 27% incest survivors Non-psychiatric
Left temporal lesions Psychoactive substances Other somatic conditions Stress/bereavement/spiritual
Negative symptoms Apathy Alogia Flat or blunted affect Anhedonia Absence of will Poor hygiene Social isolation/socially inappropriate Changes in the medial & orbital prefrontal
cortex
Cognitive functioning Working memory – ability to retain & use data Executive function – decision making
Context “If the farmer wants to keep chickens
she needs a pen” Changes in dorsolateral prefrontal cortex
In both those with schiz & those at risk for! Newer antipsychotics MAY be especially
beneficial Early evidence – may be able to treat early and
prevent psychosis from developing
Person with schizophrenia – Elyn Saks, PhD
http://www.ted.com/talks/elyn_saks_seeing_mental_illness
This is about 15 minutes long so I recommend viewing on your own time.
Nursing assessment History Presenting problem
Include suicide/homicide risk Appearance and behaviors
Speech patterns Mood and affect
Flat or blunted inappropriate
Nursing assessment
Thought process Thought content
Hallucinations Delusions Judgment and insight Self concept, relationships, self care
Nursing diagnosesfor positive symptoms
Risk for violence (self or other directed)
Altered thought processes Sensory/Perceptual alterations Personal identity disturbance Impaired verbal communication
Nursing diagnosesfor negative symptoms
Self-care deficit Social isolation Altered health maintenance Ineffective management of
therapeutic regime Diversional activity deficit
Schizophrenia case study
http://www.youtube.com/watch?v=H_jYqSA_fJk
Mindyourmind.co
Antipsychotic medications
Phenothiazines & Haldol (conventional) Decrease dopamine
Atypical antipsychotics More specific blocking of dopamine
receptors as well as increasing serotonin & norepinephrine
Dopamine system stabilizers (new generation – Abilify)
Neuroleptic Malignant Syndrome
Depletion of dopamine Muscle rigidity Hyperthermia Hypertension Diaphoresis Confusion – mutism Elevated CPK and WBC
Extrapyramidal Symptoms
Dystonia Torticollis Opisthonis Oculogyric crisis Pseudoparkinsonism Akathesia NMS Tardive dyskonesia
Anticholinergic symptoms
Dry Mouth Constipation Orthostatic Hypotension
Other side effects Weight gain &
metabolic syndrome
Sexual side effects
Clozaril/Clozapine
Potential fatal side effect of agranulocytosis
Sudden fever, sore throat, malaise
Leukopenia Weekly WBC
Non-pharmacological interventions Cognitive behavioral
therapy Support groups Social skills and
lifeskills training Cognitive
remediation Techniques for
dealing with hallucinations
Case study
Sam is a 19 yr old who has been admitted to a psychiatric evaluation unit. You are assigned as nurse. When you first see him you note he has long shaggy unwashed hair; he is relatively thin; he makes no eye contact. He tells you in a soft voice that Mary was supposed to care for him because he was nice to her, but she disappointed him by moving away. Something is keeping them apart; maybe because other people are reading his thoughts. “My thoughts are very loud and bump into the sides of my head. Can you hear them?”
Case study continued Sam moved back to his parent’s home after
living in a college dorm. He is not sure if he is still in school. “I haven’t gone to class in months because they won’t help me make Mary understand. They want me to fail and the teachers wink at me to tell me I am stupid. I don’t need school. I don’t want a job because people will make sure I would get fired.” He shows little emotion. It seems difficult for him to find the words to explain. He is easily distracted; stares off into the corner, and is restless. After a few minutes he gets up and leaves.
Preventing recidivism
Medication teaching and effective medication management
Community follow-up Effective self-care and stress
reduction Teaching pt & significant others Recognizing trigger events and early
symptoms
Recovery model
Accepts that mental illness is often a life-long illness with remissions, exacerbations, and set backs
Borrowed from substance abuse fields Focus on treating mental illness like
any other chronic illness http://www.youtube.com/watch?v=Zn6y
w2KUIwc
A beautiful mind John Nash
B.1928 Nobel prize 1994 2 sons Alicia:
1 son: Married 2X
Second son by Eleanor Stier