schizophrenia dsm 5
DESCRIPTION
SCHIZOPHRENIA_DSM_5.pptTRANSCRIPT
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SCHIZOPHRENIA
Janice A. Aloi, DMH,RN,CNE
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INTRODUCTIONSCHIZOPHRENIA PROBABLY CAUSES MORE LENGTHY HOSPITALIZATIONS, MORE CHAOS IN FAMILY LIFE, MORE EXORBITANT COSTS TO INDIVIDUALS AND GOVERNMENTS, AND MORE FEARS THAN ANY OTHER MENTAL DISORDER.
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NATURE OF THE DISORDER-results in disturbances in thought processes, perception, and affect-severe deterioration in social and occupational functioning-will affect 1 percent of the population-premorbid behavior
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PREMORBID PHASES1. Phase 1 The Schizoid Personality2. Phase 2 Prodromal-withdrawn-peculiar behavior-impaired role functioning-neglected hygiene-disturbance in ideation, perception, communication
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PREMORBID 3. Phase III Schizophrenia-psychotic symptoms (delusions, hallucinations, disorganized speech or behavior, negative symptoms, impairment in work, social relations and self-care)At least 6 months4. Phase IV Residual-similar to prodromal phase with flat affect and impairment in role functioning being prominent
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ETIOLOGY-BIOLOGICAL INFLUENCES-GENETICS-BIOCHEMICAL-PHYSIOLOGICAL
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ETIOLOGYPSYCHOLOGICAL INFLUENCES-POOR EARLY MO-CHILD RELATIONSHIP-DYSFUNCTIONAL FAMILY SYSTEM-DOUBLE-BIND COMMUNICATION
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ETIOLOGYENVIRONMENTAL-LOWER SOCIOECONOMIC STATUS-STRESSFUL LIFE EVENTS
-Most likely the result of a combination of biological, psychological, and environmental influences.
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POSITIVE AND NEGATIVE SYMPTOMS
POSITIVE-DEVIANT-PRESENT BUT SHOULD BE ABSENT-PSYCHOTIC-OUT OF REALITY-EX. DELUSIONS, HALLUCINATIONSNEGATIVE-ABSENCE OF NORMAL CHARACTERISTICS-EX. APATHY, AFFECT, SPEECH, ANHEDONIA
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TYPES
The DSM 5 identifies a spectrum of psychotic disorders from least to most severe.
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GENERAL APPEARANCE-CHRONIC-REGRESSED-FLAT OR GROSSLY INAPPROPRIATE AFFECT-BIZARRE MANNERISMS-SOCIAL IMPAIRMENT EXTREMENEGLECT OF HYGIENE & APPEARANCE
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SCHIZOTYPAL PERONALITY DISORDERA MORE SEVERE SCHIZOID PERSONALITYODDALOOFMAGICAL THINKINGDEPERSONALIZATIONSPEECH SOMETIMES BIZARRE
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DELUSIONAL DISORDER-EROTOMANIC-GRANDIOSE-JEALOUS-PERSECUTORY-SOMATICMIXED
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BRIEF PSYCHOTIC DISORDER-SUDDEN ONSET
-PSYCHOTIC SYMPTOMS (LESS THAN ONE MONTH)
MAY OR MAY NOT BE PRECEDED BY A SEVERE STRESSOR
EVENTUAL RETURN TO PREMORBID LEVEL OF FUNCTIONING
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SUBSTANCE-INDUCED PSYCHOTIC DISORDERMAY BE:SUBSTANCE INTOXICATIONWITHDRAWALMEDSTOXINSSYMPTOMS SEVERE
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PSYCHOTIC DISORDER DUE TO ANOTHER MEDICAL CONDITION
HALLUCINATIONSDELUSIONSEX. Epilepsy, neuro trauma, thyroid disease
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CATATONIC DISORDER DUE TO ANOTHER MEDICAL CONDITION
Symptoms of catatoniaEx. Metabolic disorders, tumors
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SCHIZOPHRENIFORM DISORDERSYMPTOMS OF SCHIZOPHRENIAAT LEAST ONE MONTHLESS THAN 6 MONTHSPROVISIONAL DIAGNOSIS
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SCHIZOAFFECTIVE DISORDERSCHIZOPHRENIC BEHAVIORSDISTURBANCE OF MOOD
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CATATONIA (specifier)-A. STUPORMOTOR RETARDATION, MUTE,POSTURING, WAXY FLEXIBILITY
-B. EXCITEMENTAGITATION, PURPOSELESS MOVEMENTS, POSSIBLE INJURY TO SELF
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ASSESSMENTPOSITIVE SYMPTOMS
-content of thought-delusions-religiosity-paranoia-magical thinking-form of thinking-associative looseness-neologisms-concrete thinking-clang associations-word salad-circumstantiality-tangentiality-mutism-perseveration
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ASSESSMENT (pos)PERCEPTION
-HALLUCINATIONS
-ILLUSIONS
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ASSESSMENT (pos)SENSE OF SELF-ECHOLALIA-ECHOPRAXIA-IMITATION-DEPERSONALIZATION
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ASSESSMENT NEGATIVE SYMPTOMSVOLITION-IMPAIRMENT OF THE ABILITY TO INITIATE GOAL-DIRECTED ACTIVITY
DETERIORATED APPEARANCE
AMBIVALENCE-POS & NEG FEELINGS ABOUT THE SAME PERSON OR THING. CANT MAKE A DECISION.
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ASSESSMENT (-)SOCIAL IMPAIRMENT
AFFECTInappropriateFlatApathy
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ASSESSMENT (-)PSYCHOMOTOR BEHAVIOR-ANERGIA-WAXY FLEXIBILITY-POSTURINGPACING AND ROCKING
ASSOCIATED FEATURES-ANHEDONIA-REGRESSION
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NURSING DIAGNOSES-alteration in thought processes-sensory-perceptual alteration-social isolation-risk for violence-impaired verbal communication-self-care deficit-ineffective family coping-altered health maintenance
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KEY COMPONENTS OF PSYCHOSOCIAL TREATMENT-client and family teaching-collaborative decision-making-monitoring drug therapy-assistance obtaining drugs-supervision of financial resources-activities of daily living-self-help groups-psychotherapy
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GENERAL NURSING INTERVENTIONS-establish trust and rapport; use same staff, if possible; keep all promises-avoid physical contact, crowding-calm, unhurried manner-maintain an assertive, genuine, matter-of-fact approach-intervene at the first sign of escalation-maximize level of functioning
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GENERAL NURSING INTERVENTIONS-remove all dangerous objects from the clients environment-check the level of stimuli in the environment; may be to high for some clients-promote social skills-ensure safety
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GENERAL NURSING INTERVENTIONS-avoid laughing and whispering where the client can see but cannot hear what is being said-do not tease or joke-keep it real focus on reality-offer simple, matter of fact explanations; avoid cliches and abstract phrases (concrete thinking)-deal with hallucinations distraction voice dismissal -respond to feelings, themes-connect hallucinations with increased anxiety-convey acceptance of clients need for false belief, but indicate that you do not share the belief-do not argue or deny the belief use reasonable doubt
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GENERAL NURSING INTERVENTIONS-encourage compliance with drug therapy-look for adverse drug reactions-mouth checks may be necessary-encourage family involvement
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DRUG THERAPY
Antipsychotic drugs control symptoms adequately in most schizophrenics. The wide choice of drug treatment options available today has improved clients chances for remission and recovery.
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PROGNOSIS-1/3 Improve
-1/3 Intermittent relapses
-1/3 Severe incapacity
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ANTIPSYCHOTIC DRUGS-also called neuroleptics are effective in the treatment of schizophrenia
TWO TYPES:Typical (Traditional) reduce mostly positive symptomsAtypical effective against both positive and negative symptoms, less likely to produce EPS
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ACTION OF TYPICALS-not really known-might block dopamine receptors leading to the inhibition of transmission of neural impulses at the synapsesEx. Thorazine, Prolixin, Haldol, Stellazine, Navane, Trilafon, Mellaril
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ACTION OF ATYPICALSBlock dopamine and serotonin receptorsSimultaneous blocking may account for their increased successDecreased incidence of long-term side effectsEx. Clozaril, Risperdal, Seroquel, Zyprexa
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SIDE EFFECTS1. Anticholinergic effects dry mouth, blurred vision, constipation, urinary retention2. Nausea 3. Skin rash4. Sedation5. Orthostatic hypotension6. Photosensitivity7. Hormonal effects
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SIDE EFFECTS8. ECG changes9. Reduction of seizure threshold10.Agranulocytosis (Clozapine)11.Hypersalivation (Clozapine)12.Extrapyramidal symptoms-pseudoparkinsonism-akinesia-akathisis-oculogyric crisis-dystonia
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SIDE EFFECTS13. Tardive dyskinesia (bizarre facial and tongue movements, stiff neck, difficulty swallowing-potentially irreversible-stop drug at the first sign
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SIDE EFFECTS14. Neuroleptic Malignant Syndrome (severe muscle rigidity, fever up to 107, tachycardia, BP fluctuations, diaphoresis, mental status deterioration to stupor and coma-onset hours or years-stop drug-monitor vital signs15. Hyperglycemia and Diabetes
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ANTIPARKINSONIAN DRUGS-GIVEN FOR THE RELIEF OF PARKINSONIAN SYMPTOMS-Cogentin-Parlodel-SIDE EFFECTS-anticholinergic-nausea-drowsiness-psychotic symptoms-orthostatic hypotension
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CLIENT EDUCATION-CAUTION WHEN DRIVING-CONTINUE MEDS-SUNSCREEN-KNOW SYMPTOMS AND REPORT IF OCCUR-ORAL CARE-NO ALCOHOL-NO OTC DRUGS WITHOUT APPROVAL
*Psychosis/ thought disorderNo single cause/tx
Late aldosecentsChild hood schizopernia 4rth leading cause of disability
*************Has some sym of szhiopernia and mood disorder thing going on *Very severe/***********************