Schizophrenia Chapter 14

Louis Wain cat This cat, like many painted during that period, is shown with abstract patterns behind it. Psychologists have cited this increased abstraction as symptomatic of Wain's schizophrenia

Devastating brain disease that affects thinking, language, emotions, social behavior, and ability to perceive reality accurately Often misunderstood and stigmatized by society Many people function well with medication and social support Others, more disabled may need higher level of support Schizophrenia

Lifetime prevalence is 1% worldwide with no differences related to race, social status, culture, gender, or environment Early onset (18-25 yrs) usually male with more prominent negative symptoms Onset (25-35 yrs) usually female, and have better outcomes The younger the onset the more discouraging the diagnosis Prevalence and comorbidity

Neurochemical (catecholamines and serotonin), genetic, and neuroanatomical findings help explain the symptoms of schizophrenia At present no one theory accounts for all phenomena found in schizophrenia disorders Theory

Biologically based disease of brain Not one disorder but a group of disorders Psychotic symptoms are more pronounced and disruptive than are symptoms found in other disorders Basic differences are in degree of severity, withdrawal, alteration in affect, impairment of intellect and regression Depression is almost always present Necessitates identification and must be treated to lower the potential for suicide, substance abuse and relapse Schizophrenia facts

3 groups of symptoms No one symptom is found in all subtypes  Positive (hallucinations, delusions, bizarre behavior, & paranoia) -Respond to antipsychotic therapy  Negative (apathy, anhedonia, poor social functioning, and poverty of thought) -Do not respond to antipsychotic therapy  Cognitive (affect 40%-60%) difficulty with attention, memory, decision making, disorganized thinking and problem solving). Warrants careful assessment and interventions to increase the quality of life and functioning Symptoms

4 Phases  Prodromal Phase: S&S that precede acute  Acute Phase: Periods of florid positive symptoms  Maintenance Phase: Acute symptoms decrease in severity, particularly positive symptoms  Stabilization Phase: Symptoms are in remission Course of disease

Assessment: 5 Subtypes  Paranoid, Catatonic, Disorganized, Undifferentiated, Residual Diagnosis  Define by positive, negative or family focused Outcomes Identification Planning  Proceeds by identifying phase & assessing individual needs based on functional ability & involves identification of short term & intermediate indicators  Review and reassess data frequently Implementation Evaluation: Review and reassess the data frequently Application of nursing process

2 Types -Traditional Side Effects: tardive dyskinesia, EPS (acute dystonia, akathisia & pseudoparkinsonism), NMS & agranulocytosis -Atypical (less side effects than traditional) Side effects: Weight gain, glucose impairment, elevated cholesterol, hypertension) Antipsychotic medications