1. { Schizophrenia

2.  Affect – flat, inappropriate emotions  Associative looseness – jumbled, illogical thinking  Autism – thinking not bound to reality  Ambivalence – holding two opposing emotions, ideas, or wishes 4 A’s of Schizophrenia 2

3.  No clear cause-  factors include: presence in first degree relatives  age 16-40  Men  poor prenatal nutrition  Substance misuse-stimulants  Obstetric complications

4.  Cause:  Genetic  Combined with a viral infection, birth injuries etc that alter brain structure affecting- neuotransmitters Diathesis-stress model

5. Phase I – Acute  Onset or exacerbation of symptoms Phase II – Stabilization  Symptoms diminishing  Movement towards previous level of functioning Phase III – Maintenance  At or near baseline functioning Phases of Schizophrenia 5

6. DSM-V Criteria Characteristic Symptoms  Two or more of the following  Delusions  Hallucinations  Disorganized speech  Grossly disorganized or catatonic behavior  Negative symptoms  Social/Occupational Dysfunction  Duration (6 months)

7.  Negative symptoms  Affect-flat  Alogia- poverty of thought  Anergia- lack of energy  Anhedonia- lack of pleasure  Avolition- Lack of motivation

8. {{ Alterations in thinking Alterations in thinking Delusions are false, fixed beliefs Concrete thinking is an inability to think abstractly Thought broadcasting Alterations in speech Neologisms-creating new words Echolalia-automatic repeating of others words Echopraxia-automatic repeating of others actions Word salad Catatonia Motor retardation Motor agitation Stereotyped behaviors Waxy flexibility Negativism Impaired impulse control Positive Symptoms ALTERATIONS IN PERCEPTION ALTERATIONS IN BEHAVIOR Depersonalization Derealization Hallucinations Auditory Command Mind control Visual hallucinations Religious delusions Boundary impairment

9. Related Psychotic Disorders  Schizoaffective D/O-both schizophrenia and depression or bipolar  Schizophreniform D/O-symptoms like schizophrenia but only lasts 1- 6 months  Induced or Secondary Psychotic D/O- usually from substance abuse

10. Positive symptoms  Disturbed sensory perception  Risk for self-directed or other-directed violence  Disturbed thought processes Negative symptoms  Social isolation  Chronic low self-esteem Potential Nursing Diagnoses 10

11. Subtypes of Schizophrenia

12.  Any medical problems & co-occurring disorders  Abuse of or dependence onalcohol or drugs  Abuse of or dependence on alcohol or drugs  Suicide risk/Risk to self or others  Command hallucinations  Belief system  Ability to ensure self-safety  Medications  Presence & severity of positive & negative symptoms  Patient & family insight into illness Assessment Guidelines 12

13.  Acute Phase  Psychiatric, medical & neurological evaluation  Psychopharmacological treatment(antipsychotic)  Support groups/art therapy  Supervision & limit setting  Cognitive behavioral therapy  Family interventions Interventions Interventions 13

14.  Establish a therapeutic relationship  Normalize psychotic experience  Modify thought processes  Enhance coping strategies  Prevent social isolation  Promote social functioning  Focus on relapse prevention  Alleviate symptoms

15. Interventions  Provide a safe environment  Use direct, clear, concrete verbal communication  Address related feelings  Do not pretend that you understand the client’s communication  Help client recognize events that increase anxiety  Encourage client to make some choices  Increase the type & frequency of social interactions gradually  Reassess client’s mental state regularly  Medication administration & teaching

16.  Persecution  Grandeur  Somatic- body is changing growing another arm  Jealousy  Being controlled  Thought broadcasting  Religiosity Typical Delusions

17.  Treat both positive & negative symptoms  Minimal to no extrapyramidal side effects (EPSs) or tardive dyskinesia  Disadvantage – significant weight gain Atypical Antipsychotics 17

18.  Risperidone (Risperdal)  Olanzapine (Zyprexa)  Quetiapine (Seroquel)  Ziprasidone (Geodon)  Aripiprazole (Abilify)  Clozapine (Clozaril) – use declining due to agranulocytosis risk Atypical Antipsychotics 18

19. { Somatic Disorders “Body”

20.  Expressing psychological stress with physical symptoms  Somatic symptom disorder  Illness anxiety disorder (hypochondriasis)  Conversion disorder  Factitious Disorders

21. Causes  Having a negative outlook or personality  Being sensitive to pain  Family history  Genetics

22. Symptoms  Must be felt for at least 6 months  Extreme anxiety about symptoms  Feel that these sx are leading to a serious disease  Go to doctor for multiple tests  Feel doctor not taking them seriously  Spend time and energy dealing with health  Has trouble functioning in daily life

23. Illness Anxiety Disorder Hypochondriasis

24.  Preoccupation with disease or illness like somatic symptom  Difference- somatic symptoms not present

25. Conversion disorder  Is seen by the presence of problems with voluntary motor and/or sensory functions  They channel emotional problems into physical symptoms

26. Assessment  Obtain data such as location, onset, duration of the symptoms  Thorough physical and mental exam  Somatic symptom severity scale  Page 330- asks about 15 common somatic complaints and the severity they feel these

27. Implementation  Outpatient help  Establish therapeutic relationship with patient  Focus on getting needs met without resorting to physical symptoms  Evaluate and help develop better coping skills  ( assertiveness training, problem solving skills)

28. Factitious Disorder Munchausen syndrome

29.  Somatic disorders are not conscious  Factitious is- in fact it is pretending to be ill to get emotional needs met  They want to be ill ex- fever, seizures, hallucinations

30. Factitious disorder imposed on others or Munchausen by proxy  To make someone dependent on them ill so as to get attention.  Ex- introducing bacteria into a child's wound, infant apnea and sudden infant death.  Attention becomes- poor parents  Disorder has nothing to do with money; all to do with attention

31.  Malingering- conscious motivated act to deceive to obtain money (fraud and not a mental illness)