1. SCHIZOPHRENIA 2 nd most frequent diagnosis of patients 14-64 y/o at CRH in 2008

2. Target Audience Nursing Staff to include nurses and technicians

3. Last update 6/25/09 ajj In this module we will cover What is schizophrenia Symptoms of schizophrenia Types of schizophrenia Some of the more common treatments for schizophrenia

4. CRH most frequent diagnosis in 2008 Under 14 y/o –Attention Deficit Disorder –Oppositional Defiant Disorder –PTSD –Bipolar –Adjustment disorder 65 and over –Persistent mental disorder due to conditions classified elsewhere –Alzheimer –Schizoaffective disorder –Other and alcohol dependence –Bipolar, Manic episode

5. CRH most frequent diagnosis in 2008 14-64 y/o –Other & unspecified alcohol dependence –Schizoaffective disorder –Cocaine dependence –Depressive disorder –Combo of drug dependence excluding opioid type drugs

6. What is schizophrenia? A chronic severe brain disorder; often they hear voices, believe media are broadcasting their thoughts to the world or may believe someone is trying to harm them. In men it usually develops in teen years and early 20s; in women it usually develops in 20s and 30s.

7. Diagnosis Currently there is no physical or lab test that can absolutely diagnose schizophrenia. A psychiatrist usually comes to the diagnosis based on clinical symptoms.

8. Misdiagnosis This is a common problem since schizophrenia shares a significant number of symptoms with other disorders. Per the Nat’l Depression & Bipolar Support Alliance there is an average of 10 years from onset to correct diagnosis & tx.

9. Disorders that may appear like Schizophrenia Schizoid personality Schizophreniform disorder Schizotypal personality Bipolar Disorder Asperger’s syndrome

10. Symptoms of Schizophrenia Profound disruption in cognition and emotion, affecting the most fundamental human attributes: –Language –Thought –Perception –Affect –Sense of self

11. Positive Symptoms Those that appear to reflect an excess or distortion of normal functions.

12. Positive Symptoms Delusions. Those where the patient thinks he is being followed or watched are common; also the belief that people on TV, radio are directing special messages to him/her.

13. Positive Symptoms Hallucinations. Distortions or exaggerations of perception in any of the senses. Often they hear voices within their own thoughts followed by visual hallucinations.

14. Positive Symptoms Disorganized thinking/speech. AKA loose associations; speech is tangential, loosely associated or incoherent enough to impair communication.

15. Positive Symptom Grossly disorganized behavior. Difficulty in goal directed behavior (ADLs), unpredictable agitation or silliness, social disinhibition, or bizarre behavior. There is a purposelessness to behavior.

16. Positive Symptom Catatonic behavior. Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.

17. Other Positive Symptoms Inappropriate response to stimuli Unusual motor behavior (pacing, rocking) Depersonalization Derealization Somatic preoccupations

18. Summary of Positive Symptoms Delusions Hallucinations Disorganized thinking Disorganized behavior Catatonic behavior Inappropriate responses

19. FYI: Positive Symptoms Positive symptoms are those that have a positive reaction from some treatment. In other words, positive symptoms respond to treatment.

20. Negative Symptoms Those that appear to reflect a diminution or loss of normal functions. May be difficult to evaluate because they are not as grossly abnormal as positive symptoms.

21. Negative Symptoms Affective flattening. Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.

22. Negative Symptom Alogia (poverty of speech) Lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts; often manifested as short, empty replies to questions.

23. Negative Symptom Avolition The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.

24. Examples of Avolition No longer interested in going out with friends No longer interested in activities that the person used to show enthusiasm No longer interested in anything Sitting in the house for hours or days doing nothing

25. Disorganized Symptoms This one is somewhat new and may not be considered valid. It is thought disorder, confusion, disorientation and memory problems.

26. Summary of Negative Symptoms Lack of emotion Low energy Lack of interest in life Affective flattening Alogia Inappropriate social skills Inability to make friends Social isolation

27. Cognitive Symptoms Difficulties in concentration and memory: –Disorganized thinking –Slow thinking –Difficulty understanding –Poor concentration –Poor memory –Difficulty expressing thoughts –Difficulty integrating thoughts, feelings, behaviors

28. FYI: Negative Symptoms Currently there is no treatment that has a consistent impact on negative symptoms.

29. Types of Schizophrenia Paranoid Hebephrenic Catatonic Residual Schizoaffective Undifferentiated

30. Paranoid Schizophrenia Persons are very suspicious of others and often have grand schemes of persecution at the root of their behavior. During this phase they may have hallucinations and frequent delusions.

31. Hebephrenic Schizophrenia AKA disorganized schizophrenia; characterized by emotionless, incongruous, or silly behavior, intellectual deterioration, frequently beginning insidiously during adolescence. May be verbally incoherent and may have moods and emotions that are not appropriate to the situation. Hallucinations not usually present.

32. Catatonic Schizophrenia Person is extremely withdrawn, negative and isolated. May have marked psychomotor disturbances.

33. Residual Schizophrenia Lacks motivation and interest in day-to- day living. Person is not usually having delusions, hallucinations or disorganized speech.

34. Schizoaffective Disorder There will be symptoms of schizophrenia as well as mood disorder (depression, bipolar, mixed mania).

35. Undifferentiated Schizophrenia Conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the previous types. Exhibits more than one of the previous types without a clear dominance of one.

36. Summary Before a diagnosis the psychiatrist must make a thorough evaluation including a physical/medical exam, a mental status exam, appropriate labs, and a full history. History includes changes in thinking, behavior, movement, mood, etc. as seen by the family.

37. Medications In general it may take up to 6 months for medications to show consistent effects. The newest medication is Invega. Meds include atypicals: Abilify, Geodon, Clozapine, Risperidone, Seroquel, Zyprexa. –[Remember: a giraffe can really see a zebra]

38. These medications may have such intolerable side effects that the patient will stop the drugs. One study showed the average time the meds were taken regularly was 3 months.

39. Treatments Psychotherapy - an adjunct to meds and is very useful to keep the patient on the meds. Group therapy Family therapy Community support groups

40. Early detection and treatment has the best results/response to treatment. Per patients, once you have schizophrenia you have it for life. The best you can hope for is control.

41. FYI: Cancer Study A study in France in 1993, with 3470 patients with schizophrenia, showed that breast cancer was the second most common cause of death. www.komen.org/schizophreniaassociated withincreasedcancermortality. Cancer 2009.www.komen.org/schizophreniaassociated withincreasedcancermortality

42. The next few slides are a review of general psychiatric definitions, defense mechanism and communication techniques. They may or may not be related to the current topic.

43. Psych Definitions Delusion = fixed beliefs that usually involve a misinterpretation of experience. “Client believes someone is reading his thoughts” Several types: grandiose, nihilistic, persecutory, somatic

44. Psych Definitions Hallucinations = perceptual experiences that occur in absence of actual sensory stimuli; involves the 5 senses.

45. Psych Definitions Illusions= person misperceives or exaggerates stimuli that actually exist in the external environment.

46. Defense Mechanism Affiliation = Turning to others for help or support; sharing problems with others without implying that someone else is responsible. Ex: An individual has a fight with spouse and turns to their best friend for emotional support.

47. Defense Mechanism Devaluation = Attributing exaggerated negative qualities to self or others. Ex: A boy has been rejected by his long time girlfriend. He tells his friends that he realizes that she is stupid and ugly.

48. Defense Mechanism Displacement = Transferring a feeling about, or a response to, one object onto another (usually less threatening) substitute object Ex: A child is mad at her mother for leaving for the day, but says she is really mad at the sitter for serving her food she does not like.

49. Communication Technique Confrontation = Presenting the patient with a different reality of the situation. Ex: My best friend never calls. She hates me. Nurse ‘I was in the room yesterday when she called.’

50. Communication Technique Doubt= Expressing or voicing doubt when a patient relates a situation. Ex: My best friend hates me. Nurse ‘From what you have told me, that does not should like her. When did she last call you?’

51. Resources Schizophrenia Symptoms, by NARSAD, The Mental Health Research Association. Schizophrenia Treatment, by John Grohol, PsychCentral, 08/07/08 Psychiatric Study Guide by Central Regional Hospital

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