1. 16
Schizophrenia

2. Features of Schizophrenia *
Prevalence in U.S. is 1.1%.
Average onset is late teens to early twenties, but can be as late as mid-fifties
Affects cognitive, emotional, and behavioral function
30% to 40% relapse rate in the first year
LO 16-1: Describe the central features of schizophrenia.
CFL

3. Features of Schizophrenia (cont'd)
Progression varies from one client to another
Exacerbations and remissions
Chronic but stable
Progressive deterioration
LO 16-1: Describe the central features of schizophrenia.
CFL

4. Features of Schizophrenia (cont'd)
DSM-IV-TR Diagnosis
Symptoms present at least 6 months
Active-phase symptoms present at least 1 month
Symptoms are defined as positive and negative
LO 16-1: Describe the central features of schizophrenia.
CFL

5. Features of Schizophrenia (cont'd) *
Positive symptoms
Excess or distortion of normal functioning
Aberrant response
Negative symptoms
Deficit in functioning
LO 16-1: Describe the central features of schizophrenia.
CFL

6. Features of Schizophrenia (cont'd) *
Positive Symptoms of Schizophrenia
Hallucination
Delusions
Disordered speech and behavior
LO 16-1: Describe the central features of schizophrenia.
CFL

7. Table 16-3 (continued) Positive Symptoms *

8. Table 16-3 (continued) Positive Symptoms *

9. Features of Schizophrenia (cont'd) *
Negative Symptoms of Schizophrenia
Flat affect and apathy
Alogia
Avolition
Anhedonia
LO 16-1: Describe the central features of schizophrenia.
CFL

10. Table 16-4 Negative Symptoms *

11. Subtypes of Schizophrenia *
Paranoid type
Disorganized type
Catatonic type
Undifferentiated type
Residual Type
LO 16-2: Distinguish among the subtypes of schizophrenia.
CFL

12. Subtypes of Schizophrenia (cont'd) *
Paranoid Type
Delusions
Persecutory and grandiose
Somatic or religious
Hallucinations
Delusions link with a hallucination
LO 16-2: Distinguish among the subtypes of schizophrenia.
CFL

13. Subtypes of Schizophrenia (cont'd) *
Disorganized type
Disorganized speech, behavior, appearance
Flat or inappropriate affect
Fragmented hallucinations and delusions
Most severe form of schizophrenia
LO 16-2: Distinguish among the subtypes of schizophrenia.
CFL

14. Subtypes of Schizophrenia (cont'd) *
Catatonic type
Psychomotor retardation and stupor
Extreme psychomotor agitation
Waxy flexibility
Echolalia
Mutism
Echopraxia
LO 16-2: Distinguish among the subtypes of schizophrenia.
CFL

15. Subtypes of Schizophrenia (cont'd)
Undifferentiated type
Active psychotic state
Lacks symptoms of other subtypes
Residual type
At least one episode of schizophrenia
No prominent positive symptoms
Negative symptoms present
LO 16-2: Distinguish among the subtypes of schizophrenia.
CFL , CFL

16. Other Psychotic Disorders *
Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
Brief psychotic disorder
LO 16-2: Distinguish among the subtypes of schizophrenia.
CFL

17. Causes of Schizophrenia
Biopsychosocial theories
Interrelated factors
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL

18. Causes of Schizophrenia (cont'd)
Biologic theories
Psychological theories
Family theories
Humanistic-interactional theories
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL: A

19. Causes of Schizophrenia (cont'd) *
Biologic Theory: Genetic
Only genetic predisposition for developing schizophrenia is inherited
10% of first-degree relatives
25%–39% of monozygotic twins
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL:

20. Causes of Schizophrenia (cont'd)
Biologic Theory: Brain Structure Abnormality
Differs from those with no symptoms
May be genetically based
Requires more study
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL:

21. Figure 16-2 PET scans measuring regional cerebral blood flow
Figure PET scans measuring regional cerebral blood flow. (a) Areas of lower blood flow and brain activity are seen in the individual with schizophrenia. (b) Areas of normal blood flow and brain activity are visible in the unaffected individual. Photo courtesy of R. Haier/Photolibrary.

22. Causes of Schizophrenia (cont'd)
Biologic Theory: Biochemical Theories
Dopamine hypothesis
Traditional antipsychotic medications are dopamine blockers
Dopamine blocker alleviate positive symptoms
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL:

23. Causes of Schizophrenia (cont'd)
Psychological theories
Information processing
Difficulty controlling the amount and type of information that is processed in the brain.
Attention and arousal
Hyper or hypo responsiveness to various situations
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL:

24. Causes of Schizophrenia (cont'd)
Psychological theories
Information processing
Deficient in automatic processing
Deficient in controlled or effortful processing
Attention and arousal
Hypo-, hyper-responses
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL: , CFL

25. Causes of Schizophrenia (cont'd)
Family Theories
Dysfunctional interaction not supported by research
Disordered family communication linked only with genetic predisposition
Family emotional tone influences course of schizophrenia
Expressed emotions theory (EE)
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL:

26. Causes of Schizophrenia (cont'd)
Humanistic-interactional theories integrate biological and psychosocial theories
Combine influences of:
Genetic predisposition or biologic vulnerability
Environmental stressors
Social support
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL:

27. Causes of Schizophrenia (cont'd)
Stress-Vulnerability Model
Stressors increase vulnerability
Cumulative effect of:
Genetic predisposition
Personal stressors
Familial factors
Environmental factors
LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL:

28. Influences on the Course of Schizophrenia
Social Pressures
Lack of social support
Financial problems
Stigma
LO 16-4:    Explain how psychological and social pressures can influence the course of schizophrenia.
CFL

29. Influences on the Course of Schizophrenia (cont'd) *
Psychological pressures
Difficulty with problem-solving
Difficulty with interpreting reality
Difficulty coping
Problems with self-care
Unstable interpersonal relationships
CFL

30. Nursing Implications *
Assessment
Premorbid functioning
Content of thought
Form of thought
Perception
Sense of self
Delusions and perceptual disturbances
Hallucinations
Drug use
LO 16-5: Discuss the major nursing implications in caring for clients with difficult and chronic illnesses such as schizophrenia.
CFL

31. Nursing Implications (cont'd) *
Nursing Diagnoses
Altered thought process
Social isolation
Risk for violence
Self-care deficits
Altered health maintenance
Ineffective family coping
LO 16-5: Discuss the major nursing implications in caring for clients with difficult and chronic illnesses such as schizophrenia.
CFL

32. Nursing Implications: Supporting Families
Family needs vary with degree of illness and involvement in client’s care
Education
Financial support
Psychosocial support
Advocacy
LO 16-6: Discuss the major nursing implications in supporting the families of persons with schizophrenia.
CFL

33. Nursing Implications: Supporting Families (cont'd) *
Schizophrenia is a “family illness.”
Family members need to be involved.
Educate family about
Medication
Illness
Relapse prevention
LO 16-6: Discuss the major nursing implications in supporting the families of persons with schizophrenia.
CFL

34. Nursing Implications: Supporting Families (cont'd)
Nurse assists family by
Identifying community agencies/groups for family members
Advocating for rights
LO 16-6: Discuss the major nursing implications in supporting the families of persons with schizophrenia.
CFL

35. Measures to Prevent Relapse *
Ensure client takes medication
Educate family about signs and symptoms of relapse
Client and family to participate in relapse prevention program
LO 16-7: Describe methods to prevent or minimize relapses in schizophrenia.
CFL

36. Measures to Prevent Relapse (cont'd)
Relapse prevention programs work best when:
Psychosocial treatment and social skills training are combined with antipsychotic medication
Behavior patterns are monitored
Family members understand triggers
LO 16-7: Describe methods to prevent or minimize relapses in schizophrenia.
CFL

37. Measures to Prevent Relapse (cont'd)
Relapse prevention programs provide education and support regarding:
Individual triggers, symptoms of relapse
Managing side effects of medications
Interventions to reduce or eliminate triggers
Strategies to facilitate early intervention
Cognitive therapy
Community resources
LO 16-7: Describe methods to prevent or minimize relapses in schizophrenia.
CFL

38. Challenges to Adherence *
Side effects
Level of symptomatology
Cognitive, motivational, financial, and cultural issues
Issues with caregivers
Insufficient medication teaching
LO 16-7: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL:

39. Increasing Adherence *
Involve clients in treatment
Instruct client about reducing discomfort
Provide peer support
Provide reminders and positive feedback
Recognize accomplishments
LO 16-7: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia.
CFL:

40. Personal Awareness * Identify personal feelings.
Recognize personal perceptions.
What behaviors do you expect to see?
How will you respond to these behaviors?
What is the meaning of the behaviors?
LO 16-8:   Identify the personal characteristics you bring to the care of clients with schizophrenia that might cause you to distance yourself or fail to understand their experience and difficulties.
CFL

41. Personal Awareness (cont'd)
What defines “normal” behavior?
What are my fears associated with mental illness?
LO 16-8:   Identify the personal characteristics you bring to the care of clients with schizophrenia that might cause you to distance yourself or fail to understand their experience and difficulties.
CFL B

42. Personal Awareness (cont'd)
Be honest with your feelings.
Identify what strengths you bring to the situation.
Remember that clients are human beings with a mental disorder and do not choose to be this way.
LO 16-8:   Identify the personal characteristics you bring to the care of clients with schizophrenia that might cause you to distance yourself or fail to understand their experience and difficulties.
CFL C

43. Resources
NAMI
The National Alliance on Mental Illness provides information, education, and support relating to mental health illnesses and disorders for clients, families, and professionals.

44. Resources (cont'd) National Institute of Mental Health
The National Institute of Mental Health is part of the Department of Health and Human Services and has information about research on various mental health illnesses.

45. Resources (cont'd) Medline Plus
Medline Plus is a service of the National Library of Medicine and the National Institutes of Health. This site provides definitions related to various aspects of schizophrenia.

46. Resources (cont'd) Brain & Behavior Research Foundation
The Brain & Behavior Research Foundation awards grants from the National Alliance for Research on Schizophrenia and Depression (NARSAD), a non-for-profit charity organization primarily organized to raise funds for research.

47. Resources (cont'd) Mayo Clinic
Search by topic on this Mayo Clinic link to find current information about mental illness.

48. Box 16-4 Challenges to Adherence

49. Box 16-4 Challenges to Adherence