1. Ch 31 Schizophrenia and Other Psychoses

2. http://www.npr.org/programs/atc/features/2002/aug/schizophrenia/ http://www.medicalview.com/Topic.asp?ProgID=62&CatID=0#

3. http://www.medicalview.com/nsf/3.html#

4. Psychoses The inability to recognize reality, relate to others or cope with life’s demands

5. Schizophrenia Most common psychosis Group of related disorders characterized by disordered thinking, perceptions and behaviors Other psychotic disorders –Delusional disorder –Drug related psychosis –Brief psychotic disorder

6. Continuum of Neurobiological Responses Adapting to environment – able to use logical thought, have clear perceptions and able to socially relate in appropriate ways Not adapting (middle)-function within reality but have emotional overreactions, distorted thoughts or odd behaviors Maladaptive- hallucinations, inability to experience emotions

7. Psychoses in Childhood Processing or combining information is a near impossible task. FTT-related to neglect, environmental problems or severe family stress Psychosis can occur as young as 5 Etiology unknown – 3 risk factors –Genetics – parents,siblings, relatives –Complications during pregnancy or birth – flu virus exposure during 2 nd trimester –Biochemical influences - dopamine

8. Signs and Symptoms vary Core behaviors –Lack of contact with reality –Withdrawal into world of their own –Impaired ability to process visual information, regulate attention and sort out incoming info –Affect changes –Language and communication disturbances –Problems with motor control, emotional control and expression

9. Psychoses in Adolescence Ups and downs intensified Family members may note changes in behavior Poor hygiene, grooming habits poor Strange vague speech and lack of interest lead to social withdrawal Hoarding, talking to self Thoughts and beliefs may be bizarre Unusual superstitions Belief in telepathy Belief one is remotely controlled Self injury and self destructive behaviors arise

10. First treatment is inpatient for assessment, monitoring and controlled Interventions focus on –Decreasing acute symptoms –Improving relationships –Education

11. Psychoses in Adulthood Onset often men middle 20s Women late 20’s Men endure longer before seeking help 1/3 persons improve with treatment 1/3 improve without treatment 1/3 progress into chronic course with or without treatment

12. Prognosis – outlook is better if adaptive interpersonal relationships, school performance and work histories were present before the onset of symptoms Outlook better for women Men have higher relapse rates and spend more time inpatient

13. Length of stays are shorter – individuals with schizophrenia return home while still psychotic requiring observation and support Parents struggle with guilt and frustration attempting to understand “why” Grieve losing the ‘normal child’

14. Older Adulthood Seldom diagnosed at this age Possible onset 40s and 50s Many elders suffer irreversible side effects from long term antipsychotic use Hallucinations/delusions of younger years often disappear Become more withdrawn or paranoid Frequently homeless End of life in nursing facilities

15. Biological Theory Brain disorder evidence rising Neurochemical production and transmission problems are being investigated Stress/disease/trauma- effects of stress during prenatal period, viral infection, severe malnutrition Birthing difficulty contributes-long labor, difficult birth, umbilical cord prolapse Cocaine use

16. Psychological model Character flaw with poor family relationships Overprotective or anxious mothers Cold, uncaring fathers Couples who stayed together for the sake of the children Failure to accomplish task trust or intimacy

17. Sociocultural theory Effects of environment Poverty, homelessness, unstable families

18. Subtypes Catatonic Disorganized Paranoid Undifferentiated Residual

19. Signs and Symptoms Physical appearance- –Unkempt –Focus on inner matters –Personal hygiene is poor –Body images are distorted –Motor activity ranges agitated to immobile

20. Hallucinations-false sensory inputs with no external stimuli –Olfactory –Auditory –Gustatory –Visual –Tactile –Feelings of altered internal workings of the body Illusions- false perceptions of real stimuli Agnosia-inability to recognize familiar objects or people is common

21. Problems with attention, memory and use of language Delusions-fixed false ideas not based in reality Ideas of reference-people or media are talking about oneself Derealization-loss of ego boundaries with inability to tell where one’s body ends nad the environment begins

22. Speech- –Clang associations –Concrete thinking –Echolalia –Flight of ideas –Loose associations –Ideas of reference –Mutism –Neologisms –Verbigerations –Word salad

23. Perseveration-repeating of the same idea in response to different questions Poverty of thought-lack of ability to produce new thoughts or follow a train of thought Little insight into illness, poor judgment General decline in intellectual abilities as the disorder progresses

24. s Blunted or flat affect Alexithymia- difficulty in identifying and describing emotions Apathy- lack of concern interest, feelings Anhedonia- inaibility to experience pleasure in life Little impulse control Anger management is poor

25. Avolition- lack of energy or motivation Substance abuse – dual diagnosis Unable to establish or maintain relationships with others Self esteem is low and gender identity confusion may exist Social behaviors are inappropriate

26. Positive symptoms- r/t maladaptive thoguhts and behaviors –Hallucinations, speech problems, bizarre behaviors Negative Symptoms-lack of adaptive mechanisms –Flat affect, poor grooming, withdrawal, poverty of speech

27. Phases of Disorganization Prodromal- withdrawal, lack of energy, little motivation, complain about multiple physical problems –Ideas beliefs and become odd, unusual –Hygiene ignored –Agitated and angry Prepsychotic phase- quite, passive and obedient –Hallucinations, delusions may be present –Slip away

28. Acute – disturbances in thought, perception, behavior and emotion Residual phase- lack of energy, no interest in goal directed activities Remission-manage basic ADLs, relief from some distresses of psychosis

29. Other Brief psychotic disorder-lasts more than one day but less than a month Delusional Disorder- more than one month of nonbizarre reality based fixed ideas Shared Psychotic-disturbance that develops in an individual who is influenced by someone else who has an established delusion with similar content Schizoaffective-diagnosed when depression and mania are present

30. Treatment and Therapies Combination therapy and medications Stress reduction Family education Early intervention

31. Pharmacological Therapy Antipsychotics – slow the CNS system –Emotional quieting, sedation, slowed motor responses –Interrupt dopamine Neuroleptics

32. Nursing Process Basic goal- assist clients in controlling their symptoms and achieving highest possible level of functioning EPS- abnormal involuntary movement disorder

33. Akathisia- inability to sit still, nervous and jittery, lots of nervous energy Akinesia-absence of movement Bradykinesia-slowing of body movement, do not try to move or speak Dyskinesia-involuntary skeletal muscle movements, jerking, affect gait Dystonia-impaired muscle tone, rigidity –Oculogyric – eye rolls into back of head –Torticollis-force face and neck into twisted position

34. Laryngeal-pharyngeal dystonia- muscles of neck and throat become rigid, client begins to gag, choke and become cyanotic Treated with anticholinergic drugs

35. NMS Neuroleptic malignant syndrome Death can occur from resp. failure, renal failure, aspiration pneumonia, PE Cardinal sign is high body temp Tachycardic, changes in BP, incr. perspiration, incontinence, rapid labored respirations

36. TD Irreversible side effect of long term treatment Involuntary repeated movements of muscles of the face, trunk, arms and legs

37. Anticholinergic Effects Hypotension Protect from falls

38. Nursing Responsibilities Oil vs water based injectables Monitor client responses to meds Client and family education