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Schizophrenia
{
4 A’s of Schizophrenia
Affect – flat, inappropriate emotions
Associative looseness – jumbled, illogical thinking
Autism – thinking not bound to reality
Ambivalence – holding two opposing emotions, ideas, or wishes
No clear causefactors include: presence in first degree
relatives
age 16-40
Men
poor prenatal nutrition
Substance misuse-stimulants
Obstetric complications
Cause:
Genetic
Combined with a viral infection, birth injuries
etc that alter brain structure affectingneuotransmitters
Diathesis-stress model
Phases of Schizophrenia
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
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)
Negative symptoms
Affect-flat
Alogia- poverty of thought
Anergia- lack of energy
Anhedonia- lack of pleasure
Avolition- Lack of motivation
Alterations in thinking
{
Delusions are false, fixed beliefs
Concrete thinking is an inability
to think abstractly
Thought broadcasting
ALTERATIONS IN
PERCEPTION
Depersonalization
Derealization
Hallucinations
Auditory Command
Mind control
Visual hallucinations
Religious delusions
Boundary impairment
Alterations in speech
{
Neologisms-creating new words
Echolalia-automatic repeating of
others words
Echopraxia-automatic repeating of
others actions
Word salad
ALTERATIONS IN
BEHAVIOR
Catatonia
Motor retardation
Motor agitation
Stereotyped behaviors
Waxy flexibility
Negativism
Impaired impulse control
Positive Symptoms
Related Psychotic
Disorders
Schizoaffective D/O-both
schizophrenia and depression or
bipolar
Schizophreniform D/O-symptoms
like schizophrenia but only lasts 16 months
Induced or Secondary Psychotic
D/O- usually from substance abuse
Positive symptoms
Disturbed sensory perception
Risk for self-directed or other-directed violence
Disturbed thought processes
Negative symptoms
Potential Nursing
Diagnoses
Social isolation
Chronic low self-esteem
Subtypes of Schizophrenia
Assessment Guidelines
Any medical problems & co-occurring disorders
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
Interventions
Acute Phase
Psychiatric, medical & neurological evaluation
Psychopharmacological treatment(antipsychotic)
Support groups/art therapy
Supervision & limit setting
Cognitive behavioral therapy
Family interventions
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
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
Persecution
Grandeur
Somatic- body is changing growing another
arm
Jealousy
Being controlled
Thought broadcasting
Religiosity
Typical Delusions
Atypical Antipsychotics
Treat both positive & negative symptoms
Minimal to no extrapyramidal side effects (EPSs) or tardive
dyskinesia
Disadvantage – significant weight gain
Atypical Antipsychotics
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Clozapine (Clozaril) – use declining due to agranulocytosis risk
Somatic Disorders
{
“Body”
Expressing psychological stress with physical
symptoms
Somatic symptom disorder
Illness anxiety disorder (hypochondriasis)
Conversion disorder
Factitious Disorders
Having a negative outlook or personality
Being sensitive to pain
Family history
Genetics
Causes
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
Symptoms
Illness Anxiety Disorder
Hypochondriasis
Preoccupation with disease or illness like
somatic symptom
Difference- somatic symptoms not present
Is seen by the presence of problems with
voluntary motor and/or sensory functions
They channel emotional problems into physical
symptoms
Conversion disorder
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
Assessment
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)
Implementation
Factitious Disorder
Munchausen syndrome
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
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
Factitious disorder imposed
on others or Munchausen by
proxy
Malingering- conscious motivated act to
deceive to obtain money (fraud and not a
mental illness)
