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Rebecca Sposato MS, RN SCHIZOPHRENIA AND PSYCHOSIS Brief Psychotic Disorder Mental disturbance involving one of the following symptoms ◦ Hallucinations ◦ Delusions ◦ Disorganized speech/mannerisms Episode lasts over one day but less then one month Person returns to premorbid level of function Substance use and medical conditions did not cause the episode Schizophrenia “Split mind” as in separated from reality Symptoms are acutely present for >1 month (if not being treated) and persist in a lesser form over 6 months ◦ Anecdotal research suggests prodromal period Symptoms are severe enough to impair ability to function Etiology and Epidemiology Over expression of dopamine in cerebrum and a collection of structural changes Stressed conditions as fetus Lifetime prevalence of 1%, most cases start in young adulthood, more male Over 80% use nicotine, over 50% have substance abuse diagnosis The earlier the onset the more severe and chronic the schizophrenic course Psychomotor changes Catatonia – changes in rate and amount of motion, not reactive to environment ◦ Retardation: slow stiff movement ◦ Agitation/excitement: repetitive and purposeless or pacing motions Rule out EPS/TD from meds ◦ Posturing/catalepsy: holding same position for extended length of time Positive Symptoms Represent an excess or distortion of a normal function ◦ Thought content: delusions, concrete thinking, ◦ Perceptions: hallucinations, derealizations, depersonalizations, capgras (imposters) ◦ Language: word salad, clang associations, neologisms Acute onset and recovery, respond well to treatment and medications Negative Symptoms Represent a loss or lessened form of a normal function ◦ Emotive: flat, blunt, inappropriate, and anhedonia ◦ Speech/thought: alogia ◦ Behavior: avolition Chronic course, greater contributor to disability and social withdrawal Subtypes Paranoid: delusions of persecution or imminent harm Disorganized: purposeless and fragmented speech, thought and behavior patterns Catatonic: diminished or peculiar movement patterns ◦ Speech: mute or echolalia Residual: presence of negative symptom or positive symptom in diminished form after the acute phase has passed Schizophreniform Similar clinical picture to Schizophrenia except: ◦ Symptoms present less than 6 months ◦ Does not require impairment of social functioning Schizoaffective Period of illness includes both schizophrenic and depression features ◦ Delusions/hallucination had to be present over 2 weeks (in the absence of depression) Delusion Disorder Presence of non-bizarre delusion for over 1 month despite lack of evidence, without the other features of psychosis ◦ Erotomanic- another person is in love with individual ◦ Grandiose- individual has great but unrecognized talent ◦ Jealous- spouse or lover is unfaithful ◦ Persecutory- others conspire, harass, harm and malign individual ◦ Somatic- altered body functions Therapeutic Communication Do not dissuade or use logic to convince patient of reality Ask patient to explain the experience, but do not explore or go along with the hallucinations or delusions Address patient’s reaction to psychosis Your statements should communicate what is real, here and now Treatment – Acute Phase Patient/other safety ◦ Calm, organized and safe environment Reduce symptoms and their impact Antipsychotic medication: reduce activity of dopamine and other neurotransmitters ◦ EPS: TD/dystonia, akathisia Neuroleptic malignant syndrome A life threatening acute reaction to antipsychotic medications due to their blockage of dopamine-2 pathways Signs: changes in consciousness, delirium, hyperthermia, muscle cramps/rigidity, increased and unstable VS ◦ Elevated CPK, WBC ◦ Rapid course, peaks in 3 days Cease all suspect medications, support clinical picture, provide dopamine agonist Treatment – Maintenance Phase Provide supportive environment to prevent relapse and adherence to treatment ◦ ◦ ◦ ◦ Partial hospital program Crisis centers Halfway houses/group homes Day treatment programs Recreation and vocational programs
