Chapter 12

metabolic syndrome

Weight gain, dyslipidemia, and altered glucose metabolism caused by atypical antipsychotic drugs.

1.) Positive symptoms 2.) Negative symptoms 3.) Psychomotor symptoms

What are the 3 categories that symptoms of schizophrenia can be grouped into?

1.) Prodromal 2.) Active 3.) Residual

What are the 3 phases that people with schizophrenia go through?

Schizoaffective disorder

When an episode of major depression, mania, or mixed depression and mania occurs in the presence of symptoms of schizophrenia, it is called schizoaffective disorder.

Schizoaffective Disorder

When an episode of major depression, mania, or mixed presentation occurs in the presence of symptoms of schizophrenia.

According to the cognitive explanation, when people attempt to understand these unusual experiences, more features of their disorder emerge

When first confronted by voices or other troubling sensations, the individuals turn to friends and relatives. Naturally, the friends and relatives deny the reality of the sensations, and eventually the sufferers conclude that the others are trying to hide the truth. They begin to reject all feedback, and some develop beliefs (delusions) that they are being persecuted

Hallucination are?

When your senses are affected (voices, sounds) -No stimulus exists -Mostly auditory senses

neologisms

Words a person makes up that have meaning only for that person; often part of a delusional system.

It is not clear why African Americans are more likely than white Americans to receive this diagnosis. One possibility is that African Americans are more prone to develop schizophrenia. Another is that clinicians from majority groups are unintentionally biased in their diagnoses of African Americans or misread cultural differences as symptoms of schizophrenia.

Yet another explanation for the difference between African Americans and white Americans may lie in the economic sphere. On average, African Americans are more likely than white Americans to be poor;

token economy program

a behavioral program in which a person's desirable behaviors are reinforced systematically throughout the day by the awarding of tokens that can be exchanged for goods or privileges

thought deletion

a belief that one's thoughts have been taken or are missing

in the past if these symptoms shoed up, they would increase the dose. But now

a clinician will typically add an additional drug to achieve a synergistic effect, stop the drug and try an alternative one, or stop all medications

tangential speech

a communication disorder in which the train of thought of the speaker wanders and shows a lack of focus, never returning to the initial topic of the conversation.

case manager

a community therapist who offers a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patients' rights

alogia (poverty of speech)

a decrease in speech or speech content; a symptom of schizophrenia

catatonic excitement

a different form of catatonia, move excitedly, sometimes with wild waving of arms and legs

Phenothiazines

a group of antihistamine drugs that became the first group of effective antipsychotic medications

milieu therapy

a humanistic approach to institutional treatment based on the belief that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity

flat affect

a lack of emotional responsiveness significantly dulled emotional tone or outward reaction

psudoparkinsonima

a med induced temporary constellation of symptoms associated with parkinsons disease, including tremor, reduced accessory movements, impaired gait, and stiffening of muscles

circumstantial speech

a non-linear thought pattern and occurs when the focus of a conversation drifts, but often comes back to the point

anosognosia

a patients inability to realize that he or she is ill. caused by illness itself

catatonia

a pattern of extreme psychomotor symptoms, found in some forms of schizophrenia, which may include catatonic stupor, rigidity, or posturing

aftercare

a program of post-hospitalization care and treatment in the community

Schizophrenia

a psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of strange perceptions, unusual emotions, and motor abnormalities

second-generation antipsychotic drug

a relatively new group of antipsychotic drugs whose biological action is different from that of the traditional antipsychotic drugs. Also known as atypical antipsychotic drugs.

psychosis

a state in which a person loses contact with reality in key ways

delusion

a strange false belief firmly held despite evidence to the contrary

Many people recovering from such disorders receive occupational training in a sheltered workshop—

a supervised workplace for employees who are not ready for competitive or complicated jobs. For some, the sheltered workshop becomes a permanent workplace. For others, it is an important step toward better-paying and more demanding employment or a return to a previous job.

community mental health centers

a treatment facility that provides medication, psychotherapy, and emergency care for psychological problems and coordinates treatment in the community

Schizophrenia mothers

a type of mother-supposedly cold, domineering, and uninterestedin the needs of her children-who was once taught to cause schizophrenia in her child

Many studies suggest that schizophrenia, like a number of other mental disorders, is often linked to family stress. Parents of people with schizophrenia often

(1) display more conflict, (2) have more difficulty communicating with one another, and (3) are more critical of and overinvolved with their children than other parents.

The genetic view has been supported by studies of

(1) relatives of people with schizophrenia, (2) twins with schizophrenia, (3) people with schizophrenia who are adopted, and (4) genetic linkage and molecular biology.

formal thought disorders

(Disorganized thinking and speech) a disturbance in the production and organization of thought

neolgisms

(Disorganized thinking and speech) made-up words that typically have meaning only to the person using them

Perseveration

(Disorganized thinking and speech) repeat their words and statements again and again

clang

(Disorganized thinking and speech) rhyme to think or express themselves

loose associations (derailment)

(Disorganized thinking and speech) the most common formal thought disorder. When people rapidly shift from one topic to another, believing that their incoherent statements make sense.

auditory hallucinations

(Heighten perceptions and hallucinations) (most common) hear sounds and voices that seem to come from outside their heads

somatic hallucinations

(Heighten perceptions and hallucinations) feel as if something is happening inside the body, such as a snake crawling inside one's stomach

visual hallucinations

(Heighten perceptions and hallucinations) may produce vague perceptions of colors or clouds or distinct visions of people or objects

tactile hallucinations

(Heighten perceptions and hallucinations) may take the form of tingling, burning, or electric-shock sensations

gustatory hallucinations

(Heighten perceptions and hallucinations) regularly find that their food or drink tastes strange

olfactory hallucinations

(Heighten perceptions and hallucinations) smell odors that no one else does, such as the smell of poison or smoke

Hallucinations

(Heighten perceptions and hallucinations) the experiencing of sights, sounds, or other perceptions in the absence of external stimuli

ambivalence

(Loss of Volition) conflicting feelings, about most things

Avolition (or apathy)

(Loss of Volition) feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action

Positive symptoms of schizophrenia

(e.g., hallucinations, delusions, associative looseness) are easier to recognize and respond best to antipsychotic drug therapy.

delusions of persecution

(most common) believe they are being plotted or discriminated against, spied on, slandered, threatened, attacked, or deliberately victimized

Anhedonia

(restricted affect) general lack of pleasure or enjoyment

flat affect

(restricted affect) show almost no emotions at all

blunted affect

(restricted affect) they show less anger, sadness, joy, and other feelings than most people

Word salad

(schizophasia) is a jumble of words that is meaningless to the listener—and perhaps to the speaker as well—because of an extreme level of disorganization

biological

(the most support) -certain kinds of events or stressors are present -Genetic factors: inherit. when they face extremestress during adolescence or early adulthood...relaives, twins, adopted, genetic linkage -enlarged ventricles

List Neg Sx: Affective symptoms

**Assessment for depression is crucial** -May herald impending relapse -Increases substance abuse -Increases suicide risk -Further impairs functioning

implementation / interventions phase 1 acute: factors that affect choice of tx settings

*level of care / restrictiveness needed to prevent harm *needs for external structure / support *ability to cooperate with tx *need for tx only available in certain settings *need for tx of another medical condition *availability of 3rd party info & tx hx required so staff can assess needs

throughout much of the twentieth century the label "schizophrenia" was assigned to most people with psychosis. Clinical theorists now realize that many people with psychotic symptoms are instead experiencing a severe form of bipolar disorder or major depressive disorder and that such people were in past times inaccurately diagnosed with schizophrenia

,

residual phase

- return to prodromal like level of functioning- may retain some negative symptoms but have a lessening of the striking symptoms of the active phase

EPIDEMIOLOGY

-1/10,000 children -lifetime prevalence 1% -early onset: 18-25, males, poor fx before onset, brain structure abnormality, increased apathy -late onset: 25-35, female, less brain structure abnormality, better outcomes

Interventions for Hallucinations (nine of them)

-Ask directly about the hallucinations (Having them, content, command type?) -Watch for cues they are hallucinating -Redirect focus to your convo or a reality based thing -Assess and treat anxiety -Use competing stimuli -Address underlying issues: Fear, Self-esteem, Guilt -Assess triggers -Offer quiet room -Offer prn antianxiety agents and prn antipsychotics

Alteration in behavior (Pos sx) 10 of these

-Catatonia -Motor Retardation -Motor agitation -Stereotyped behaviors (repeated, illogical) -Wavy flexibiligy (pose pt and they stay until repositioned) -Echopraxia (copy your movements) -Negativism -Impaired impulse control -Gesturing or posturing (walk backwards, hop 3x) -Boundary impairment (dont know what's real)

Hypotension/Postural Hypotension Interventions

-Check BP before administering -Hold dose if systolic <80 mmHG when standing -Subsides in 1-2 wks -Check hydration, support hose (ted's)

List an actual psychiatric emergency

-Command Hallucinations Voices are telling you to kill someone or yourself Tx: Haldol or Thorazine

(Three) Nursing Dx for positive symptoms

-Disturbed sensory perception -Risk for self-directed or other directed violence -Impaired verbal communication

Interventions for Paranoid/Persecutory Delusions (Five)

-Do NOT touch patient without consent -Sealed food and drink -If patient has off ward privileges, let pt pick out food from vending -Allow family to bring in food -If pt appears paranoid while your talking to someone else. Include pt in discussion and explain what your talking about. No whispering

Anticholinergic Toxicity SE

-Dry Mucous Membranes, no peristalsis, mydriasis (dilated pupils), -Non-reactive pupils, hot dry skin with hyperthermia -Tachycardia, more psychosis, seizure, repetitive motor movement

Affective Sx of Schizophrenia

-Dysphoria, suicidality, hopelessness (Dysphoria- mood doesnt match what's going on)

Antipsychotics are: (six points)

-Effective for replases -Take 2-6 weeks to work -Increase mortality in elderly (atypicals) -Nonaddictive -Not lethal in overdose by themselves -Impaired swallowing

Traditional Antipyschotics: Low potency/High dose

-High sedation -High Ach SE -Low EPS -Thorazine "wine coolers"

Traditional Antipsychotics: High potency/ Low dose

-Low sedation -Low Ach SE -High EPS -Haldol "tequila,whiskey"

Interventions for delusions (five of them)

-Matter of fact approach -Asses content of delusions and quickly move onto reality topics -Focus on feelings underlying delusion (fear, self-esteem) -Gently question beliefs "Any other explanation?" -Observe triggers that precede delusions or make delusions worse

Interventions: Stabilization and Maintenance Phases (3)

-Med administration/adherence -Relationships with trusted care providers -Community based therapeutic services

First-Gen Antipsychotics target what symptoms?

-Positive schizophrenia sx -Dopamine antagonists

CBT in schizophrenia

-Provide clients education and evidence about biological causes of hallucinations -Help clients learn about comings and goings of hallucinations and delusions (learn triggers) -Challenge inaccurate ideas about power of hallucinations; Conduct behavioral experiments to test inaccurate ideas -Teach clients to more accurately interpret hallucinations -Teach techniques for coping with hallucinations and distract selves during hallucinations

Interventions: Acute Phase (6)

-Psych, med, neuro evaluation -Psyopharmacological Tx -Support, psychoeducation, and guidance -Supervision and limit setting in the milieu **Monitor fluid intake** --> Polydipsia & FVE -Identify needs for follow up and support early in admission

(Two) Nursing Dx for negative symptoms

-Social isolation -Chronic low self-esteem

Prodromal (forewarning sx) are?

-Socially awkward, lonely, depressed, vague/odd/eccentric expressions. -Intrusive thoughts, decreased functioning, mystical/ symbolic meanings, cant read other peoples facial expressions.

Treatment for Neuroleptic Malignant Syndrome (6)

-Stop/hold neuroleptic meds -STAT to ICU -Dantrium/Parlodel -Heparin (PE) -Cooling -Treat arrythmias and symptoms **NO REVERSAL MEDS**

Those at risk for Neuroleptic Malignant Syndrome ? (5)

-Those taking more psychotropic meds -Older females -Young Males -Rapid dose titration & Dehydration

1st gen antipsychotics common s/e

-ace & ach toxicity -orthostasis (orthostatic hypoTN) -photosensitivity -decreased seizure threshold -weight increase -sexual dysfunction -drooling

brief psychotic disorder

-acute onset of psychosis or grossly disorganized or catatonic bx in response to extreme stress. -lasts less than 1 month then goes away.

antipsychotics

-all take 2-6 weeks to work -may require significant dose adjustment to find the right balance with s/e -may need an adjunct med if MI fails to respond to antipsychotic alone -not addictive -may increase mortality rates in alz pts -may cause dysphagia so monitor meals and make diet changes if needed monitor airway

positive sxs inlude

-alterations in thought (delusions, concrete thinking, religiosity, magical thinking, paranoia,cog retardation, flight of ideas, thought blocking, thought insertion, thought deletion, inability to maintain attn) -alterations in speech (associative looseness, clang association, word salad, neologisms, echolalia, tangents, alogia, rapid speech) -alterations in perception (hallucinations) -bx alterations (bizzare agitated bxs, catatonia, motor retardation, stereotyped bxs, waxy flexibility, echopraxia, impaired impulse control, gesturing or posturing, boundary impairment)

1st gen antipsychotics ace s/e and nursing interventions

-anti eps drugs can cause ace s/e too and can worsen ace s/e of antipsychotics -urinary retention (run water, warm towel on abd) -dilated pupils -blurred vision (usually goes away in 1-2 weeks) -constipation (laxative) -reduced peristalsis -dry mucous membrances -dry eyes (avoid wind, fake tears) -dry mouth (fake saliva, ice chips) -cognitive impairment -sexual dysfunction (call dr)

3rd gen antipsychotics

-aripiprazole -DA system stabilizer -tx pos & neg & cog sxs -little r/f eps, td -little ace -unlikely to cause metabolic syndrome, hypoTN, sex s/e

etiology > course of disorder more prodromal stuff

-as anxiety increases, concentration, memory & completion of work deteriorates -intrusive thoughts, "mind wandering", need to spend more time maintaining thoughts reported. -routine stimuli can become overwhelming -events misinterpreted, mystical / symbolic meaning given to events -reading emotions becomes difficult

CLINICAL PICTURE children & adolescents & schizophrenia

-as children, schizophrenic pts often have unusual characteristics, do less well in school, less social, less positive, unusual motor development. -childhood schizophrenia is rare, dx before 12, worse prognosis -adolescents may experience social withdrawal, irritability, depression, antagonistic bx - common- conduct disorders, academic decline, suspicious, low level thought distortion -in children sxs severe enough to disrupt milestones

biological factors > neurobiological > other neurobiological hypothesis

-atypical (2nd gen) antipsychotics block 5HT & DA, suggesting 5HT plays a role too -PCP induces state closely resembling schizophrenia, this observation leads to interest in NDMA receptor & possible role of GLUTAMATE. (it may destroy brain tissue) -ACH also implicated

alterations in perception > hallucinations

-auditory is the most common -theory that voices are misinterpreted internally generated conversation -person struggles to understand AH & sometimes develops related delusions to explain the voices

1st gen antipsychotics

-blocks D2 receptors in limbic & motor systems (which causes EPS) -less expensive, less metabolic syndrome -divided into two classes 1) low potency (high sedation, high ACE, low EPS) 2) high potency (low sedation, low ACE, high EPS)

1st gen antipsychotics ace toxicity nursing interventions

-call the dr stat -hold all the meds -emergency cooling protocol -catheter -bzd or sedative prn administration -physostigmine may be ordered

alterations in thought

-cant reality test -make maintain & build upon errors in thinking & contributes to delusions

alterations in thought > concrete thinking

-cant think abstractly, often assessed via their interpretation of proverbs "a friend in need is a friend indeed" -decreases their ability to understand & address abstract concepts like love and the passing of time

ach toxicity

-cause by drugs c anticholinergic effects (anti eps meds and antipsychotics) -usually seen in older pts, ppl on mult meds c ace -hyperthermia -hot red dry skin -decreased bowel sounds -paralytic illeus -aggression -delirium -fluctuating vitals -tachycardia -mydriasis -confusion -mental status changes -worsening of pyschotic sxs -coma

NMS cause & sxs

-caused by excessive DA receptor block -usually occurs early in therapy -decreased consciousness, delirium, stupor, coma -muscular rigidiity -autonomic dysfunction( FEVER, labile HTN, tachycardia, tachypnea, SWEATING, drooling) -severe eps (cogwheeling, occulogyrocrisis, dysphagia) -FEVER FEVEER FEVERRRRRR IS CARDINAL FEATURE OVER 103

implementation / interventions phase 2 & 3 community resources

-community based programs may include psychotherapy, activities, training -give fam contact c support groups -other resources include community MH centers, HHS, supported employment services, peer services (club houses), fam edu / skills groups (nami), respite

NMS tx

-dc med -management of fluid balance -rapid temperature decrease -monitor for DVT, rhabdomyalasis (heparin) -bromocrptiine or dantrium

negative symptoms affective blunting

-decrease in expression, range, intensity of affect

adjuncts to therapy

-depression is common -mood stabilizers may increase effectivness of antipsychotics -valproate used in acute exacerbation of psychosis to quicken response to antipsychotic -bzds decrease anxiety, agitation, and contribute to positive & negative sx improvement

negative symptoms

-develop slowly, interfere the most with adjustment & coping -impedes ability to start & maintain conversations, make decisions & follow through, maintain good hygiene / grooming -contributes to poor social functioning & social withdrawl

assessment > prepsychotic stage

-early dx & tx lessens dev of the illness and decreases severity if it develops -delay in dx & tx leads to psychotic process being more entrenched leading to maladaptive coping -each relapse leads to increase in residual dysfunction & deterioration -early warning sx of relapse = decreased sleep & concentration

implementation / interventions teamwork & safety

-effective care provides 1 protection from undue stress 2 structure - milieu designed to give phys & social environment that is safe & gives opportunity to learn & practice skills

Delusional Disorder

-experiences non bizarre delusions (things that could happen like being followed, erotomania, somatic delusions). -NO psychosis -functions not significantly impaired.

socicultural treatments in schizophrenia

-family therapy -social therapy

application of nursing process > assessment

-focus is on sxs, coping, functioning, safety -interview pt & observe -include mental status exam, review of spiritual, cultural, biological, psychological, social & environmental elements that might affect presentation or may help recovery

anxiety, depression, suicide

-frequently co occur with schizophrenia! -anxiety may be response to sxs, circumstances (over stim, isolation), may worsen sxs & prognosis -10% of pts commit suicide (8.5x higher than gen pop)

1st gen antipsychotics a2block cv s/e & nursing interventions

-hypoTN & postural hypotn -tachycardia *check BP before administration *hold & call dr if systolic is <80 *assure adequate hydration *elastic bandages to prevent pooling

etiology > psychological & environmental factors prenatal stressors

-increased r/f schizophrenia c hx of pregnancy or birth complications -prenatal r/fs: poor nutrition, hypoxia, infectious agents (hsv2) -psychological trauma during pregnancy -father older than 35 -born in late winter/ early spring

biological factors > genetic

-increased rate in relatives of ppl c schizophrenia -r/f schizophrenia is 10% with first degree relative with it -twins 50% concordance rate (identical) -degree to which genetics play a role in causing it is 65-80% -multiple genes on different chromosomes interact in complex ways leading to vulnerability

psychotic or catatonic disorder NOS

-involve psychotic features (impaired reality testing, bizzare bxs) but dont meet criteria for dx as specific psychotic disorder -OR- -pt has gross change in motor bx but dont meet criteria for catatonic disorder

interventions counseling & communication techniques for associative looseness

-it often mirrors the pts idiosyncratic & disorganized thinking -an increase in associative looseness often follows increased anxiety or overwhelming internal & external stimuli -dont pretend you understand, dont tell them they arent making sense -"im having trouble following you -tell pt what you DO understand -look for recurring topics & themes and tie to events & timelines -summarize / paraphrase to model and let correct

1st gen antipsychotics what can help with EPS

-lowering dose, or low potency drug -anti parkinson drugs -ativan for akasthisia

polydipsia

-may lead to death -indicated by hyponatremia, confusion, worsening psych sxs, coma -s/e of meds contribute (dry mouth), so does compulsive bx & neuroendocrine abnormalities

alterations in perception > command hallucinations

-may warrant psych emer -essential to asses if they know they are not real and their ability to resist the commands

agranulocytosis

-monitor for total WBC below 3000/mm3 or neutropenia (ANC below 1500/mm3) -monitor for liver impairment -infection / sore throat -fever -malaise -mouth sores -increased infections -decreased wbcs and neutrophils

assessment >pre psychotic stage primary prevention

-monitor high risk ppl for sxs (abnormal social development & cognitive dys function) -reduce stressors, build resiliency, prophylactic meds

physical health illness

-more common, premature death higher, r/t HTN, obesity, CVD, DM, COPD -pts @ higher r/f apathy, poor health habits, meds, poverty, limited access to health care, failure to recognize sxs. -may not get good health care due to poverty, stigma, stereotyping (HCP thinks theyre delusional)

cognitive symptoms

-most people with schizophrenia have these -difficulty with attention, memory, information processing, cognitive flexibility, & executive functions -leads to poor judgement, less able to learn, cope,have job, manage health

sociocultural

-multicultural factors -social labeling -family dysfunctioning

substance abuse disorders

-nearly 1/2 of pts c schizophrenia -associated with non adherence, relapse, incarceration, homelessness, violence, suicide, poorer prognosis -may represent maladaptive way of coping with illness

NMS risk factors

-on more than 1 antipsychotic -older age -female (3.2) -have a mood disorder -rapid dose titration

phases of disorder phase 1 acute

-onset / worsening of extravagant disruptive sxs. -(hallucinations, delusions, apathy, withdrawl) -with resultant loss of functional abilities, increased care / hospitalization may be needed. -severe psychosis

outcomes identification phase 2 stabilization

-outcomes criteria focuses on: 1 help pt understand the MI & tx 2 become stabilized on meds 3 control or cope c sxs -targets (-) sxs & may address ability to succeed in social, vocational or self care activities

outcomes identification

-outcomes should focus on illness management, coping, maximizing quality of life -should be consistent with the RECOVERY MODEL

1st gen antipsychotics TD

-persistent eps in 10% of pts -choreoathetoid (snake/worm) movements -all in the face, tongue protrusion, rolling, lip smacking -as it progresses it can lead to similar movements in the fingers, toes,trunk, flapping arms. *NI: educate pt how to hide movements, check for it every 3 months

biological factors > brain structure abnormalities what do pet scans show

-pet scans show decreased rate of blood flow & glucose metabolism in frontal lobes which govern planning, abstract thinking, social adjustment, & decision making -also show decreased brain activity in frontal lobe -less brain matter -> lower blood flow -> lower 02 & glucose -decreased volume of grey matter, especially in frontal & temporal lobes -more tissue loss -> worse sx

planning phase 1 acute what does it focus on

-planning focuses on best ways to keep pt safe & control sx -discharge planning: pt & team ID needs for follow up & support. nurse considers external factors (home, supports) & internal factors (resilience, coping skills) -vigorous efforts made to connect pt & fam with communication resources

planning

-planning interventions guided by phase of MI & pt strengths and needs -cultural considerations, resources & pt preferences influences planning

etiology >course of disorder prodromal sxs

-prodromal sxs are like the forewarning, and may appear 1 month to more than 1 year before 1st psychotic break / full blown manifestation -in prodromal phase, anxiety, phobias, obsessions, dissociation & compulsions may be noted.

implementation / interventions phase 1 acute interventions include....

-psychiatric, med, & neuro evals -psychopharmacology -support, psychosocial education & guidance -supervision & structure in milieu -monitor fl intake -length of stay often short, end when acute sxs stabilize

phases of disorder phase 3 maintenance

-pt @ or nearing baseline -sxs absent or diminished

etiology > course of disorder prognostic considerations

-residual sxs when on meds, varying disability / dysfunction -abrupt sx onset is a favorable prognosis -good premorbid social & occupational functioning =better chance of remission -less (+) prognosis for... a slow and insidious onset (like 2-3 years), younger onset age, longer duration between 1st sx and tx, longer periods of un tx illness, more (-) sxs.

ETIOLOGY

-schizophrenia may actually be a group of disorders with common but varying features & multiple overlapping etiologies. -occurs when multiple inherited gene abnormalities combine with non genetic factors (viral infection, etc) altering the brain structure, affecting the brains NTM systems & or injuring brain directly. (DIATHESIS STRESS MODEL)

etiology > psychological & environmental factors psychological stressors

-stress increases cortisol, leads to hypothalamic development & other changes that may speed up illness in vulnerable ppl -schizophrenia often manifests @ times of dev & fam stress -other factors that increase risk: childhood sex abuse, psych trauma / social defeat, migration, social adversity

biological factors > brain structure abnormalities what parts of brain are different & how

-structure abnormalities may cause communication disruption -enlarged lateral cerebral ventricles, 3rd ventricle dilation, &/or ventricular asymmetry -decreased cortical, frontal lobe,hippocampal, &/or cerebellar volumes (reduced brain volume) -increased size of sulci (fissures) on brain surface (deeper sulci = less brain) -decreased cortical thickeness -decreased connectivity in various brain regions

CO-MORBIDITY schizophrenia can go hand in hand with...

-substance abuse disorders -nicotine dependence -anxiety, depression, suicide -physical health illnesses -polydipsia

phases of disorder phase 2 stabilization

-sxs diminishing, movement to baseline -partial hosp, care in residential crisis center, supervised group home may be needed

planning phase 2 & 3 stabilization & maintenance

-the focus is on providing pt & fam edu & skills training (psychosocial edu) -relapse prevention skills are vital -planning IDs interpersonal coping, health care, & vocational needs & addresses how & where these needs can be met in community

alterations in speech > associative looseness

-the mental threads that logically tie thoughts together are interrupted / disjointed. -thinking becomes random, illogical, difficult to follow.

outcomes identification phase 1 acute

-the overall goal is patient safety & stabilization -pt r/f violence to self or others, initial outcomes are about safety -want patient to realize hallucinations & delusions are not real, are part of their MI

2nd gen antipsychotics

-tx neg & pos sx -minimal EPS TD -weight increase -metabolic syndrome

biological factors > neurobiological > DA theory

-typical antipsychotics block D2 receptors in brain & reduce some sxs -because not all sxs go away, its likely other NTMs are involved -coke, meth, ritalin, levodopa all increase DA in brain & may bring on schizophrenia in biologically susceptible people

esearch finds that this practical, active, and broad approach, called social therapy or personal therapy, does indeed help keep people out of the hospital

. These clinicians offer practical advice; work with clients on problem solving, decision making, and social skills; make sure that the clients are taking their medications properly; and may even help them find work, financial assistance, appropriate health care, and proper housing

interventions patient & family education

1 learn all you can about the MI 2 develop a relapse plan, know early sx of relapse (avoiding others, lack of sleep, troubling thoughts) 3 participate in various types of therapy 4 learn new ways to act & cope 5 have a plan of coping skills for when things get tough 6 adhere to tx 7 avoid alc & drugs 8 have a support system 9 keep healthy & balanced

implementation / interventions phase 2 & 3 stabilization & maintenance effective long term care relies on...

1 med administration & adherence 2 relationships with care providers 3 community based therapeutic services

1st gen antipsychotics most common forms of EPS

1) acute dystonia (contraction of muscles, usually in head and neck is what book says, but our module said repetitive twisting motions) 2) akasthisia 3) psuedoparkinson

general assessment > major sx groups

1) positive sxs 2) negative sxs 3) cognitive sxs (subtle changes in thinking, attention, memory. impaired executive functioning) 4) affective sxs

Pos Sx: Other disorders of thought or speech (five)

1. Alogia (poverty of speech) 2. Flight of ideas 3. Thought blocking --> voices tell them to stop talking and leave 4. Thought Insertion --> Putting aluminum foil to block thoughts 5. Thought deletion --> Thinks their brain is being sucked out and their thoughts are being stolen

Guidelines require you to assess: (11 listed)

1. Any medical problems 2. Abuse of or dependence on alcohol or drugs 3. Risk to self or others 4. Command hallucinations 5. Delusions 6. Suicide Risk 7. Ability to ensure self-safety 8. Medications 9. Mental status exam 10. Patient's insight into illness (wont admit their mentally ill) 11. Family's knowledge of patient's illness and symptoms

Schizophrenics must have: (3 things) in order to be diagnosed with schizophrenia

1. At least one psychotic sx: (Hallucinations, delusion or disorganized speech) 2. Unable to function 3. Neglecting basic needs

List 4 alterations in a Schizophrenics speech

1. Clang Associations 2. Word Salad --> cant make sense of anything 3. Neologisms --> made up words 4. Echolalia --> repeating your phrases

Other positive sx of Schizophrenia are? (six)

1. Religiosity 2. Magical thinking- superstitions 3. Paranoia 4. Circumstantiality --> Ask a question and they give you small talk 5. Tangentiality --> Redirect them back to question- Distracted Pt 6. Cognitive retardation --> Doesnt answer you just stares at you

The therapists believe that if people can be guided to interpret such experiences in a more accurate way, they will not suffer the fear and confusion produced by their delusional misinterpretations. Thus, the therapists use a combination of behavioral and cognitive techniques:

1. They provide clients with education and evidence about the biological causes of hallucinations. 2. They help clients learn more about the "comings and goings" of their own hallucinations and delusions. The clients learn, for example, to identify which kinds of events and situations trigger the voices in their heads. 3. The therapists challenge their clients' inaccurate ideas about the power of their hallucinations, such as the idea that the voices are all-powerful and uncontrollable and must be obeyed. The therapists also have the clients conduct behavioral experiments to put such notions to the test. What happens, for example, if the clients occasionally resist following the orders from their hallucinatory voices? 4. The therapists teach clients to more accurately interpret their hallucinations. Clients may, for example, adopt alternative conclusions such as, "It's not a real voice, it's my illness." 5. The therapists teach clients techniques for coping with their unpleasant sensations (hallucinations). The clients may, for example, learn ways to reduce the physical arousal that accompanies hallucinations—using special breathing and relaxation techniques and the like. Similarly, they may learn to distract themselves whenever the hallucinations occur

assessment guidelines

1. med work up, assess for med probs that mimic psychosis 2. assess drug / alc abuse / dependency 3. determine risk to self / others 4. assess command hallucinations 5. assess for delusions (are they firmly held, can pt reality test, does pt believe they want to hurt self or fam, does pt feel need to protect) 6. assess for suicide risk 7. assess for ability to ensure personal safety (food & fl intake, can walk safely, hygiene & self care, impulse control / judgement) 8. assess rx meds & fx affecting adherence 9. mental status exam 10. assess insight, knowledge of the mi, relationships, support system, coping resources, strengths 11 assess fam knowledge & response to the MI& its sxs

Schizophrenia checklist

1.For 1 month, individual displays two or more of the following symptoms much of the time: -Delusions -Hallucinations -Disorganized speech -Very abnormal motor Activity, including catatonia -Negative symptoms 2.At least one of the individual's symptoms must be delusions, hallucinations, or disorganized speech 3.Individual functions much more poorly in various life spheres than was the case prior to the symptoms 4.Beyond this 1 month of intense symptomology, individual continues to display some degree of impaired functioning for at least 5 additional months.

nicotine dependence

70-90% of pts increased incidence of CV & respiratory disorders

bx alterations waxy flexibility

?

Token economy program

A behavioral program in which a person's desirable behaviors are reinforced systematically throughout the day by the awarding of tokens that can be exchanged for goods of privileges

Thought deletion

A belief that one's thoughts have been taken or are missing

Case manager

A community therapist who offers a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patient's rights

case manager

A community therapist who offers a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patients' rights.

alogia

A decrease in speech or speech content; a symptom of schizophrenia. Also known as poverty of speech.

Alogia (poverty of speech)

A decrease in speech or speech content; symptom of schizophrenia

Catatonic excitement

A different form of catatonia in which people move excitedly, sometimes wildly waving their arms and legs

catatonic excitement

A different form of catatonia, move excitedly, sometimes wildly waving their arms and legs.

Polygenic disorder

A disorder caused by a combination of gene defects

formal thought disorder

A disturbance in the production and organization of thought. Often take the form of positive symptoms (pathological excesses), as in loose associations, neologisms, perseveration, and clang.

Formal thought disorder

A disturbance in the production and organization of thought; can cause the sufferer great confusion and make communication extremely difficult

associative looseness

A disturbance of thinking in which ideas shift from one subject to another in an oblique or unrelated manner

delusions

A false belief held to be true even with evidence to the contrary (e.g., a false belief that one is being singled out for harm by others)

Derealization

A false perception that the environment has changed (e.g., everything seems bigger or smaller, or familiar surroundings seem somehow strange and unfamiliar)

Depersonalization

A feeling that one is somehow different or unreal or has lost his identity

Cognitive retardation

A generalized slowing in the pace of thinking, represented by delays in responding to questions or difficulty finishing one's thoughts

Phenothiazines

A group of antihistamine drugs that became the first group of effective antipsychotic medications

Phenothiazines

A group of antihistamine drugs that became the first group of effective antipsychotic medications.

Mileau Therapy

A humanistic approach to institutional treatment based on the premise that institutions can help patients recover by creating a climate that promotes self-respect, individual responsible behavior, and meaningful activity

Milieu therapy:

A humanistic approach to institutional treatment based on the premise that institutions can help patients recover by creating a climate that promotes self-respect, individual responsible behavior, and meaningful activity.

Milieu therapy

A humanistic approach to institutional treatment based on the premise that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity

L-dopa

A medication that raises the dopamine activity so much that it produced psychosis

pseudoparkinsonism

A medication-induced temporary constellation of symptoms associated with Parkinson's disease, including tremor, reduced accessory movements, impaired gait, and stiffening of muscles.

word salad

A mixture of words meaningless to the listener and to the speaker as well.

recovery model

A model that is patient/consumer-centered, is hopeful and empowering, and emphasizes the person and the future rather than the illness and the present

stereotyped behaviors

A motor pattern that originally had meaning to the person (e.g., sweeping the floor, washing windows) but has become mechanical and lacks purpose.

third-generation antipsychotics

A newer classification of antipsychotics includes aripiprazole (Abilify), a unique antipsychotic dopamine system stabilization. In areas of the brain with excess dopamine, it lowers the dopamine level by acting as a receptor antagonist; however, in regions with low dopamine, it stimulates receptors to raise the dopamine level. Side effects include insomnia and akathisia.

second-generation antipsychotics

A newer classification of drugs (compared to first-generation antipsychotics) that produces fewer extrapyramidal side effects (EPS) and targets both the negative and positive symptoms of schizophrenia.

Schizophrenia spectrum disorders

A number of schizophrenia-like disorders listed in the DSM-5, each distinguished by particular durations and sets of symptoms

anosognosia

A patient's inability to realize that he or she is ill, which is caused by the illness itself.

Catatonia

A pattern of extreme psychomotor symptoms, found in some forms of schizophrenia, which may include catatonic stupor, rigidity, or posturing

catatonia

A pattern of extreme psychomotor symptoms, found in some forms of schizophrenia, which may include catatonic stupor, rigidity, or posturing.

Delusional disorder

A person with delusional disorder experiences nonbizarre delusions (e.g., situations that could occur in real life, such as being followed, being loved by another, or having a disease). Apart from the delusion, functioning is not significantly impaired and there are no other symptoms of psychosis. A related disorder, Capgras Syndrome, involves a delusion about a significant other (e.g., family member or pet) being replaced by an imposter; this disorder may be due to psychiatric or organic brain diseas

Delusional Disorder

A person with delusional disorder experiences nonbizarre delusions.

depersonalization

A phenomenon whereby a person experiences a sense of unreality of or estrangement from the self. For example, one may feel that limbs or extremities have changed, that one is seeing self and events from a distance, or that one is in a dream

depersonalization

A phenomenon whereby a person experiences a sense of unreality of or estrangement from the self. For example, one may feel that limbs or extremities have changed, that one is seeing self and events from a distance, or that one is in a dream a feeling that one is somehow different of unreal or has lost his identity a phenomenon whereby a person experiences a sense of unreality of or estrangement from the self.

reality testing

A process by which a person is objectively able to evaluate the external world and adequately distinguish it from the internal world (the self).

Aftercare

A program of post-hospitalization care and treatment in the community

aftercare

A program of post-hospitalization care and treatment in the community

Day center (day hospital)

A program that offers hospital-like treatment during the day only

day center

A program that offers hospital-like treatment during the day only. Also known as a day hospital.

Catatonia

A pronounced increase or decrease in the rate and amount of movement; the most common form is stuporous behavior in which the person moves little or not at all

Schizophrenia

A psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of strange perceptions, disturbed thought processes, unusual emotions, and motor abnormalities.

Schizophrenia

A psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities

neuroleptic malignant syndrome (NMS)

A rare and sometimes fatal reaction to high-potency neuroleptic drugs. Symptoms include muscle rigidity, fever, and elevated white blood cell count. It is thought to result from dopamine blockage at the basal ganglia and hypothalamus.

Alogia, or poverty of speech

A reduction in spontaneity or volume of speech, represented by a lack of spontaneous comments and overly brief responses

Thought blocking

A reduction in the amount of thinking; an abrupt stoppage of thought that derails conversation

atypical antipsychotic drugs

A relatively new group of antipsychotic drugs whose biological action is different from that of the conventional antipsychotic drugs. Also known as second-generation antipsychotic drugs.

Second-generation antipsychotic drugs (atypical antipsychotic drugs)

A relatively new group of antipsychotic drugs whose biological action is different from that of the traditional antipsychotic drugs

Halfway house (group home)

A residence for people with schizophrenia or other severe disorders often started by paraprofessionals

Halfway house:

A residence for people with schizophrenia or other severe problems, often staffed by paraprofessionals. Also known as a group home or crisis house. Many people do not require hospitalization but are unable to live alone or with their families.

hallucinations

A sense perception (seeing, hearing, tasting, smelling, or touching) for which no external stimulus exists (e.g., hearing voices when none are present).

tardive dyskinesia (TD or TDK)

A serious and irreversible side effect of phenothiazines and related drugs; consists of involuntary tonic muscle spasms typically involving the tongue, fingers, toes, neck, trunk, or pelvis

paranoia

A state characterized by the presence of intense and strongly defended irrational suspicions. These ideas cannot be corrected by experience and cannot be modified by facts or reality.

Psychosis

A state in which a person loses contact with reality in key ways

Delusion:

A strange false belief firmly held despite evidence to the contrary. Delusions of persecution are the most common in schizophrenia

Delusion

A strange, false belief firmly held despite evidence to the contrary

Sheltered workshop

A supervised workplace for people who are not yet ready for competitive jobs

sheltered workshop

A supervised workplace for people who are not yet ready for competitive jobs.

Community mental health center

A treatment facility that provides medication, psychotherapy, and emergency care for psychological problems and coordinates treatment in the community

Schizophrenogenic mother

A type of mother--supposedly cold, domineering, and uninterested in the needs of her children--who was once thought to cause schizophrenia in her children

Schizophrenogenic mother:

A type of mother—supposedly cold, domineering, and uninterested in the needs of her children—who was once thought to cause schizophrenia in her child. In fact, the majority of people with schizophrenia do not appear to have mothers who fit the schizophrenogenic description

schizophrenic mother

A type of mother—supposedly cold, domineering, and uninterested in the needs of her children—who was once thought to cause schizophrenia in her child. (psychodynamic)

extrapyramidal side effects (EPSs)

A variety of signs and symptoms that are often side effects of the use of certain psychotropic drugs, particularly phenothiazines. Three reversible extrapyramidal side effects are acute dystonia, akathisia, and pseudoparkinsonism. A fourth, tardive dyskinesia, is the most serious and is not reversible.

Which assessment finding represents a negative symptom of schizophrenia: A. Apathy B.Delusion C. Motor tic D. Hallucination

A. Apathy

A patient with schizophrenia says "There are worms under my skin eating the hair follicles." How would you classify this assessment finding? A. Pos Symptom B. Neg Symptom C. Cognitive Symptom D. Depressive Symptom

A. Positive Symptom

Third Gen Antipsychotic is? And what does it do?

Abilify -Dopamine stabillizer -Improves positive and negative symptoms and cognitive function -Little risk of EPS or tardive dyskinesia

Third Gen/ Antipsychotics (one)

Abilify (aripiprazole)

cognitive symptoms

Abnormalities in how a person thinks., Include feelings of pessimism, loss of interest and motivation, ideas of guilt, difficulty in concentration and making decisions

the cognitive explanation for schizophrenia starts with the premise that people with the disorder do indeed actually hear voices (or experience other kinds of hallucinations) as a result of biologically triggered sensations.

According to this theory, the journey into schizophrenia takes shape when people try to make sense of these strange sensations and conclude incorrectly that the voices are coming from external sources, that they are being persecuted, or another such notion. These misinterpretations are essentially delusions.

Community Mental Health Act (CMHA)

Act which provided that patients with psychological disorders were to receive a range of mental health services

Outcomes for phase I (List one)

Acute -Patient safety and medical stabilization

Phase I of Schizophrenia

Acute Phase -Onset or exacerbation of symptoms

acute dystonia

Acute, often painful, sustained contraction of muscles, usually of the head and neck, which typically occurs from 2 to 5 days after the introduction of antipsychotic medications.

Phases of Schizophrenia: Phase I

Acute: Onset or exacerbation of florid, disruptive symptoms (e.g., hallucinations, delusions, apathy, withdrawal) with resultant loss of functional abilities; increased care or hospitalization may be required.

Advantages vs Disadvantages of First Gen Antipsychotics

Advantage: less expensive than 2nd gen Disadvantages: -EPS Side effects -Anticholinergic SE -Tardive Dyskinesia -Weight gain, sexual Dysfunction, endocrine disturbances

Second Gen Atypical Antipsychotics Advantages/Disadvantages

Advantages: Treat both positive and negative symptoms -Minimal to no EPS symptoms or Tardive Dyskinesia Disadvantages: Causes significant weight gain (except abilify) -Metabolic syndrome

List Negative Sx of Schizophrenia (four)

Affect: Outward expression of feelings 1. Flat 2. Blunted 3. Inappropriate/noncongruent 4.Bizarre

It also appears that schizophrenia differs from country to country in key ways

Although the overall prevalence of this disorder is stable—around 1 percent—in countries across the world, the course and outcome of the disorder may vary considerably.

neuroleptic drugs

An alternative term for conventional antipsychotic drugs, so called because they often produce undesired effects similar to the symptoms of neurological disorders.

command hallucinations

An individual hearing voices that direct the person to take action.

Adjuncts to antipsychotic drug therapy (3 types)

Antidepressants Mood stabilizing agents Antianxiety agents (emergency)

Second-generation antipsychotic drugs

Antipsychotic drugs which appear to be more effective than the conventional antipsychotics

Extrapyramidal areas

Areas of the brain that control motor activity

Third-Generation Antipsychotic (drug)

Aripiprazole (Abilify)

the move toward institutionalization in hospitals began in 1793 when French physician Philippe Pinel "unchained the insane" at La Bicêtre asylum and began the practice of "moral treatment."

As Pinel's ideas spread throughout Europe and the United States, they led to the creation of large mental hospitals rather than asylums to care for those with severe mental disorders

Rates of schizophrenia appear to differ between racial and ethnic groups, particularly between African Americans and white Americans

As many as 2.1 percent of African Americans receive a diagnosis of schizophrenia, compared with around 1.4 percent of white Americans

Second-Generation Antipsychotics (drugs)

Asenapine (Saphris) Clozapine (Clozaril) Iloperidone (Fanapt) Lurasidone (Latuda) Olanzapine (Zyprexa) Paliperidone (Invega) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon)

Catatonic posturing

Assuming awkward, bizarre positions for long periods of time

Gesturing or posturing

Assuming unusual and illogical expressions (often grimaces) or positions

List Neg Sx: Cognitive Symptoms

Attention, memory, information processing Cognitive flexibility, and executive functions

Psychomotor symptoms

Awkward movements or repeated grimaces and odd gestures that seem to have a private purpose

For more than half of the twentieth century, most people diagnosed with schizophrenia were institutionalized in a public mental hospital.

Because patients with schizophrenia did not respond to traditional therapies, the primary goals of these hospitals were to restrain them and give them food, shelter, and clothing. Patients rarely saw therapists and generally were neglected.

people with schizophrenia may withdraw from their social environment and attend only to their own ideas and fantasies

Because their ideas are illogical and confused, the withdrawal has the effect of distancing them still further from reality. The social withdrawal seems also to lead to a breakdown of social skills, including the ability to recognize other people's needs and emotions accurately

Delusion: Erotomanic

Believing that another person desires you romantically

Delusion: Control

Believing that another person, group of people, or external force controls thoughts, feelings, impulses, or behavior

Delusion: Grandeur

Believing that one is a very powerful or important person

Delusion: Persecution

Believing that one is being singled out for harm by others; this belief often takes the form of a plot by people in power

Delusion: Jealousy

Believing that one's mate is unfaithful

Delusion: Somatic

Believing that the body is changing in unusual ways (e.g., rotting inside)

Virus theory

Brain abnormalities may result from exposure to viruses before birth

Enlarged ventricles

Brain cavities that contain cerebrospinal fluid

Before the discovery of antipsychotic drugs, psychotherapy was not really an option for people with schizophrenia. Most were too far removed from reality to profit from it. Today, however, psychotherapy is helpful to many such patients

By helping to relieve thought and perceptual disturbances, antipsychotic drugs allow many people with schizophrenia to learn about their disorder, participate actively in therapy

Neuroleptic Malignant Syndrome Symptoms (12)

Can occur anytime, can progress over 2 days -Pallor, drooling, sweating, severe EPS, rigidity, Rigid/Board-like -Hyperpyrexia, HTN, tachycardia, incontinence, stupor, coma

Low Potency 1st generation

Chlorpromazine (Thorazine) Thioridazine(Mellaril)

Back wards

Chronic wards where patients were transferred to if they failed to improve quickly

What med do you give for agranulocytosis? Labs to check?

Clozaril Check WBC & ANC (neutrophils) --> Normal is 5-10,000 for WBC

Second Gen/Atypical Antipsychotics (four)

Clozaril, Zyprexa, Seroquel, Risperal

Ambivalence

Conflicting feelings about most things

Neuroleptic drugs (conventional antipsychotic drugs

Conventional antipsychotic drugs, so called because they often produce undesired effects similar to the symptoms of neurological disorders

Loose associations in a person with schizophrenia indicate: A. Paranoia B. Mood Instability C. Depersonalization D. Poorly organized thinking

D. Poorly organized thinking

partial hospitalization

Day Centers: Program that offers hospital like tx during day where return home at night (day hospital) -Provide daily supervised activities, tx, and programs to improve social skills

Define Depersonalization vs Derealization

Depersonalization is when your personal identity has changed Derealization is when the environment has changed

Negative Sx of Schizophrenia

Develop slowly, interfere with coping Absence of something that should be there Blunted/flat affect Alogia (poverty of thought), avolition (no motivation), and anhedonia (unable to experience pleasure/joy)

Maxwell Jones

Developed the first application of milieu therapy

Psychotic or catatonic disorder not otherwise specified

Disorders that involve psychotic features such as impaired reality testing or bizarre behavior but do not meet the criteria for diagnosis as specific psychotic disorders are diagnosed as Psychosis Not Otherwise Specified (NOS). Similarly, persons exhibiting gross changes in the rate of motor behavior but who do not meet the criteria for Catatonic Disorder are categorized as Catatonic Disorder NOS.

Psychotic of Catatonic Disorder Not Otherwise Specified

Disorders that involve psychotic features such as impaired reality testing or bizarre behavior but do not meet the criteria for diagnosis of specific psychotic disorders.

inappropriate affect

Display of emotions that are unsuited to the situation; a symptom of schizophrenia.

Inappropriate affect

Displays of emotions that are unsuited to the situation; symptom of schizophrenia

Schizophrenia Nursing dx

Disturbed sensory perception, Acute confusion, Impaired communication, Ineffective coping, Risk for self-directed or other-directed violence, and Impaired family coping

negativism

Doing the opposite of what others want

Which neurotransmitter does schizophrenia affect?

Dopamine

Agranulocytosis Interventions

Drug discontinued, reverse isolation, mortality is high WBC below 3,000 or ANC below 1500 --> If this happens you can never be on clozaril ever again, it's very deadly.

Dopamine antagonists

Drugs that bind to dopamine receptors, prevent dopamine from binding there, and so prevent the neurons from firing

Antipsychotic drugs

Drugs that revolutionized schizophrenia treatment; help correct grossly confused or distorted thinking

Anticholinergic SE:

Dry mouth, urinary retention, constipation, blurred vision, photo sensitivity, dry eyes, sexual dysfunction.

the 25 million schizophrenic patients who live in developing countries have better recovery rates than schizophrenic patients in Western and other developed countries

During the course of the two-year study, the schizophrenic patients from developing countries (Columbia, India, and Nigeria) were more likely than those in developed countries (the Czech Republic, Denmark, Ireland, Japan, Russia, the United Kingdom, and the United States) to recover from their disorder and less likely to have continuous symptoms, impaired social functioning, or require heavy antipsychotic drugs or hospitalization.

Psychosis of Catatonia Associates with Another Medical Condition

E.g. delirium, neurological or metabolic conditions, hepatic or renal diseases, etc. caused by a medical condition.

Polydipsia

EXCESSIVE THIRST, can lead to fatal water intoxication (indicated by hyponatremia, confusion, worsening psychotic symptoms, and ultimately coma).

Freida Fromm-Reichmann

Elaborated on an earlier notation by Freud that cold or un-nurturing parents may set schizophrenia in motion

illusions

Errors in the perception of a sensory stimulus. For example, a person may mistake polka dots on a pillow for hairy spiders.

United States were even required by law to establish public mental institutions, state hospitals, for patients who could not afford private ones.

Eventually, however, the state hospital system encountered serious problems. Between 1845 and 1955, nearly 300 state hospitals opened in the United States, and the number of hospitalized patients on any given day rose from 2,000 in 1845 to nearly 600,000 in 1955. During this expansion, wards became overcrowded, admissions kept rising, and state funding was unable to keep up

Motor agitation

Excited behavior such as running or pacing rapidly, often in response to internal or external stimuli; it can pose a risk to the patient (e.g., exhaustion, collapse, and even death) or others (being knocked down)

Tardive dyskinesia

Extrapyramidal effects involving involuntary movements that some patients have after they have taken conventional antipsychotic drugs for an extended time

tardive dyskinesia

Extrapyramidal effects that appear in some patients after they have taken conventional antipsychotic drugs for an extended time.

Define FEVER mnemonic for NMS (neuroleptic syndrome)

F= Fever E= Encephalopathy -->confusion, disorientation V= Vital sign instability --> tachycardia, fluctuating BP E= Enzyme elevations (CPK levels) R= Rigidity

Positive Sx- Delusions are?

False fixed beliefs that cannot be changed by logic Usually: Persecutory, grandiose, somatic, ideas of reference

Somatic hallucinations

Feel as if something is happening inside the body

Avolition (apathy)

Feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action

Thought insertion

Feeling that one's thoughts are not one's own or that they were inserted into one's mind

Later onset (25-35) means:

Females usually Less structural damage= better outcomes

Second-generation antipsychotic drugs appear to be more effective than the conventional drugs

Given such advantages, more than half of all medicated patients with schizophrenia now take the second-generation drugs, which are considered the first line of treatment for the disorder

Delusion: Ideas of Reference

Giving personal significance to unrelated or trivial events; perceiving events as relating to you when they are not

First Gen/ Typical Antipsychotics (four)

Haldol, Thorazine, Prolixin, Navane

Supervised Residences

Halfway house: Staffed by paraprofessionals with milieu tx- also known as group home or crisis house

Define Hallucination vs Delusion

Hallucination is a sensory stimuli that isn't there Delusion is a belief that isn't real

tactile hallucinations

Hallucination primarily involving the sense of touch alcohol withdrawal (formication) cocaine abusers ("cocaine bugs") when someone experiences some perception related to touch when it is not really there.

Semi-hospital (residential crisis center)

Houses or other structures in the community that provide 24-hour care for people with severe mental disorders

concordant

If both members of a pair of twins have a particular trait, they are said to be

delusions of grandeur

Im a governor

Jones

In 1953, Maxwell _______, a London psychiatrist, converted a ward of patients with various psychological disorders into a therapeutic community—the first application of milieu therapy in a hospital setting

prodromal, active, residual

In Schizophrenia, many sufferers experience three phases:

Various studies have pointed to genetic factors, poor nutrition, fetal development, birth complications, immune reactions, and toxins

In addition, some investigators suggest that the brain abnormalities may result from exposure to viruses before birth. Perhaps the viruses enter the fetus' brain and interrupt proper brain development, or perhaps the viruses remain quiet until puberty or young adulthood, when, activated by changes in hormones or by another viral infection, they help to bring about schizophrenic symptoms

More than 50 percent of those who are recovering from schizophrenia and other severe mental disorders live with their families:

In family therapy, relatives develop more realistic expectations and become more tolerant, less guilt-ridden, and more willing to try new patterns of communication. Family therapy also helps the person with schizophrenia cope with the pressures of family life, make better use of family members, and avoid troublesome interactions. Research has found that family therapy—particularly when it is combined with drug therapy—helps reduce tensions within the family and so helps relapse rates go down

In 1953, Maxwell Jones, a London psychiatrist, converted a ward of patients with various psychological disorders into a therapeutic community—the first application of milieu therapy in a hospital setting.

In such settings, patients are often given the right to run their own lives and make their own decisions. They may participate in community government, working with staff members to set up rules and decide penalties.

akathesia

Inability to remain still; motor restlessness and anxiety

Congnitive Sx of schizophrenia

Inattention, impaired memory, poor problem solving poor decision making, illogical thinking, impaired judgement

Circumstantiality

Including unnecessary and often tedious details in one's conversation (e.g., describing your breakfast when asked how your day is going)

Dual diagnosis patients (mentally ill chemical abusers)

Individuals with psychotic disorders as well as substance use disorders

researchers have run studies of genetic linkage and molecular biology to pinpoint the possible genetic factors in schizophrenia

It is most likely, however, that schizophrenia, like a number of other disorders, is a polygenic disorder, caused by a combination of gene defects

Henri Laborit soon discovered that one group of antihistamines, phenothiazines, could also be used to help calm patients about to undergo surgery.

Laborit suspected that the drugs might also have a calming effect on people with severe psychological disorders. One of the drugs, chlorpromazine, was eventually tested on six patients with psychotic symptoms and found to reduce their symptoms sharply.

Tangentiality

Leaving the main topic to talk about less important information; going off on tangents in a way that takes the conversation off-topic.

Live-in staff members usually are paraprofessionals—lay people who receive training and ongoing supervision from outside mental health professionals. The houses are usually run with a milieu therapy philosophy that emphasizes mutual support, resident responsibility, and self-government.

Live-in staff members usually are paraprofessionals—lay people who receive training and ongoing supervision from outside mental health professionals. The houses are usually run with a milieu therapy philosophy that emphasizes mutual support, resident responsibility, and self-government.

Med. Potency 1st generation

Loxapine (Loxitane) Molindone (Moban) Perphenazine (Trilafon)

Neologisms

Made-up words that typically have meaning only to the person using them

Phase III of Schizophrenia

Maintenance -At or near baseline functioning

Outcomes for phase III

Maintenance -Maintain achievement -Prevent relapse -Achieve independence, satisfactory quality of life

Phases of Schizophrenia: Phase III

Maintenance: The patient is at or nearing baseline (or premorbid) functioning; symptoms are absent or diminished; level of functioning allows the patient to live in the community. Ideally, recovery with reduced or no residual symptoms has occurred.

Schizophrenia is more frequently found in?

Males & Urban areas Onset: late teens to early twenties

Early onset (18-25) means:

Males usually Poor functioning before onset, more structural brain damage, increased apathy.

Cognitive explanation

Match the biological view -strange unreal sensations- triggered by Biological factors

Visual hallucinations

May produce vague perceptions of colors, clouds, distinct visions of people or objects

Tactile hallucinations

May take the form of tingling, burning, or electric-shock sensations

Social withdrawal in schizophrenia

May withdraw from social environment and attend only to their own ideas and fantasies -attend only to their own ideas and fantasies Seems to lead to a breakdown of social skills, including the ability to accurately recognize other people's needs and emotions

echopraxia

Mimicry or imitation of the movements of another person.

Research has shown that antipsychotic drugs reduce symptoms in at least 65 percent of patients diagnosed with schizophrenia

Moreover, in direct comparisons the drugs appear to be a more effective treatment for schizophrenia than any of the other approaches used alone, such as psychotherapy, milieu therapy, or electroconvulsive therapy.

Delusions of persecution

Most common delusion in those with schizophrenia

Flight of ideas

Moving rapidly from one thought to the next, making it difficult for others to follow the conversation

Amphetamine psychosis

Observed that people who take high doses of amphetamines may develop a syndrome very similar to schizophrenia

Cognitive symptoms

Often subtle changes in memory, attention, or thinking (e.g. impaired executive functioning)

Phase I—Acute

Onset or exacerbation of florid, disruptive symptoms (e.g., hallucinations, delusions, apathy, withdrawal) with resultant loss of functional abilities; increased care or hospitalization may be required.

EPS symptoms: Acute dystonia (Onset, SE, Tx)

Onset: 1-5 days SE: Opisthonotus, Oculogyric crisis, Laryngeal dystonia: monitor airway, and Cogwheel rigidity. Tx: Congentin or Benedry --> Response in minutes

EPS symptoms: Akathesia (Onset, SE, Tx)

Onset: 2 hours-60 days SE: Motor internal restless motor restlessness, Increase Suicide Tx: Congentin, Inderal, Ativan

Tardive Dyskinesia (Onset, Face SE, Limbs SE, Tx)

Onset: 20% taking meds for 2 years develop TD Face: Protruding/rolling tongue, smacking, licking, sucking, spastic facial distortions Limbs: Choreic: rapid purposeless irregular movements Athetoid: serpentine, writhing Trunk: Hip jerks, pelvic thrusts Tx: AIMS screen q 3 months, change meds **Irreversible, may or may not progress**

EPS symptoms: Pseudoparkisonism (Onset, SE, Tx)

Onset: 5 hour-30 days Se: Masklike facies, stiff/stooped posture, shuffling gait, drooling, tremor, pill rolling Tx: Artane, Congentin, or Benedryl

Delusions of reference

People attach special and personal meaning to the actions of others or to various objects/events

Delusions of persecution

People believe that they're being plotted or discriminated against, spied on, slandered, threatened, attacked, or deliberately victimized; most common

Delusions of control

People believe their feelings, thoughts, and actions are being controlled by other people

Delusions of grandeur

People believe themselves to be great inventors, religious saviors, or other specially empowered persons

Auditory hallucinations

People hear sounds and voices that seem to come from outside their heads, most common kind

Catatonia

People in a catatonic stupor stop responding to their environment, remaining motionless and silent for long stretches of time. Recall how Richard would lie motionless and mute in bed for days. People with catatonic rigidity maintain a rigid, upright posture for hours and resist efforts to be moved. Still others exhibit catatonic posturing, assuming awkward, bizarre positions for long periods of time. Finally, people with catatonic excitement, a different form of catatonia, move excitedly, sometimes wildly waving their arms and legs.

Catatonic rigidity

People maintain a rigid, upright posture for hours and resist efforts to be moved

Catatonic stupor

People stop responding to their environment, remaining motionless and are silent for long stretches of time

Do such findings mean that family dysfunctioning helps cause and maintain schizophrenia? Not necessarily. It is also the case that people with schizophrenia greatly disrupt family life In so doing, they themselves may help produce the family problems that clinicians and researchers continue to observe

People who are trying to recover from schizophrenia are almost four times more likely to relapse if they live with such a family than if they live with one low in expressed emotion

rapidly shift from one topic to another, believing that their incoherent statements make sense. A single, perhaps unimportant word in one sentence becomes the focus of the next.

People who have loose associations, or derailment, the most common formal thought disorder,

Diathesis-stress relationship

People with a biological predisposition will develop schizophrenia only if certain kinds of events or stressors are also present; often seems to be operating in the development of other kinds of psychotic disorders

Phases of schizophrenia

Phase I—Acute Phase II—Stabilization Phase III—Maintenance

What are prenatal stressors that cause schizophrenia?

Poor maternal nutirition, hypoxia Viral Infections Father older than 35 years at child's conception (bad sperm) Born in late winter/early spring

Give an example of Alogia

Poverty of thought "Jesus is a man, he has a beard....you have a beard so then you must be Jesus"

Social therapy (personal therapy)

Practical, active, and broad approach therapeutic approach which helps keep people out of the hospital

Positive Sx of Schizophrenia

Presence of something not usually present Hallucinations, delusions, disorganized speech, bizarre Appear early on in the illness Usually respond to antipsychotics

Substance-induced psychotic disorder

Psychosis induced by drugs of abuse, alcohol, medications, or toxins.

Substance-Induced Psychotic Disorder

Psychosis induced by drugs, alcohol, medications, or toxins.

Psychosis or catatonia associated with another medical condition

Psychosis or catatonia caused by a medical condition (e.g., delirium, neurological or metabolic conditions, hepatic or renal diseases, and many others). Medical conditions and substance abuse must always be ruled out before a diagnosis of schizophrenia or other psychotic disorder can be made.

State hospitals

Public mental hospitals in the U.S., run by individual states

alterations in thought > tangentiality

R. O. B. E. R. T. O.

Loose associations (derailment)

Rapidly shift from one topic to another, believing that their incoherent statements make sense; most common formal thought disorder

Parkinsonian symptoms

Reactions that closely resemble features of Parkinson's disease; most common extrapyramidal symptoms

akathisia

Regular rhythmic movements, usually of the lower limbs, with constant pacing sometimes seen; often noticed in people taking antipsychotic medication.

Gustatory hallucinations

Regularly find that their food or drink tastes strange

Perservation

Repeat their words and statements over and over

echolalia

Repeating of the last words spoken by another; mimicry or imitation of the speech of another person.

VIGNETTE

Sam, a 25-year-old man soon to be discharged from the hospital, constantly tells his family he wants his own apartment. When Sam is told that an apartment has been found for him, he asks, "But who will take care of me?" Sam is acting out his ambivalence between his desire to be independent and his desire to be taken care of.

What affects the ability to perceive reality accurately and is the most disruptive and disabling of all mental disorders?

Schizophrenia

Downward drift theory

Schizophrenia causes its sufferers to fall from a higher to lower socioeconomic level or remain poor because they're unable to function effectively

Residual phase

Schizophrenics return to a prodromal-like level of functioning

Schizophreniform disorder

Schizophreniform disorder is the diagnosis used in situations in which a person has many of the features of schizophrenia but has had these for a period of less than six months. It may or may not develop into schizophrenia.

Occupational training and support

Sheltered Workshop: Supervised workplace for people who are not yet ready for competitive jobs -Supported Employment: Vocational agencies help find competitive jobs in community and provide psychological support

Flat affect

Show almost no emotions

Blunted affect

Show less anger, sadness, joy, and other feelings

new-wave cognitive-behavioral therapists believe that the most useful goal of treatment is often to help clients accept their streams of problematic thoughts rather than to judge them, act on them, or try fruitlessly to change them.

Similarly, in cases of schizophrenia, new-wave cognitive-behavioral therapists try to help clients become detached and comfortable observers of their hallucinations—merely mindful of the unusual sensations and accepting of them—while otherwise moving forward with the tasks and events of their lives

Olfactory hallucinations

Smell odors that no one else does

Adolescent Schizophrenia (Age 17-19): List Prodromal Sx

Social withdrawal, irritability, depression, conduct problems, suspiciousness

At least half of patients on conventional antipsychotic drugs have muscle tremors and muscle rigidity at some point in their treatment; they may shake, move slowly, shuffle their feet, and show little facial expression

Some also have related symptoms such as movements of the face, neck, tongue, and back; and a number experience significant restlessness and discomfort in their limbs.

assertive community treatment

Some of the key features of effective community care programs are (1) coordination of patient services, (2) short-term hospitalization, (3) partial hospitalization, (4) supervised residencies, and (5) occupational training.

Agranulocytosis SE

Sore throat, fever, malaise, flu like sx, reduced WBC & Neutrophils Occurs suddenly, usually in the first 12 weeks of therapy

Outcomes for phase II (List four)

Stabilization -Help patient understand illness and treatment -Stabilize meds -Control or cope with sx

Phase II of Schizophrenia

Stabilization -Symptoms diminish, Movement toward previous level of functioning.

Phases of Schizophrenia: Phase II

Stabilization: Symptoms are diminishing, and there is movement toward one's previous level of functioning (baseline); partial hospitalization or care in a residential crisis center or a supervised group home may be needed.

Phase II—Stabilization

Symptoms are diminishing, and there is movement toward one's previous level of functioning (baseline); partial hospitalization or care in a residential crisis center or a supervised group home may be needed.

Active phase

Symptoms become apparent- sometimes triggered by stress or trauma

Affective symptoms

Symptoms involving emotions and their expression

affective symptoms

Symptoms involving emotions and their expression.

Prodromal phase

Symptoms of schizophrenia are not yet obvious, but the person is beginning to deteriorate

Negative symptoms

Symptoms of schizophrenia that seem to be deficits of normal thought, emotions, or behavior

Positive symptoms

Symptoms of schizophrenia that seem to be excesses of or bizarre additions to normal thoughts, emotions, or behaviors

Positive symptoms

Symptoms of schizophrenia that seem to be excesses of or bizarre additions to normal thoughts, emotions, or behaviors.Delusions, disorganized thinking and speech, heightened perceptions and hallucinations, and inappropriate affect are the ones most often found in schizophrenia.

Tardive dyskinesia

TDK consists of involuntary choreoathetoid (writhing, worm like) movements especially of the tongue and face; a slow, worm like movement of the tongue (fasciculations), lip-smacking movements, and in-and-out tongue protrusion

executive functioning

The ability to set priorities or make decisions.

Negative symptoms

The absence of something that should be present (e.g., interest in hygiene, motivation, ability to experience pleasure)

negative symptoms

The absence of something that should be present (e.g., apathy, lack of motivation, anhedonia, poor thought processes).

Patients were transferred to back wards, or chronic wards, if they failed to improve quickly

The back wards were human warehouses filled with hopelessness. Staff members relied on straitjackets and handcuffs to deal with difficult patients.

Community approach

The broadest approach for the treatment of schizophrenia and other severe mental disorders

Since the discovery of the phenothiazines, other kinds of antipsychotic drugs have been developed. The ones developed throughout the 1960s, 1970s, and 1980s are now referred to as "conventional" antipsychotic drugs in order to distinguish them from the "second-generation" antipsychotics (also called "atypical" antipsychotic drugs) that have been developed in more recent decades.

The conventional drugs are also known as neuroleptic drugs because they often produce undesired movement effects similar to the symptoms of neurological diseases.

Deinstitutionalization

The discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs

Hallucination

The experiencing of sights, sounds, or other perceptions in the absence of external stimuli

Waxy flexibility

The extended maintenance of posture, usually seen in catatonia. For example, the nurse raises the patient's arm, and the patient continues to hold this position in a statue like manner.

affect

The external manifestation of a feeling or emotion that is manifested in facial expression, tone of voice, and body language. For example, a patient may be said to have a flat affect, meaning that there is an absence or a near absence of facial expression. The term may be used loosely to describe a feeling, emotion, or mood

ideas of reference

The false impression that outside events have special meaning for oneself.

derealization

The false perception by a person that his or her environment has changed. For example, everything may seem bigger or smaller, or familiar objects may appear strange and unfamiliar.

Dopamine Theory

The first antipsychotic drugs are known as conventional (or first-generation) antipsychotics (e.g., haloperidol and chlorpromazine). These drugs block the activity of dopamine- 2 (D2) receptors in the brain, limiting the activity of dopamine and reducing some of the symptoms of schizophrenia.

Expressed emotion

The general level of criticism, disapproval, and hostility expressed in a family

expressed emotion

The general level of criticism, disapproval, and hostility expressed in a family. People recovering from schizophrenia are considered more likely to relapse if their families rate high in expressed emotion.

expressed emotion

The general level of criticism, disapproval, hostility, and intrusiveness expressed in a family. People recovering from schizophrenia are considered more likely to relapse if their families rate high in expressed emotion.

ambivalence

The holding, at the same time, of two opposing emotions, attitudes, ideas, or wishes toward the same person, situation, or object.

clang association

The meaningless rhyming of words, often in a forceful manner.

Echopraxia

The mimicking of movements of another. It is also seen in catatonia.

Parkinsonian symptoms

The most common extrapyramidal effects; reactions that closely resemble the features of Parkinson's disease, including muscle tremors and muscle rigidy

Schizotypal personality disorder

The patient demonstrates a personality alteration characterized by altered interpersonal boundaries, eccentric behavior, eccentric use of language, restricted or socially inappropriate expression of emotion, increased mistrust and sensitivity regarding the intent or responses of others, and difficulty setting goals, determining their own beliefs, and other alterations in identity. Although such persons may appear eccentric or odd, they do not exhibit the frank psychotic features seen in psychotic disorders, such as hallucinations and delusions.

Phase III—Maintenance

The patient is at or nearing baseline (or premorbid) functioning; symptoms are absent or diminished; level of functioning allows the patient to live in the community. Ideally, recovery with reduced or no residual symptoms has occurred.

Positive symptoms

The presence of something that is not normally present (e.g., hallucinations, delusions, bizarre behavior, paranoia, abnormal movements, gross errors in thinking) -associates with acute onset -appear early in the illness

positive symptoms

The presence of something that is not normally present (e.g., hallucinations, delusions, bizarre behavior, paranoia)

Schizotypal Personality Disorder

The pt demonstrates a personality alteration characterized by altered interpersonal boundaries, eccentric behavior, eccentric use of language, restricted or socially inappropriate expression of emotion.

Dopamine hypothesis

The theory that schizophrenia results from excessive activity of the neurotransmitter dopamine

dopamine hypothesis

The theory that schizophrenia results from excessive activity of the neurotransmitter dopamine

Why is polydipsia common with schizophrenics?

They never know when their satisfied with liquids so they drink way too many liquids which causes: Hyponatremia (CNS SE)

concrete thinking

Thinking grounded in immediate experience rather than abstraction. There is an overemphasis on specific detail as opposed to general and abstract concepts

Brief psychotic disorder

This disorder involves an acute onset of psychosis (delusions, hallucinations, disorganized speech) or grossly disorganized or catatonic behavior in response to extreme stress. It lasts less than 1 month, and a full recovery usually occurs.

Brief Psychotic Disorder

This disorder involves an acute onset of psychosis lasting less than 1 month.

In short, according to this theory, people with schizophrenia take a "rational path to madness"

This process of drawing incorrect and bizarre conclusions (delusions) may be helped along by a cognitive bias that many people with schizophrenia have—a tendency to jump to conclusions

Whereas most undesired drug effects appear within days or weeks, a reaction called tardive dyskinesia (meaning "late-appearing movement disorder") does not usually unfold until after a person has taken conventional antipsychotic drugs for more than a year

This reaction may include involuntary writhing or ticlike movements of the tongue, mouth, face, or whole body; involuntary chewing, sucking, and lip smacking; and jerky movements of the arms, legs, or entire body. Patients over 50 years of age seem to be at greater risk. Tardive dyskinesia can be difficult, sometimes impossible, to eliminate

These and related findings suggest that in schizophrenia, messages traveling from dopamine-sending neurons to dopamine receptors on other neurons, particularly to the D-2 receptors, may be transmitted too easily or too often

This theory is appealing because certain dopamine neurons are known to play a key role in guiding attention

but they found it gives side effects of tremors

This undesired reaction to antipsychotic drugs offered the first important clue to the biology of schizophrenia. Scientists already knew that people who suffer from Parkinson's disease have abnormally low levels of the neurotransmitter dopamine in some areas of the brain and that lack of dopamine is the reason for their uncontrollable shaking. If antipsychotic drugs produce Parkinsonian symptoms in people with schizophrenia while removing their psychotic symptoms, perhaps the drugs reduce dopamine activity.

Type II schizophrenia

Thought to be dominated by negative symptoms

Type I schizophrenia

Thought to be dominated by positive symptoms

The new drugs bind not only to D-2 dopamine receptors, like the traditional antipsychotic drugs, but also to many D-1 and D-4 receptors and to receptors for other neurotransmitters such as serotonin

Thus, it may be that schizophrenia is related to abnormal activity or interactions of both dopamine and other neurotransmitters, rather than to abnormal dopamine activity alone

POOR COORDINATION OF SERVICESThe various mental health agencies in a community often fail to communicate with one another.

To help deal with such problems in communication and coordination, a growing number of community therapists have become case managers for people with schizophrenia and other severe mental disorders. they are A community therapist who offers a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patients' rights.

In the 1950s, behaviorists discovered that the systematic use of operant conditioning techniques on hospital wards could help change the behaviors of patients

Token economy program: A behavioral program in which a person's desirable behaviors are reinforced systematically throughout the day by the awarding of tokens that can be exchanged for goods or privileges.

Are behaviorists changing a patient's psychotic thoughts and perceptions or simply improving the patient's ability to imitate normal behavior?

Token economy programs are no longer as popular as they once were, but they are still used in many mental hospitals, usually along with medication, and in many community residences as well

Long Acting Antipsychotics Depot Injections (Traditional & Atypical)

Traditional: -Fluphenazine decanoate (Prolixin D) -Haloperidal decanoate (Haldol D) Atypical: -Long acting Risperidone (Consta)

High Potency 1st generation

Trifluoperazine (generic only) Thiothixene (Navane) Fluphenazine (Prolixin) Haloperidol (Haldol) Pimozide (Orap)

True

True or False: Hallucinations and delusional ideas often occur together

T/F Command Hallucinations are high lethality

True, command hallucinations are psych emergencies Resisting command of voices= decreases lethality in patients

Anticholinergic Tx & Interventions

Tx: Life threatening medical emergency Interventions: Hold med, consult Dr, BZD, Eserine (physostigmine)

two

Type ______schizophrenia have more negative symptoms, such as restricted affect, poverty of speech, and loss of volition. May be tied largely to structural abnormalities in the brain

one

Type ___schizophrenia are thought to be dominated by positive symptoms, such as delusions, hallucinations, and certain formal thought disorders. -Pts generally seem to have been better adjusted prior to the disorder, to have later onset of symptoms, and to be more likely to show improvement, especially when treated with medications. -May be linked more closely to biochemical abnormalities in the brain

Extrapyramidal effects

Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by conventional antipsychotic drugs

Extrapyramidal effects:

Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by conventional antipsychotic drugs.

extrapyramidal effects

Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by conventional antipsychotic drugs.

Clang

Using rhyme to express themselves

clang

Using rhyme to think or express themselves

Supported employment

Vocational agencies and counselors help clients find competitive jobs in the community and provide psychological support while the clients are employed

day centers, or day hospitals,

all-day programs in which patients return to their homes for the night. Such programs provide patients with daily supervised activities, therapy, and programs to improve social skills. People recovering from severe disorders in day centers often do better than those who spend extended periods in a hospital or in traditional outpatient therapy

automatic obedience

an exaggerated, robotic cooperation with requests

delusions of control

another person or ppl or external forces control their thoughts, impulses, feelings, bxs the gov is controlling their thoughts

positive, negative

antipsychotic drugs, particularly the conventional ones, reduce the _________ symptoms of schizophrenia more completely, or at least more quickly, than the __________ symptoms

avolition

apathy, feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action

Neologisms

are made-up words (or idiosyncratic uses of existing words) that have meaning for the patient but a different or nonexistent meaning to others

Physical health illnesses

are more common among people with schizophrenia than in the general population. The risk of premature death is 1.6 to 2.8 times greater than that in the general population; on average, patients with schizophrenia die 28 years prematurely due to disorders such as hypertension (22%), obesity (24%), cardiovascular disease (21%), diabetes (12%), chronic obstructive pulmonary disease (COPD) (10%), and trauma (6%)

People with Type I schizophrenia

are thought to be dominated by positive symptoms, such as delusions, hallucinations, and certain formal thought disorders. Type I patients generally seem to have been better adjusted prior to the disorder, to have later onset of symptoms, and to be more likely to show improvement, especially when treated with medications

first-generation antipsychotics

are usually those products available OTC that patients use before the see a health care provider. Most of these products cross the blood brain barrier and cause sedation (sleepiness) and used in particular for helping older adult patients sleep. These products are very effective in helping remove some symptoms of sneezing, itching, and watery rhinorrhea when used for a short time.

half

around ______ of those with schizophrenia have significant difficulties with memory and other kinds of cognitive functioning

catatonic posturing

assuming awkward, bizarre positions for long periods of time

bx alterations gesturing or posturing

assuming unusual & illogical expressions (often grimaces) or positions

ambivalence

at the same time holding two opposing emotions, attitudes, ideas, wishes, towards the same person, situation or object

thought insertion

belief that thoughts are being placed in one's head

delusions of control

believe their feelings, thoughts, and actions are being controlled by other people

delusions of control

believe their feelings, thoughts, and actions are being controlled by other people.

delusions of grandeur

believe themselves to be great inventors, religious saviors, or other specially empowered persons

People with delusions of grandeur

believe themselves to be great inventors, religious saviors, or other specially empowered persons.

somatic delusions

believes that his body is changing in an unusual way, such as growing a third arm preoccupations regarding health and organ function

alterations in thought > magical thinking

believing their thoughts or actions can control things im gonna wear pjs outside and its gonna snow

Research has pointed to two kinds of biological abnormalities that could conceivably be inherited—

biochemical abnormalities and abnormal brain structure.

bx alterations (still positive sxs)

bizarre & agitated bxs (stilted, rigid demeanor or eccentric dress and rituals)

Second-Generations Antipsychotics

block serotonin (5-hydroxytryptamine 2A, or 5-HT2A) as well as dopamine, which suggests that serotonin may play a role in schizophrenia as well

Second-generation (unconventional) antipsychotics

block serotonin as well as dopamine, which suggests that serotonin may play a role in schizophrenia as well. If we can better understand how second-generation agents modulate the expression and targeting of serotonin and its receptors, we may better understand schizophrenia.

Some theorists believe that the psychosocial environments of developing countries tend to be more supportive and therapeutic than those of developed countries, leading to more favorable outcomes for people with schizophrenia

c

that cold or unnurturing parents may set schizophrenia in motion. Fromm-Reichmann described the mothers of people who develop the disorder as cold, domineering, and uninterested in their children's needs. She claimed that these mothers may appear to be self-sacrificing but are actually using their children to meet their own needs. At once overprotective and rejecting, they confuse their children and set the stage for schizophrenic functioning.

c

formal thought disorders

can cause the sufferer great confusion and make communication extremely difficult. Often such thought disorders take the form of positive symptoms (pathological excesses), as in loose associations, neologisms, perseveration, and clang.

psychosis or catatonia associated c another med condition

caused by something like delirium, hepatic, or renal disease

Over the past four decades, researchers have developed a dopamine hypothesis to explain their findings on schizophrenia:

certain neurons that use the neurotransmitter dopamine fire too often and transmit too many messages, thus producing the symptoms of schizophrenia

Clang association

choosing words based on their sound rather than their meaning, often rhyming or having a similar beginning sound ("On the track . . . have a Big Mac"; "Click, clack, clutch, close")

alterations in speech > clang association

cling clang mr chang hang dang fang

Anxiety, depression, and suicide

co-occur frequently in schizophrenia. Anxiety may be a response to symptoms (e.g., hallucinations) or circumstances (e.g., isolation, overstimulation) and may worsen schizophrenia symptoms and prognosis. Approximately 10% of persons with schizophrenia commit suicide, a rate 8.5 times that of the general population; both depression and suicide attempts can occur at any point in the illness (

emotional ambivalence

coexistence of opposite emotions toward same object, person, or situation

Therapeutic interventions for schizophrenia

cognitive behavioral interventions, cognitive enhancement/remediation (evidence-based, highly structured, classes that educate patients about cognitive skills and provide computer-based and interpersonal practice of cognitive skills)

pschodynamic explaination

cold unnuturing parents

neuroleptic drugs

conventional antipsychotic drugs, so called because they often produce undesired effects similar to the symptoms of neurological disorders

Schizophrenia usually first appears between the person's late teens and mid-thirties

d

implementation / interventions counseling & communication techniques aim to

decrease anxiety, build trust, encourage clear communication, increase self awareness, encourage interaction, increase self esteem, enhance reality testing & assertiveness

negative symptoms avolition

decreased motivation & spontaneous activity, cant initiate tasks like social contacts, grooming, ADLS

negative symptoms poverty of speech

decreased spontaneity & amount of speech, one word answers

Capgras syndrome

delusion of significant other being replaced by an impostor, may be due to psychiatric or organic brain disease.

ideas of reference delusion

describe the phenomenon of an individual's experiencing innocuous events or mere coincidences and believing they have strong personal significance. It is "the notion that everything one perceives in the world relates to one's own destiny".

inappropriate affect

display of emotions that are unsuited to the situation; a symptom of schizophrenia

Type 1 Schizophrenia

dominated by positive symptoms, such as delusions, hallucinations, and certain formal thought disorders

antipsychotic drugs

drugs that help correct grossly confused or distorted thinking

Schizophrenia usually presents

during the late teens and early twenties

schizophreniform disorder

dx used when patient has many features of schizophrenia but for LESS than 6 months, may or may not develop into schizophrenia

alterations in speech > echolalia echolalia

echolalia echolalia echolalia echolalia echolalia echolalia echolalia echolalia echolalia echolalia

inappropriate affect

emotions that are unsuited to the situation

bx alterations motor agitation

excited bxs like running or pacing often in response to internal stimuli, can pose risk to pt or others

tardive dyskinesia

extrapyramidal effects involving involuntary movements that some patients have after they have taken conventional antipsychotic drugs for an extended time

multicultural factors, social labeling, and family dysfunctioning

factors affecting those with schizophrenia, according to socio-cultural theorists

delusions

false beliefs

alterations in perception > derealization

false perception that everything in the environment has changed

somatic

feel as if something is happening inside the body, such as a snake crawling inside one's stomach (type of hallucination)

Many people with schizophrenia experience avolition, or apathy,

feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action. This problem is particularly common in people who have had schizophrenia for many years, as if they have been worn down by it

alterations in perception > depersonalization

feeling that one is different, unreal, or lost identity. may feel that body parts dont belong to them or their body has drastically changed.

cholestatic jaundice

fever malaise nausea ABD PAIN bed rest, high protein high carb diet LFT q6m

Dopamine theory.

first-generation antipsychotics block the activity of dopamine-2 (D2) receptors in the brain, limiting the activity of dopamine and reducing some of the symptoms of schizophrenia

grandeur delusions

fixed, false belief that one possesses superior qualities such as genius, fame, omnipotence, or wealth

gustatory hallucinations

food or drink tastes strange on a regular basis tasting things that are not present

People with schizophrenia sometimes experience psychomotor symptoms,

for example, awkward movements or repeated grimaces and odd gestures that seem to have a private purpose—perhaps ritualistic or magical The psychomotor symptoms of schizophrenia may take certain extreme forms, collectively called catatonia.

alterations in thought > cognitive retardation

generalized slowing in pace of thinking, pauses, difficulty finishing thoughts

delusions ideas of reference

giving personal significance to unrelated trivial evenings, perceiving events as relating to them when they arent the birds are singing just to them the weather man is talking just to them

Type 2 Schizophrenia

have more negative symptoms, such as restricted affect, poverty of speech, and loss of volition

Those with Type II schizophrenia

have more negative symptoms, such as restricted affect, poverty of speech, and loss of volition.

auditory hallucination

hearing one or more talking voices. A hallucination involving the perception of sound, most commonly of voice.

psychotherapy in schizophrenia

helpful now because of good drugs -relieve thought and perceptual disturbances -includes: CBT and sociocultural

second-generation ("atypical") antipsychotic drugs have been developed in recent decades.

hese include clozapine (trade name Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify). As noted earlier, these drugs are received at fewer dopamine D-2 receptors and more D-1, D-4, and serotonin receptors than the conventional antipsychotic drugs

1st gen antipsychotics acetylcholine toxicity symptoms

hot dry skin non reactive pupils vitals unstable worse psychotic sxs looks like relapse stereotypic bxs fever without sweat!! fast heart beat decreased or absent peristalsis (also decreased bowel sounds)

magical thinking

ideas that one's thoughts or behaviors have control over specific situations thinking based on irrational assumptions thinking based on assumptions that don't hold up to rational scrutiny

How are hallucinations different from illusions

illusions are misperceptions or misinterpretations of a real experience

nihilistic

im fuhhh king dead

negative symptoms flat affect

immobile / blank

bx alterations boundary impairment

impaired ability to sense where ones body or influence ends and another's begins. your drink is near me and is mine

Much of the credit goes to antipsychotic drugs—

imperfect, troubling, and even dangerous though they may be. These medications help many people with schizophrenia and other psychotic disorders to think clearly and to profit from psychotherapies that previously would have had little effect for them

short-term hospitalization—

in a mental hospital or a general hospital's psychiatric unit—that lasts a few weeks (rather than months or years). Soon after the patients improve, they are released for aftercare, a general term for follow-up care and treatment in the community.

short-term hospitalization

in a mental hospital or general hospital's psychiatric unit-last a few weeks -aftercare

Others may have the formal thought disorder of perseveration,

in which they repeat their words and statements again and again.

people with schizophrenia eventually enter a residual phase

in which they return to a prodromal-like level of functioning. They may retain some negative symptoms, such as blunted emotion, but have a lessening of the striking symptoms of the active phase. Although 25 percent or more of patients recover completely from schizophrenia, the majority continue to have at least some residual problems for the rest of their lives

supported employment,

in which vocational agencies and counselors help clients find competitive jobs in the community and provide psychological support while the clients are employed

negative symptoms anhedonia

inability to feel pleasure

negative symptoms inappropriate affect

incongruent with emotional state / situation (laughs at a threat)

implementation / interventions working c aggressive pt

increase supervision, decrease stimuli, address sxs, diversion,teach coping skills, cog bx approaches

mentally ill chemical abusers (MICAs), or dual diagnosis patients

individuals with psychotic disorders as well as substance use disorders

alterations in thought > paranoia

irrational fear of others, mild to profound

The prevalence of childhood-onset schizophrenia

is about 1 in 10,000 children

bx alterations motor retardation

its slow

delusions of somatic

ive got the hiiiiv. my insides are rotting. my skin is made of worms.

society assigns the label "schizophrenic" to people who fail to conform to certain norms of behavior. Once the label is assigned, justified or not, it becomes a self-fulfilling prophecy that promotes the development of many schizophrenic symptoms

j

negative symptoms thought blocking

just stops talking

delusions of erotomania

justin timberlake loves me. he wants my babies

There are various reasons for this shortage of services. The primary one is economic

k

coordination of patient services, short-term hospitalization, partial hospitalization, supervised residencies, and occupational training.

key features of effective community care programs (5)

negative symptoms anergia

lack of energy, lack of persistence, passivity

paraprofessional

lay people who receive training and ongoing supervision from outside mental health professionals.

schizotypal personality disorder

least severe in the category personality alteration, altered interpersonal boundaries, eccentric behavior & use of language, restricted or inappropriate emotional expressions, increased mistrust and sensitivity related to others. Difficulty setting goals, determining own beliefs, & other ID alterations. NO hallucinations or delusions

The antipsychotic drugs, particularly the conventional ones, reduce the positive symptoms of schizophrenia (such as hallucinations and delusions) more completely, or at least more quickly, than the negative symptoms

m

it was the discovery of antipsychotic drugs in the 1950s that truly revolutionized treatment for schizophrenia. These drugs eliminate many of its symptoms and today are almost always a part of treatment.

m

alterations in speech > neologisms

made up words slippintime waterfudge ??? idk?

neologisms

made-up words that typically have meaning only to the person using them

Some people with schizophrenia use neologisms

made-up words that typically have meaning only to the person using them.

catatonic rigidity

maintain a rigid, upright posture for hours and resist efforts to be moved

waxy flexibility

maintenance of posture or position over time even when it is awkward or uncomfortable

implementation / interventions activities & groups

may decrease withdrawl, enhance motivation, modify bad bxs, increase social competence and self esteem through task completion

bx alterations impaired impulse control

may interrupt group or throw food

In the 1950s, clinicians developed two institutional approaches that finally brought some hope to patients who had lived in institutions for years:

milieu therapy, based on humanistic principles, and the token economy program, based on behavioral principles.

bx alterations echopraxia

mimicking other peoples movements. seen in catatonia

recovery model

model thats pt centered, hopeful, empowering, emphasizes the person & the future vs the MI & the present

loose associations or derailments

most common formal thought disorder. rapid shift from one topic to another, believing that their incoherent statements make sense

auditory

most common kind of hallucination in schizophrenia

Agranulocytosis

most often seen with clozapine (Clozaril) but possible with most antipsychotics, is a serious blood dyscrasia that can be fatal

jealousy

my lover is cheating on me (....but he actually was)

Substance abuse disorders

occur in nearly 50% of persons with schizophrenia and are associated with treatment nonadherence, relapse, incarceration, homelessness, violence, suicide, and a poorer prognosis

negative symptoms bizzare affect

odd, illogical, grossly inappropriate or unfounded. grimace. giggle.

The broadest approach for the treatment of schizophrenia and other severe mental disorders is the community approach

ongress passed the Community Mental Health Act, which provided that patients with psychological disorders were to receive a range of mental health services—outpatient therapy, inpatient treatment, emergency care, preventive care, and aftercare—in their communities rather than being transported to institutions far from home.

ambivalence,

or conflicting feelings, about most things.

Finally, some use clang,

or rhyme, to think or express themselves.

outcomes identification phase 3 maintenance

outcomes criteria focus on 1 maintaining achievement, adhering to tx 2 preventing relapse 3 achieving independence & satisfactory quality of life

persecution delusions

paranoid the affected persons believe they are being persecuted. Specifically, they have been defined as containing two central elements: The individual thinks that harm is occurring, or is going to occur.

Echolalia

pathological repeating of another's words and is often seen in catatonia

assertive community treatment

people recovering from schizophrenia and other severe disorders need medication, psychotherapy, help in handling daily pressures and responsibilities, guidance in making decisions, social skills training, residential supervision, and vocational counseling

o far, the biological explanations have received by far the most research support. diathesis-stress relationship may be at work:

people with a biological predisposition will develop schizophrenia only if certain kinds of events or stressors are also present. Similarly, a diathesis-stress relationship often seems to be operating in the development of other kinds of psychotic disorders

During the past decade, researchers have also linked schizophrenia, particularly cases dominated by negative symptoms, to abnormalities in brain structure

people with schizophrenia have enlarged ventricles—the brain cavities that contain cerebrospinal fluid

phenothiazines and other antipsychotic drugs bind to many of these receptors. Apparently the drugs are dopamine antagonists—drugs that bind to dopamine receptors, prevent dopamine from binding there, and so prevent the neurons from firing.

phenothiazines bind most strongly to the D-2 receptors

alterations in speech > alogia

poverty of speech decreased spontaneity or volume of speech, represented by lack of spontaneous comments & overly brief responses

alogia

poverty of speech relative absence of speech

Although its course varies widely from case to case, many sufferers seem to go through three phases—

prodromal, active, and residual

bx alterations > catatonia

pronounced increase or decrease in rate and amount of movement. stupor is most common.

psychological

pschodynamic and cognitive perspective

akathisia

psychomotor restlessness evident as pacing or fidgeting, sometimes pronounced and very distressing to patients

substance induced psychotic disorder

psychosis induced by drugs, booze, meds, toxins

Schizophreniform Disorder

pt has many of the features of schizophrenia but has had these for a period of less than 6 months. It may or may not develop into schizophrenia.

bx alterations negativism

pts does opposite of directed (active) or fails to do as directed (passive)

state hospitals

public mental hospitals in the United States, run by the individual states

labile affect

rapid & abrupt changes in affect

alterations in speech > flight of ideas

rapid flow of thoughts quickly changing topics

Nicotine dependence

rates in schizophrenia range from 70% to 90% and contribute to an increased incidence of cardiovascular and respiratory disorders

dopamine hypothesis biggest challenge

recent discovery of a new group of antipsychotic drugs, initially referred to as atypical antipsychotic drugs and now called second-generation antipsychotic drugs, which are often more effective than the traditional ones.

negative symptoms blunted affect

reduced / minimal

impaired impulse control

reduced ability to resist one's impulses

concrete thinking

refers to an impaired ability to think abstractly

bx alterations stereotyped bxs

repeated motor bxs that serve no logical purpose

Negative symptoms of schizophrenia

respond less well to antipsychotic therapy and can be more debilitating. Psychosocial interventions such as support groups improve negative symptoms

residual

return to a prodromal-like level of functioning. They may retain some negative symptoms, such as blunted emotion, but have a lessening of the striking symptoms of the active phase (phase of schizophrenia)

Acceptable behaviors likely to be included are caring for oneself and for one's possessions (making the bed, getting dressed), going to a work program, speaking normally, following ward rules, and showing self-control. Researchers have found that token economies do help reduce psychotic and related behaviors

s

downward drift theory

schizophrenia causes its sufferers to fall from a higher to a lower socioeconomic level or to remain poor because they are unable to function effectively

visual hallucinations

seeing objects, people, or things that do not actually exist

blunted affect

show less anger, sadness, joy, and other feelings than most people. Their faces are still, their eye contact is poor, and their voices are monotonous

blunted affect

showing little or a slow-to-respond facial expression; few observable facial expressions

metabolic syndrome

sig concern of 2nd gen weight gain dyslipidemia (high cholesterol) altered glucose metabolism increases r/f DM, HTN, atherosclerotic heart disease

cognitive retardation

significant limitations in their ability to learn and function.

olfactory hallucinations

smelling odors that are not really present

negative symptoms poverty of content of speech

speech conveys little info because of vagueness or superficiality

catatonia

state of immobility and unresponsiveness lasting for long periods of time

catatonic stupor

stop responding to their environment, remaining motionless and silent for long stretches of time

bizarre thinking

strange or unusual thinking

euphoric affect

such pts appear calm, consistent in emotional expression, reasonable & cooperative.

schizoaffective disorder

sx of schizophrenia & MDD or mania or bipolar disorder

flight of ideas

symptom of mania that involves an abruptly switching in conversation from one topic to another

prodromal

symptoms are not yet obvious, but the person is beginning to deteriorate. He or she may withdraw socially, speak in vague or odd ways, develop strange ideas, or express little emotion

During the prodromal phase,

symptoms are not yet obvious, but the person is beginning to deteriorate. He or she may withdraw socially, speak in vague or odd ways, develop strange ideas, or express little emotion.

prodromal phase

symptoms are not yet obvious, but the person is beginning to deteriorate. may speak in odd ways, develop strange ideas, and express little emotion

active phase

symptoms become apparent. Sometimes this phase is triggered by stress or trauma in the person's life

active

symptoms become apparent. Sometimes this phase is triggered by stress or trauma in the person's life (phase of schizophrenia)

During the active phase,

symptoms become apparent. Sometimes this phase is triggered by stress or trauma in the person's life.

negative symptoms of schizophrenia

symptoms of schizophrenia that seem to be deficits in normal thought, emotions, or behaviors -pathological deficits, deficits of thought, emotion, and behavior

positive symptoms of schizophrenia

symptoms of schizophrenia that seem to be excesses of or bizarre additions to normal thoughts, emotions, or behaviors -pathological excessess, excesses of thought, emotion, and behavior

tactile

take the form of tingling, burning, or electric-shock sensations (type of hallucination

alterations in thought > circumstantiality

telling tedious info when you ask them something

ome patients with schizophrenia also have smaller

temporal and frontal lobes than other people, smaller amounts of cortical white and gray matter, and, perhaps most importantly, abnormal blood flow—either reduced or heightened—in certain areas of the brain

Family theorists have long recognized that some families are high in expressed emotion—

that is, members frequently express criticism, disapproval, and hostility toward each other and intrude on one another's privacy.

executive functioning

the ability to set priorities or make decisions

community approach to schizophrenia

the broadest approach for the treatment of schizophrenia and many other mental disorders is the?

Deinsititutionalization

the discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs

religiosity

the importance of religion in a person's life

negative symptoms affect

the outward expression of a persons internal emotional state

dopamine hypothesis

the theory that schizophrenia results from excessive activity of the neurotransmitter dopamine

associative looseness

these threads are interrupted or disjointed; thinking becomes haphazard, illogical, and difficult to follow

delusions of reference

they attach special and personal meaning to the actions of others or to various objects or events

People with schizophrenia may also have delusions of reference:

they attach special and personal meaning to the actions of others or to various objects or events.

perseveration

they repeat their words and statements again and again

delusions of persecutioin

theyre being singled out for harm by ppl in power secret service is out to poison them

prodromal, active, and residual

three phases of schizoprenia

etiology > psychological & environmental factors environmental stressors

toxins solvents

Poor coordination of services and shortage of services

two factors that are primarly responsible for community treatment failure are?

psychomotor symptoms of schizophrenia

unusual movements or gestures

extrapyramidal effects

unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by conventional antipsychotic drugs

As you will see later in this chapter, the chain of events leading to this hypothesis began with the accidental discovery of antipsychotic drugs, medications that help remove the symptoms of schizophrenia

v

supported employment

vocational agencies and counselors help clients find competitive jobs in the community and provide psychological support while the clients are employed

The first group of antipsychotic medications, the phenothiazines,

was discovered in the 1950s by researchers who were looking for better antihistamine drugs to combat allergies. Although phenothiazines failed as antihistamines, it soon became obvious that they were effective in reducing schizophrenic symptoms, and clinicians began to prescribe them widely

prior to the illness, a person with schizophrenia

was socially awkward, lonely, perhaps depressed, and expressed himself or herself in vague, odd, or eccentric ways. In this prodromal phase, anxiety, phobias, obsessions, dissociation, and compulsions may be noted

metabolic syndrome

weight gain, dyslipidemia, altered glucose metabolism caused by atypical antipsychotic drugs

A fuller recovery from schizophrenia is more likely in people who functioned quite well before the disorder;

whose disorder is triggered by stress, comes on abruptly, or develops during middle age; and who receive early treatment

alterations in speech > schizophasia

wurrrd. salad.

Key points to remember

• Schizophrenia spectrum disorders are biological disorders of the brain; they are a group of disorders with overlapping symptoms and treatments, and are categorized from least severe to most severe (schizophrenia). • Schizophrenia varies in terms of which symptoms dominate, their severity, the impairment in affect and cognition, and the impact on social and other areas of functioning. • Symptoms vary considerably among patients and fluctuate over time. • Psychotic symptoms are often more pronounced and obvious than symptoms of other disorders, making schizophrenia more apparent to others and increasing stigmatization. • Neurochemical, genetic, and neuroanatomical findings help explain the symptoms of schizophrenia; however, no one theory accounts fully for the complexities of schizophrenia. • Positive symptoms of schizophrenia (e.g., hallucinations, delusions, associative looseness) are easier to recognize and respond best to antipsychotic drug therapy. • Negative symptoms of schizophrenia (e.g., social withdrawal and dysfunction, lack of motivation, reduced affect) respond less well to antipsychotic therapy and can be more debilitating. Psychosocial interventions such as support groups improve negative symptoms. • Cognitive impairment varies; it warrants careful assessment and active intervention to increase the patient's ability to function and maximize the ultimate quality of life. • Comorbid depression must be identified and treated to reduce the potential for suicide, substance abuse, nonadherence, and relapse. • Some applicable nursing diagnoses include Disturbed sensory perception, Acute confusion, Impaired communication, Ineffective coping, Risk for self-directed or other-directed violence, and Impaired family coping. • Outcomes are chosen based on the phase of schizophrenia and the patient's individual symptoms, needs, strengths, and level of functioning. Short-term and intermediate indicators are also developed to better track the incremental progress typical of schizophrenia. • Interventions for people with schizophrenia include trust-building and therapeutic communication: support; assistance with self-care, nutrition and sleep; promoting independence and stress management; promoting socialization; psycho-education about the illness and its treatment; milieu management; on-going risk assessment. • Therapeutic interventions for schizophrenia include cognitive-behavioral interventions, cognitive enhancement/remediation (evidence-based, highly structured, classes that educate patients about cognitive skills and provide computer-based and interpersonal practice of cognitive skills). • Improving and promoting reality testing are essential in care for people with schizophrenia. • Antipsychotic medications are essential in patients with schizophrenia. Nurses must understand the properties, desired and undesired effects, and dosages of first-, second-, and third-generation antipsychotics and other medications used. • Schizophrenia can produce countertransference responses in staff; clinical supervision and self-assessment help the nurse remain objective and therapeutic.

people with schizophrenia have structural brain abnormalities, including the following:

•Enlargement of the lateral cerebral ventricles, third ventricle dilation, and/or ventricular asymmetry •Reduced cortical, frontal lobe, hippocampal and/or cerebellar volumes •Increased size of the sulci (fissures) on the surface of the brain •Reduced cortical thickness •Reduced connectivity in various brain regions

Acute phase interventions include the following:

•Psychiatric, medical, and neurological evaluation •Psychopharmacology •Support, psychoeducation, and guidance •Supervision and structure in a therapeutic environment (milieu) •Monitor fluid intake