Schizophrenia Syndrome – many varieties Disordered & bizarre thoughts Disordered & bizarre perceptions ï¯ Bizarre behaviors and movements ï¯ Flat or blunted

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  • SchizophreniaSyndrome many varietiesDisordered & bizarre thoughtsDisordered & bizarre perceptionsBizarre behaviors and movementsFlat or blunted emotionsImpaired communication & social functioningImpaired cognition

  • Brain & Behavior Research Foundation - ART

  • Schizophrenia

    Onset usually late adolescence or early adulthoodAbout 1% of populationOnset abrupt or slowClinical course varies; can be debilitatingEarlier onset = poor prognosisInheritability estimated 80%

  • Inheritability of schiz as high as 80%Identical Twin studies About 50% chance both will develop schiz why dont both get the disease?Over 1000 genes examined as candidate genes heterogeneityAlleles of very small effect and rare mutations interact with environmental factors to confer risk ( Journal of Nursing Scholarship, 2013)

  • Positive symptomsHallucinationsDelusions & illusionsEchopraxia/echolaliaFlight of ideas & loose associationsPerseverationIdeas of referenceAmbivalenceSymptoms related to changes in subcortical limbic circuits

  • Auditory hallucinations53% schizophrenics28% MDD27% incest survivorsNon-psychiatricLeft temporal lesionsPsychoactive substancesOther somatic conditionsStress/bereavement/spiritual

  • Negative symptomsApathyAlogiaFlat or blunted affectAnhedoniaAbsence of willPoor hygieneSocial isolation/socially inappropriateChanges in the medial & orbital prefrontal cortex

  • Cognitive functioningWorking memory ability to retain & use dataExecutive function decision makingContextIf the farmer wants to keep chickens she needs a penChanges in dorsolateral prefrontal cortexIn both those with schiz & those at risk for!Newer antipsychotics MAY be especially beneficialEarly evidence may be able to treat early and prevent psychosis from developing

  • Person with schizophrenia Elyn Saks, PhDhttp://www.ted.com/talks/elyn_saks_seeing_mental_illness

    This is about 15 minutes long so I recommend viewing on your own time.

  • Nursing assessmentHistoryPresenting problemInclude suicide/homicide riskAppearance and behaviorsSpeech patternsMood and affectFlat or bluntedinappropriate

  • Nursing assessmentThought processThought contentHallucinationsDelusionsJudgment and insightSelf concept, relationships, self care

  • Nursing diagnosesfor positive symptomsRisk for violence (self or other directed)Altered thought processesSensory/Perceptual alterationsPersonal identity disturbanceImpaired verbal communication

  • Nursing diagnosesfor negative symptomsSelf-care deficitSocial isolationAltered health maintenanceIneffective management of therapeutic regimeDiversional activity deficit

  • Schizophrenia case studyhttp://www.youtube.com/watch?v=H_jYqSA_fJkMindyourmind.co

  • Antipsychotic medicationsPhenothiazines & Haldol (conventional)Decrease dopamineAtypical antipsychoticsMore specific blocking of dopamine receptors as well as increasing serotonin & norepinephrineDopamine system stabilizers (new generation Abilify)

  • Neuroleptic Malignant SyndromeDepletion of dopamineMuscle rigidityHyperthermiaHypertensionDiaphoresisConfusion mutismElevated CPK and WBC

  • Extrapyramidal SymptomsDystonia TorticollisOpisthonisOculogyric crisisPseudoparkinsonismAkathesiaNMSTardive dyskonesia

  • Anticholinergic symptomsDry MouthConstipationOrthostatic Hypotension

  • Other side effectsWeight gain & metabolic syndromeSexual side effects

  • Clozaril/ClozapinePotential fatal side effect of agranulocytosis

    Sudden fever, sore throat, malaise

    LeukopeniaWeekly WBC

  • Non-pharmacological interventionsCognitive behavioral therapySupport groupsSocial skills and lifeskills trainingCognitive remediationTechniques for dealing with hallucinations

  • Case studySam is a 19 yr old who has been admitted to a psychiatric evaluation unit. You are assigned as nurse. When you first see him you note he has long shaggy unwashed hair; he is relatively thin; he makes no eye contact. He tells you in a soft voice that Mary was supposed to care for him because he was nice to her, but she disappointed him by moving away. Something is keeping them apart; maybe because other people are reading his thoughts. My thoughts are very loud and bump into the sides of my head. Can you hear them?

  • Case study continuedSam moved back to his parents home after living in a college dorm. He is not sure if he is still in school. I havent gone to class in months because they wont help me make Mary understand. They want me to fail and the teachers wink at me to tell me I am stupid. I dont need school. I dont want a job because people will make sure I would get fired. He shows little emotion. It seems difficult for him to find the words to explain. He is easily distracted; stares off into the corner, and is restless. After a few minutes he gets up and leaves.

  • Preventing recidivismMedication teaching and effective medication managementCommunity follow-upEffective self-care and stress reductionTeaching pt & significant othersRecognizing trigger events and early symptoms

  • Recovery modelAccepts that mental illness is often a life-long illness with remissions, exacerbations, and set backsBorrowed from substance abuse fieldsFocus on treating mental illness like any other chronic illnesshttp://www.youtube.com/watch?v=Zn6yw2KUIwc

  • A beautiful mindJohn NashB.1928Nobel prize 19942 sonsAlicia: 1 son:Married 2XSecond son by Eleanor Stier