schizophrenia
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SCHIZOPHRENIA
2nd most frequent diagnosis of patients 14-64 y/o
Pamela M. Veroy RN, MAN
Retrieved sources from: CRH (2008)
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Last update 6/25/09 ajj
In this module we will cover
• What is schizophrenia
• Symptoms of schizophrenia
• Types of schizophrenia
• Some of the more common treatments for schizophrenia
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What is schizophrenia?
• A chronic severe brain disorder; often they hear voices, believe media are broadcasting their thoughts to the world or may believe someone is trying to harm them.
• In men it usually develops in teen years and early 20s; in women it usually develops in 20s and 30s.
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Diagnosis
• Currently there is no physical or lab test that can absolutely diagnose schizophrenia.
• A psychiatrist usually comes to the diagnosis based on clinical symptoms.
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Misdiagnosis
• This is a common problem since schizophrenia shares a significant number of symptoms with other disorders.
• Per the Nat’l Depression & Bipolar Support Alliance there is an average of 10 years from onset to correct diagnosis & tx.
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Disorders that may appear like Schizophrenia
• Schizoid personality
• Schizophreniform disorder
• Schizotypal personality
• Bipolar Disorder
• Asperger’s syndrome
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Symptoms of Schizophrenia
• Profound disruption in cognition and emotion, affecting the most fundamental human attributes: – Language– Thought– Perception– Affect– Sense of self
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Positive Symptoms
• Those that appear to reflect an excess or distortion of normal functions.
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Positive Symptoms
• Delusions. Those where the patient thinks he is being followed or watched are common; also the belief that people on TV, radio are directing special messages to him/her.
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Positive Symptoms
• Hallucinations. Distortions or exaggerations of perception in any of the senses.
• Often they hear voices within their own thoughts followed by visual hallucinations.
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Positive Symptoms
• Disorganized thinking/speech.
• AKA loose associations; speech is tangential, loosely associated or incoherent enough to impair communication.
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Positive Symptom
• Grossly disorganized behavior.
• Difficulty in goal directed behavior (ADLs), unpredictable agitation or silliness, social disinhibition, or bizarre behavior.
• There is a purposelessness to behavior.
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Positive Symptom
• Catatonic behavior.
• Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.
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Other Positive Symptoms
• Inappropriate response to stimuli
• Unusual motor behavior (pacing, rocking)
• Depersonalization
• Derealization
• Somatic preoccupations
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Summary of Positive Symptoms
• Delusions
• Hallucinations
• Disorganized thinking
• Disorganized behavior
• Catatonic behavior
• Inappropriate responses
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FYI: Positive Symptoms
• Positive symptoms are those that have a positive reaction from some treatment.
• In other words, positive symptoms respond to treatment.
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Negative Symptoms
• Those that appear to reflect a decline or loss of normal functions.
• May be difficult to evaluate because they are not as grossly abnormal as positive symptoms.
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Negative Symptoms
• Affective flattening.
• Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.
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Negative Symptom
• Alogia (poverty of speech)
• Lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts; often manifested as short, empty replies to questions.
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Negative Symptom
• Avolition
• The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.
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Examples of Avolition
• No longer interested in going out with friends
• No longer interested in activities that the person used to show enthusiasm
• No longer interested in anything
• Sitting in the house for hours or days doing nothing
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Disorganized Symptoms
• This one is somewhat new and may not be considered valid.
• It is thought disorder, confusion, disorientation and memory problems.
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Summary of Negative Symptoms
• Lack of emotion• Low energy• Lack of interest in life• Affective flattening• Alogia• Inappropriate social skills• Inability to make friends• Social isolation
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Cognitive Symptoms
• Difficulties in concentration and memory:– Disorganized thinking– Slow thinking– Difficulty understanding– Poor concentration– Poor memory– Difficulty expressing thoughts– Difficulty integrating thoughts, feelings,
behaviors
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FYI: Negative Symptoms
• Currently there is no treatment that has a consistent impact on negative symptoms.
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Types of Schizophrenia
• Paranoid
• Hebephrenic
• Catatonic
• Residual
• Schizoaffective
• Undifferentiated
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Paranoid Schizophrenia
• Persons are very suspicious of others and often have grand schemes of persecution at the root of their behavior.
• During this phase they may have hallucinations and frequent delusions.
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Hebephrenic Schizophrenia
• AKA disorganized schizophrenia; characterized by emotionless, incongruous, or silly behavior, intellectual deterioration, frequently beginning insidiously during adolescence.
• May be verbally incoherent and may have moods and emotions that are not appropriate to the situation.
• Hallucinations not usually present.
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Catatonic Schizophrenia
• Person is extremely withdrawn, negative and isolated.
• May have marked psychomotor disturbances.
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Residual Schizophrenia
• Lacks motivation and interest in day-to-day living.
• Person is not usually having delusions, hallucinations or disorganized speech.
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Schizoaffective Disorder
• There will be symptoms of schizophrenia as well as mood disorder (depression, bipolar, mixed mania).
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Undifferentiated Schizophrenia
• Conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the previous types.
• Exhibits more than one of the previous types without a clear dominance of one.
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Summary
• Before a diagnosis the psychiatrist must make a thorough evaluation including a physical/medical exam, a mental status exam, appropriate labs, and a full history.
• History includes changes in thinking, behavior, movement, mood, etc. as seen by the family.
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Medications
• In general it may take up to 6 months for medications to show consistent effects.
• The newest medication is Invega.
• Meds include atypicals: Abilify, Geodon, Clozapine, Risperidone, Seroquel, Zyprexa. – [Remember: a giraffe can really see a zebra]
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• These medications may have such intolerable side effects that the patient will stop the drugs.
• One study showed the average time the meds were taken regularly was 3 months.
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Treatments
• Psychotherapy - an adjunct to meds and is very useful to keep the patient on the meds.
• Group therapy
• Family therapy
• Community support groups
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• Early detection and treatment has the best results/response to treatment.
• Per patients, once you have schizophrenia you have it for life. The best you can hope for is control.
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Psych Definitions
• Delusion = fixed beliefs that usually involve a misinterpretation of experience. “Client believes someone is reading his thoughts”
• Several types: grandiose, nihilistic, persecutory, somatic
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Psych Definitions
• Hallucinations = perceptual experiences that occur in absence of actual sensory stimuli; involves the 5 senses.
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Psych Definitions
• Illusions = person misperceives or exaggerates stimuli that actually exist in the external environment.
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Defense Mechanism
• Affiliation =
Turning to others for help or support; sharing problems with others without implying that someone else is responsible.
Ex: An individual has a fight with spouse and turns to their best friend for emotional support.
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Defense Mechanism
• Devaluation =
Attributing exaggerated negative qualities to self or others.
Ex: A boy has been rejected by his long time girlfriend. He tells his friends that he realizes that she is stupid and ugly.
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Defense Mechanism
• Displacement =
Transferring a feeling about, or a response to, one object onto another (usually less threatening) substitute object
Ex: A child is mad at her mother for leaving for the day, but says she is really mad at the sitter for serving her food she does not like.
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Communication Technique
• Confrontation =
Presenting the patient with a different reality of the situation.
Ex: My best friend never calls. She hates me. Nurse ‘I was in the room yesterday when she called.’
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Communication Technique
• Doubt =
Expressing or voicing doubt when a patient relates a situation.
Ex: My best friend hates me. Nurse ‘From what you have told me, that does not should like her. When did she last call you?’
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Thank you...