Psychosis and Schizophrenia: Symptoms, Disorders, and Treatment

What is psychosis?

A state of disturbed thoughts and perceptions; difficulty distinguishing reality.

Symptoms of psychosis?

Hallucinations, delusions, disorganized thoughts, speech, or behavior.

Name 3 schizophrenia spectrum disorders.

Schizophrenia, schizoaffective disorder, delusional disorder.

What is brief psychotic disorder?

Sudden onset of psychotic symptoms lasting less than 1 month.

Is schizophrenia linked to race or gender? what are 2 main factors?

No, it affects all groups equally…genetic factors and biochemical factors(differences in brain structure, function, and interactions among neurotransmitters)

Main neurotransmitter in schizophrenia?

Dopamine.

What does excessive dopamine cause?

Hallucinations, agitation, delusions.

what is high norepinephrine linked to in schizophrenia?

positive symptoms

Environmental stressors contributing to schizophrenia?

Toxins, pollution, lead exposure…Interactions between genetic risk and aspects of an individual’s environment play a role in the development of schizophrenia.

How many symptoms for DSM-5 diagnosis?

At least 2 symptoms for 1 month.

Core DSM-5 symptoms?

Delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms.

Duration required for schizophrenia diagnosis?

At least 6 months…one or more major areas of functioning (work, relationships, self-care)

What is the prodromal stage?

Early warning signs before full psychosis…social awkwardness, loneliness, perhaps depression.

Phase I of schizophrenia?

Acute onset of symptoms,…hallucinations, delusions, apathy, withdrawal, loss of function, hospitalization.

Phase II of schizophrenia?

Symptoms diminish, partial recovery toward previous level of functioning

Phase III of schizophrenia?

Return to baseline functioning.

What domains are assessed in schizophrenia?

Medical, psychiatric, psychosocial, labs, sleep, nutrition, mental status.

What are positive symptoms?

Added experiences that are abnormally present like delusions and hallucinations.

Types of delusions?

Paranoid, persecutory, grandiose, religious.

Speech disturbances in schizophrenia?

Tangentiality: tangent, neologisms: new word creation, word salad.

disorganized behavioral signs of schizophrenia?

Catatonia: staring/unable to show emotion, echopraxia: mimiciing others movement, aggression, waxy flexibility.

LIMPMEN

• Lethargic stupor (appears sedated or comatose, but awake)

• Immobility (a state of physical lack of movement)

• Mutism (minimal or absent verbal communication)

• Posturing or peculiar voluntary motor activity

• Motor activity purposelessness

• Echolalia (repeating words) or Echopraxia (repeating movements)

• Negativism (resistance to instructions or attempts to move)

What are negative symptoms?

Loss of normal functions like emotion, motivation, speech…these creep up..

Examples of negative symptoms?

Flat affect, anhedonia, alogia-limited speech, apathy-poor grooming.

Cognitive impairments in schizophrenia?

Memory deficits, poor attention, weak decision-making.

Mood symptoms in schizophrenia?

Depression, anxiety, inappropriate emotional responses.

Positive symptoms nursing concerns?

Disturbed sensory perception, violence risk, impaired communication.

Negative symptom nursing concerns?

Social isolation, low self-esteem.

Phase I treatment goal?

Safety and medical stabilization (biggest reason pts return back med adherence).

Phase II treatment goal?

help patients understand illness, stabilize meds, manage symptoms.

Phase III treatment goal?

Prevent relapse, maintain independence and quality of life.

What is milieu therapy?

Safe, low-stimulation environment to promote recovery.

Key nursing interventions in schizophrenia?

Build trust, promote self-care, monitor meds, involve family.

How to manage hallucinations/delusions?

Assess, use therapeutic communication, reality-based activities.

Schizophreniform disorder duration?

At least 1 month but less than 6 months…if longer than 6 months it becomes schizophrenia

What is schizoaffective disorder (SAD)?

Psychosis + mood disturbance (bipolar or depression)…at risk for suicide

Schizoaffective bipolar type symptoms?

Mania and depression with psychosis.  Must meet the diagnostic criteria for both schizophrenia and bipolar disorder for at least six months.

Schizoaffective depressed type symptoms?

Depression with psychosis. The presence of both schizophrenia and depression symptoms simultaneously for at least two weeks.

Treatment for schizoaffective bipolar type?

Combination of Antipsychotics, mood stabilizers, antidepressants, psychotherapy.

Treatment for schizoaffective depressed type?

Antipsychotics, antidepressants, CBT, social support.