Schizophrenia and Related Disorders

Psychotic symptoms that last for at least 6 months

schizophrenia

mood related symptoms and symptoms of schizophrenia occur simultaneously

schizoaffective disorder

delusions only, no other psychotic symptoms

delusional disorder

symptoms similar to schizophrenia, but only lasts 1 month

brief psychotic disorder

symptoms equivalent to those of schizophrenia except for the duration (less than 6 mo.) and the absence of a decline in functioning

schizophreniform disorder

psychotic symptoms caused by a substance or medication

substance-induced psychotic disorder

pervasive pattern of deficits including social and interpersonal, cognitive or perceptual distortion, and eccentricities

schizotypal personality disorder

characterized by the presence of delusions that have been experienced for at least 1 month. Hallucinations are not prominent, and behavior is not bizarre

delusional disorder

individual believes that someone, usually of a higher status, is in love with him/her

erotomanic delusions

irrational ideas regarding their own worth, talent, knowledge, or power

grandiose delusions

Irrational assumption their sexual partner in unfaithful

jealous delusions

individuals believe they are being persecuted or malevolently treated

persecutory delusions

believe they have some type of general medical condition

somatic delusions

delusions are prominent but no single thing is predominant

mixed type delusions

medical conditions can cause psychotic symptoms such as prominent hallucinations and delusions

psychotic disorder due to another medical condition

a severe mental condition in which there is disorganization of the personality, deterioration in social functioning, and loss of contact with, or distortion of, reality

psychosis

schizophrenia causes disturbances in

thought processes

perception

affect

there is a severe deterioration of social and occupational functioning in

schizophrenia

what is the lifetime prevalence of schizophrenia in the US

1%

what are the 4 phases of schizophrenia

premorbid phase

prodromal phase

active psychotic phase

residual phase

signs that occur before there is clear evidence of illness and may include distinctive personality traits.

traits:

shy and withdrawn / antisocial behavior

poor peer relationships

doing poorly in school

premorbid phase

begins with a change from premorbid functioning and extends until the onset of psychotic symptoms.

Average length is between 2-5 years.

traits:

deterioration in role functioning and social withdrawl

substantial functional impairment

depressed mood, poor concentration, fatigue

sudden onset of ODC

prodromal phase

phase where psychotic systems are prominent

s/s:

delusions

hallucinations

impairment in work, social relations, self-care

acute phase

usually follows active phase, negative symptoms may remain, and residual impairment often increases between active episodes

flat affect and impairment in role functioning

residual phase

what are the biologic predisposing factors of schizophrenia

structural brain abnormalities

familial patterns + genetics

neurodevelopment

NTs

suggests that schizophrenia mat be caused by an excess of dopamine dependent neuronal activity in the brain

dopamine hypothesis

an excess of serotonin has been hypothesized to be responsible for

positive and negative symptoms of schizophrenia

what is the most consistent structural brain abnormality associated with schizophrenia

larger lateral and third ventricles

smaller total brain volume

what are the predisposing physiological factors of schizophrenia

viral infection

anatomical abnormalities

huntingtons disease

birth trauma

head injury in adulthood

alcohol abuse

researchers now focus their studies of schizophrenia as a

brain disorder

what sociocultural factor has been linked with the development of schizophrenia

poverty

poor social conditions seen as consequence of, rather than a cause of, schizophrenia

downward drift hypothesis

stressful life events are associated with

schizophrenic symptom exacerbation

increased rates of relapse

genetic studies have linked certain genes to increased risk for psychosis and particularly in what demographic

adolescents who use cannabinoids

reflect an alteration or distortion of normal mental functions

associated with normal brain structures, and relatively good responses to treatment

positive symptoms of schizophrenia

what are the positive symptoms of schizophrenia

content of thought

form of thought

perception

fixed, false personal beliefs

delusions

shift of ideas from one unrelated topic to another

loose association

made-up words that have meaning only to the person who invents them

neoplogisms

literal interpretations of the environment

concrete thinking

choice of words is governed by sound

clang associations

group of words put together in a random fashion

word salad

delay in reaching the point of communication because of unnecessary and tedious details

circumstantiality

inability to get to the point of communication due to the introduction of many new topics

tangentiality

inability or refusal to speak

mutism

persistent repetition of the same word or idea in response to different questions

perseveration

interpretation of stimuli through the senses

perception

false sensory perceptions not associated with real external stimuli

hallucinations

what are the different types of hallucinations

auditory

visual

tactile

gustatory

olfactory

false perceptions of sound, most commonly voices

auditory hallucinations

may consist of formed images, such as people, or of unformed images, such as flashes of light

visual hallucinations

false perceptions of the sense of touch, or something on or under the skin

tactile hallucinations

false perceptions of taste

gustatory hallucinations

false perceptions of the sense of smell

olfactory hallucinations

misperceptions of real external stimuli

illusions

repeating movements that are observed

echopraxia

what are the negative symptoms of schizophrenia

affect

avolition

impaired interpersonal functioning

lack of insight

lack of abstract thinking ability

reflect a diminution or loss of normal functions

negative symptoms of schizophrenia

the feeling state or emotional tone

affect

weak emotional tone

bland affect

appears to be void of emotional tone

flat affect

disinterest in the environment

apathy

impairment in the ability to initiate goal-directed activity

avolition

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

emotional ambivalence

impaired personal grooming and self-care activities

deterioration in appearance

clinging and intruding on the personal space of others, exhibiting behaviors that are not culturally and socially acceptable

impaired social function

a focus inward on the self to the exclusion of the external environment

social isolation

deficiency of energy

anergia

inability to experience pleasure

anhedonia

behaviors or attitudes that reflect rage, hostility, and the potential for physical or verbal destructiveness

aggression

inability to sit still or attend others, accompanied yb heightened emotions and tension

agitation

voluntary assumption of inappropriate or bizarre postures

posturing

pacing back and forth and rocking the body

pacing and rocking

diagnosis may be defined as sensory perceptions that are inconsistent with external stimuli and mau include auditory, visual, tactile, olfactory, or gustatory perceptions

disturbed sensory perception: auditory/visual

diagnosis is defined as a disruption in cognitive operations and activities

disturbed thought processes

defined as vulnerable to behaviors in which an individual demonstrates that he or she can be physically, emotionally, and/or sexually harmful either to self or to others

risk for self-or other-directed violence

what are the client goals for risk of self harm or harm of others

client will not harm self or others

what are the interventions for a risk of self harm or harm to others

intervene @ first sign of increased anxiety, agitation, or aggression

validation of the client’s feelings

defined as decreased, delayed, or absent ability to receive, process, transmit, and/or use a system of symbols

impaired verbal communication

helping the client remain on topic when talking and demonstrating the ability to carry on verbal communication in a socially acceptable manner

client goals

facilitating trust and understanding in a non-threatening manner, orienting the client to reality as required, and avoiding abstract phrases and cliches

interventions

digrammatic teaching and learning strategy that allows visualization of interrelationships between medical and nursing diagnoses, assessment data, and treatments

concept map care plan

what are the types of treatments for a patient with schizophrenia

psychopharmacology

nonpharmacological management

what are the kinds of nonpharm management of schizophrenia

ECT therapy

psychosocial intervention

psychoeducation

psychological treatments

what are the psychological treatments

individual psychotherapy

group therapy

behavior therapy

social skills training

family therapy

long term therapeutic approach, can be difficult because of clients impairment in interpersonal functioning

individual psychotherapy

some success if occurring over the long-term course of the illness, less success in acute short term treatment

group therapy

chief drawback has been inability to generalize to community setting after client has been discharged from treatment

behavior therapy

use of role play to teach client appropriate eye contact, interpersonal skills, voice intonation, posture etc. aimed at improving relationship development

social skills training

aimed at helping family members cope with long-term effects of the illness

family therapy

possible alternative when schizophrenia is not being successfully treated by medication alone

ECT

when is ECT indicated

catatonic patient that is not treatable by any other means

what kind of patients may ECT be useful for

medication resistant

assaultive

psychotic

what are the features of behavior modification that have led to the most positive results

clearly defining goals, and how they will be measured

attaching positive, negative, and adverse reinforcements to adaptive and maladaptive behavior

using simple, concrete instructions and prompts to elicit the desired behavior

what are the psychosocial interventions

therapeutic interactions

enhancement of cognitive functioning

using behavioral interventions

what are the main points of psychoeducation

teaching strategies + coping

symptom teaching

social skills training

providing family education