Schizophrenia

SCHIZOPHRENIA MOD#1

• A MAJOR FORM OF PSYCHOTIC DISORDER THAT AFFECTS A
PERSON THINKING , LANGUAGE , EMOTION , BEHAVIOR AND
ABILITY TO PERCIEVED REALITY.
• AT LEAST 2 OF 5 TYPES OF POSITIVE AND NEGATIVE
SYMPTOMS
• CHARACTERISTICS SYMPTOMS
• SOCIAL OR OCCUPATIONAL DYSFUNCTION
• IPR (INTERPERSONAL RELATIONSHIP )
• SELF CARE

CAUSES OF SCHIZOPHRENIA
• HEREDITY

RESEARCH SHOWS THAT THE CONDITION TENDS TO RUN IN FAMILIES. A PERSON WITH SCHIZOPHRENIE RELATIVES IS TEN TIMES AS LIKELY TO DEVELOP SCHIZOPHRENIA AS SOMEONE WHO HAS NO HISTORY OF THE DISEASE IN THE FAMILY

• VIRAL INFECTION

SOME RESEARCHERS HAVE ARGUED THAT SCHIZOPHRENIA IS CAUSED BY A VIRUS THAT ATTACKS THE BRAIN. THE WIRUS IS THOUGHT TO ATTACK THE PART OF THE BRAIN THAT INTERPRETS MESSAGES FROM THE SENSES. DAMAGE TO THIS PART OF THE BRAIN MAY ACCOUNT FOR A PERSON'S DELUSIONS AND HALLUCINATIONS.

• CHEMICAL IMBALANCE

POPULAR THEORY IS THAT SCHIZOPHRENIA IS CAUSED BY AN IMBALANCE OF NEUROTRANSMITTERS IN THE BRAIN. NEUROTRANSMITTERS ARE CHEMICALS THAT CARRY ELECTRICAL MESSAGES BETWEEN NERVE CELLS. TOO MUCH OF A NEUROTRANSMITTER. OR TOO LITTLE. MAY ACCOUNT FOR VARIOUS MENTAL DISORDERS, INCLUDING SCHIZOPHRENIA.

SYMPTOMS

POSITIVE AND NEGATIVE SYMPTOMS ARE MEDICAL TERMS FOR TWO GROUPS OF SYMPTOMS IN SCHIZOPHRENIA.

POSITIVE SYMPTOMS
• ANY CHANGE IN BEHAVIOR OR THOUGHTS.
• EXAGGERATED IDEAS, PERCEPTIONS, OR ACTIONS THAT SHOW THE PERSON CAN'T TELL WHAT'S REAL FROM WHAT ISN’T.
• HALLUCINATIONS- FALSE SENSORY PERCEPTIONS OR PERCEPTUAL EXPERIENCES THAT DO NOT EXIST IN REALITY.
• DELUSIONS- FIXED FALSE BELIEFS THAT HAVE NO BASIS.
• ABNORMAL THOUGHT PATTERNS OR PERCEPTION-
• BIZARRE BEHAVIOR – OUTLANDISH APPERANCE OR CLOTHING; REPETITIVE OR STEREOTYPED, SEEMINGLY PURPOSELESS MOVEMENTS ; UNSUAL SOCIAL OR SEXUAL BEHAVIOR.

NEGATIVE SYMPTOMS
• WHERE PATIENT APPEAR TO WITHDRAW FROM THE WORLD
• NEGATIVE SYMPTOMS WORSEN PATIENTS' QUALITY OF LIFE
AND FUNCTIONING.

• AFFECTIVE FLATTENING - ABSENCE OF FACIAL EXORESSION TTHAT WOULD INDICATE EMORTIONS OR MOOD
• ANHEDONIA - FEELING NO JOY OR PLEASURE FROM LIFE OR ANY ACIVITIES OR RELATIONSHIPS
• ATTENTION IMPAIRMENT - INABILITY TO CONCENTRATE OF FOCUS ON A TOPIC OR ACITIVITY , REGARDLESS OF ITS IMPORTANCE.
• ASOCIAL BEHAVIOR - SOCIAL WITHDRAWAL , FEW OR NO RELATIONSHIPS, LACKS OF CLOSENESS
• ANERGIA - A CONTINUAL FEELING OF TIREDNESS, LACK OF ENERGY, OR SLEEPINESS
• AUTISM - A COMPLEX DEVELOPMENTAL CONDITION INVOLVING PERSISTENT CHALLENGES WITH SOCIAL COMMUNICATION, RESTRICTED INTERESTS AND REPETITIVE BEHAVIOR.
• AVOLITION - ABSENCE OF WILL , AMBITION , OR DRIVE TO TAKE ACTION OR ACCOMPLISH TASKS

DISTURBED THOUGHT PROCESESS
• LOOSENESS OF ASSOCIATION
• FLIGHT OF IDEAS
• AMBIVALENCE
• MAGICAL THINKING
• ECHOLALIA / ECHOPRAXIA
• WORD SALAD
• CLANG ASSOCIATION
• NEOLOGISM
• THOUGHT BLOCKING
• CONCRETE ASSOCIATION
• DELUSION , HALLUCIANTION AND ILLUSION

TYPES OF SCHIZOPHRENIA

1.     PARANOID SCHIZOPHRENIA

• PATIENTS DIAGNOSED WITH PARANOID SCHIZOPHRENIA TEND TO SUFFER FROM DELUSIONS AND HALLUCINATIONS.
• A DELUSION IS A BELIEF ABOUT THE WORLD THAT IS NOT CONSISTENT WITH THE FACTS
• HALLUCINATIONS OFTEN TAKE THE FORM OF HEARING IMAGINARY VOICES AND A PATIENT MAY BELIEVE THAT HE OR SHE IS RECEIVING MESSAGES FROM A SUPERNATURAL OR UNKNOWN SOURCE

2.     DISORGANIZED SCHIZOPHRENIA

• PATIENTS WITH DISORGANIZED SCHIZOPHRENIA HAVE CONFUSED, DISORGANIZED PATTERNS OF SPEECH, THOUGHT, AND BEHAVIOR.
• THEY MAY ACT SILLY OR WITHDRAW FROM THE WORLD AROUND THEM. AT ONE TIME, DISORGANIZED SCHIZOPHRENI WAS CALLED HEBEPHRENIA

3.     CATATONIC SCHIZOPHRENIA

• CATATONIC SCHIZOPHRENIA IS CHARACTERIZED BY ABNORMAL TYPES OF POSTURE AND MOVEMENT.
• A PATIENT MAY STAND OR WALK IN PECULIAR PATTERNS, MAY REPEAT CERTAIN MOTIONS OVER AND OVER AGAIN, OR BECOME RIGID AND UNMOVING FOR LONG PERIODS OF TIME.

4.     UNDIFFERENTIATED SCHIZOPHRENIA

• THIS CATEGORY IS RESERVED FOR PATIENTS WHO SHOW SOME SYMPTOMS OF SCHIZOPHRENIA BUT DO NOT FIT INTO ANY OF THE THREE CATEGORIES DESCRIBED ABOVE.

5.     RESIDUAL SCHIZOPHRENIA

• PATIENTS IN THIS CATEGORY HAVE HAD AT LEAST ONE SCHIZOPHRENIC EPISODE BUT NO LONGER DISPLAY THEMOST SEVERE SYMPTOMS OF THE FIRST THREE TYPES OF
SCHIZOPHRENIA

OTHER PSYCHOSIS
• BRIEF PSYCHOTIC DISORDER
• MAYBE SEEN WHEN A PERSON EXHIBITS CLINICAL SYMPTOMS OF ILLOGICAL THINKING, INCOHERENT SPEECH, DELUSIONS, OR DISORGANIZED BEHAVIOR AFTER PSYCHOLOGICAL TRAUMA INDUCED PSYCHOTIC DISORDER DEVELOPS IN A SECOND PERSON AS A RESULT OF A CLOSE RELATIONSHIP WITH A PERSON WHO HAS PSYCHOSIS

• SCHIZOAFFECTIVE DISORDER
• CHARACTERIZED BY DEPRESSION OR ELATION AS THE PSYCHOSIS SYMPTOMS OF SCHIZOPHRENIA AND MAJOR DEPRESSIVE DISORDER
• SCHIZOPHRENIFORM
• WHEN A PERSON EXHIBITS FEATURES OF SCHIZOPHRENIA FOR MORE THAN ONE WEEK BUT LESS THAN 6 MONTHS

PSYCHOTHERAPEUTIC MANAGEMENT

NURSE – PATIENT RELATIONSHIP

• ESTABLISH TRUST
• USE OF THERAPEUTIC COMMUNICATION CLARIFYING FEELINGS OF
THE CLIENT
DO NOT CONFRONT THE DELUSION OR ARGUE WITH THE CLIENT
• ESTABLISH AND MAINTAIN REALITY TO THE CLIENT
• TEACH PATIENT POSITIVE SELF TALK-IGNORE DELUSIONAL
BELIEFS
• ENGAGE CLIENT IN REALITY-BASED ACTIVITIES
• • TREATMENT-MILIEU
• TEACH PATIENT SOCIAL SKILLS

PSYCHOPHARMACOLOGY

NEUROLEPTICS (ANTIPSYCHOTIC MEDICATIONS)
• THIS IS NOT USED TO CURE SCHIZOPHRENIA, BUT MANAGE THE SYMPTOMS OF THE DISEASE
• TYPICAL ANTIPSYCHOTICS - ARE MOST EFFECTIVE FOR TREATING ACUTE PSYCHOSES AND THE AGITATION ASSOCIATED WITH MANIA
• ATYPICAL ANTIPSYCHOTICS- EFFECTIVE IN THE TREATMENT   OF MORE CHRONIC FORMS OF PSYCHOSES.

TYPICAL ANTIPSYCHOTICS
• CLORPROMAZINE(THORAZINE)
• TRIFLUOPERAZINE (TRILAFON)
• HALOPERIDOL (HALDOL)
• FLUPHENAZINE (PROLIXIN)

ATYPICAL ANTIPSYCHOTICS
•CLOZAPINE (CLORAZIL)
•RISPERIDONE (RISPERDAL)
•ZIPRASIDONE (GEODON)
•OLANZAPINE (ZYPREXA)
•QUETIAPINE( SEROQUEL)

MAINTENANCE THERAPY
SIX ANTIPSYCHOTICS ARE AVAILABLE AS LONG-ACTING INJECTIONS (LAI),
• FORMERLY CALLED DEPOT INJECTIONS
✓FLUPHENAZINE (PROLIXIN)
✓ARIPIPRAZOLE (ABILIFY MAINTENA)
✓RISPERIDONE (RISPERDAL CONSTA)
✓HALOPERIDOL (HALDOL) IN DECANOATE
✓OLANZAPINE (ZYPREXA RELPREVV)
✓PALIPERIDONE (INVEGA SUSTENNA)        

SIDE EFFECTS

DYSTONIA
• APPEAR EARLY IN THE COURSE OF TREATMENT
• CHARACTERIZED BY SPASMS IN DISCRETE MUSCLE GROUPS, SUCH AS THE NECK MUSCLES (TORTICOLLIS) OR EYE MUSCLES (OCULOGYRIC CRISIS)
• PROTRUSION OF THE TONGUE, DYSPHAGIA, AND LARYNGEAL AND
PHARYNGEAL SPASMS

PSEUDOPARKINSONISM
• A REACTION TO MEDICATIONS THAT IMITATES THE SYMPTOMS AND APPEARANCE OF PARKINSON'S DISEASE.
• COGWHEELING RIGIDITY
• SHUFFLING GAIT
• DROOLING
• AKINESIA( LOSS OF ABILITY TO MOVE YOUR MUSCLES VOLUNTARILY)
• MASKLIKE FACE

TARDIVE DYSKINESIA
• A LATE-APPEARING SIDE EFFECT OF ANTIPSYCHOTIC MEDICATIONS
• IS CHARACTERIZED BY ABNORMAL, INVOLUNTARY MOVEMENTS SUCH AS LIP SMACKING, TONGUE PROTRUSION, CHEWING, BLINKING, GRIMACING, AND CHOREIFORM MOVEMENTS OF THE LIMBS AND FEET.
• IRREVERSIBLE ONCE IT APPEARS
• DECREASING OR DISCONTINUING THE MEDICATION CAN ARREST THE PROGRESSION

AKATHISIA
• IS CHARACTERIZED BY RESTLESS MOVEMENT, PACING, INABILITY TO REMAIN STILL, AND THE CLIENT’S REPORT OF INNER RESTLESSNESS
• USUALLY DEVELOPS WHEN THE ANTIPSYCHOTIC IS STARTED OR WHEN THE DOSE IS INCREASED.

NEUROLEPTIC MALIGNANT SYNDROME
• IS A SERIOUS AND FREQUENTLY FATAL CONDITION SEEN IN THOSE BEING TREATED WITH ANTIPSYCHOTIC MEDICATIONS.
• IT IS CHARACTERIZED BY A DISTINCTIVE CLINICAL SYNDROME OF MENTAL STATUS CHANGE, RIGIDITY, FEVER.

MILIEU THERAPHY
• A THERAPEUTIC COMMUNITY
• AN INTERACTION AMONG CLIENTS OR PATIENTS ARE SEEN AS
BENEFICIAL, AND TREATMENT EMPHASIZES THE ROLE OF
CLIENT TO CLIENT INTERACTION.
• SAFETY IS THE MOST IMPORTANT PRIORITY IN MANAGING THE
MELIEU THERAPHY

ELECTROCONVULSIVE THERAPY (ECT)
- IS A MEDICAL TREATMENT MOST COMMONLY USED IN PATIENTS WITH
SEVERE MAJOR DEPRESSION OR BIPOLAR DISORDER THAT HAS NOT
RESPONDED TO OTHER TREATMENTS.
- ECT INVOLVES A BRIEF ELECTRICAL STIMULATION OF THE BRAIN WHILE
THE PATIENT IS UNDER ANESTHESIA.

BENEFITS OF ECT
• ECT OFFERS SEVERAL BENEFITS FOR PATIENTS WITH SEVERE MENTAL
HEALTH DISORDERS:
• RAPID SYMPTOM RELIEF: ECT CAN BRING RELIEF FROM SEVERE
SYMPTOMS QUICKER THAN OTHER TREATMENTS.
• REDUCED SUICIDE RISK: ECT CAN RAPIDLY ALLEVIATE SUICIDAL
THOUGHTS AND BEHAVIORS.
• EFFECTIVE IN TREATMENT-RESISTANT CASES: ECT OFTEN WORKS
WHEN OTHER TREATMENTS HAVE FAILED.
• IMPROVED QUALITY OF LIFE: SUCCESSFUL ECT TREATMENT CAN
SIGNIFICANTLY ENHANCE AN INDIVIDUAL’S OVERALL WELL-BEING.

NURSING CARE BEFORE ECT
•ASCERTAIN IF THE CLIENT AND THE FAMILY HAVE RECEIVED A FULL EXPLANATION, INCLUDING THE OPTION TO WITHDRAW THE CONSENT
AT ANY TIME.
•WITHHOLD FOOD AND FLUIDS FOR 6 TO 8 HOURS BEFORE TREATMENT.
•REMOVE DENTURES, GLASSES, CONTACT LENSES, HEARING
AIDS, HAIR PINS AND ETC.
•HAVE THE CLIENT VOID BEFORE THE TREATMENT.
•GIVE PREOPERATIVE MEDICATIONS AS ORDERED:
• GIVE EITHER GLYCOPYRROLATE (ROBINUL) TO REDUCE SALIVA OR ATROPINE TO
PREVENT THE POTENTIAL FOR ASPIRATION AND TO HELP MINIMIZE
BRADYARRHYTHMIAS IN RESPONSE TO ELECTRICAL STIMULANTS.

NURSING CARE DURING ECT
• PLACE A BLOOD PRESSURE CUFF ON ONE OF THE CLIENT’S ARMS.
• AS THE INTRAVENOUS LINE IS INSERTED AND ECG ELECTRODES ARE ATTACHED,
GIVE A BRIEF EXPLANATION TO THE CLIENT.
• PUT ON THE PULSE OXIMETER ON THE CLIENT’S FINGER.
• MONITOR BLOOD PRESSURE THROUGHOUT THE TREATMENT.
• MEDICATIONS TO BE GIVEN:
• SHORT-ACTING ANESTHETIC (BREVITAL )
• MUSCLE RELAXANT (SUCCINYLCHOLINE)
• 100% OXYGEN BY MASK
• CHECK IF THE BITE BLOCK IS PLACED TO PREVENT BITING OF THE TONGUE
• AN ELECTRICAL STIMULUS WAS GIVEN (THE SEIZURE SHOULD LAST 30 TO 60
SECONDS).

• Nursing Care After ECT
• Have the client go to a properly staffed recovery room.
• Once the client is awake, talk to the client and check the vital signs.
• Give frequent orientation and reassurance to allay confusion .
• Check the gag reflex before giving the client fluids, medications, or
breakfast.