5.schizophrenia

Mental HealthSchizophrenia

Define the following terms

Schizophrenia

Delusions

Hallucinations

Illusions

Alogia

Echolalia

Echopraxia

Waxy flexibility

SCHIZOPHRENIA

Split mind – a serious brain disorder of thought and association and is characterized by an inability to distinguish between what is real and what is not, hallucinations, delusions, and limited socialization.

People with schizophrenia may not be able to differentiate what is theirs and what is not theirs.

It is difficult for them to focus on one topic for any length of time, and can be very distractible.

Cont.

It is a group of psychotic disorders that affect thinking behavior emotions and the ability to perceive reality.

Schzohrenia seems to strike adolescents and young adults between 16 and 35.

Has an insidious onset, developing over time, and symptoms may go unnoticed for a time.

People with schizophrenia have a split between their thoughts and their feelings and between their reality and society’s reality. Poor self esteem is also an issue.

Cont.

These individuals are generally highly intelligent.

Early symptoms of quietness and withdrawal in adolescents unfortunately get shrugged off as just a stage.

School grades may begin to drop off.

Signs and symptoms must be present for 6 months or more before a positive diagnosis can be made.

Four A’s to define Schizophrenia

1. Associative disturbances – making up words “neologisms”

1. Rambling from topic to topic, using revolving words and syllables that may associate to a specific word but are out of context with the conversation.

2. Making up words that rhyme with other words is another behavior that is sometimes observed.

2. Affect – generally have what is called a flat, or blunted affect.

2. Rarely show signs of emotion.

3. There may also be inappropriate or incongruent affect such as laughing when the patient states that he feels sad or depressed.

4. Exaggerations of affect are also present sometimes.

3. Autism

-emotional detachment. Preoccupied with self and show little concern for any reality outside their own world.

4. Ambivalence

-having opposite feelings about one person or situation at the same time. Love hate relationship.

INSIDIOUS

Gradual onset making it hardly noticed

DELUSIONS

Fixed false beliefs that cannot be changed by logic and are usually bizarre.

Patients resist any factual proof that their beliefs do not exist.

Typically patients exhibit delusion of grandeur, persecution, or guilt.

See ATI for different types of delusions.

HALLUCINATIONS

False sensory perceptions that can affect any

of the 5 senses.

ILLUSIONS

Mistaken perceptions of reality.

ALOGIA

Is lack of general unprompted content seen in normal speech. A way of avoiding questions.

Example;

_____Alogia_______

Q. Do you have any children?

A Yes.

Q. How many?

A. Two

Q. How old are they?

A. Six and sixteen.

Q. Are they boys or girls?

A. One is a boy, the other is a girl.

_____Normal speech_

Q. Do you have any children?

A. Yes I have two, a boy and a girl

Q. How old are they?

A. Rachel is sixteen and Ryan is six.

Alogia Continued

Q. Who is the sixteen year old?

A. The boy.

Q. What is his name?

A. Edmond

Q. And the girl’s?

A. Alice.

Q. Do you have any children?

A. Yes, a boy and a girl.

Q. How old are they?

A. Edmond is sixteen and Alice is sex

AVOLUTION

General lack of desire, drive or motivation to

pursue meaningful goals.

ECHOLALIA

The repetition of words the patient may hear.

For example, if the nurse is passing meds and tells Mrs. Brown that “it is time for your pills” a person experiencing echolalia may repeat “your pills….your pills….your pills…” over and over.

ECHOPRAXIA

Same kind of repetition, except that the patient repeats an action. This patient may mimic the nurses action of handling the med to Mrs. Brown by pretending to hand a pill to someone who is probably not there.

WAXY flexibility

Is a psychomotor symptom of catatonic schizophrenia which leads to a decreased response to stimuli and a tendency to remain in an immobile posture.

For instance, if one were to move the arm of someone with waxy flexibility, they would keep their arm where you moved it until it was moved again, as if it were made from wax.

Define the 4 phases of Schizophrenia

1.Schizoid personality

2.Prodromal phase3.Schizophrenia4.Residual phase

Schizoid personality

Individuals are indifferent, cold. And aloof.

Often described as loners and don’t seem to enjoy close relationships with others.

Not all individuals with schizoid personality go on to develop schizophrenia.

Prodromal phase

Individuals continue to be socially withdrawn and begin to exhibit behavior that is peculiar or eccentric.

Role functioning is impaired, personal hygiene is neglected, and disturbances are evident in communication, ideation, and perception.

Schizophrenia

The third and active phase of disorder. Psychotic symptoms are prominent and include delusions, hallucinations, and impairment in work social relations and self care.

Residual phase

Symptoms are similar to the prodromal phase with flat affect and impairment in role functioning.

What are positive symptoms of Schizophrenia

and list examples.

Positive Symptoms

Positive symptoms are the most easily identified symptoms.

Positive symptoms can be thought of as those symptoms that reflect an excess or distortion of normal functioning.

Positive symptoms include hallucinations, delusions, disorganized thinking, and disorganized behavior and speech, and bizarre behavior such as walking backward constantly.

What are negative symptoms and list examples.

Negative Symptoms

Negative symptoms are more difficult to treat successfully than positive symptoms.

Negative symptoms can be thought of as a loss of normal functioning.

They include affect usually blunted (narrow range of normal expression) or flat (facial expression never changes).

Alogia-poverty of thought or speech; mumble or respond vaguely to questions.

Avolition lack of motivation in activities and hygiene, poor ability to perform ADL’s

Anhedonia-lack of pleasure or joy the client is indifferent to things that often make other happy, such as looking at beautiful scenery. Just plain lack of interest.

Anergia lack of energy.

Cognitive symptoms

Problems with thinking make it very difficult for the client to live independently.

Show disordered thinking, inability to make decisions, poor problem solving ability, difficulty concentrating to perform tasks, memory deficits-long term memory and inability to follow directions.

Depressive symptoms

Hopelessness and suicidal ideations

Causes of Schizophrenia

Genetics

Neurochemical Changes-dopamine, norepinephrine, serotonin, GABA

Changes in brain structure-enlargement of brain ventricles

Cognitive impairments-4 types of thinking are affected

Neurological abnormalities-abnormal reflexes, eye movements, abnormal sensations

Brain electrical abnormalities-abnormal electrical activity

Immunological and inflammatory abnormalities-reduced immune function, abnormalities in leukocytes and immunoglobulins

Season of birth-winter and spring

Urban living-city living twice as high as rural living

Other-pregnancy and birth complications

Course of the Disease

The onset is usually young adulthood, although it can affect people of any age

Most cases develop between the ages of 16-30

People can have exacerbations and then go into a period where symptoms subside

If people recognize symptoms that lead up to the prodromal phase, medications and therapy can lessen the psychotic episode that follows

Suicide, car accidents, early death, heart disease, diabetes are more likely in schizophrenics

List 6 medical treatment for Schizophrenia

1. Medications-typical and atypical antipsychotics which block dopamine action n the brain.

2. Individual and family psychotherapy

3. Nutritional supplement-some doctors and nutritionists suggest a dose of niacin B3 may be helpful in some patients with Schizophrenia. Niacin has an affect on the serotonin and tryptophan in the brain and increasing it may help lower the behaviors associated with Schizophrenia.

4. Social skill training.

5. Neurolinguistic programming-using words, but be careful and use appropriate framing (terminology) for people who may be hearing voices…

6. Massage therapy

7. ECT- used in severe cases or in cases that are difficult to treat.

8. Current opinion holds that Schizophrenia is not curable but is treatable.

Medications (Antipsychotics)

Thorazine

Prolixin

Mellaril

Stelazine

Haldol

Inapsine

Loxitane

Navane

Moban

Clozaril

Risperdal

Zyprexa

Seroquel

Geodon

Abilify

Discuss assessment of Schizophrenia

Observation for positive and negative symptoms.

Observe interactions with others.

Monitor for response to meds and possible side effects.

Determine ability to function with ADLs.

As always assess yourself and your personal feelings and responses to clients family or other support system, their responses to illness and how they deal with symptoms.

Assess the clients delusions, hallucinations, and behavior to determine whether self or other directed violence is likely. CONT.>

Assess for alterations in thought (delusions), alterations in speech; flight of ideas, neologisms, clang association (rhyming). Word salad (words jumbled together with little meaning).

Alterations in perception.

Hallucination.

Personal boundaries difficulties, alterations in behaviors; extreme agitation, including pacing and rocking,, wavy flexibility, etc.

List 10 nursing interventions for the client

with Schizophrenia

1. Never reinforce hallucinations, delusions, or illusions. It is necessary to keep the patient in reality.

1. Nurses must realize how frightening hallucinations are and must be prepared to spent time with patient to help decrease anxiety level.

2. When commenting on hallucinations, ask them directly about them. Do not argue about hallucinations just simply state" I don’t hear anything, but you seem to be feeling frightened”.

3. Use a calm voice and use simple commands

2. Never whisper or laugh when the patient cannot hear the whole conversation. Face the patient when talking to them. Whispering, laughing, or turning away from patient may be enough to cause aggressive behavior.

3. Avoid placing patient in situations of competition or embarrassment.

4.Trust – it is crucial for a trusting relationship to exist between nurse and patient. Keep promises. Be honest and consistent in all aspects. Allow patient to vent thoughts and feelings, in the appropriate places and times! Whenever possible assign same nurse to same patient to ensure consistency in care.

5.Communication-keep it simple. Brief, and clear with all instructions. State what is acceptable and give rational and consequences. Emphasize behavior that is appropriate.

6. Milieu – treatment setting must be calm and conducive to making progress. Should be safe, structured environment to decrease anxiety and to distract patient from constant thinking about hallucinations.

7. State information in the positive rather than negative, For example, eat your food calmly, don’t throw your food!

8. Encourage development of social skills and friendships.

9. Encourage participation in group work and psychotherapy.

10. Identify symptoms triggers, loud noises

11. Be genuine and empathetic in all dealings with the patient.

12. Educate patient and family about illness and treatment

13. Promote self care.

14. Use symptoms management techniques- music to distract voices, attend activities, talk to a trusted person when hallucinations are most bothersome, and actually interacting with hallucination by telling it to stop or go away.