Schizophrenia and Other Psychotic Disorders Chapter 1

1
Schizophrenia and Other Psychotic Disorders

• Chapter 14

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• Schizophrenia
• http//www.youtube.com/watch?vH_jYqSA_fJk
• Schizophrenia Part 1 - ABC 20/20 coverage
• http//www.youtube.com/watch?vmoP_e-gx5hk
• Schizophrenia Part 2 - ABC 20/20 coverage
• http//www.youtube.com/watch?vQPXkwYM9G-s
• What is Schizophrenia? (Schizophrenia 1)
• http//www.youtube.com/watch?vKnoTwOUb0aQ
• Diagnosing and Treating Schizophrenia
  (Schizophrenia 2)
• http//www.youtube.com/watch?vWwlM1pxIbaI

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Introduction

• The word schizophrenia is derived from the Greek
  words skhizo (split) and phren (mind).
• Schizophrenia is probably caused by a
  
• combination of factors, including
• Of all mental illnesses, schizophrenia probably
  causes more
• Lengthy hospitalizations
• Chaos in family life
• Exorbitant costs to people and governments
• Fears

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Nature of the Disorder

• Schizophrenia disturbs
• Thought processes, Perception and Affect
• With schizophrenia, there is a severe
  deterioration of social and occupational
  functioning
• In the United States, the lifetime prevalence
  of schizophrenia is about 1 percent.

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• Premorbid behavior of the patient with
  schizophrenia can be viewed in four phases.
• First Phase Schizoid Personality
• Indifferent, cold, and aloof, these people are
  loners. They do not enjoy close relationships
  with others.
• Second Phase Prodromal Phase
• These people are socially withdrawn and show
  evidence of peculiar or eccentric behavior.
• Neglect of personal hygiene and grooming
• Blunted or inappropriate affect
• Disturbances in communication
• Bizarre ideas
• Lack of initiative
• Third Phase Schizophrenia
• In the active phase of the disorder, psychotic
  symptoms are prominent
• Delusions
• Hallucinations
• Impairment in work, social relations, and
  self-care
• Fourth Phase Residual Phase
• Symptoms similar to those of the prodromal phase

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Predisposing Factors

• Various physical conditions
• Epilepsy
• Huntingtons chorea
• Birth trauma
• Head injury in adulthood
• Alcohol abuse
• Cerebral tumor
• Cerebrovascular accident
• Systemic lupus erythematosus
• Myxedema
• Parkinsonism
• Wilsons disease

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Characteristic Symptoms

• Negative symptoms

• Positive symptoms

• Delusions
• Hallucination
• Disorganized speech
• Grossly disorganized or catatonic behavior

• Affective Flattening
• Alogia
• Apathy
• Anhedonia
• Social isolation

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Types of schizophrenia and other psychotic
disorders

• Paranoid
• Disorgainzed
• Catatonic
• Residual
• Undifferentiated
• Schizoaffective disorder

• Brief psychotic disorder
• Schizophreniform disorder
• Delusional Disorder
• Shared psychotic disorder
• substance-Induced psychotic disorder

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Content of Thought

• Delusions

• Form

• Of Persecution
• Of Grandeur
• Of Reference
• Of control or influence
• Somatic
• Nihilistic
• Religiosity
• Paranoia
• Magical thinking

• Associative Looseness
• Neologisms
• Concrete thinking
• Clang associations
• Word salad
• Circumstantialities
• Tangentiality
• Mutism
• Perseveration

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• Perception

• Affects

• Hallucination
• Auditory
• Visual
• Tactile
• Olfactory

• Inappropriate affect
• Bland or flat affect
• Apathy

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Conventional Antipsychotics

• Generic
• Haloperidol
• Chlorpromazine
• Fluphenazine
• Thiothixene
• Trifluoperazine
• Thioridazine
• Perphenazine
• Loxapine

• Brand
• Haldol
• Thorazine
• Prolidixin
• Navane
• Stelazine
• Mellari
• Trilafon
• Loxitane

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Conventional Antipsychotics

• Advantage
• -Effective for positive
• symptoms of
• schizophrenia
• - Available in IM
• formulation for acute
• psychosis/agitation
• - Cheap

• Disadvantage
• Could worsen
• cognitive function
• Minimally effective for
• negative symptoms
• of schizophrenia
• Higher incidence of
• side effects (EPS, NMS,
• tardive dyskinesia, etc.

13
Atypical Antipsychotics

• Generic
• Clozapine
• Olanzapine
• Risperidone
• Quetiapine
• Ziprasidone
• Aripiprazole
• Paliperidonen

• Brand
• Clozaril, FazaClo
• Zyprexa (Aydis)
• Risperdal (Consta, M-tab)
• Seroquel, Seroquest XR
• Geodon
• Abilify
• Invega (newest)

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Atypical Antipsychotics

• Advantage
• Effective for positive
• of symptoms of
• schizophrenia
• May improve negative
• symptoms of
• schizophrenia
• Lower incidence of
• side effects compared to conventional
  antipsychotics

• Disadvantage
• Higher incidence of
• weight gain
• Higher incidence of
• diabets
• - Expensive

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Side Effects

• Neuroleptic malignant syndrome (NMS)
• Potentially life threatening
• High fever, unstable BP, myoglobinemia
• Extrapyramidal symptoms (EPS)
• Involuntary muscle symptoms similar to those of
  Parkinsons disease
• Akathisia (distressing muscle restlessness)
• Acute dystonia (painful muscle spasms)
• Treated with benztropine (Cogentin) and
  trihexyphenidyl (Artane)
• Tardive dyskinesia (TD)
• Involuntary contractions of oral and facial
  muscles
• Choreoathetosis (wavelike movements of
  extremities)
• Occurs with continuous long-term antipsychotic
  therapy

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Nursing Process

• Nursing Assessment
• Nursing Diagnosis
• Related to
• Evidenced by
• Interventions
• Education

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Conventional Antipsychotics

• Generic
• Haloperidol
• Chlorpromazine
• Fluphenazine
• Thiothixene
• Trifluoperazine
• Thioridazine
• Perphenazine
• Loxapine

• Brand
• Haldol
• Thorazine
• Prolidixin
• Navane
• Stelazine
• Mellari
• Trilafon
• Loxitane

18
Conventional Antipsychotics

• Advantage
• -Effective for positive
• symptoms of
• schizophrenia
• - Available in IM
• formulation for acute
• psychosis/agitation
• - Cheap

• Disadvantage
• Could worsen
• cognitive function
• Minimally effective for
• negative symptoms
• of schizophrenia
• Higher incidence of
• side effects (EPS, NMS,
• tardive dyskinesia, etc.

19
Atypical Antipsychotics

• Generic
• Clozapine
• Olanzapine
• Risperidone
• Quetiapine
• Ziprasidone
• Aripiprazole
• Paliperidonen

• Brand
• Clozaril, FazaClo
• Zyprexa (Aydis)
• Risperdal (Consta, M-tab)
• Seroquel, Seroquest XR
• Geodon
• Abilify
• Invega (newest)

20
Atypical Antipsychotics

• Advantage
• Effective for positive
• of symptoms of
• schizophrenia
• May improve negative
• symptoms of
• schizophrenia
• Lower incidence of
• side effects compared to conventional
  antipsychotics

• Disadvantage
• Higher incidence of
• weight gain
• Higher incidence of
• diabets
• - Expensive

21
Antipsychotics

• Background Assessment Data
• Indications Treatment of acute and chronic
  psychoses selected agents are also used as
  antiemetics in the treatment of intractable
  hiccoughs and for control of tics and vocal
  utterances in Tourettes disorder
• Actions Unknown thought to block postsynaptic
  dopamine receptors in the basal ganglia,
  hypothalamus, limbic system, brainstem, and
  medulla. Newer antipsychotics may block action on
  receptors specific to dopamine, serotonin, and
  other neurotransmitters.

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• Contraindications/precautions
• Contraindicated with known hypersensitivity
  with CNS depression when blood dyscrasias exist
  in clients with Parkinsons disease or those
  with liver, renal, or cardiac insufficiency
• Caution with elderly, debilitated, or diabetic
  clients or those with respiratory insufficiency,
  prostatic hypertrophy, or intestinal obstructio
• Interactions
• Additive anticholinergic effects with other
  drugs that produce these properties
• Additive hypotensive effects with beta-blockers
• Decreased absorption of antipsychotics with
  antacids and antidiarrheals
• Decreased effectiveness of antipsychotics with
  barbiturates
• Additive CNS depression with alcohol,
  antihistamines, antidepressants,
  sedative-hypnotics, and anxiolytics

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Nursing Diagnosis

• Risk for other-directed violence
• Risk for injury
• Risk for activity intolerance
• Noncompliance

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Neuroleptic Malignant Syndrome

• Signs and symptoms of NMS are muscle rigidity,
  hyperthermia, decreased ventilation,
  cardiovascular collapse, and an elevate CPK

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Side effects

• Neuroleptic malignant syndrome (NMS)
• Potentially life threatening
• High fever, unstable BP, myoglobinemia
• Extrapyramidal symptoms (EPS)
• Involuntary muscle symptoms similar to those of
  Parkinsons disease
• Akathisia (distressing muscle restlessness)
• Acute dystonia (painful muscle spasms)
• Treated with benztropine (Cogentin) and
  trihexyphenidyl (Artane)
• Tardive dyskinesia (TD)
• Involuntary contractions of oral and facial
  muscles
• Choreoathetosis (wavelike movements of
  extremities)
• Occurs with continuous long-term antipsychotic
  therapy

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• A 29 year old woman is being discharged in 2 days
  form the hospital after her first psychotic break
  (paranoid schizophrenia). She is recently
  divorced and has been working as a legal
  secretary, although her work had become erratic,
  and her suspicious behavior was calling attention
  to herself at work. She will be discharged in
  her mothers care until she is able to resume
  working. Her mother is overwhelmed and asked the
  nurse how she is going to cope. She has become
  so distant and she always takes thing the wrong
  way. I can hardly say anything to her with her
  misconstruing everything. She is very mad at me
  because I called 911 and had her admitted after
  she told me she was going to get justice back in
  the world by blowing up evil forces that have
  been haunting her life and then proceeded to try
  to run over her ex-husband, thinking he was the
  devil. She told me there is nothing wrong with
  her and I am concerned she wont take her
  medication once she is discharge.

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• What are some of the priority concern that nurse
  could address in the hospital setting before she
  is discharge?
• How would you explain to the mother some of the
  symptoms that she is experience in? What
  suggestion could you give her to handle some of
  the immediate concerns?
• What issues could you bring up to the staff about
  her medication compliance? What would be some
  ways to deal with this issue?
• 4. What do you think of the prognosis for her?
  Support your hypothesis with data regarding
  influences on the course of schizophrenia.