Unit 5 schizophrenia online3
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Transcript of Unit 5 schizophrenia online3
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Schizophrenia History
19th CenturyKraepelin- Dementia Praecox
20th CenturyBleuler
autism-apathy-ambivalence-anhedonia
Arieti
associative looseness, auditory
hallucinations
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Current theories
Genetic
↓ 1% of population
10 % of 1st degree relatives
35-55% concordance rate in monozygotic
twins (genetically identical)
15-17% concordance rate in dizygotic
twins (share half their genes)
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Slightly more men than women Early 20s age of first psychotic break 75% of people have permanent disability Cultural component on relapse Developing countries have better prognosis than
developed countries
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Neurotransmitter imbalance
Dopamine system hyperactivity
Norepinepherine elevation
Serotonin elevation
Diminished levels of GABA
Decreased co-enzyme for conversion of PKU to tyrosine
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Central Nervous System Anomaly
Type 2 enlarged ventricles
negative symptoms resistant to medication
Type 1 positive symptoms respond to medication
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Positive Symptoms
Delusions
Hallucinations
Disorganized speech
Bizarre or disorganized behavior
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Negative Symptoms
Flat Affect
Avolition
Alogia
Anhedonia
Attention Impairment
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History of Therapy
Psychoanalytic
Sullivan/Peplau
Interpersonal Communication
Somatic
Insulin Coma
Electroconvulsive Therapy
Psychosurgery
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Psychopharmacology
1950s phenothiazines
1990s D1-D2 receptor medications
Community Mental Health
Milieu
Therapeutic Community
De-institutionalization
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Typology of Thought Disorder
Paranoid
Catatonic
Disorganized
Undifferentiated
Residual
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Paranoid
Delusions- especially persecutory
Auditory Hallucinations
No loose associations
No marked affective problem
Paranoid
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Catatonic
Stupor or mutism
Negativism
Rigidity
Excitement
Posturing (waxy flexibility)
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Disorganized
Marked looseness of associations
Grossly inappropriate affect
Disorganized
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UndifferentiatedProminent delusions
Hallucinations or grossly disorganized behavior
Residual
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Diagnosis
Presence of 1,2, or 3 for more than 1 week
1. Two of the following:
delusions, prominent
hallucinations, marked
associative looseness
catatonic behavior
flat or silly affect
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2. Bizarre delusions
3. Prominent hallucinations
Continuous signs of disturbance ↑ 6 months
18 years if age or more
Downward course
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Nursing Process- Assessment
1.Perceptual changes:
illusions, hallucinations
2. Thought disorder:
loose associations, clanging, delusions
3. Communication changes:
thought disorganization,
blocking, tangential, circumstantial
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4. Motor Changes:
catatonia-excited, posturing, waxy
flexibility
5. Family:
enmeshed, family burden
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Nursing Diagnosis
Impaired communication
poverty of speech
blunt emotions
Self-care deficits
Activity intolerance
Social isolation
Decisional conflict
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Sensory alterations
Body image distortion
Altered thought processes
delusions, magical thinking
thought insertions, withdrawal
thought broadcasting
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Altered emotional response
blunted or flat affect
anhedonia
Altered family function
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Nursing Planning & Intervention
Adequate communication
Grooming & hygiene
Social skills
Intervene with delusions
Family understanding
Medication usage
Organize behavior
Reality based perceptions
Congruent emotional responses
Community contacts
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Nursing Planning & Intervention
Adequate communication
Grooming & hygiene
Social skills
Intervene with delusions
Family understanding
Medication usage
Organize behavior
Reality based perceptions
Congruent emotional responses
Community contacts
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Nursing Implications with Neuroleptic Medications
1. Phenothiazines
Thorazine(Chlorpromazine)
Mellaril (Thiorizidine)
Stelazine (Trifluoperazine)
Prolixin (Fluphenazine)
Prolixin Decanoate
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2. Butyrophenes
Haldol (Haloperidol)
Haldol LA
3. Low potency D1-D2 medications
Clozaril (Clozapine)
Risperdol (Resperidone) & Risperdol E
Zyprexa (Olanzapine)
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Abilify (Ariprazole) Geodon (Ziprasidone)
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Side Effects
Nervous system Extra Pyramidal SymptomsAkathisiaDystoniaAkinesiaPseudo parkinsonismTardive dyskinesia
Tardive Dyskinesia
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Other Side Effects
Photophobia
Leukocytosis
Orthostatic hypotension
Anti-cholinergic effects
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D1 and D2 effects
Weight gain Impotence Risk for development of Diabetes Mellitus (Geodon) Gallactarhea
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Neuroleptic malignant syndrome
Possibly fatal side effect of neuroleptics Non-dose related Fever Confusion Convulsions Death Rx-stop neuroleptic- emergency care
Amantadine 200-400 mgmpo/day in divided doses
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Side Effect Treatment
Anti-parkinson medications:
Cogentin (Benztropine)
Artane (Trihexyphenidyl)
Symmetrel (Amantadine)
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Atropine Psychosis
Mad as a hatter confused
Red as a beet fever
Dry as a bone anticholinergia
Blind as a bat diplopia
Rx. Hold medication and re-hydrate
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Laboratory Values for Schizophrenia
White blood cell count Leukopenia (WBC 2,000 – 3,000)and agranulocytosis
(granulocytes less than 1,000) with certain psychotropic mendiations, such as phenothiazines , carbamazepine, and CLOZARIL
Leukocytosis with neuroleptic malignant syndrome
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Assessment Tools for Schizophrenia
Abnormal Involuntary Movement Scale (AIMS) (public)
Brief Psychiatric Rating Scale (Psychological Reports, 1962 10:799)
Schedule for Affective Disorders and Schizophrenia (SADS) (Archives of General Psychiatry, 1978 35:837)
Scale for the Assessment of Negative Symptoms (SANS) (University of Iowa Press, 1983)
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Scale for the Assessment of Thought, Language, and Communication (TLC) (University of Iowa Press, 1978)
Thought Disorder Index (TDI) (Archives of General Psychiatry, 1983 40:1281)
Quality of Life Scale (QLS) (Schizophrenia Bulletin, 1984, 10: 383
Chestnut Lodge Prognastic Scale for Chronic Schizophrenia (Schizophrenia Bulletin, 1987 13:277)