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Schizophrenia

16. Schizophrenia. Features of Schizophrenia *. Prevalence in U.S. is 1.1%. Average onset is late teens to early twenties, but can be as late as mid-fifties Affects cognitive, emotional, and behavioral function 30% to 40% relapse rate in the first year. Features of Schizophrenia (cont'd).

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Schizophrenia

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  1. 16 Schizophrenia

  2. Features of Schizophrenia * • Prevalence in U.S. is 1.1%. • Average onset is late teens to early twenties, but can be as late as mid-fifties • Affects cognitive, emotional, and behavioral function • 30% to 40% relapse rate in the first year

  3. Features of Schizophrenia (cont'd) • Progression varies from one client to another • Exacerbations and remissions • Chronic but stable • Progressive deterioration

  4. Features of Schizophrenia (cont'd) • DSM-IV-TR Diagnosis • Symptoms present at least 6 months • Active-phase symptoms present at least 1 month • Symptoms are defined as positive and negative

  5. Features of Schizophrenia (cont'd) * • Positive symptoms • Excess or distortion of normal functioning • Aberrant response • Negative symptoms • Deficit in functioning

  6. Features of Schizophrenia (cont'd) * • Positive Symptoms of Schizophrenia • Hallucination • Delusions • Disordered speech and behavior

  7. Table 16-3 (continued) Positive Symptoms *

  8. Table 16-3 (continued) Positive Symptoms *

  9. Features of Schizophrenia (cont'd) * • Negative Symptoms of Schizophrenia • Flat affect and apathy • Alogia • Avolition • Anhedonia

  10. Table 16-4 Negative Symptoms *

  11. Subtypes of Schizophrenia * • Paranoid type • Disorganized type • Catatonic type • Undifferentiated type • Residual Type

  12. Subtypes of Schizophrenia (cont'd) * • Paranoid Type • Delusions • Persecutory and grandiose • Somatic or religious • Hallucinations • Delusions link with a hallucination

  13. Subtypes of Schizophrenia (cont'd) * • Disorganized type • Disorganized speech, behavior, appearance • Flat or inappropriate affect • Fragmented hallucinations and delusions • Most severe form of schizophrenia

  14. Subtypes of Schizophrenia (cont'd) * • Catatonic type • Psychomotor retardation and stupor • Extreme psychomotor agitation • Waxy flexibility • Echolalia • Mutism • Echopraxia

  15. Subtypes of Schizophrenia (cont'd) • Undifferentiated type • Active psychotic state • Lacks symptoms of other subtypes • Residual type • At least one episode of schizophrenia • No prominent positive symptoms • Negative symptoms present

  16. Other Psychotic Disorders * • Schizophreniform disorder • Schizoaffective disorder • Delusional disorder • Brief psychotic disorder

  17. Causes of Schizophrenia • Biopsychosocial theories • Interrelated factors

  18. Causes of Schizophrenia (cont'd) • Biologic theories • Psychological theories • Family theories • Humanistic-interactional theories

  19. Causes of Schizophrenia (cont'd) * • Biologic Theory: Genetic • Only genetic predisposition for developing schizophrenia is inherited • 10% of first-degree relatives • 25%–39% of monozygotic twins

  20. Causes of Schizophrenia (cont'd) • Biologic Theory: Brain Structure Abnormality • Differs from those with no symptoms • May be genetically based • Requires more study

  21. Figure 16-2 PET scans measuring regional cerebral blood flow. (a) Areas of lower blood flow and brain activity are seen in the individual with schizophrenia. (b) Areas of normal blood flow and brain activity are visible in the unaffected individual. Photo courtesy of R. Haier/Photolibrary.

  22. Causes of Schizophrenia (cont'd) • Biologic Theory: Biochemical Theories • Dopamine hypothesis • Traditional antipsychotic medications are dopamine blockers • Dopamine blocker alleviate positive symptoms

  23. Causes of Schizophrenia (cont'd) • Psychological theories • Information processing • Difficulty controlling the amount and type of information that is processed in the brain. • Attention and arousal • Hyper or hypo responsiveness to various situations

  24. Causes of Schizophrenia (cont'd) • Psychological theories • Information processing • Deficient in automatic processing • Deficient in controlled or effortful processing • Attention and arousal • Hypo-, hyper-responses

  25. Causes of Schizophrenia (cont'd) • Family Theories • Dysfunctional interaction not supported by research • Disordered family communication linked only with genetic predisposition • Family emotional tone influences course of schizophrenia • Expressed emotions theory (EE)

  26. Causes of Schizophrenia (cont'd) • Humanistic-interactional theories integrate biological and psychosocial theories • Combine influences of: • Genetic predisposition or biologic vulnerability • Environmental stressors • Social support

  27. Causes of Schizophrenia (cont'd) • Stress-Vulnerability Model • Stressors increase vulnerability • Cumulative effect of: • Genetic predisposition • Personal stressors • Familial factors • Environmental factors

  28. Influences on the Course of Schizophrenia • Social Pressures • Lack of social support • Financial problems • Stigma

  29. Influences on the Course of Schizophrenia (cont'd) * • Psychological pressures • Difficulty with problem-solving • Difficulty with interpreting reality • Difficulty coping • Problems with self-care • Unstable interpersonal relationships

  30. Nursing Implications * • Assessment • Premorbid functioning • Content of thought • Form of thought • Perception • Sense of self • Delusions and perceptual disturbances • Hallucinations • Drug use

  31. Nursing Implications (cont'd) * • Nursing Diagnoses • Altered thought process • Social isolation • Risk for violence • Self-care deficits • Altered health maintenance • Ineffective family coping

  32. Nursing Implications:Supporting Families • Family needs vary with degree of illness and involvement in client’s care • Education • Financial support • Psychosocial support • Education • Advocacy

  33. Nursing Implications:Supporting Families (cont'd) * • Schizophrenia is a “family illness.” • Family members need to be involved. • Educate family about • Medication • Illness • Relapse prevention

  34. Nursing Implications:Supporting Families (cont'd) • Nurse assists family by • Identifying community agencies/groups for family members • Advocating for rights

  35. Measures to Prevent Relapse * • Ensure client takes medication • Educate family about signs and symptoms of relapse • Client and family to participate in relapse prevention program

  36. Measures to Prevent Relapse (cont'd) • Relapse prevention programs work best when: • Psychosocial treatment and social skills training are combined with antipsychotic medication • Behavior patterns are monitored • Family members understand triggers

  37. Measures to Prevent Relapse (cont'd) • Relapse prevention programs provide education and support regarding: • Individual triggers, symptoms of relapse • Managing side effects of medications • Interventions to reduce or eliminate triggers • Strategies to facilitate early intervention • Cognitive therapy • Community resources

  38. Challenges to Adherence * • Side effects • Level of symptomatology • Cognitive, motivational, financial, and cultural issues • Issues with caregivers • Insufficient medication teaching

  39. Increasing Adherence * • Involve clients in treatment • Instruct client about reducing discomfort • Provide peer support • Provide reminders and positive feedback • Recognize accomplishments

  40. Personal Awareness * • Identify personal feelings. • Recognize personal perceptions. • What behaviors do you expect to see? • How will you respond to these behaviors? • What is the meaning of the behaviors?

  41. Personal Awareness (cont'd) • What defines “normal” behavior? • What are my fears associated with mental illness?

  42. Personal Awareness (cont'd) • Be honest with your feelings. • Identify what strengths you bring to the situation. • Remember that clients are human beings with a mental disorder and do not choose to be this way.

  43. Resources • NAMI • The National Alliance on Mental Illness provides information, education, and support relating to mental health illnesses and disorders for clients, families, and professionals.

  44. Resources (cont'd) • National Institute of Mental Health • The National Institute of Mental Health is part of the Department of Health and Human Services and has information about research on various mental health illnesses.

  45. Resources (cont'd) • Medline Plus • Medline Plus is a service of the National Library of Medicine and the National Institutes of Health. This site provides definitions related to various aspects of schizophrenia.

  46. Resources (cont'd) • Brain & Behavior Research Foundation • The Brain & Behavior Research Foundation awards grants from the National Alliance for Research on Schizophrenia and Depression (NARSAD), a non-for-profit charity organization primarily organized to raise funds for research.

  47. Resources (cont'd) • Mayo Clinic • Search by topic on this Mayo Clinic link to find current information about mental illness.

  48. Box 16-4 Challenges to Adherence

  49. Box 16-4 Challenges to Adherence

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