1 / 56

Schizophrenia

Schizophrenia. Schizophrenia. It is a brain disorder of unknown etiology Theories of causation include: genetics, biochemistry, and psychosocial factors Symptoms vary greatly among different patients depending on what area of the brain that is primarily effected.

everly
Download Presentation

Schizophrenia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Schizophrenia

  2. Schizophrenia • It is a brain disorder of unknown etiology • Theories of causation include: genetics, biochemistry, and psychosocial factors • Symptoms vary greatly among different patients depending on what area of the brain that is primarily effected. • Treatment varies to meet individual needs, tho usually includes psychotropic medications, pt. and family education and social support

  3. Incidence and Prognosis • In all societies, occurs in 1% of population with slightly higher incidence in males • Prognosis: approx. 25% remain highly functional • 50% remain non-functional • 25% are in-between, in and out of hospital • Age of onset is late adolescence/ early adulthood

  4. Prognosis • Acute phase • Severe psychotic symptoms • Stabilizing phase • Patient is getting better • Stable phase • May still have hallucinations and delusions • Not as severe • Most patients alternate between acute and stable phases

  5. GENETIC Brain structure and Function Etiology ENVIRONMENT BIOCHEMICAL

  6. GENETICS • Probability of Schizophrenia in Families • 1 parent 10% probability • 1 sibling 10% • Identical twin 50% • Both parents varies 40% • A gene identified ---research continues

  7. BIOCHEMICAL • Too much dopamine overwhelms the brain and binds with too many receptors and causes positive symptoms, therefore, anti-psychotics act as dopamine antagonist • Ratio between serotonin and dopamine, therefore atypical anti-psychotics effect serotonin also. • Endogenous dopamine antagonist is GABA • Can you induce psychosis? • Marijuana, LSD, Amphetamines

  8. BRAIN STRUCTURE AND FUNCTION PET SCAN ILLUSTRATES FUNCTIONAL DIFFERENCES IN THE LIVING BRAIN

  9. PET Scan and Schizophrenia

  10. MRI Comparing Identical Twins: One without Schizophrenia and One with Schizophrenia • When the ventricles are enlarged the brain has lost mass; tissue has shrunk

  11. ENVIRONMENTAL • Inherited susceptibility to schizophrenia • Prenatal infections • Poor Family Communication • Greater % of pts. come from lower socio-economic class • STRESS • Can you make someone a schizophrenic? • What about prevention?

  12. STRESS: Onset or Relapse • Biological (medical illness) • Psychological (loss of a relationship) • Sociocultural (homeless) • Emotional (persistent criticism)

  13. Bleuler’s 4 A’s • Affective Disturbance: • Inappropriate, blunted or flattened • Autistic Thinking: • Preoccupation with the self • Little concern for external reality • Associative Looseness • Stringing together of unrelated topics • Ambivalence • Simultaneously opposing feelings

  14. DSM IV Criteria:Schizophrenia • Delusions: false fixed beliefs • Fixed Delusions (permanent; not affected by medications) • Hallucinations (auditory; visual; tactile) • Disorganized Speech • Grossly disorganized or catatonic behavior • Negative symptoms • flat affect, apathy, alogia (inability to speak). • Generally, 2 or more symptoms need to be present for 1 month for diagnosis

  15. DSM IV Criteria Cont. • Social or Occupational dysfunction • Pts. ability to perform self care, work or relate to people has declined markedly. • Duration • Decline in function for this criteria must be six months. • Exclusions • R/O Schizoaffective disorder and mood disorder • R/O substance abuse and OBS • R/O pervasive developmental disorder (autism)

  16. Positive symptoms of Schizophrenia • Positive Symptoms (+) Person with schizophrenia does more (+) than Person who is functioning normally • agitation/aggression • delusions • hallucinations • formal thought disorder:loose associations, word salad • bizarre behavior • Typical Anti-psychotic meds usually control these symptoms

  17. Negative symptoms of Schizophrenia • Negative Symptoms (-) Person with schizophrenia does less (-) than Person who is functioning normally • flat affect • avolition; lack of direction or purpose • ambivalence; indecisive and changeable • constricted, concrete thinking • alogia; poverty of speech • social withdrawal; anhedonia • deep apathy • minimal or poor self care • Atypical antipsychotics will help these symptoms • Typical antipsychotics can make these worse

  18. Schizophrenia Subtypes • Paranoid • Catatonic • Disorganized • Undifferentiated • Residual

  19. Paranoid • Preoccupation with: 1. Delusions • Persecution • Grandiose • Can be VERY dangerous to others. Can get themselves into situation where they think they are protecting themselves and they get themselves killed. 2. Auditory hallucinations • Command • No disorganized speech • Usually neat and clean.

  20. Catatonic • Stupor • Negativism • Rigidity • Posturing: waxy flexibility

  21. Disorganized • Disorganized speech • Disorganized behavior • Flat or inappropriate affect • Dissheveled appearance

  22. Undifferentiated • Positive symptoms • Do not meet criteria for paranoid.

  23. Residual • No positive symptoms • Mostly negative symptoms • Chronic

  24. Pyschosis-Induced Polydipsia • Compulsive water drinking (6% to 20%) • Thirst and Osmotic dysregulation • Hyponatremia • Confusion • Convulsions • Coma • Lightheadedness • Nausea and vomiting • Weakness • Muscle Cramps • Treatment • Weigh • Restrict fluid • Sodium replacement • Constant supervision

  25. Other Psychotic Disorders • Psychotic Disorder NOS • Delusional Paranoid Disorder • Schizophreniform Disorder • Symptoms of schizophrenia last one month but no longer than six months • Schizoaffective disorder • A puzzle • Characterized by: • Schizophrenic symptoms are dominant • Accompanied by major depressive or manic symptoms

  26. Nursing Diagnosis for Schizophrenia • Altered thought processes: Delusions • Sensory/perceptual alterations: specify Hallucination • Social isolation • Potential for violence • self-care deficit • Impaired verbal communication • Sleep pattern disturbance • Altered nutrition • Impaired home maintenance management • Related to: Neuro chemical imbalance

  27. Treatment • Antipsychotic Medication • Supportive Psychotherapy and Education • Individual • Group • Milieu • Family • Social supports • Follow-up mental health care/Medication • Housing • Day treatment • Employment

  28. Antipsychotic Medications • Typical • Atypical

  29. Typical Antipsychotics • High Potency Neuroleptic • Haldol (Haloperidol) • Prolixin (Fluphenazine) • Available in pills, liquid, Intramuscular and Depo injection • Low Potency Neuroleptic • Thorazine (Chorprmazine) • Mellaril (Thiroidazine) • In-betweens • Stelazine • Trilafon • Navane

  30. Antiparkinsonian Agents • Cogentin (benztropine) • Artane (trihexyphenidyl) • Benadryl (diphenhydramine) • Symetrel (amantadine) • Ativan (Lorazepam)

  31. Acetylcholine and Dopamine • A balance between dopamine and acetycholine is required for normal movement • Antipsychotic meds decrease dopamine, causing EPS symptoms • Antiparkinsonian meds act by decreasing ACH, thus restoring balance • All antiparkinsonian meds increase the anticholenergic effects

  32. Extrapyramial Side Effects (EPSE) Acute Dystonia Akathisia Tardive Dyskinesia Anticholenergic effects Drowsiness Dry mouth Skin reactions, sunburn Constipation urinary retention Orthostatic hypotension Side effects of Typical Antipsychotics

  33. early onset Abnormal posture involuntary, sustained, muscle spas Sustained twisted contracted positioning of the limbs, trunk, neck or mouth This is PAINFUL Treated with parenteral anticholinergics due to the gravity of the situation Oculogyric Crises Torticolis Acute Dystonia

  34. Akathisia • “Ants in the pants” • Subjective feeling of restlessness • Nervous energy • Most common EPSE

  35. (Psuedo)Parkinsonism • Tremor at rest • Pill rolling • Muscle rigidity • Bradykinesia Stiff, shuffling gait

  36. Tardive Dyskinesia • Involuntary movements, • Especially of the face and tongue • IRREVERSIBLE if not corrected immediately • LONG TERM USE OF TYPICAL ANTIPSYCHOTIC

  37. Tardive Dyskinesia

  38. Neuroleptic Malignant Syndrome • Syndrome is very RARE but can be LETHAL • 1% of patients taking antipsychotics • 5% to 20% will die without treatment • Predisposing factors; • Youth • male • high potency neuroleptic • new patient • Cardinal symptoms • Lead pipe rigidity • Autonomic instability • High fever • Tachycardia • LOC changes • Elevated CPK

  39. Neuroleptic Malignant Syndrome • Medical emergency • STOP all medication • may resume meds after crisis. • Rx: Dantrolene (Dantrium): skeletal muscle relaxant and Bromocriptine (Parlodel): a dopamine agonist

  40. Atypical Antipsychotics • Clozaril (Clozapine) • Risperidal (Resperidone) • Zyprexa (Olanzapine) • Seroquel (Quetiapine) • Geodon (Ziprasidone) • Abilify (Aripiprazole)

  41. Clozaril (Clozapine) • Atypical antipsychotic • Decreases negative symptoms of schizo • No Extrapyramidal symptoms (EPS) • May decrease symptoms of tardive dyskinesia • Effects both dopamine and serotonin • Side effects: drowsiness and drooling • Very costly $9,000. per year. • Side effects • Agranulocytosis, weekly blood draws • Sedation, excessive salivation, dizziness, seizures • Hyperglycemia/Wt. Gain, Type 2 DM

  42. Risperidal (Resperidone) • Drug is costly--$400. for 1 month supply • Atypical; effects serotonin and dopamine. • 1st line; effects both positive & negative symptoms • Can cause EPS, but lower incidence • Side effects: CNS, drowsiness (most common, given at night) Insomnia agitation, headache, anxiety --Orthostatic hypotension Hyperglycemia • GI: Constipation, nausea, vomiting and dyspepsia • High potency--8 mgm per day in 2 doses • Available in long lasting IM form (2weeks)

  43. Zyprexa (Olanzapine) • 1st line drug: Positive and negative symptoms • High potency: 10 mgm a day--up to 20. • Side effects: Drowsiness, constipation, dry mouth, headache. Rare EPS, NMS, • Effects both serotonin and dopamine • Weight Gain long term/Hyperglycemia/ • Type 2 DM • Drug is costly-- 10 mgm per day for 30 days is $250. • Available in short acting IM form

  44. Seroquel (Quetiapine) • Atypical antipsychotic, low potentcy • Effective in positive and negative symptoms • EPS profile same as placebo • No increase in prolactin levels • No sexual dysfunction problems • Side effects: somnolence and hypotension • Doses: effective at 150mgm to 750 mgm per day • Average: 300 mgm;100 in AM-200 in PM • Titrate doses: begin at 50 mgm per day • Available in IM injection

  45. Ziprasidone (Geodon) • Geodon/Atypical Antipsychotic-Antagonizes Dopamine and Sertonin/ • Low EPS • No increase in prolactin levels • Side effects-somnolence in short term and insomnia in long term use • Weight Gain neutral • Big issue-prolongs the QT interval • Patient cannot have any cardiac or electrolyte imbalance • Monitor serum potassium and magnesium • Starting dose of 80 mgm per day in 2 doses • Can go to 160 mgm • Available in short acting IM form

  46. (Aripiprazole ) Abilify • Atypical antipsychotic, effects both dopamine and serotonin, antagonizing some receptors and serving as a partial agonist for others • Decrease in the EPS side effects and minimal Wt. Gain, minimal sedation, no problems with QT interval • Side effects: headache, Anxiety, Insomnia, somnolence, occasional stomach upset • Akathisia • Dosage: 10 to 15 mgm daily can go up to 30

  47. Patient and Family teaching • Teach Pt. and family about schizophrenia • Compare with an illness that cannot be cured: ie Diabetes • Teach Pt. and family about medications • Emphasize importance of follow-up care • If possible have pt. attend a community program. • Teach family concept of Negative Symptoms • Teach concept of stress(high expressed emotion) • Refer family to NAMI. (national alliance mentally ill) • Respite care is important for family.

  48. Issues for Nursing care • Defense Mechanisms • denial • projection • regression • Delusion of • persecution • grandeur • Challenges rules, may be argumentative and agitated

  49. Paranoid Patient • Very fearful-mistrusting • Very aware of authority • Onset of illness is often late 20’s- may have been a lawyer, accountant, or engineer • Sexual issues-often accuse others of being homosexual

More Related