Schizophrenia & Thought Disorders

Schizophrenia

Onset generally late adolescence to young adulthood

Approximately 1% or 2.2 million people are diagnosed with
schizophrenia
Approximately 50% of schizophrenics have comorbid substance
abuse disorder

Etiology
No one cause known
Brain imaging being used
Research into:
Genetic Predisposition
Viral Theory
Biochemical/Neurostructural Changes
Environmental Influences
Genetic: Risk 10-20% if one immediate family member; 40% if
both parents or an identical twin. Looking at chromosome 13 & 8
Viral: theory
Biochemical: Dopamine
Positive Symptoms
Hallucinations
Delusions
Suspiciousness
**Most easily recognized symptoms
Negative Symptoms

Decreased functioning
Flattening of affect
A-motivation
Anhedonia
Anergia
Alogia
Emotional withdrawal
Difficulty with abstract thinking

Disorganized Symptoms
Cognitive deficits
Confusion

 Disorganized/incoherent speech
Repetitive rhythmic gestures
Attention deficits
Sub Types of Schizophrenia

Paranoid
Catatonic
Disorganized
Undifferentiated
Residual

Assessment

Suicidality (25-50% attempt at least once; 5-9% succeed)

Positive, negative, disorganized symptoms
Behavioral changes including aggressiveness/violence
Substance use/abuse
Nicotine (lowers blood levels of neuroleptics)
Compliance
Ability to care for self
Side effects of medication
Metabolic Syndrome
Pica
Psychogenic Polydipsia
Homeless

Vocabulary (reviewed)
Neologisms
Echolalia
Echopraxia
Clang Association
Word Salad
Depersonalization
Derealization
Thought Insertion
Magical Thinking
Thought Broadcasting
Psychogenic Polydypsia
Interventions

Box 22.2 page 333

Interventions target symptoms and side effects of medications
Interventions may involve comorbid medical conditions

Interventions may also center around lifestyle issues

Medications
Dopamine
Stimulates heart
Increases blood flow to kidneys, spleen, liver
Controls muscle movement and motor coordination
Traditional antipsychotics were called neuroleptics/dopamine receptor
agonists because they reduced dopamine transmission
This decreased positive symptoms~antipsychotic effect
Atypical antipsychotics: positive and negative sx

First Generation Antipsychotics

Thorazine
Mellaril
Haldol
Haldol Decanoate
Prolixin
Prolixin Decanoate
Trilafon

Atypical Antipsychotics

Clozaril*
Risperdal
Risperdal Consta
Zyprexa*
Seroquel
Geodon
Abilify
Invega
Long acting injection
Fanapt
Black Box Warning 2003

Metabolic Syndrome

Blood Pressure (greater than 130/85)

HDL < 40 men/50 women
Abdominal obesity

Triglycerides =/> 150

Fasting blood sugar =/> 110

Extrapyramidal Symptoms (EPS)

Acute Dystonia
Akathisia
Parkinsonism
Oculogyric Crisis
AIMS: Abnormal Involuntary Movement Scale developed by NIMH
Give anticholinergic:
Cogentin
Artane
Benadryl
Tardive Dyskinesia (TD)
Involuntary rhythmic movements
Stereotypical movements
Tongue protrusion
Cheek puffing
Neuroleptic Malignant Syndrome (NMS)

Elevated temperature
Altered consciousness/cognitive changes
Severe muscle rigidity
Labile pulse & blood pressure
Diaphoresis, tremor, dystonia, seizures, arrhythmias
Elevated CPK
Elevated WBC

Other Thought Disorders

Psychotic Disorder NOS

Delusional Disorder
Folie `a deux (shared psychosis)
Classified by type/content
Culturally bound

Other Thought Disorders

Schizoaffective Disorder

Depressed
Bipolar
Manic
Depressed
Mixed