Schizophrenia split personality; schizophrenia is not characterized by a changing personality but is

characterized by a deteriorating personality.

Disturbances associated with schizophrenia:

- Perception (hallucinations)
- Thought Processes (thought derailment)
- Reality Testing (delusion)
- Feeling (flat or inappropriate affect)
- Behavior (social withdrawal)
- Attention (inability to concentrate)
- Motivation (cannot indicate or persist in goal-directed activities)

Morel dementia praecox (precocious senility)

Kaklbaum and Hecker catatonia and hebephrenia

Kraepelin paranoia schizophrenia

BLEULERS four As

- Affective disturbance: inappropriate, blunted, or flattened affect

- Autism: preoccupation with self, with little concern for external reality
- Associative looseness: The stringing together of unrelated topics
- Ambivalence: Simultaneous opposite feelings

Course of Illness

- Acute phase: experiences of severe psychotic symptoms

- Stabilizing phase: getting better
- Stable phase: might experience hallucinations and delusions but are not severe or disabling

DSM-IV-TR Criteria for Schizophrenia

A. Characteristic symptoms
a. Delusions
b. Hallucinations
c. Disorganized Speech
d. Grossly disorganized or catatonic behavior
e. Negative symptoms
B. Social-Occupational dysfunction
a. work, interpersonal, and self-care functioning below the level achieved before onset
C. Duration
a. Continuous signs of the disturbances for at least 6 months
D. Schizoaffective and mood disorders not present and not responsible for the signs and symptoms
E. Not caused by substance abuse or a general medical disorder

Key Nursing Interventions

a. Do not argue about delusions

b. Do not reinforce hallucinations
c. Focus on real people and real events
d. Be diligent in attempting to understand patients
 e. Attempt to balance siding with inappropriate behavior and crushing a fragile ego

Major Side Effects of Antipsychotic Drugs

A. Dopamine D2 blockade in nigrostriatal tract, causing ESPEs:

a. Parkinsonism
b. Akathisia
c. Dystonias
d. Neuroleptic Malignant Syndrome
e. Pisa Syndrome
B. Muscarinic blockade in parasympathetic systems, causing anticholinergic effects:
a. Dry mouth
b. Blurred vision
c. Constipation
d. Urinary hesitation
e. Tachycardia
C. Hypersensitivity to dopamine in nigrostriatal tract, causing tardive dyskinesia
D. Elevated prolactin related to dopamine blockade in tuberoinfundibular tract, causing
amenorrhea, galactorrhea, impotency, and decreased libido
E. Histamine blockade, causing sedation
F. Alpha-1 blockade, causing orthostatic hypotension

Major Depressive Disorders

A. Major Depressive Disorder: characterized by one or more depressive episodes; 2 weeks of

depressed mood or loss of interest
B. Dysthymic Disorder: characterized by at least 2 years of depressed mood for more days than
not

MOOD is a persons state of mind exhibited through feelings and emotions

DSM-IV-TR for mood disorder

a. Depressive disorders
b. Bipolar disorders
c. Mood disorder resulting from a general condition
d. Substance-induced mood disorder

Key Features

A. Symptoms
a. Depressed mood
b. Inability to experience pleasure, or markedly diminished interest in pleasurable activities
c. Appetite disturbances with weight change
d. Sleep disturbance
e. Psychomotor disturbance
f. Fatigue or loss of energy
g. Feelings of worthlessness or excessive or inappropriate guilt
h. Diminished ability to concentrate or indecisiveness
i. Recurrent thoughts of death or suicidal ideations
Predisposing factors for children and adolescents

a. Loss of parents through divorce, separation, or death

b. Death of other individuals close to the child
c. Death of pet
d. Move to another neighborhood or town
e. Academic problems or failure
f. Significant physical illness or injury

DSM-IV-TR for dysthymic disorder

a. Depressed mood for most of the day

b. Presence of two or more of the following:
i. Poor appetite or overeating
ii. Insomnia or hypersomnia
iii. Low energy or fatigue
iv. Low self-esteem
v. Poor concentration or difficulty making a decision
vi. Feelings of hopelessness

Psychological Theories of Depression

General Themes:

A. Adverse early life experiences

B. Intrapsychic conflicts
C. Reactions to life events

Theories:

i. Psychoanalytic theorists: depression occurs as a result of an early life loss. Freud viewed
depression as the aggressive instinct inappropriately directed at the self, often triggered by the
loss of a loved person or object.
ii. Cognitive theorists: depression results when a person perceives all stressful situations as being
negative
iii. Interpersonal theorists: coping with problems can be inordinately stressful and leads to
depression
iv. Behavioral theorists: depression occurs when feeling of helplessness and unworthiness develops

Milieu Management

For patients with low self-esteem

a. Encourage to participate in activities, including group activities

b. Provide assertiveness training
c. Help patients avoid embarrassing themselves

For withdrawn patients

a. Keep contacts with withdrawn patient brief but frequent

b. Lock the patient inside a room or let them sit silently during an activity

For anorectic patients

a. Be responsible to let patient have their meals regularly

b. Allow patients to participate in selecting preferred foods from the menu
 c. Promote a proper diet, adequate fluid intake, and exercise

For patients with sleep disturbances

a. Interventions for insomnia

Bipolar Disorder

Bipolar disorders: individuals experience the extremes of mood polarity.

Mixed state: mood episodes which includes both of mania and depression.

Phases of Bipolar Disorder

b. Depressed phase
c. Manic or hypomanic phase
d. Euthymia or asymptomatic phase

Other term

Bipolar disorder: manic depressive or bipolar affective disorder

Symptoms (Box 29-1 p295)

Medical Conditions that cause Mania

a. Anoxia
b. Hyperthyroidism
c. Hemodialysis
d. Lyme disease
e. Hypercalcemia
f. Acquired immunodeficiency syndrome
g. Stroke
h. Brain Tumor
i. Multiple Sclerosis
j. Normal-pressure hydrocephalus
k. Other neurologic disorders

Hypomanic Episodes

- Characterized by an abnormal period of persistent elevated, expansive, or irritable mood.

Symptoms

a. Increased self-esteem or grandiosity

b. Decreased need for sleep
c. Subjective sense that thoughts are racing
d. Distractibility
e. Increase in goal-directed or motor agitation
f. Excessive involvement in pleasurable activities that have a high potential for painful
consequence
Bipolar I Disorder

- Swings between manic episodes and major depression

Subtypes

a. Bipolar I disorder: single manic episode

b. Bipolar I disorder: manic episode
c. Bipolar I disorder: hypomanic episode
d. Bipolar I disorder: manic and depressive symptoms
e. Bipolar I disorder: depressed
f. Bipolar I disorder: unspecifies

Bipolar II Disorder

- The same with bipolar I disorder except that the person never experienced a manic episode
only hypomanic.

Cyclothymic Disorder

- Swing between hypomanic and dysthymia

Key Nursing Interventions

a. Provide patients with foods (fingerfoods) because some patients cannot sit long enough to eat.
b. Provide high-protein and high-calorie snacks for patients
c. Weigh patients regularly
d. Provide a quiet place to sleep
e. Structure patients days so that there are fewer stimulating activities toward bedtime
f. Do not allow caffeinated drinks before bedtime
g. Assess amount of rest that patients are receiving

Milieu Management

a. Safety
b. Consistency among staffs
c. Reduction of environmental stimuli
d. Dealing with patients who are escalating
e. Reinforcement of appropriate hygiene and dress
f. Nutrition and sleep issues
g. Routines