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Schizophrenia
Introduced by Swiss psychiatrist Eugene Bleuler in 1911 Schizein- to split Phren -mind Reflects a split from the emotional and cognitive aspects of personality
Symptoms of Schizophrenia
Positive symptoms are exaggerated behaviors such as delusions, hallucinations, disorganized speech, bizarre behavior. Negative symptoms include loss of behaviors such as loss of affect, inability to maintain social contacts, impaired decision making, and inability to maintain attention.
Symptoms
Problems with information processing (abnormal brain function) Inability to produce logical thoughts and express coherent sentences
Perceptual Distortions
Are often the first symptoms in many brain illnesses Hallucinations false perceptual distortions Types include: Auditory 70% Visual 20% Olfactory Tactile (experiencing pain)
Emotions
Mood- a sustained feeling tone Affect- refers to behaviors such as facial expression, hand and body movements, and voice pitch
Maladaptive movements
Abnormal eye movements Catatonia (stuporous state associated with posturing) Abnormal gait Grimacing Apraxia-inability to carry out a purposeful task, like dressing.
Social Isolation
Caused by stigma Literal definition means mark of shame As students, describe your own attitudes about stigma
Predisposing factors
Combination of genetic and environmental factors Neurobiological factors imaging studies show decreased brain volume (white matter). Findings include atrophy in the frontal lobe, cerebellum and limbic structures. There are also alterations in neurotransmitters (dopamine, serotonin, and glutamate)
Biological Stressors
Information-processing overload Abnormal gating mechanisms refers to nerve potentials and feedback systems within the nervous system.
Nursing Diagnoses
Impaired verbal communication Disturbed sensory perception Impaired social interaction Disturbed thought processes
Medical Diagnoses
Schizophrenias Schizophreniform disorder Schizoaffective disorder Delusional disorder Brief psychotic disorder Shared psychotic disorder
Outcome Identification
The patient will live, learn, and work at a maximum possible level of success, as defined by the individual. Prevention of relapse is key. Relapse is the return of symptoms severe enough to interfere with ADLs.
Planning
When the person is in the acute or crisis stage of illness, care is often given in a hospital. Overall goal: help the patient reach stability while establishing a foundation for rehab and recovery
Interventions
In crisis and acute phases: Most important is patient safety Help the patient feel safe Manage delusions and hallucinations
Psychopharmacology
Clozapine- limited use for patients who are treatment resistant to typical antipsychotics, because of its potential to cause agranulocytosis.
Other atypical antipsychotics are Risperdal, Olanzapine, Seroquel, Geodon and Abilify. Typical antipsychotics include: Navane, Haldo, Loxatane, Moban,and Orap.
Stages of Relapse
Stage 1: Overextension: patient feels overwhelmed and overloaded. Stage 2: restricted consciousness:depression is coupled with anxiety and withdrawal. Crucial to intervene during stage 1 or 2 Stage 3: disinhibition: emergence of hallucinations and delusions that patient can no longer control. (first appearance of psychotic features)
Managing Relapse
Awareness of the onset of behaviors indicating relapse Prodromal phase occurs before relapse. Time between the onset of symptoms and the need for treatment. Identify and manage symptoms helps decrease the # and severity of relapses.Teach the patient to self report symptoms, problems with meds, and difficulties with ADLs.
Typical Antipsychotics
Thorazine Mellaril Trilafon Stelazine Prolixin Haldol Loxitane