Académique Documents
Professionnel Documents
Culture Documents
Neurobiochemical
Dopamine hypothesis
Serotonin
Glutamate
Neuroanatomical
Structural cerebral abnormalities
Genetic
Several genes on different chromosomes
interact with environment
Nongenetic risk factors
Complications of pregnancy and birth
Stress
GENETIC PREDISPOSITION
Affect
Associative looseness
Autism
Ambivalence
Signs and Symptoms: Relevant
to Treatment
Positive symptoms
Negative symptoms
Cognitive symptoms
Mood symptoms
Dimensions Altered in
Individuals with
Schizophrenia
Ability to work
Interpersonal relationships
Self-care abilities
Social functioning
Quality of life
Positive Symptoms:
Alteration in Thinking
Delusions: false, fixed beliefs that cannot be
corrected by reasoning
Ideas of reference
Persecution
Grandiosity
Somatic sensations
Jealousy
Control
Thought broadcasting
Thought insertion
Thought withdrawal
Delusion of being controlled
Concrete thinking
Positive Symptoms:
Alterations in Speech
Associative looseness
Neologisms
Echolalia
Clang association
Word salad
Positive Symptoms:
Alterations in Perception
Hallucinations: sensory perceptions
for which no external stimulus exists
Auditory
Visual
Olfactory
Tactile
Personal boundary difficulties
Positive Symptoms:
Alterations in Behavior
Affective blunting
Anergia
Anhedonia
Avolition
Poverty of content of speech
Thought blocking
Flat affect/inappropriate affect
Cognitive Symptoms
Dysphoria
Suicidal ideation
Hopelessness
Types of Schizophrenia
Subtypes
Paranoid
Catatonic
Disorganized
Undifferentiated
Residual
Self-Assessment: Working
with Schizophrenic Clients
Peer group supervision
Client's intense emotions produce
Acute phase
Client safety and medical stabilization
Maintenance phase
Adherence to medical regimen
Understanding schizophrenia
Participation of client and family in psychoeducational activities
Stabilization phase
Target negative symptoms
Anxiety control
Relapse prevention
Planning of
Appropriate Interventions
Acute phase
Possible hospitalization
Ensure client safety
Provide symptom stabilization
Maintenance and stabilization phases
Psychosocial education
Relapse prevention skills
Interventions: Basic Level
Acute phase
Administer antipsychotic medication as
prescribed
Observe client behavior closely
Set limits on inappropriate behavior
Do not touch without warning
Offer foods that are not easily contaminated
Assist with ADL if needed
Supportive counseling
Milieu management
Family psychoeducation
Interventions: Basic Level
Continued
Individual therapy
Social skills training (SST)
Cognitive remediation
Cognitive adaptation training (CAT)
Cognitive behavioral therapy (CBT)
Group therapy
Family therapy
Psychopharmacology
Psychopharmacology
Antipsychotics
Standard/ Typical
Atypical
Antiparkinson
Psychopharmacology
Traditional Antipsychotic
Dopamine antagonists (D2 receptor antagonists)
Target positive symptoms of schizophrenia
Advantage
Less expensive than atypical antipsychotics
Disadvantages
Do not treat negative symptoms
Extrapyramidal side effects (EPS)
Tardive dyskinesia
Anticholinergic effects (ACH)
Lower seizure threshold
Antipsychotic Medications:
Traditional
Medium potency
Loxapine (Loxitane)
Molindone (Moban)
Perphenazine (Trilafon)
Antipsychotic Medications:
Traditional continued
Low potency = high sedation + high
ACH + low EPSs
Chlorpromazine (Thorazine)
Thioridazine (Mellaril)
Mesoridazine ( Serentil)
Decanoate = Long acting injection
Haloperidol decanoate (Haldol D)
Fluphenazine decanoate (Prolixin D)
Atypical Antipsychotics
(First-Line Antipsychotics)
Serotonin-dopamine antagonists
(5-HT2A receptor antagonists)
Advantages
Diminishes negative as well as positive symptoms of
schizophrenia
Less side effects encourages medication compliance
Improves symptoms of depression and anxiety
Decreases suicidal behavior
Disadvantages
Weight gain
Metabolic abnormalities
Antipsychotic Medications:
Atypical
Clozapine (Clozaril)
Quetiapine (Seroquel)
Risperidone (Risperdal
Zipreasidone (Geodon)
Olanzapine (Zyprexa)
Aripiprazole (Abilify)
Side Effects- Atypical
Orthostatic Hypotension
Decreased Libido
Agranulocytosis (Clozapine)
Weight gain
Tachycardia
Edema
Side Effects:
Anticholinergic Symptoms
Dry mouth
Urinary retention and hesitancy
Constipation
Blurred vision
Photosensitivity
Dry eyes
Inhibition of ejaculation or impotence in
men
Side Effects:
Extrapyramidal Side Effects
Pseudoparkinson
Drooling, lack of facial responsiveness,
shuffling gait, and fine intentional tremors.
Acute Dystonia
Muscle spasms of the jaw, tongue, neck or
eyes. Laryngeal spasms possible. Oculogyric
crisis, Opisthotonos.
Akathisia
Motor restlessness, pacing, rocking, etc
Side Effects:
Extrapyramidal Side Effects
Tardive Dyskinesia
Hypotension
Postural hypotension
Tachycardia
Side Effects:
Rare and Toxic Effects
Agranulocytosis
Cholestatic jaundice
Neuroleptic malignant syndrome
(NMS)
Severe extrapyramidal
Hyperpyrexia
Autonomic dysfunction
NEUROLEPTIC MALIGNANT
SYNDROME
RARE, POTENTIALLY FATAL
ONSET WITHIN HOURS OR YEARS
EPS REACTIONS
CPK
HYPERTHERMIA 102° AND ABOVE
TACHYCARDIA
FLUCTUATING B.P.
DIAPHORESIS
STUPOR AND COMA
AGRANULOCYTOSIS
COGENTIN
ARTANE
AKINETON
PARLODOL
KEMADRIN
BENEDRYL
CLIENT AND FAMILY TEACHING