Schizophrenia Spectrum Overview

Study Notes

Schizophrenia Spectrum and Other Psychotic Disorders

Schizophrenia is a severe mental illness characterized by a disconnect from reality with symptoms including hallucinations, delusions, disorganized thinking, and negative symptoms such as social withdrawal and alogia (poverty of speech).
Biological explanations for schizophrenia include genetics, neurochemical imbalances, and structural brain abnormalities.
Major historic figures, events, and theories that contribute to the current understanding of schizophrenia:
- Emil Kraepelin defined dementia praecox, a term later replaced with schizophrenia.
- Eugen Bleuler coined the term schizophrenia and identified the “four A’s” of schizophrenia:
  - Associative looseness: disorganized speech
  - Autism: social withdrawal
  - Affect: inappropriate emotional response
  - Ambivalence: conflicting feelings
Two theoretical psychodynamic explanations suggest:
- Freud: Schizophrenia results from a failure to develop a strong ego, leading to a breakdown of reality testing.
- Sullivan: Schizophrenia arises from early and inadequate interpersonal relationships.
Nursing care plan for patients with schizophrenia focuses on safety and security, promoting therapeutic communication, encouraging medication compliance, assisting with self-care, and promoting social skills.
DSM-5 Criteria and Terminology for Schizophrenia include:
- Positive symptoms: Hallucinations, delusions, disorganized thinking/speech (e.g., word salad), and grossly disorganized or catatonic behavior.
- Negative symptoms: Flat affect, alogia (poverty of speech), avolition (lack of motivation), anhedonia (inability to experience pleasure), and social withdrawal.
**Type I schizophrenia (positive) ** is characterized by positive symptoms.
**Type II schizophrenia (negative) ** is characterized by negative symptoms.
Major drugs used in the treatment of schizophrenia include:
- First-generation antipsychotics (typical): chlorpromazine (Thorazine), haloperidol (Haldol), and fluphenazine (Prolixin).
- Second-generation antipsychotics (atypical): risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and clozapine (Clozaril).
Mechanism of action for antipsychotics involves blocking dopamine receptors in the brain.
Target symptoms of antipsychotics include hallucinations, delusions, disorganized thinking, and agitation.
Major side effects of antipsychotics include:
- Extrapyramidal symptoms (EPS): muscle stiffness, tremors, restlessness, akathisia (inability to sit still).
Tardive dyskinesia (TD): involuntary movements of tongue, face, and extremities.
Neuroleptic malignant syndrome (NMS): life-threatening condition with high fever, muscle rigidity, altered mental status, and autonomic instability.
Anticholinergic side effects: dry mouth, constipation, blurred vision, and urinary retention.
Effectiveness of nursing interventions for patients with schizophrenia is measured by improved symptom management, medication compliance, social functioning, and quality of life.