Chapter 15: Schizophrenia Spectrum PDF

Chapter 15 Schizophrenia Spectrum and Other Psychotic Disorders SCHIZOPHRE NIA The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind). EUGENE BLEULER https://www.britannica.com/biography/Eugen- Bleuler IMPACT Schizophr...

Chapter 15 Schizophrenia Spectrum and Other Psychotic Disorders SCHIZOPHRE NIA The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind). EUGENE BLEULER https://www.britannica.com/biography/Eugen- Bleuler IMPACT Schizophrenia requires treatment that is comprehensive and presented in a multidisciplinary effort. Of all mental illnesses, schizophrenia probably causes more: Lengthy hospitalizations Chaos in family life Exorbitant costs to people and governments Fears Nature of the Disorder Schizophrenia causes disturbances in: Thought processes Perception Affect Prevalence With schizophrenia, there is a severe deterioration of social and occupational functioning. In the United States, the lifetime prevalence of schizophrenia is about 1%. Phases: Phase1/ Personality Phase/Premorbid phase Shy and withdrawn Poor peer relationships Doing poorly in school Antisocial behavior Phase 2: Prodromal phase Lasts from a few weeks to a few years Deterioration in role functioning and social withdrawal Substantial functional impairment Depressed mood, poor concentration, fatigue Sudden onset of obsessive- compulsive behavior  Phase 3: Acute schizophrenic episode In the active phase of the disorder, psychotic symptoms are prominent. Delusions Hallucinations Impairment in work, social relations, and self- care https://www.gbhoh.com/schizophrenia-signs-symptoms- treatments/ Phase 4 : Residual phase Symptoms similar to those of the prodromal phase. Flat affect and impairment in role functioning are prominent. https://www.verywellmind.com/understanding-inappropriate- affect-4767992  https://www.todayshospitalist.com Factors associated with a positive prognosis Good premorbid functioning Later age at onset Prognosis Female gender Abrupt onset precipitated by a stressful event Associated mood disturbance Brief duration of active-phase symptoms  Factors associated with a positive Prognosi prognosis include (continued) s Minimal residual symptoms Absence of structural brain (continu abnormalities Normal neurological functioning ed) No family history of schizophrenia Predisposing Factors Biological factors Genetics 5-10%. Predisposing Factors (continued_1) Biochemical factors One theory suggests that schizophrenia may be caused by an excess of dopamine activity in the brain. Abnormalities in other neurotransmitters have also been suggested.  Viral infection Anatomical abnormalities Electrophysiology Epilepsy Physiologi Huntington’s disease cal Birth trauma factors Head injury in adulthood Alcohol abuse Cerebral tumor Cerebrovascular accident Systemic lupus erythematosus Psychological factors These theories no longer hold credibility. Researchers now focus their studies of schizophrenia as a brain disorder. Psychosocial theories probably developed early on out of a lack of information related to a biological connection. Sociocultural factors: Poverty has been linked with the development of schizophrenia. Downward drift hypothesis: Poor social conditions seen as consequence of, rather than a cause of, schizophrenia Theoretical integration Schizophrenia is most likely a biologically based disease, the onset of which is influenced by factors in the internal or external environment. Types of Schizophrenia and Other Psychotic Disorders  https://psych2go.net/delusional-disorder-what-is-it/ The existence of prominent, nonbizarre delusions Erotomanic type Delusional Grandiose type disorder Jealous type Persecutory type Somatic type Mixed type  Brief psychotic disorder Sudden onset of symptoms May or may not be preceded by a severe psychosocial stressor Lasts less than 1 month Return to full premorbid level of functioning https://ananda.ai/brief-psychotic-disorder/ Substance- and medication-induced psychotic disorder The presence of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal Psychotic disorder due to another medical condition Prominent hallucinations and delusions are directly attributable to a general medical condition. Catatonic disorder due to another medical condition This diagnosis is made when the catatonic symptoms are directly attributable to the physiological consequences of a general medical condition. Schizophreniform disorder Same symptoms as schizophrenia with the exception that the duration of the disorder has been at least 1 month but less than 6 months  Schizophrenic symptoms accompanied by a strong element of Schizoaffectiv symptomatology associated with e disorder mood disorders of either mania or depression Positive Symptoms Content of thought Delusions: Fixed, false personal beliefs Persecutory Grandiose Somatic Erotomanic Jealous  Positive Symptoms Form of thought Associative looseness (also called loose association): Shift of ideas from one unrelated topic to another Neologisms: Made-up words that have meaning only to the person who invents them Concrete thinking: Literal interpretations of the environment Clang associations: Choice of words is governed by sound (often rhyming)  Positive Symptoms Form of thought Word salad: Group of words put together in a random fashion Circumstantiality: Delay in reaching the point of a communication because of unnecessary and tedious details Tangentiality: Inability to get to the point of communication due to the introduction of many new topics Mutism: Inability or refusal to speak Positive Symptoms Form of thought Perseveration: Persistent repetition of the same word or idea in response to different questions  Positive Symptoms Perception: interpretation of stimuli through the senses Hallucinations: False sensory perceptions not associated with real external stimuli Auditory Visual Tactile Gustatory Olfactory Illusions: Misperceptions of real external stimuli Echopraxia: Repeating movements that are observed Negative Symptoms Affect: The feeling state or emotional tone Inappropriate affect: Emotions are incongruent with the circumstances Bland: Weak emotional tone Flat: Appears to be void of emotional tone Apathy: Disinterest in the environment Negative Symptoms Avolition: Impairment in the ability to initiate goal-directed activity Emotional ambivalence: Coexistence of opposite emotions toward same object, person, or situation Deterioration in appearance: Impaired personal grooming and self-care activities Negative Symptoms Impaired interpersonal functioning and relationship to the external world Impaired social interaction: Clinging and intruding on the personal space of others, exhibiting behaviors that are not culturally and socially acceptable Social isolation: A focus inward on the self to the exclusion of the external environment Negative Symptoms Lack of insight Anergia: deficiency of energy Anhedonia: Inability to experience pleasure Lack of abstract thinking ability Negative Symptoms Associated features Waxy flexibility: Passive yielding of all movable parts of the body to any effort made at placing them in certain positions Posturing: Voluntary assumption of inappropriate or bizarre postures Pacing and rocking: Pacing back and forth and rocking the body Regression: Retreat to an earlier level of development Eye movement abnormalities Nursing Diagnosis Disturbed Sensory Perception (auditory and visual) Related to panic anxiety, extreme loneliness, and withdrawal into self Disturbed Thought Processes Related to inability to trust, panic anxiety, or possible hereditary or biochemical factors Social Isolation related to inability to trust, panic anxiety, weak ego development, delusional thinking, regression Risk for Violence: Self-directed or Other-directed related to Extreme suspiciousness Panic anxiety Catatonic excitement Rage reactions Command hallucinations  Nursing Diagnosis Impaired Verbal Communication related to Panic anxiety Regression Withdrawal Disordered unrealistic thinking Self-Care Deficit related to Withdrawal Regression Panic anxiety Perceptual or cognitive impairment Inability to trust Disabled Family Coping related to difficulty coping with client’s illness Nursing Care Plan Pages 355-359  Management of the illness Connection of exacerbation of symptoms to times of stress Appropriate medication management Side effects of medications Importance of not stopping medications When to contact healthcare provider Relaxation techniques Social skills training Daily living skills training Support services Caregiver Financial Legal support assistance assistance groups Respite Home care healthcare Treatment Modalities: Psychological treatments Individual psychotherapy: Long- term therapeutic approach; difficult because of client’s impairment in interpersonal functioning Group therapy: Some success if occurring over the long-term course of the illness; less successful in acute, short-term treatment Behavior therapy: Chief drawback has been inability to generalize to community setting after client has been discharged from treatment. Social treatments Social skills training: Use of role play to teach client appropriate eye contact, interpersonal skills, voice intonation, posture, and so on; aimed at improving relationship development Family therapy: Aimed at helping family members cope with long- term effects of the illness Program of Assertive Community Treatment A program of case management that takes a team approach in providing comprehensive, community- based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness The Recovery Model A concept of healing and transformation enabling a person with mental illness to live a meaningful life in the community while striving to achieve his or her full potential Research provides support for recovery as an obtainable objective for individuals with schizophrenia. Recovery After an Initial Schizophrenia Episode (R A I S E) A program of case management that takes a team approach in providing comprehensive, community- based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness  Psychopharmac ology See Chapter 4 and Pages 367-370 https://www.sandiego.gov/environmental-services/ep/hazardous/ medications