Schizophrenia Spectrum Disorders PDF

# Schizophrenia Spectrum Disorders ## Chapter 12 **S. JOHNSON, MNS, CCM, RN** ## Objectives - Describe the various types of schizophrenia and other psychotic disorders. - Identify predisposing factors in the development of schizophrenia and other psychotic disorders. - Identify symptoms associat...

# Schizophrenia Spectrum Disorders ## Chapter 12 **S. JOHNSON, MNS, CCM, RN** ## Objectives - Describe the various types of schizophrenia and other psychotic disorders. - Identify predisposing factors in the development of schizophrenia and other psychotic disorders. - Identify symptoms associated with schizophrenia and other psychotic disorders. - Utilize the nursing process to formulate care for patients with schizophrenia and other psychotic disorders. - Discuss various modalities relevant to the treatment of schizophrenia and other psychotic disorders. - Describe indications, actions, contraindications, precautions, side effects and nursing implications for antipsychotic medications. - Discuss pharmacotherapy in the treatment of schizophrenia. - Compare and contrast therapeutic responses from first- and second-generation antipsychotics. ## Schizophrenia Spectrum Disorders - Refers to a group of severe, chronic and disabling psychiatric disorders marked by withdrawal from reality, illogical thinking, possible delusions and hallucinations and other emotional, behavioral or intellectual disturbances. - **Affects** - Language - Emotions - Social behavior - Ability to perceive reality accurately. ## Spectrum Disorders - Delusional Disorder - Brief psychotic disorder - Substance induced psychotic disorder - Schizophreniform disorder - Schizoaffective disorder ## Substance-Induced Psychotic Disorder and Psychotic Disorder Due To Another Medical Condition - Drugs, alcohol, medications, or toxins - Delusions or hallucinations from delirium, neurological disease, hepatic or renal disease, and many more ## Schizophrenia - **Causes** - Genetics - Perinatal complications - Biochemical - Structural Abnormalities - Other causes ## Phases of Schizophrenia - **Disease Phases** - **Prodromal** - Onset; mild changes - **Acute** - Exacerbation of symptoms - **Stabilization** - Symptoms diminishing - Movement toward previous level of functioning - **Maintenance or residual** - New baseline is established ## Schizophrenia Symptoms - **Positive Symptoms** - Delusions - Hallucinations - Bizarre behavior - Catatonia - **Negative Symptoms** - Apathy - Lack of motivation - Blunted affect - Poverty of speech - Anhedonia ## Schizophrenia Symptoms Cont. - **Cognitive Symptoms** - Impairment in memory - Disruption in social learning - Inability to reason - Solve problems - Focus attention - Concrete thinking - **Affective Symptoms** - Depression - Anxiety - Demoralization - Dysphoria - Suicidality ## Disorders or Distortions of Thought - **Thought blocking:** A reduction or stoppage of thought. Interruption of thought by hallucinations can cause this. - **Thought insertion:** The uncomfortable belief that someone else has inserted thoughts into their brains. - **Thought deletion:** A belief that thoughts have been taken or are missing. - **Magical thinking:** Believing that thoughts or actions affect others' consequences. - **Paranoia:** An irrational fear, ranging from mild (wary, guarded) to profound (believing irrationally that another person intends to kill you). ## Alterations in Speech - **Associative looseness:** thinking is very illogical and confused, therefore conversation will not make sense because words will have no logical pattern, Individual will just ramble. **Word Salad:** Words that are put together randomly without logical connection. - **Neologism:** made up words that are meaningless to others but have symbolic or meaning to the individual speaking them. - **Clang Association:** using words that rhyme. - **Echolalia:** Repeating words or phrases spoke by another person. ## Alterations in Perception - **Depersonalization:** A feeling of being unreal or having lost identity. Body parts do not belong or the body has drastically changed. Out of touch with self. - **Hallucinations:** involve perceiving a sensory experience for which no external stimulus exists. - **A command hallucination:** is an auditory command that can be particularly disturbing symptom and directs the person to take an action. - **Illusions:** are misconception misperceptions or misinterpretations of a real experience. - **Derealization:** A feeling that the environment has changed. Detachment with reality, living in a dream state. ## Alterations in Behavior - **Catatonia:** pronounced lack of movement or communication but can also include agitation, confusion, and restlessness. - **Motor retardation:** Slowing of movement or sluggish or diminished body movement. - **Stereotyped behaviors:** motor patterns that do not have any purpose. - **Waxy flexibility:** putting oneself in a specific position and remains in that position for a unknown timeframe. May also be seen in patients experiencing catatonia. - **Echopraxia:** The mimicking of movements of another. - **Stereotyped behaviors:** Repetitive behaviors that do not serve a logical purpose. - **Gesturing or posturing:** Assuming unusual and illogical expressions (often grimaces), posture or positions. - **Boundary impairment:** An impaired ability to sense where one's body or influence ends and another's. ## Planning Stage - **Treatment Phases** - **Phase I - acute** - Best strategies to ensure patient safety and provide symptom stabilization - **Phase II - stabilization** - **Phase III - maintenance** - Provide patient and family education. - Relapse prevention skills are vital. ## Medications - **Treatment** - **1st generation antipsychotics** - Fluphenazine - Haloperidol (Haldol) - Perphenazine - Thioridazine - Thiothixene (Navane) - Trifluoperazine - Chlopromazine (Thorazine) ## Medication Cont. - **Treatment** - **Atypical antipsychotics** - Clozapine - Olanzapine - Quetiapine (Seroquel) - Risperidone (Risperdal) - Ziprasidone - Aripiprazole (Abilify) - Lurasidone (Latuda) - Paliperidone - Iloperidone ## Schizophrenia - **Treatment** - Psychosocial treatment - Psychological therapies - Rehabilitation - ECT ## Check your Knowledge Loose associations in a person with schizophrenia indicate: A. Paranoia. B. Mood instability C. Depersonalization D. Poorly organized thinking. ## Check your Knowledge #2 Which assessment finding represents a negative symptom of schizophrenia? A. Apathy B. Delusion C. Motor tic D. Hallucination ## Test your Knowledge #3 Eric's roommate says his speech "... doesn't connect; it doesn't make any sense. He sort of gets derailed." Which of the following symptoms is Eric displaying? A. Avolitional speech B. Delusional speech C. Disorganized speech D. Diminished emotional expression