schizophrenia online2
TRANSCRIPT
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Schizophrenia History
19th CenturyKraepelin- Dementia Praecox
20th CenturyBleuler autism-apathy-ambivalence-anhedoniaArieti associative looseness, auditory hallucinations
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Current theories
Genetic 1% of population
10 % of 1st degree relatives 35-55% concordance rate in monozygotic
twins (genetically identical)15-17% concordance rate in dizygotic
twins (share half their genes)
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Slightly more men than womenEarly 20s age of first psychotic break75% of people have permanent disabilityCultural component on relapse
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Neurotransmitter imbalance Dopamine system hyperactivity Norepinepherine elevation Serotonin elevation Diminished levels of GABA Decreased co-enzyme for conversion of PKU
to tyrosine
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Central Nervous System Anomaly Type 2 enlarged ventricles negative symptoms resistant to
medicationType 1 positive symptoms respond to
medication
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Positive Symptoms
DelusionsHallucinationsDisorganized speechBizarre or disorganized behavior
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Negative Symptoms
Flat AffectAvolitionAlogiaAnhedoniaAttention Impairment
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History of Therapy
PsychoanalyticSullivan/PeplauInterpersonal Communication
SomaticInsulin ComaElectroconvulsive TherapyPsychosurgery
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Psychopharmacology1950s phenothiazines1990s D1-D2 receptor medications
Community Mental HealthMilieuTherapeutic CommunityDe-institutionalization
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Typology of Thought Disorder
ParanoidCatatonicDisorganizedUndifferentiatedResidual
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Paranoid
Delusions- especially persecutoryAuditory HallucinationsNo loose associationsNo marked affective problem
Paranoid
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Catatonic
Stupor or mutismNegativismRigidityExcitementPosturing (waxy flexibility)
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Disorganized
Marked looseness of associationsGrossly inappropriate affect
Disorganized
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UndifferentiatedProminent delusionsHallucinations or grossly disorganized
behavior
Residual
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Diagnosis
Presence of 1,2, or 3 for more than 1 week1. Two of the following:
delusions, prominent hallucinations, marked
associative loosenesscatatonic behaviorflat or silly affect
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2. Bizarre delusions3. Prominent hallucinations
Continuous signs of disturbance 6 months18 years if age or moreDownward course
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Nursing Process- Assessment
1. Perceptual changes:illusions, hallucinations
2. Thought disorder:loose associations, clanging, delusions
3. Communication changes:thought disorganization,
blocking, tangential, circumstantial
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4. Motor Changes:catatonia-excited, posturing, waxy
flexibility
5. Family:enmeshed, family burden
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Nursing Diagnosis
Impaired communicationpoverty of speechblunt emotions
Self-care deficitsActivity intoleranceSocial isolationDecisional conflict
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Sensory alterationsBody image distortionAltered thought processes
delusions, magical thinkingthought insertions, withdrawalthought broadcasting
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Altered emotional responseblunted or flat affectanhedonia
Altered family function
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Nursing Planning & Intervention
Adequate communication
Grooming & hygieneSocial skillsIntervene with
delusionsFamily understanding
Medication usageOrganize behaviorReality based
perceptionsCongruent emotional
responsesCommunity contacts
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Nursing Planning & Intervention
Adequate communication
Grooming & hygieneSocial skillsIntervene with
delusionsFamily understanding
Medication usageOrganize behaviorReality based
perceptionsCongruent emotional
responsesCommunity contacts
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Nursing Implications with Neuroleptic Medications
1. PhenothiazinesThorazine (Chlorpromazine)Mellaril (Thiorizidine)Stelazine (Trifluoperazine)Prolixin (Fluphenazine)Prolixin Decanoate
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2. ButyrophenesHaldol (Haloperidol)Haldol LA
3. Low potency D1-D2 medicationsClozaril (Clozapine)Risperdol (Resperidone) & Risperdol EZyprexa (Olanzapine)
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Abilify (Ariprazole)Geodon (Ziprasidone)
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Side Effects
Nervous system Extra Pyramidal SymptomsAkathisia--restelessnessDystonia– muscle contractions
Opisthotonis—tongue sticking outOcculogryic Crisis- eye rolling
Akinesia– muscle heavinessPseudo parkinsonism- mask like fascies and other symptomsTardive dyskinesia—tongue movements
Tardive Dyskinesia
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Other Side Effects
PhotophobiaLeukocytosisOrthostatic hypotensionAnti-cholinergic effects
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D1 and D2 effects
Weight gainImpotenceRisk for development of Diabetes Mellitus
(Geodon)Gallactarhea
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Neuroleptic malignant syndrome
Possibly fatal side effect of neurolepticsNon-dose relatedFeverConfusionConvulsionsDeathRx-stop neuroleptic- emergency care
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Side Effect Treatment
Anti-parkinson medications:Cogentin (Benztropine)Artane (Trihexyphenidyl)Symmetrel (Amantadine)
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Atropine Psychosis
Mad as a hatter confusedRed as a beet feverDry as a bone anticholinergiaBlind as a bat diplopia