Professional Documents
Culture Documents
College of Nursing
Tabontabon, Leyte
SCHIZOPHRENIA
we will cover the ff:
What is schizophrenia?
Epidemiology
Cause/s
Criteria for diagnosis
Types of Schizophrenia
Prognosis
Symptoms of schizophrenia (+) (-)
Types of schizophrenia
Treatment (psychopharma and psychosocial tx)
Therapeutic communication for schizophrenic
Management ( utilizing the nursing process)
Future Direction in the treatment of schizophrenia
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Schizophrenia
- A disorder characterized by
disturbance in thought, sensory
perception, grossly disorganized
behavior , and deterioration in
psychosocial functioning.
Main problem:
Altered thought process.
Epidemiology
1% of population world wide
Males and females equally
affected but females have later
onset and better functional
outcome
Onset in late adolescence, early
adulthood
CAUSES
Genetics
Highly heritable
Risk increases with relationship
e.g. 10% for first degree relative or
fraternal twin, 50% concordance
for monozygotic twin
Genetic Risk
Obstetric Complications
Stress and reduction in brain oxygen during:
pregnancy
labor & delivery
Evidence from animal models:
Fetal hypoxia leads to neuropathology similar to
one observed in schizophrenia:
Enlarged ventricles (reduced brain weight)
Function:
Prognosis:
Favorable Prognosis Unfavorable Prognosis
1. Good socialization. 1. Poor/no socialization.
2. Late/acute onset 2. Early & insidious prognosis
3. Adequate support system. 3. Few/no support system
4. Family history of mood 4. History of chronicity/ many
disorder. relapses.
Fundamental Signs and Symptoms
(Bleuler’s 4 A’s of Schizophrenia)
1. Associative looseness
2. Autistic thinking
3. Ambivalence
4. Affect
Two Major Categories of Signs & Symptoms:
Positive/Hard Symptoms: Negative/Soft Symptoms:
• Clozapine (Clozaril)
• Ziprasidone (Geodon)
TREATMENT:
Psychopharmacology:
Antipsychotic drugs / neuroleptics
Conventional / Typical
• Chlorpromazine (Thorazine)
• Trifluoperazine (Trilafon)
• Fluphenazine (Prolixin)
• Thioridazine (Mellaril)
• Mesoridazine (Serentil)
• Thiothixene (Navane)
• Haloperidol (Haldol)
• Loxapine (Loxitane)
• Molindone (Moban)
• Perphenazine (Etrafon)
• Trifluoperazine (Stelazine)
- Mechanism of action:
> Block receptors for the neurotransmitter dopamine.
- Side Effects:
A. Extrapyramidal Side Effects (EPS)
a. Dystonia -torticollis, oculogyric crisis, protrusion
of the tongue
Txt: Diphenhydramine (Benadryl), Benztropin
(Cogentin)
b. Pseudoparkinsonism – shuffling gait, masklike face,
drooling, muscle stiffness, akinesia
Txt:
Benztropin(Cogentin),Trihexyphenidyl(Artane),Biperid
en (Akineton), Amantadine (Symmetrel),
Diphenhydramine (Benadryl), Diazepam (Valium),
Lorazepam (Ativan), Propanolol (Inderal)
ANTIPSYCHOTICS
• Drink sugar free fluids and eat sugar-free hard candy to ease the
anticholinergic effects of dry mouth.
• Avoid calorie-laden beverages and candy because they promote
dental caries, contribute to weight gain, and
do little to relieve dry mouth.
• Constipation can be prevented or relieved by increasing intake
of water and bulk-forming foods in the diet
and by exercising.
• Stool softeners are permissible, but laxatives should be avoided.
• Use sunscreen to prevent burning. Avoid long periods of time in
the sun, and wear protective clothing. Photosensitivity
can cause you to burn easily.
• Rising slowly from a lying or sitting position will prevent falls
from orthostatic hypotension or dizziness due to
a drop in blood pressure. Wait until any dizziness has subsided
before you walk.
• Monitor the amount of sleepiness or drowsiness you experience.
Avoid driving a car or performing other
potentially dangerous activities until your response time and
reflexes seem normal.
• If you forget a dose of antipsychotic medication, take it if the
dose is only 3 to 4 hours late. If the missed dose
is more than 4 hours late or the next dose is due, omit the forgotten
dose.
• If you have difficulty remembering your medication, use a chart
to record doses when taken, or use a pill box
labeled with dosage times and/or days of the week to help you
remember when to take medication.
•The most common side effect for
all antipsychotics is drowsiness
•Many of the antipsychotics block the
chemoreceptor trigger zone and vomiting
(emetic) center in the brain producing an
antiemetic effect.
Ideas of reference
The nurse assess the client's and
families knowledge of schizophrenia,
its treatment, and the potential for
relapse. Adherence to medication
regimens and other therapeutic
schedules is bolstered when clients
and families understand the biologic
basis of the illness, signs of recovery
and relapse, and their role in treatment.
3. Assessing social
support:
1. Schizophreniform disorder
The client exhibits the symptoms of schizophrenia
but for less than the 6 months necessary to meet
the diagnostic criteria for schizophrenia. Social or
occupational functioning may or may not be
impaired.
2. Schizoaffective disorder
The client exhibits the symptoms of psychosis and
at the same time, all the features of a mood
disorder, either depression or mania.
3. Delusional disorder
The client has one or more nonbizarre delusions –
that is, the focus of the delusion is believable.
Psychosocial functioning is not markedly impaired,
& behavior is not obviously odd or bizarre.
4. Brief Psychotic Disorder
The client experiences the sudden onset of at
least one psychotic symptom, such as delusions,
hallucinations, or disorganized speech or
behavior, which lasts from 1 day to 1 month. The
episode may or may not have an identifiable
stressor or may follow childbirth.
5. Shared psychotic disorder (folie à deux)
Two people share a similar delusion. The peron
with this diagnosis develops this delusion in the
context of a close relationship with someone who
has psychotic delusions.
Situation: Manny Kin is a 23-year-old graduate
student who has just been admitted to the unit with
behaviors of withdrawal, flat affect, disregard of
hygiene & grooming, and associative looseness.
His diagnosis is paranoid schizophrenia.
1. Which of the following is not characteristic of the
patient with paranoid schizophrenia?
a. Delusions
b. Hallucinations
c. Decreased sensitivity
d. Ideas of reference
2. Which defense mechanism is most characteristic
of the patient with paranoid schizophrenia?
a. Undoing
b. Projection
c. Rationalization
d. Suppresion
3. Thiodazine (Mellaril), an antipsychotic, is usually
effective in treating all but one of the following
symptoms of schizophrenia. Which symptom will
not be affected by this drug?
a. Agitation
b. Hallucinations
c. Delusions
d. Ambivalence
4.The nurse is caring for a patient with disorganized
schizophrenia. The patient is responding well to therapy
but has had limited social contact with others. Which of the
following interventions is most appropriate?
a. Discourage the patient from interacting with others
because if his efforts fail it will be too traumatic to him.
b. Encourage the patient to attend a party thrown for the
residents of the facility.
c. Encourage the patient to participate in one-on-one
interactions.
d. Encourage the patient to place a personal
advertisement in the local newspaper but not reveal his
main disability.
5. A 23-year-old female has been admitted to the
inpatient psychiatric unit with diagnosis of catatonic
schizophrenia. She appears weak & pale. The
nurse would expect to observe which behavior in
this patient?
a. Scratching cat-like motions of the extremities.
b. Exaggerated suspiciousness, excessive food
intake.
c. Stuporous withdrawal, hallucinations &
delusions.
d. Sexual preoccupation, word salad.
http://www.youtube.com/watch?
v=eKhOVaY-YNo&NR=1
http://www.youtube.com/watch?
v=HEKxWzvoD7M&feature=relat
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