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Causative Factors of Schizophrenia:
- Most common onset: Late teen to early adult hood
- Patients commonly have comorbiditys hypertension, diabetes, cardiovascular disease, and metabolic syndrome
- Affects men and women equally
- Onset an relapse are almost always due to stress
- Prenatal and perinatal events associated with disease
- Higher incidence if born in late Winter or early Spring
- Can have a genetic predisposition
- - Alcohol, smoking, and drugs are all high in people with schizophrenia
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What is Schizophrenia?
- Diagnostic term used to describe a major psychotic disorder characterized by disturbances in:
- Perceptions
- Thought Processes
- Reality Testing
- Feelings
- Behaviors
- Attention
- Motivation
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Brain Changes and Theories
- Enlarged ventricles--> MOST COMMON
- - Considered to have poorer prognosis
- Smaller hippocampus
- Increased number of dopamine receptors
- - Excessive dopamine activity in limbic area
- ^how you have positive symptoms
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Features of Schizophrenia
- DETERIORATING PERSONALITY
- Disordered thoughts
- Language disturbance
- Loss of function
- Delusions
- Hallucinations
- Cognitive dysfunction
- Hopelessness and suicidal ideation is very common
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Objective Signs of Schizophrenia
--> Things you can see
- -- Alterations in Personal Relationships
- - Decreased attention to appearance and social amenities related to introspection and autism
- - Inadequate or inappropriate communication
- - Hostility
- - Withdrawal
- -- Alterations of Activity
- - Psychomotor agitation
- - Catatonic rigidity
- - Echopraxia (repetitive movements)
- - Stereotypy (repetitive acts or words)
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Subjective Signs of Schizophrenia:
--> Things you cannot see
- --Altered Perception
- - Hallucination
- - Illusions
- - Paranoid thinking
- -- Alterations of Thought
- - Loose associations
- - Retardation
- - Blocking
- - Autism
- - Ambivalence
- - Delusions
- - Poverty of speech
- - Ideas of reference
- - Mutism
- -- Altered Consciousness
- - Confusion
- - Incoherent speech
- - Clouding
- - Sense of "going crazy"
- -- Alterations of Affect
- - Inappropriate, blunted, flattened, or labile affect
- - Apathy
- - Ambivalence
- - Overreaction
- - Anhedonia
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Positive- Type 1 Symptoms
- - Too much of something
- - Most easy to identify
- - Due to excess dopamine
- - Hallucinations
- - Grandiosity
- - Agitation, tension
- - Bizarre behavior
- - Delusions
- - Suspiciousness
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Negative- Type 2 Symptoms
- - Lack of feelings
- - Harder to treat
- - More difficult to detect
- - Flattened affect
- - Alogia
- - Avolition (lack of motivation)
- - Anhedonia (lack of pleasure/joy)
- - Communication difficulties
- - Poor grooming
- - Asocial behavior
- - Attention deficitis** (hard time concentrating and paying attention)
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Phases of Schizophrenia:
- -- Prodomal (before diagnosis)
- - Start showing subtal sx
- - Sleep disturbances, trouble thinking, most people go through this
- -- Acute
- - Severe psychotic symptoms
- - Can be positive or negative symptoms
- -- Stabilizing
- - Getting better
- - But symptms still getting in way of normal functioning
- -- Stable
- - Hallucinations/delusions not as severe; or can be asymptomatic
- - Can still be having these problems, they just learn to ignore and function normally
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DSM-lV-TR Criteria:
- Atleast 2 characteristic symptoms
- Social- occupational dysfunction
- Duration - atleast 6 months
- No other causes (shizoaffective, medical, or substance abuse)
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Catatonic Schizophrenia:
- Intense psychomotor disturbance
- Stupor, posturing, vegetative condition
- Waxy flexibility
- Mute, negative, purposeless motor activity
- Magical thinking
- Responds well to meds
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Disorganized Schizophrenia:
- Disintegration of personality
- Word salad, clanging, odd behavior
- Poor grooming
- Poor prognosis
- Flat innappropriate affect
- Rhyming words over and over again
- Many homeless have this
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Paranoid Schizophrenia:
- Better prognosis
- Less neurologic, cognitive impairments
- Persecutory delusions, auditory hallucinations common
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Undifferentiated Schizophrenia:
- Fragmented delusions, vague hallucinations, bizarre & disorganized behavior, disorientation, incoherence
- Inappropriate affect
- Poor prognosis
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Residual Schizophrenia:
- Had at least 1 acute episode of schizophrenia, only negative symptoms
- Unpredictable prognosis
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Psychosocial and Rehabilitation:
- Trust building
- Behavior therapy
- Follow up
- Group theraphy
- Address non-compliance
- High suicide risk***
- Occupational therapy is very effective with them
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Nursing Diagnosis:
- Impaired thought processes
- Impaired sensory perceptions
- Impaired verbal communication
- Impaired role performance
- Self-care deficit
- Social isolation
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Nursing Intervention:
- Promote trust
- Promote positive orienation
- Promote perceived control
- Promote strengths
- Meet health-oriented goals
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Things You Should NOT Do:
- Reinforce hallucinations/delusions
- Touch without warning
- Whisper, laugh when patient can't hear conversation
- No competing
- Do not embarrass
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Psychosis Induced Polydipsia:
- Cumpulsive H20 drinking (4-10 liters/day)
- Occurs because of thirst and osmotic dysregulation
- - Major concern= HYPONATREMIA
- ---- sx: lightheadedness, weakness, lethargy, muscle cramps, n/v, confusion, convulsions, coma
- Treatment: frequent weighings, restricted fluid intakes, sodium replacement and positive reinforcement
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Schizoaffective Disorder:
- Affective & Schizophrenic symptoms
- Severe mood swings
- Criteria that meets schizophrenia and a mood disorder
- Prognosis better than schizophrenia but less for just a mood disorder
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Delusional Disorder:
- Display symptoms similar to schizophrenia
- Normal behavior
- Sx similar to schizophrenia delusions which have the basis to reality
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Schizophreniform Disorder:
- Same symptoms as schizophrenia except symptoms > 1 month but < 6 months
- Usually occurs later in life
Common in elderly patients with a reaction to medication
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Manic Episodes:
- Bipolar: usually less severe
- Substance abuse, medical/neuro problems
- Have fewer sx of bipolar
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Psychotic Disorders:
- Delusions, hallucinations, disordered thoughts, bizarre behavior
- --Late Onset Schizophrenia
- - Late onset after 60 years old
- - More bizarre, hallucinations, and delusions
- - Hallucinations and delusions of all five senses
- - Do not show negative symptoms very often
- - Use antipsychotics
- - Very often need long term care
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Alzheimers Disease:
Agnosia: Can't recognize familiar object
Amnesia: Loss of memory
Aphasia: Language disturbance
Apraxia: Inability to show motor activity
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Anxiety Disorders:
- Highest of all disorders in the elderly
- Anxiety, phobias, panic
- Nonbenzodiazepines
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Depression:
- Common; often overlooked
- Treated with SSRI's (Prozac, Paxil)
- BuSpar, ECT
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Substance Abuse:
-ALCOHOL
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