Schizophrenia

Severe disorder of the brain like epilepsy or multiple sclerosis.

It is a clinical syndrome, not just one cause

It is a NO fault illness.

Acute periods with relapses

Perception, judgement, and emotions

it is Highly Genetic

Does not mean “split personality”.

Not caused by bad parenting.

Not caused by personal weakness.

Disconnect btw what the pt is seeing and the outside world

(emotions not expressed congruently). Difficult time in relationships

When they are taking drugs they are more prone to think more clearly and able to plan a suicide

When not on meds there are so many thoughts they cant distinguish and paln and think clearly

The later your diagnosed, the better level of functioning overall. Outcomes are greater if you were functional before you were diagnosed

more likely you will be able to function bc you know what is normal and what is not

• their outcomes are worse bc they didnt have a chance to
• develop and function well before.

The earlier your diagnosed the less of a life you will have

Kids wont know the difference btw normal and not

• ppl with schizo produce more excess dopamine and they dont have as good things to break it dop down so theres higher concentrations the increased doamine craving cells and a decrease in activity in antagonis (more cells want
• dopamine and less want to block it )

Winter birth

Viral infection 28th-30th week of pregnancy

Rh incompatibility

Starvation during pregnancy

Oxygen deprivation at birth

MRI: identifies small changes in brain

PET: high activity in temporal lobe , metabolism, sugars can be seen

EEG: just shows pt is alive, and current seizure

Lasting 6 months

• Active-phase symptoms lasting at least 1 month include
• two of the following:

–Hallucinations

–Delusions

–Disorganized or catatonic behavior

• –Disorganized
• speech

• Paranoid
• Disorganized
• Catatonic
• Undifferentiated
• Residual

• delusional thought.
• Voices.
• See the enviroment as threatening and hostile.
• They can be dangerous.
• Highest functioning, most successful in recovery

able to work and go to school, just have to manage with the voices, able to functionin life,sees life as threating and hostile enviornment (hypervigulent), want to know whattheir thoughts are (I wonder what its like for you)

can have hallucinations. Looseness of assoc. disconnection in their affect

(laughing when talking about someone who died). Harder to understand.

walking around, not really talking or have awareness of surroundings. Could be motionless, like a mannequin.

Look unaware of their environment. They say theres so much going in their head that it immobilizes them. Can be successful

• worried about DVT and eating , catatonic can be succesful
• too,

they can still hear you even though they may look like they are a maniquien

could be a combo of the other ones. Might not be as successful in recovery.

little bits and pieces of everything, lots of things going on, a mess and not able to function well

don’t have active symptoms but still difficult time in social situations

left over behaviors after treatment, no active symptom

• Prodromal
• Acute
• Mainenance
• Stabilization

pre before diagnosis

–Early symptoms preceding diagnosis: social withdrawal, deterioration in function, perceptual disturbances, magical thinking, and peculiar behavior

• Usually before pt has their first break there are SOME symptoms. Start disconnecting social-wise. Magical thinking , change in behavior usually don’t act like this
• is a sign

when postive symptoms occur crack and start to be schizophrenic

Acute symptoms decrease, especially positive symptoms

When meds and treatment are given

Symptoms are in remission

Even in remission, pts will have some type of delusional thinking but it might not prevent them from functioning

Hallucinations-distortion of perceptions

Delusions-distortion of thought content

Disorganized speech

Grossly disorganized or catatonic behaviors

• Apathy
• Alogia
• Lack of motivation
• Blunted flat affect
• Loss of emotional warmth
• Impaired social skills

• Treatment:
• Atypical antipsychotics-newer. They help these

Schizophrenia

Bipolar

• Delusions
• Circumstantially
• Tangentiality
• Thought blocking
• Losse association

somebody who doesn’t know what is more important.

You ask them about a movie and they tell you everything (the parking spot, etc) THE WHOLE STORY

start talking about something then going off on tangent (refocus pt)

• might not be a connection.
• They go from one topic to another.
• (random, I cant follow you)

A delusion

A Hallucination

Mental status examination

Positive and negative symptoms

Assessment scales

–PHATS (Bp, HDL (good cholesterol), Abdominal obesity, Triglycerides, sugar) how they are reacting to the atipical drugs

Newer bc a lot of the newer drugs cause these

Then they will not be discharged

planning strategies to ensure patient safety and stabilize symptoms

planning strategies to provide patient and family education

planning strategies to prevent relapse

i find it hard to believe but i believe that you think youre jesus christ”

Imbalanced nutrition:less than body requirements

Block D2 receptors in limbic region

Positive symptoms

Haldol, Prolixin, Thorazine, trilafon

dopamine blockage (EPS), noradrenergic (Alpha 1)blockage, cholinergic blockage

Atropine-like Side Effects

•Dry mouth

•Blurred vision

•Sinus tachycardia

•Urinary retention

•Constipation

•Nasal congestion

•Treatment: Supportive measures

• Haldol
• Stelazine
• Prolixin
• Navane

• Loxaprin (loxitane)
• Moban
• Trilafon

• Thorazine
• Taractan
• Mellaril

los sedative affect

3-4 wks

every 2-4 wks

Thorazine

Thorazine

Thorazine

Orthostatic hypotension-risk of falling and monitor blood pressure

Dysrhythmias, palpitations

Extrapyramidal Side Effects

• Dystonia
• Pseudoparkinsonism
• Akathisia
• Tradive Dyskinesia

(stiffness)(see this right away)

IM diphenhydramine (benadryl) or benztropine (cogentin, artane) followed by oral antiparkinsonism drug, eyes rolling back

Haldol and Prolixin

Change to low-potency drug

Oral antiparkinsonism (symmetrel) drug

(see this a lot. Movements uncontrolled. Pacing, moving legs) (they look agitated)

Decrease antipsychotic dose

Propranolol (Inderal)

chronic result) (involuntary movement of facial area a lot of times) tongue might be moving. feeling of caramel stuck in your mouth

Change to atypical antipsychotic make comment of what you are seeing

Photosensitivity( doesn’t matter what your skin color is)wear sunscreen

Poikilothermia (Temperature Regulation Affected)-body isnt telling them if theyre hot or cold. Could be sweating but wont know to take their coat off

Galactorrhea and Gynecomastia

Clozapine (Clozaril)-agranulocytosis,wt gain

•Risperidone (Risperdal)

•Olanzapine (Zyprexa)-wt gain

•Quetiapine (Seroquel)

•Ziprasidone (Geodon)

•Aripiprazole (Abilify)

fewer EPS, fewer anticholinergic effects, may have sedation and hypotension

Dopamine side effects much weaker

Histamine is blocked: results in weight gain, sedation

Hyperlipidemia, Hyperglycemia and weight gain may occur over time, esp. with Olanzapine

•May improve TD

Clozaril-requires weekly WBC counts

D4 and 5HT2

Agranulocytosis

–Anticholinergic, extrapyramidal

–Neuroleptic malignant syndrome (NMS)

–Tachycardia, postural hypotension

–Weight gain

–Fever, seizures

•Potentially fatal

•Decreased Level ofbconsciousness

•Inceased Muscle tone

•Autonomic dysfunction

–Hyperpyrexia-high temp.

–Labile hypertensions

–Tachycardia

–Tachypnea

–Diaphorseis

–Drooling

•Myoglobinuria-large molecules that block your kidneys

•D/C antipsychotics

•Hydrate

•Acetaminophen

•Heparin

•Dantrolene- antidote for hyperthermia

•Dopaminergics

–Bromocriptine, amantadine

Use Abnormal Involuntary Movement Scale (AIMS) for early recognition of EPS

Anticholinergic meds

• Risperdal Consta atypical antipsychotic
• –IM
• q2weeks

• Fluphenazine (Prolixin)decanoate typical antipsychotic
• –IM or SC

• •Haloperidol decanoate typical antipsychotic
• –IM

•Denial of illness

•Noncompliance

•Lack of family support

•Inability to cope with health system

•Medication failures