Schizophrenia

describes the behavior associated with an individuals feelings or EMOTIONAL TONE

• The person will have changes in their mood and character seen by
• aggression
• depression
• rage
• euphoria
• irritability
• apathy

Norepinephrine

• decreased amounts=depression
• increased amounts= mania, anxiety, and schizophrenia

• increased levels=insomnia, anxiety, emotional lability
• decreased levels=depression, fatigue

it is the s/s that preced the characteristic manifestations of the acute fully developed illness.

Can last 2-5 years

• functional impairment and non specific symptoms;
• sleep disturbances, anxiety, irritability, depression, poor concentration, fatigue, behavioral deficits(decrease in role and social withdrawal)

• flattening
• alogia
• avolition

• perceptual abnormalities
• ideas of reference
• suspiciousness development
• psychosis

2 or more of the following for a significant portion of time during a 1 months period:

• delusions
• hallucinations
• disorganized speech (derailment or incoherent)
• grossly disorganized or catatonic behavior

• limit use of amphetamines (increase dopamine)
• if have a lot of dopamine-take neuroleptics
• get good prenatal care
• wear a helmet and protect the prain
• dont abuse alcohol

symptoms that are added to a person characteristics

• hallucinations
• delusions
• disorganized thoughts and speech
• bizarre behavior

It is irrational thinking that one is being talked about or laughed at by others.

everything going on around them has to do with them.

"someone is trying to get a message to me through the articles in the magazine.  I must break the code so I can receive the message"

• Focus on reality-here and now
• help with verbalizations of feelings-anxiety/fear
• focus on the emotional tone of the delusion
• dont argue or deny clients belief

*Use reflective technique and show empathy!!

• Encourage the client to share their delusions before acting on them.
• Do not argue or try to use logic
• Try to get the patient to see their progress since admission

• movement
• coordination
• emotions
• voluntary decision making ability

• sleep, arousal states
• libido
• appetite
• mood
• aggression
• pain perception

pain modulation

increased=insomnia, anxiety, emotional lability

decreased=depression, fatigue

increased=mood disorders, psychosis

decreased=depression, apathy, fatigue

increased=depression, anxiety, decreased libido, irritability

decreased=depression, anorexia and increased testosterone

increased sexual behavior and aggressiveness

individuals emotional tones incongruent with the circumstances.

person laughs when told mom is dead

treats extrapyramidal symptoms (EPS) associated with antipsychotic meds, also Parkinsons

when a client hides negative unacceptable thoughts/feelings by expressing positive feelings

Pt. hates mom...but says "I love my mom, she's the best"

bizarre facial and tongue movements, stiff neck and difficulty swallowing

**Adverse rxn to anti psychotic meds

depression

emotional brain...associated with feelings of fear and anxiety; anger and aggression; love, joy and hope.

Sexuality and social behavior

false sensory perceptions not associated with real external stimuli....can involve any of the 5 senses

a symptom of psychosis in which the patient believes that his or her thoughts are "broadcast" beyond the head so that other people can hear them.

a loss of contact with reality that usually includes:

• false beliefs about what is taking place or who one is(delusion)
• seeing or hearing things that arent there (hallucinations)

false personal beliefs not consistent with a person's intelligence or cultural background. 

The individual continues to have the belief in spite of obvious proof that it is false and/or irrational

psychiatry incorrect interpretation of events as having a direct reference to oneself.

ie-a woman rarely leaves her house because she experiences all conversation or laughter she hears as directed at herself

an individual with loose ego boundaries attempting to identify with another person by imitating movements that the other person makes

the parrot like repitition of the words spoken by another person

bizarre behavior-catatonia

perceptual disturbances-hallucinations, delusions

disordered thinking-loose associations, perseveration

inability to speak

lack of drive or motivation to pursue meaningful goals

the inability to experience pleasure from activities usually found enjoyable

individual has a false idea abou the functioning of his or her body...

• they smell from any orofus
• infestation of insects on or in skin
• has an internal parasite
• has misshapen or ugly body parts
• dysfunctional body parts

ie-I am 70 years old and will be the oldest person to give birth...the Dr. says I am not prego, but I know I am

sudden cessation of thought in the middle of a sentence

thinking is haphazard, illogical and confused.

Persons responses dont relate to the question asked, or a paragraph, or sentence or phrase isnt logically connected to those that occur before it

brief and empty replies to questions

impairment in the ability to initiate goal-directed activity.  Inadequate interest, motivation or ability to choose a logical course of action in a given situation

new words that an individual says that are meaningless to others, but have symbolic meaning to the psychotic person

if the combination of the predisposition and the stress exceeds a threshold, the person will develop a disorder

delusions and auditory hallucinations, but normal intellectual functioning and expression of affect.

Delusions are usually about unfair persecution or being some other person who's famous

speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. 

May laugh at changing color of a traffic light

normal activities-showering, dressing and preparing meals

disturbances of movement, can be completely immobile or move all over the place. 

May not say anything for hours, or they may repeat anything you say or do senselessly

self care deficit....cant take care of themselves

has a little of each schizo...but nothing dominant to label

a past history of at least one episode of schizo, but the person currently has no positive symptoms. 

residual schizo

• lg ventricles
• enlarged sulci
• cerebellar atrophy
• abnormal cerebral symmetry
• decreased frontal lobe size

schizo symptoms are present for a significant portion of the time within a one month period, but signs of disruption are not present for the full 6 months required for the diagnosis of schizo

• establish trust
• have client describe what is happening
• care with touch
• assess environmental triggers
• If asked-point out that you are not experiencing the hallucination, but do not deny their experience

a brain illness when a person has a split with reality characterized by remissions and exacerbations

at least 2 of the following symptoms for most of a 1 month period....and lasts for 6 months

• delusions
• hallucinations
• disorganized speech
• disorganized or catatonic behavior
• negative symptoms

• onset before 25
• poor contact with reality
• flat affect or crazy sillines
• facial grimaces and bizarre mannerisms
• incoherent communication
• poor hygiene

• motor behavior abnormalities...no movement to excessive
• mutism
• waxy flexibility
• catatonic excitement....can be destructive or violent

presence of delusions of persecution or grandeur and auditory hallucinations

tense, suspicious, guarded, argumentative, hostil and aggressive

schizo with depression or mania

• may have suicidal ideation
• euphoria, grandiosity, hyperactivity

presence of one or more non bizarre delusion that lasts for at least 1 month

• erotomanic, grandiose
• jealous
• persecutory
• somatic

individual believes that someone of a higher status is in love with them

the irrational ideas regarding their own worth, talent, knowledge or pwoer.  May believe they have a special relationship with a famous person

• most common type
• person believes they are being malevolently treated in some way;
• conspired against, cheted, spied on, followed, poisoned or drugged, harassed

infections like a UTI or upper respiratory infection

• anti depressants
• corticosteroids
• meth
• cocaine

presence of positive or negative symptoms

• can include;
• impaired verbal comm
• social isolation
• disabled thought process
• bathing hygiene self care deficit
• impaired environment

• set priorities, select interventions...client will:
• recognize distortions of reality
• perceive environment correctly
• maintain anxiety at a manageable level
• relinquish need for delusions/hallucinations
• perform self care

• provide care for client....
• observe for signs of hallucinations
• meet clients needs and keep promises to promote trust
• attend group with client
• TEACH effective communication techniques
• encourage independence with ADL

• reassess to determine if nursing process was successful....
• Is there trust?
• Is anxiety level maintained?
• Is the patient still delusional?
• Is client easily agitated?
• Is verbal communication comprehensible?

Systemized delusion and Religious delusions

Idea of reference

Delusion of control

Delusions of Persecution

Thought Broadcasting

Somatic delusion

delusion of grandeur

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