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How long do you have to have the symptoms to classify as schizophrenia?
Symptoms X30 days for >6Months
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How long for schizophrenoform DO?
Symptoms < 6 months
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What is SAFD?
- Schizoaffetive Disorder….
- Symptoms
with & without mood episode
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What is a delusional disorder?
Non-bizarre delusion x 1month
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How long is a brief psychotic disorder?
> 1 day <1 month
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What is a shared psychotic disorder?
It takes on other delusions
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Some other psychotic disorders can be caused by what?
Medicine/drugs
NOS?
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What is the diagnosis criterion for schizophrenia?
- 1. Positive or negative symptoms for 30 days for greater than 6 months
- 2. Marked social/vocational dysfunction
- 3. NOT due to:
- …….. medical
- …….. drugs
- …….. SAFD
- …….. Manic Depressive Disorder (MDD) with psychotic features
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What are the 4 types of POSITIVE symptoms?
- 1. Delusions
- 2. Hallucinations
- 3. Disorganized Speech
- 4. Catatonia
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Grandiosity, persecution, somatic, reference, thought insertion/withdrawal/broadcasting, ect?
Delusions
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auditory, visual, tactile, olfactory, gustatory?
Hallucinations
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clang, neologisms, thought block, loose assoc, perseveration?
Disorganized Speech
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stupor, posture, excitation?
Catatonia
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What are the NEGATIVE symptoms of schizophrenia? *Hint-Crazy 8's*
- Affective blunting
- Avolition
- Asociality
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What are the subtypes of schizophrenia?
- •Paranoid
- •Disorganized
- •Catatonic
- •Undifferentiated
- •Residual
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Negative symptoms persist in
spite of resolution of positive symptoms
Residual
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What is the scope of schizophrenia?
- •40 % attempt suicide within 10 yrs.
- •10 % actually complete suicide
- •9th
- leading cause of disability
- •60-70% never marry/have children
- •Occupy 25% of all hospital beds
- •70%–80% are unemployed or underemployed
- •10% of permanently disabled Americans
- • 20%–30% of the homeless population
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Schizophrenia vs. Violence
- •Evidence mixed
- •Media sensationalized?
- •Schizophrenics 14% more likely to be victim
- rather than comit violent crime
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What are the demographics of Schizophrenia?
- •0.5 - 1.5 % of population
- •Urban > Rural
- •Uniform rates across racial and ethnic groups
- in US, except for higher rates with racial minorities in large cities
- •Higher rates with maternal malnutrition
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What are the gender differences of Schizophrenia?
- •Male > Female (up to 20%)
- •Onset: male (18-25 yr); female (25-35 yr)
- •Second peak in onset women after 45 yrs.
- •Pre-morbid function females > males
- •Males – More positive symptoms
- •Females – More negative symptoms
- •Women have more
- emotional/affective
- symptoms – misdiagnosed MDD or SAFD
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What are the etiological theories concerning Schizophrenia?
- •Genetic – familial ; 10% greater chance
- •Hormonal – onset S/P puberty, thyroid, DM
- •Apoptosis/Excessive pruning
- •Virus – selectivity; dormancy; triggered by
- stress/hormonal; alter cellular process without destroying cells
- •Neurotransmitter – drugs can either mimic or eleviate
- symptoms
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What is the pathology behind Schizophrenia?
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What are the 4 stages of progression when dealing with Schizophrenia?
- 1. Premorbid
- 2. Prodromal
- 3. Psychotic
- 4. Recovery
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Asymptomatic with
genetic/environmental vulnerability.
Premorbid (0-35 yrs.)
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Insidious decline in
work/school/social/adaptive functioning
Prodromal (2-5 yrs.)
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Abrupt onset of (+) &
significant worsening of (-) symptoms.
Often hospitalized due to unable to care for self.
Psychotic (wks.-yrs.)
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Exacerbations & remissions
with 80% relapse rate. Degree of illness/level of functioning plateau after 10
yrs.
Recovery (yrs.)
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What are some ways to treat Schizophrenia without medications?
- •Supportive psychotherapy
- •Family therapy
- •Socialization/social skills training
- •Cognitive Behavioral Therapy
- •Hospitalization
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What are the two types of pharmacotherapeutics that treat Schizophrenia?
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These Alleviate positive symptoms, have More side effects, but are Less
expensive
typicals
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These will alleviate positive symptoms, offer some help with negative symptoms, have fewer side effects, and MIGHT have neuroprotective effects????
Atypicals
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What are the medication forms that treat Schizophrenia?
- •Pill/capsule
- •Elixir
- •Orally disintegrating tabs (ODT)
- •IV/IM
- •Deaconate
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What are the drug side effects for drugs that treat Schizophrenia?
- •Histaminic effects – Sedation
- •Adrenergic effects – Orthostasis
- •Anticholenergic effects – Dry mouth
- •Hyperprolactinemia – Sexual
- •Metabolic effects:
- - Weight gain
- - Hyperglycemia/diabetes
- - Hyperlipidemia
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What are the other med risks?
- •Seizures
- •Stroke
- •Sudden death (dementia)
- •QTc
- Prolongation (Geodon & Melaril)
- •Extrapyramidal symptoms (EPS)
- •Tardive dyskinesia
- (TD)
- •Neuroleptic malignant disorder (NMS)
- •Agranulocytosis (Clozaril)
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What does the nurse need to monitor the patient for that is receiving treatment for Schizophrenia?
- •Vital signs – include orthostatic BP (falls)
- •Weight & BMI
- •EKG
- •AIMS – Abnormal Involuntary Movement
- Scale (TD)
- •Labs – CBC, renal function,lipids, glucose, Hgb
- A1C, LFTs, TFTs, prolactin
•Suicidality
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