9/3/2014. Contemporary Psychiatric-Mental Health Nursing Third Edition. Features of Schizophrenia. Features of Schizophrenia (cont'd)

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Reynold Toby Atkins
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40% relapse rate in the first year About 5-6% commit suicide Features of Schizophrenia (cont'd) Progression varies from one client to another

1 Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 16 Schizophrenia Features of Schizophrenia Prevalence in U.S. is 1.1%. Average onset is late teens to early twenties, but can be as late as midfifties Affects cognitive, emotional, and behavioral function 30% to 40% relapse rate in the first year About 5-6% commit suicide Features of Schizophrenia (cont'd) Progression varies from one client to another Exacerbations and remissions Chronic but stable Progressive deterioration Early dx and tx are critical to slowing the deterioration and decline 1

2 Features of Schizophrenia (cont'd) DSM-IV-TR Diagnosis* Symptoms present at least 6 months Active-phase symptoms present at least 1 month Symptoms are defined as positive and negative Features of Schizophrenia (cont'd) Positive symptoms * Excess or distortion of normal functioning Aberrant response Negative symptoms* Deficit in functioning Features of Schizophrenia (cont'd) Positive Symptoms of Schizophrenia * Hallucination Delusions Disordered speech and behavior 2

3 Features of Schizophrenia (cont d) Hallucinations perceptual disturbances* Auditory, visual, olfactory, gustatory, tactile Most common is auditory Can be human speech or other sounds Features of Schizophrenia (cont'd) Delusions* Mistaken or false beliefs about self or environment May take many forms Features of Schizophrenia (cont'd) Negative Symptoms of Schizophrenia* (less dramatic but just as debilitating) The four A s* Affect (flat) and apathy Alogia Avolition Anhedonia 3

4 Question #1 The husband of a client reports to the nurse that his wife just doesn t seem to enjoy doing anything or being around anyone. The client s husband is describing a symptom often seen in clients with schizophrenia known as: Question #1 1.Isolation. 2.Avolition. 3.Anhedonia. 4.Alopecia. Subtypes of Schizophrenia* Paranoid type Disorganized type Catatonic type Undifferentiated type Residual Type 4

5 Subtypes of Schizophrenia (cont'd) Paranoid Type* Delusions Persecutory and grandiose Somatic or religious Hallucinations Delusions link with a hallucination Subtypes of Schizophrenia (cont'd) Disorganized type* Disorganized speech, behavior, appearance Flat or inappropriate affect Fragmented hallucinations and delusions Most severe form of schizophrenia Subtypes of Schizophrenia (cont'd) Catatonic type* Psychomotor retardation and stupor Extreme psychomotor agitation Waxy flexibility Echolalia* Mutism * Echopraxia* 5

6 Question #2 A female client believes someone is coming into her house and stealing all her jewelry. Which of the following types of schizophrenia is often associated with delusional thinking? Question #2 1.Alzheimer s 2.Paranoid 3.Catatonic 4.Affective Subtypes of Schizophrenia (cont'd) afqw8xnpa YIoLZHYI 6

7 Other Psychotic Disorders* Schizophreniform disorder Schizoaffective disorder Delusional disorder Brief psychotic disorder Causes of Schizophrenia (cont'd) Biologic theories Psychological theories Family theories Humanistic-interactional theories Causes of Schizophrenia (cont'd) Biologic Theory: Genetic * Only genetic predisposition for developing schizophrenia is inherited 10% of first-degree relatives 25% 39% of monozygotic twins 7

Causes of Schizophrenia (cont'd) Biologic Theory: Brain Structure Abnormality Differs from those with no symptoms May be genetically based Requires more study Figure 16-2 PET scans measuring regional

8 Causes of Schizophrenia (cont'd) Biologic Theory: Brain Structure Abnormality Differs from those with no symptoms May be genetically based Requires more study Figure 16-2 PET scans measuring regional cerebral blood flow. (a) Areas of lower blood flow and brain activity are seen in the individual with schizophrenia. (b) Areas of normal blood flow and brain activity are visible in the unaffected individual. Photo courtesy of R. Haier/Photolibrary. Question #3 Which of the following statements made by the daughter of a client with schizophrenia reflects an understanding of the genetic theory of schizophrenia? 8

9 Question #3 1. People with schizophrenia inherit the disease from a mutated gene. 2. People with schizophrenia can be identified by the presence of CGEMS. 3. GenoProof has identified the genetic marker for schizophrenia. 4. People with schizophrenia inherit a genetic predisposition to the disease rather than the disease itself. Causes of Schizophrenia (cont'd) Biologic Theory: Biochemical Theories* Dopamine hypothesis Traditional antipsychotic medications are dopamine blockers Dopamine blocker alleviate positive symptoms Causes of Schizophrenia (cont'd) Psychological theories Information processing Difficulty controlling the amount and type of information that is processed in the brain. Attention and arousal Hyper or hypo responsiveness to various situations 9

10 Causes of Schizophrenia (cont'd) Psychological theories Information processing Deficient in automatic processing Deficient in controlled or effortful processing Attention and arousal Hypo-, hyper-responses Causes of Schizophrenia (cont'd) Family Theories* Dysfunctional interaction not supported by research Disordered family communication linked only with genetic predisposition Family emotional tone influences course of schizophrenia Expressed emotions theory (EE) Causes of Schizophrenia (cont'd) Humanistic-interactional theories integrate biological and psychosocial theories Combine influences of: Genetic predisposition or biologic vulnerability Environmental stressors Social support 10

11 Causes of Schizophrenia (cont'd) Stress-Vulnerability Model Stressors increase vulnerability Cumulative effect of: Genetic predisposition Personal stressors Familial factors Environmental factors Influences on the Course of Schizophrenia Social Pressures Lack of social support Financial problems Stigma Question #4 The nurse is completing a family history on a client with schizophrenia. The client has an identical twin, adopted by another family, who is normal. This finding lends support to which of the following biopsychosocial theories of schizophrenia? 11

12 Question #4 1.Environmental 2.Genetic 3.Biochemical 4.Neurological Influences on the Course of Schizophrenia (cont'd) Psychological pressures* Difficulty with problem-solving Difficulty with interpreting reality Difficulty coping Problems with self-care Unstable interpersonal relationships Nursing Implications Assessment* Premorbid functioning Content of thought Form of thought Perception Sense of self Delusions and perceptual disturbances Hallucinations Drug use 12

13 Nursing Implications: Supporting Families Family needs vary with degree of illness and involvement in client s care Education Financial support Psychosocial support Education Advocacy Question #5 Which of the following jobs would the nurse recommend as most appropriate for a client with paranoid schizophrenia? Question #5 1.Working as a cashier in a grocery store. 2.Working in the baggage claims section at the bus terminal. 3.Working as a sorter in a packing department. 4.Working as a valet at the airport. 13

14 Question #6 Which of the following nursing diagnoses would specifically relate to the client with delusions of grandeur? Question #6 1.Social isolation 2.Low self-esteem 3.Ineffective coping 4.Disturbed thought processes Nursing Implications: Supporting Families (cont'd) Schizophrenia is a family illness. Family members need to be involved. Educate family about Medication Illness Relapse prevention 14

15 Nursing Implications: Supporting Families (cont'd) Nurse assists family by Identifying community agencies/groups for family members Advocating for rights Measures to Prevent Relapse Ensure client takes medication Educate family about signs and symptoms of relapse* Client and family to participate in relapse prevention program Measures to Prevent Relapse (cont'd) Relapse prevention programs work best when: Psychosocial treatment and social skills training are combined with antipsychotic medication Behavior patterns are monitored Family members understand triggers 15

16 Measures to Prevent Relapse (cont'd) Relapse prevention programs provide education and support regarding: Individual triggers, symptoms of relapse Managing side effects of medications Interventions to reduce or eliminate triggers Strategies to facilitate early intervention Cognitive therapy Community resources Challenges to Adherence Side effects Level of symptomatology Cognitive, motivational, financial, and cultural issues Issues with caregivers Insufficient medication teaching Increasing Adherence Involve clients in treatment Instruct client about reducing discomfort Provide peer support Provide reminders and positive feedback Recognize accomplishments 16

17 Personal Awareness Identify personal feelings. Recognize personal perceptions. What behaviors do you expect to see? How will you respond to these behaviors? What is the meaning of the behaviors? Personal Awareness (cont'd) What defines normal behavior? What are my fears associated with mental illness? Personal Awareness (cont'd) Be honest with your feelings. Identify what strengths you bring to the situation. Remember that clients are human beings with a mental disorder and do not choose to be this way. 17

18 Resources NAMI The National Alliance on Mental Illness provides information, education, and support relating to mental health illnesses and disorders for clients, families, and professionals. Resources (cont'd) National Institute of Mental Health The National Institute of Mental Health is part of the Department of Health and Human Services and has information about research on various mental health illnesses. Resources (cont'd) Medline Plus Medline Plus is a service of the National Library of Medicine and the National Institutes of Health. This site provides definitions related to various aspects of schizophrenia. 18

19 Resources (cont'd) Brain & Behavior Research Foundation The Brain & Behavior Research Foundation awards grants from the National Alliance for Research on Schizophrenia and Depression (NARSAD), a non-for-profit charity organization primarily organized to raise funds for research. Resources (cont'd) Mayo Clinic Search by topic on this Mayo Clinic link to find current information about mental illness. 19

8/22/2016. Contemporary Psychiatric-Mental Health Nursing Third Edition. Features of Schizophrenia. Features of Schizophrenia (cont'd)

8/22/2016. Contemporary Psychiatric-Mental Health Nursing Third Edition. Features of Schizophrenia. Features of Schizophrenia (cont'd) Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 16 Schizophrenia Features of Schizophrenia Prevalence in U.S. is 1.1%. Average onset is late teens to early twenties, but can be as