1. Schizophrenia History
19th Century
Kraepelin- Dementia Praecox
20th Century
Bleuler
autism-apathy-ambivalence-anhedonia
Arieti
associative looseness, auditory
hallucinations
2. Current theories
Genetic
↓ 1% of population
10 % of 1st degree relatives
35-55% concordance rate in monozygotic
twins (genetically identical)
15-17% concordance rate in dizygotic
twins (share half their genes)
3. Slightly more men than women
Early 20s age of first psychotic break
75% of people have permanent disability
Cultural component on relapse
4. Neurotransmitter imbalance
Dopamine system hyperactivity
Norepinepherine elevation
Serotonin elevation
Diminished levels of GABA
Decreased co-enzyme for conversion of PKU to
tyrosine
5. Central Nervous System Anomaly
Type 2 enlarged ventricles
negative symptoms resistant to
medication
Type 1 positive symptoms respond to
medication
8. History of Therapy
Psychoanalytic
Sullivan/Peplau
Interpersonal Communication
Somatic
Insulin Coma
Electroconvulsive Therapy
Psychosurgery
9. Psychopharmacology
1950s phenothiazines
1990s D1-D2 receptor medications
Community Mental Health
Milieu
Therapeutic Community
De-institutionalization
10. Typology of Thought Disorder
Paranoid
Catatonic
Disorganized
Undifferentiated
Residual
15. Diagnosis
Presence of 1,2, or 3 for more than 1 week
1. Two of the following:
delusions, prominent
hallucinations, marked
associative looseness
catatonic behavior
flat or silly affect
16. 2. Bizarre delusions
3. Prominent hallucinations
Continuous signs of disturbance ↑ 6 months
18 years if age or more
Downward course
17. Nursing Process- Assessment
1.Perceptual changes:
illusions, hallucinations
2. Thought disorder:
loose associations, clanging, delusions
3. Communication changes:
thought disorganization,
blocking, tangential, circumstantial
echolalia, echopraxia
18. 4. Motor Changes:
catatonia-excited, posturing, waxy
flexibility
5. Family:
enmeshed, family burden
20. Sensory alterations
Body image distortion
Altered thought processes
delusions, magical thinking
thought insertions, withdrawal
thought broadcasting
22. Nursing Planning & Intervention
Adequate communication Medication usage
Grooming & hygiene Organize behavior
Social skills Reality based perceptions
Intervene with delusions Congruent emotional
Family understanding responses
Community contacts
23. Nursing Planning & Intervention
Adequate communication Medication usage
Grooming & hygiene Organize behavior
Social skills Reality based perceptions
Intervene with delusions Congruent emotional
Family understanding responses
Community contacts
27. Side Effects
Nervous system Extra Pyramidal Symptoms
Akathisia--restelessness
Dystonia– muscle contractions
Opisthotonis—tongue sticking out
Occulogryic Crisis- eye rolling
Akinesia– muscle heaviness
Pseudo parkinsonism- mask like fascies and other symptoms
Tardive dyskinesia—tongue movements
Tardive Dyskinesia
29. D1 and D2 effects
Weight gain
Impotence
Risk for development of Diabetes Mellitus (Geodon)
Gallactarhea
30. Neuroleptic malignant syndrome
Possibly fatal side effect of neuroleptics
Non-dose related
Fever
Confusion
Convulsions
Death
Rx-stop neuroleptic- emergency care