Schizophrenia and Other
Psychotic Disorders
Chapter 14
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Schizophrenia
http://www.youtube.com/watch?v=H_jYqSA_fJk
Schizophrenia Part 1 - ABC 20/20 coverage
http://www.youtube.com/watch?v=moP_e-gx5hk
Schizophrenia Part 2 - ABC 20/20 coverage
http://www.youtube.com/watch?v=QPXkwYM9G-s
What is Schizophrenia? (Schizophrenia #1)
http://www.youtube.com/watch?v=KnoTwOUb0aQ
Diagnosing and Treating Schizophrenia (Schizophrenia #2)
http://www.youtube.com/watch?v=WwlM1pxIbaI
Introduction
• The word schizophrenia is derived from the
Greek words skhizo (split) and phren (mind).
• Schizophrenia is probably caused by a
combination of factors, including:
• Of all mental illnesses, schizophrenia probably
causes more
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Lengthy hospitalizations
Chaos in family life
Exorbitant costs to people and governments
Fears
Nature of the Disorder
• Schizophrenia disturbs
Thought processes, Perception and Affect
• With schizophrenia, there is a severe
deterioration of social and occupational
functioning
* In the United States, the lifetime prevalence of
schizophrenia is about 1 percent.
• Premorbid behavior of the patient with schizophrenia can be viewed in
four phases.
• First Phase: Schizoid Personality
– Indifferent, cold, and aloof, these people are loners. They do not enjoy close relationships with
others.
• Second Phase: Prodromal Phase
– These people are socially withdrawn and show evidence of peculiar or
eccentric behavior.
– Neglect of personal hygiene and grooming
– Blunted or inappropriate affect
– Disturbances in communication
– Bizarre ideas
– Lack of initiative
• Third Phase: Schizophrenia
– In the active phase of the disorder, psychotic symptoms are prominent
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Delusions
Hallucinations
Impairment in work, social relations, and self-care
• Fourth Phase: Residual Phase
– Symptoms similar to those of the prodromal phase
– Flat affect and impairment in role functioning are prominent
Predisposing Factors
– Various physical conditions
• Epilepsy
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Huntington’s chorea
Birth trauma
Head injury in adulthood
Alcohol abuse
Cerebral tumor
Cerebrovascular accident
Systemic lupus erythematosus
Myxedema
Parkinsonism
Wilson’s disease
Characteristic Symptoms
Positive symptoms:
Negative symptoms:
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Delusions
Hallucination
Disorganized speech
Grossly disorganized or
catatonic behavior
Affective Flattening
Alogia
Apathy
Anhedonia
Social isolation
Types of schizophrenia and other
psychotic disorders
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Paranoid
Disorgainzed
Catatonic
Residual
Undifferentiated
Schizoaffective disorder
• Brief psychotic disorder
• Schizophreniform
disorder
• Delusional Disorder
• Shared psychotic
disorder
• substance-Induced
psychotic disorder
Content of Thought
Delusions
• Of Persecution
• Of Grandeur
• Of Reference
• Of control or influence
• Somatic
• Nihilistic
• Religiosity
• Paranoia
• Magical thinking
Form
• Associative Looseness
• Neologisms
• Concrete thinking
• Clang associations
• Word salad
• Circumstantialities
• Tangentiality
• Mutism
• Perseveration
Perception
• Hallucination
• Auditory
• Visual
• Tactile
• Olfactory
Affects
• Inappropriate affect
• Bland or flat affect
• Apathy
Conventional Antipsychotics
Generic
Haloperidol
Chlorpromazine
Fluphenazine
Thiothixene
Trifluoperazine
Thioridazine
Perphenazine
Loxapine
Brand
Haldol
Thorazine
Prolidixin
Navane
Stelazine
Mellari
Trilafon
Loxitane
Conventional Antipsychotics
• Advantage
-Effective for positive
symptoms of
schizophrenia
- Available in IM
formulation for acute
psychosis/agitation
- Cheap
• Disadvantage
- Could worsen
cognitive function
- Minimally effective for
negative symptoms
of schizophrenia
- Higher incidence of
side effects (EPS, NMS,
tardive dyskinesia, etc.
Atypical Antipsychotics
• Generic
Clozapine
Olanzapine
Risperidone
Quetiapine
Ziprasidone
Aripiprazole
Paliperidonen
• Brand
Clozaril, FazaClo
Zyprexa (Aydis)
Risperdal (Consta, M-tab)
Seroquel, Seroquest XR
Geodon
Abilify
Invega (newest)
Atypical Antipsychotics
• Advantage
- Effective for positive
of symptoms of
schizophrenia
- May improve negative
symptoms of
schizophrenia
- Lower incidence of
side effects compared to
conventional
antipsychotics
• Disadvantage
- Higher incidence of
weight gain
- Higher incidence of
diabets
- Expensive
Side Effects
• Neuroleptic malignant syndrome (NMS)
– Potentially life threatening
– High fever, unstable BP, myoglobinemia
• Extrapyramidal symptoms (EPS)
– Involuntary muscle symptoms similar to those of Parkinson’s disease
– Akathisia (distressing muscle restlessness)
– Acute dystonia (painful muscle spasms)
– Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)
• Tardive dyskinesia (TD)
– Involuntary contractions of oral and facial muscles
– Choreoathetosis (wavelike movements of extremities)
– Occurs with continuous long-term antipsychotic therapy
Nursing Process
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Nursing Assessment
Nursing Diagnosis
Related to
Evidenced by
Interventions
Education
Conventional Antipsychotics
Generic
Haloperidol
Chlorpromazine
Fluphenazine
Thiothixene
Trifluoperazine
Thioridazine
Perphenazine
Loxapine
Brand
Haldol
Thorazine
Prolidixin
Navane
Stelazine
Mellari
Trilafon
Loxitane
Conventional Antipsychotics
• Advantage
-Effective for positive
symptoms of
schizophrenia
- Available in IM
formulation for acute
psychosis/agitation
- Cheap
• Disadvantage
- Could worsen
cognitive function
- Minimally effective for
negative symptoms
of schizophrenia
- Higher incidence of
side effects (EPS, NMS,
tardive dyskinesia, etc.
Atypical Antipsychotics
• Generic
Clozapine
Olanzapine
Risperidone
Quetiapine
Ziprasidone
Aripiprazole
Paliperidonen
• Brand
Clozaril, FazaClo
Zyprexa (Aydis)
Risperdal (Consta, M-tab)
Seroquel, Seroquest XR
Geodon
Abilify
Invega (newest)
Atypical Antipsychotics
• Advantage
- Effective for positive
of symptoms of
schizophrenia
- May improve negative
symptoms of
schizophrenia
- Lower incidence of
side effects compared to
conventional
antipsychotics
• Disadvantage
- Higher incidence of
weight gain
- Higher incidence of
diabets
- Expensive
Antipsychotics
Background Assessment Data
• Indications: Treatment of acute and chronic
psychoses; selected agents are also used as
antiemetics in the treatment of intractable
hiccoughs and for control of tics and vocal
utterances in Tourette’s disorder
• Actions: Unknown; thought to block postsynaptic
dopamine receptors in the basal ganglia,
hypothalamus, limbic system, brainstem, and
medulla. Newer antipsychotics may block action
on receptors specific to dopamine, serotonin, and
other neurotransmitters.
• Contraindications/precautions
– Contraindicated with known hypersensitivity; with CNS
depression; when blood dyscrasias exist; in clients with
Parkinson’s disease; or those with liver, renal, or cardiac
insufficiency
– Caution with elderly, debilitated, or diabetic clients or those with
respiratory insufficiency, prostatic hypertrophy, or intestinal
obstructio
• Interactions
– Additive anticholinergic effects with other drugs that produce
these properties
– Additive hypotensive effects with beta-blockers
– Decreased absorption of antipsychotics with antacids and
antidiarrheals
– Decreased effectiveness of antipsychotics with barbiturates
– Additive CNS depression with alcohol, antihistamines,
antidepressants, sedative-hypnotics, and anxiolytics
Nursing Diagnosis
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Risk for other-directed violence
Risk for injury
Risk for activity intolerance
Noncompliance
Neuroleptic Malignant Syndrome
• Signs and symptoms of NMS are: muscle
rigidity, hyperthermia, decreased ventilation,
cardiovascular collapse, and an elevate CPK
Side effects
• Neuroleptic malignant syndrome (NMS)
– Potentially life threatening
– High fever, unstable BP, myoglobinemia
• Extrapyramidal symptoms (EPS)
– Involuntary muscle symptoms similar to those of Parkinson’s disease
– Akathisia (distressing muscle restlessness)
– Acute dystonia (painful muscle spasms)
– Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)
• Tardive dyskinesia (TD)
– Involuntary contractions of oral and facial muscles
– Choreoathetosis (wavelike movements of extremities)
– Occurs with continuous long-term antipsychotic therapy
A 29 year old woman is being discharged in 2 days form the hospital after her first
psychotic break (paranoid schizophrenia). She is recently divorced and has
been working as a legal secretary, although her work had become erratic, and
her suspicious behavior was calling attention to herself at work. She will be
discharged in her mother’s care until she is able to resume working. Her
mother is overwhelmed and asked the nurse how she is going to cope. “She
has become so distant and she always takes thing the wrong way. I can hardly
say anything to her with her misconstruing everything. She is very mad at me
because I called 911 and had her admitted after she told me she was going to
get justice back in the world by blowing up evil forces that have been haunting
her life and then proceeded to try to run over her ex-husband, thinking he was
the devil. She told me there is nothing wrong with her and I am concerned she
won’t take her medication once she is discharge.
1.
What are some of the priority concern that nurse could address in the
hospital setting before she is discharge?
2. How would you explain to the mother some of the symptoms that she is
experience in? What suggestion could you give her to handle some of
the immediate concerns?
3. What issues could you bring up to the staff about her medication
compliance? What would be some ways to deal with this issue?
4. What do you think of the prognosis for her? Support your hypothesis with
data regarding influences on the course of schizophrenia.