​What is Schizophrenia?
a brain disease that is diagnosed in late adolescence or early adulthood
•Schizophrenia is a primary psychotic disorder.
•Symptoms affect the mind by enabling loss of contact with reality
•Psychotic disorders can cause abnormalities different symptomatic domains such as
delusions, hallucinations, disorganized thoughts, and abnormal motor behavior
Signs and symptoms
Positive symptoms: Hallucinations, illusions, disorganized speech, paranoia,
bizarre behavior
Negative Symptoms: apathy, withdrawal, affect, anhedonia, anergia
Cognitive symptoms: impairment of insight, problems with working memory,
inability to sustain attention
RISK FACTORS
Environment: drug use, Social adversity, chronic poverty, and growing up in high
crime areas or in a foreign culture
Genetic
Alterations of brain structure: excess levels of dopamine
Non-pharmacological treatment
hospitalization ( Acute phase to ensure safety, medical workup, testing)
Strategize safety & symptom stabilization
Patient & family education
Skills training (psychosocial)
Relapse prevention skills
Social/ vocational/ coping skills improvement
Pharmacological treatment
Antipsychotic Medications: Alleviate the symptoms of schizophrenia, no cure
- Psychotic symptoms return with medication noncompliance
- Some clients can relapse psychosis even with medication compliance
-Acute exacerbations of schizophrenia, reduces the number of relapses
-Typical 1ST generation: has intolerable side effects
-Atypical 2nd generation : less side effects
Typical antipsychotics
-target positive symptoms of schizophrenia
Examples of typical antipsychotics:
-chlorpromazine
-fluphenazine
-haloperidol
-perphenazine
-Inexpensive
Available in oral and IM injection forms - both immediate and long-acting injections
(LAIs)
Significant risk of side effects and potential adverse effects such as Extrapyramidal
symptoms (EPS) , Akathisia, Acute dystonia , Pseudoparkinsonism, Tardive dyskinesia
(TD) ,Neuroleptic malignant syndrome (NMS), Agranulocytosis, body temperature
alterations, Photosensitivity
Atypical Antipsychotics
Target both positive and negative symptoms
Most of them have metabolic syndrome effects such as weight gain
•Examples include:
•clozapine (Clozaril) : side effects agranulation so patient needs to monitor CBC
•olanzapine (Zyprexa): weight gain
•paliperidone (Invega)
•quetiapine (Seroquel)
•risperidone (Risperdal): lactation and Gynecomastia
•ziprasidone (Geodon): cardiomyopathy, (seen as prolonged QTc intervals on EKG
readings with or without dysrhythmias
Reference:
Skidmore-Roth, Linda (2021). Mosby's Drug Guide for Nursing Students. (14th ed.).
Elsevier.
•Varcarolis, E. M., & Fosbre, C. D. (2021). Essentials of psychiatric mental health nursing:
A communication approach to evidence-based care (4th ed.). Elsevier.