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 mid-fifties Affects cognitive, emotional, and behavioral function 30% to 40% relapse rate in the first year LO 16-1: Describe the central features of schizophrenia. CFL 16-1-1

Features of Schizophrenia (cont'd) Progression varies from one client to another Exacerbations and remissions Chronic but stable Progressive deterioration LO 16-1: Describe the central features of schizophrenia. CFL 16-1-2

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 LO 16-1: Describe the central features of schizophrenia. CFL 16-1-3

Features of Schizophrenia (cont'd) * Positive symptoms Excess or distortion of normal functioning Aberrant response Negative symptoms Deficit in functioning LO 16-1: Describe the central features of schizophrenia. CFL 16-1-4

Features of Schizophrenia (cont'd) * Positive Symptoms of Schizophrenia Hallucination Delusions Disordered speech and behavior LO 16-1: Describe the central features of schizophrenia. CFL 16-1-5

Table 16-3 (continued) Positive Symptoms *

Table 16-3 (continued) Positive Symptoms *

Features of Schizophrenia (cont'd) * Negative Symptoms of Schizophrenia Flat affect and apathy Alogia Avolition Anhedonia LO 16-1: Describe the central features of schizophrenia. CFL 16-1-6

Table 16-4 Negative Symptoms *

Subtypes of Schizophrenia * Paranoid type Disorganized type Catatonic type Undifferentiated type Residual Type LO 16-2: Distinguish among the subtypes of schizophrenia. CFL 16-2-1

Subtypes of Schizophrenia (cont'd) * Paranoid Type Delusions Persecutory and grandiose Somatic or religious Hallucinations Delusions link with a hallucination LO 16-2: Distinguish among the subtypes of schizophrenia. CFL 16-2-2

Subtypes of Schizophrenia (cont'd) * Disorganized type Disorganized speech, behavior, appearance Flat or inappropriate affect Fragmented hallucinations and delusions Most severe form of schizophrenia LO 16-2: Distinguish among the subtypes of schizophrenia. CFL 16-2-3

Subtypes of Schizophrenia (cont'd) * Catatonic type Psychomotor retardation and stupor Extreme psychomotor agitation Waxy flexibility Echolalia Mutism Echopraxia LO 16-2: Distinguish among the subtypes of schizophrenia. CFL 16-2-4

Subtypes of Schizophrenia (cont'd) Undifferentiated type Active psychotic state Lacks symptoms of other subtypes Residual type At least one episode of schizophrenia No prominent positive symptoms Negative symptoms present LO 16-2: Distinguish among the subtypes of schizophrenia. CFL 16-2-5, CFL 16-2-6

Other Psychotic Disorders * Schizophreniform disorder Schizoaffective disorder Delusional disorder Brief psychotic disorder LO 16-2: Distinguish among the subtypes of schizophrenia. CFL 16-2-7

Causes of Schizophrenia Biopsychosocial theories Interrelated factors LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL 16-3-1

Causes of Schizophrenia (cont'd) Biologic theories Psychological theories Family theories Humanistic-interactional theories LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-3-1A

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 LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-3-2

Causes of Schizophrenia (cont'd) Biologic Theory: Brain Structure Abnormality Differs from those with no symptoms May be genetically based Requires more study LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-3-3

Figure 16-2 PET scans measuring regional cerebral blood flow 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.

Causes of Schizophrenia (cont'd) Biologic Theory: Biochemical Theories Dopamine hypothesis Traditional antipsychotic medications are dopamine blockers Dopamine blocker alleviate positive symptoms LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-3-4

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 LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-3-5

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 LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-3-6, CFL 16-3-7

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) LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-3-8

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 LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-3-9

Causes of Schizophrenia (cont'd) Stress-Vulnerability Model Stressors increase vulnerability Cumulative effect of: Genetic predisposition Personal stressors Familial factors Environmental factors LO 16-3: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-3-10

Influences on the Course of Schizophrenia Social Pressures Lack of social support Financial problems Stigma LO 16-4:    Explain how psychological and social pressures can influence the course of schizophrenia. CFL 16-4-1

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 CFL 16-4-2

Nursing Implications * Assessment Premorbid functioning Content of thought Form of thought Perception Sense of self Delusions and perceptual disturbances Hallucinations Drug use LO 16-5: Discuss the major nursing implications in caring for clients with difficult and chronic illnesses such as schizophrenia. CFL 16-5-1

Nursing Implications (cont'd) * Nursing Diagnoses Altered thought process Social isolation Risk for violence Self-care deficits Altered health maintenance Ineffective family coping LO 16-5: Discuss the major nursing implications in caring for clients with difficult and chronic illnesses such as schizophrenia. CFL 16-5-2

Nursing Implications: Supporting Families Family needs vary with degree of illness and involvement in client’s care Education Financial support Psychosocial support Advocacy LO 16-6: Discuss the major nursing implications in supporting the families of persons with schizophrenia. CFL 16-6-1

Nursing Implications: Supporting Families (cont'd) * Schizophrenia is a “family illness.” Family members need to be involved. Educate family about Medication Illness Relapse prevention LO 16-6: Discuss the major nursing implications in supporting the families of persons with schizophrenia. CFL 16-6-2

Nursing Implications: Supporting Families (cont'd) Nurse assists family by Identifying community agencies/groups for family members Advocating for rights LO 16-6: Discuss the major nursing implications in supporting the families of persons with schizophrenia. CFL 16-6-2

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 LO 16-7: Describe methods to prevent or minimize relapses in schizophrenia. CFL 16-7-1

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 LO 16-7: Describe methods to prevent or minimize relapses in schizophrenia. CFL 16-7-2

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 LO 16-7: Describe methods to prevent or minimize relapses in schizophrenia. CFL 16-7-3

Challenges to Adherence * Side effects Level of symptomatology Cognitive, motivational, financial, and cultural issues Issues with caregivers Insufficient medication teaching LO 16-7: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-7-4

Increasing Adherence * Involve clients in treatment Instruct client about reducing discomfort Provide peer support Provide reminders and positive feedback Recognize accomplishments LO 16-7: Compare and contrast the various biopsychosocial theories that address the possible causes of schizophrenia. CFL: 16-7-5

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? LO 16-8:   Identify the personal characteristics you bring to the care of clients with schizophrenia that might cause you to distance yourself or fail to understand their experience and difficulties. CFL 16-8-1

Personal Awareness (cont'd) What defines “normal” behavior? What are my fears associated with mental illness? LO 16-8:   Identify the personal characteristics you bring to the care of clients with schizophrenia that might cause you to distance yourself or fail to understand their experience and difficulties. CFL 16-8-1B

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. LO 16-8:   Identify the personal characteristics you bring to the care of clients with schizophrenia that might cause you to distance yourself or fail to understand their experience and difficulties. CFL 16-8-1C

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.

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.

Box 16-4 Challenges to Adherence

Box 16-4 Challenges to Adherence