1. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Contemporary Psychiatric-Mental Health Nursing Chapter 16 Schizophrenia and Other Psychotic Disorders

2. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff 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

3. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Features of Schizophrenia - continued  Progression varies from one client to another –Exacerbations and remissions –Chronic but stable –Progressive deterioration

4. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Features of Schizophrenia - continued  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

5. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Features of Schizophrenia - continued  Positive symptoms –Excess or distortion of normal functioning –Aberrant response  Negative symptoms –Deficit in functioning

6. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Features of Schizophrenia - continued  Positive Symptoms of Schizophrenia –Hallucination –Delusions –Disordered speech and behavior

7. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Features of Schizophrenia - continued  Negative Symptoms of Schizophrenia –Flat affect and apathy –Alogia –Avolition –Anhedonia

8. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Subtypes of Schizophrenia  Paranoid type  Disorganized type  Catatonic type  Undifferentiated type  Residual Type

9. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Subtypes of Schizophrenia - continued  Paranoid Type –Delusions  Persecutory and grandiose  Somatic or religious –Hallucinations  Delusions link with a hallucination

10. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Subtypes of Schizophrenia - continued Click here to view a video featuring Larry, who has been diagnosed as having paranoid schizophrenia.here

11. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Subtypes of Schizophrenia - continued  Disorganized type –Disorganized speech, behavior, appearance –Flat or inappropriate affect –Fragmented hallucinations and delusions –Most severe form of schizophrenia

12. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Subtypes of Schizophrenia - continued  Catatonic type –Psychomotor retardation and stupor –Extreme psychomotor agitation –Waxy flexibility –Echolalia –Mutism –Echopraxia

13. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Subtypes of Schizophrenia - continued  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

14. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Other Psychotic Disorders  Schizophreniform disorder  Schizoaffective disorder  Delusional disorder  Brief psychotic disorder

15. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia  Biopsychosocial theories  Interrelated factors

16. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia - continued  Biologic theories  Psychological theories  Family theories  Humanistic-interactional theories

17. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia  Biologic Theory: Genetic –Only genetic predisposition for developing schizophrenia is inherited –10% of first-degree relatives –25%-39% of monozygotic twins

18. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia - continued  Biologic Theory: Brain Structure Abnormality –Differs from those with no symptoms –May be genetically based –Requires more study

19. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia Figure 16.2 Schizophrenia scans. PET scans of discordant monozygotic twins taken during a test to provoke activity and measure regional cerebral blood flow. (A) Arrows indicate areas of normal blood flow and brain activity in the unaffected twin. (B) Arrows indicate areas of lower blood flow and brain activity in the twin with schizophrenia. Source: Courtesy of Dr. Karen F. Berman, Clinical Brain Disorders Branch, National Institute of Mental Health

20. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia - continued  Biologic Theory: Biochemical Theories –Dopamine hypothesis –Traditional antipsychotic medications are dopamine blockers –Dopamine blocker alleviate positive symptoms

21. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia - continued  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

22. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia - continued  Psychological theories –Information processing  Deficient in automatic processing  Deficient in controlled or effortful processing –Attention and arousal  Hypo-, hyper-responses

23. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia - continued  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)

24. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia - continued  Humanistic-interactional theories integrate biological and psychosocial theories  Combine influences of: –Genetic predisposition or biologic vulnerability –Environmental stressors –Social support

25. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Causes of Schizophrenia - continued  Stress–Vulnerability Model –Stressors increase vulnerability –Cumulative effect of:  Genetic predisposition  Personal stressors  Familial factors  Environmental factors

26. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Influences on the Course of Schizophrenia  Social Pressures –Lack of social support –Financial problems –Stigma

27. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Influences on the Course of Schizophrenia - continued  Psychological pressures –Difficulty with problem-solving –Difficulty with interpreting reality –Difficulty coping –Problems with self-care –Unstable interpersonal relationships

28. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Nursing Implications  Assessment –Premorbid functioning –Content of thought –Form of thought –Perception –Sense of self –Delusions and perceptual disturbances –Hallucinations –Drug use

29. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Nursing Implications - continued  Nursing Diagnoses –Altered thought process –Social isolation –Risk for violence –Self-care deficits –Altered health maintenance –Ineffective family coping

30. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Nursing Implications: Supporting Families  Family needs vary with degree of illness and involvement in client’s care –Education –Financial support –Psychosocial support –Education –Advocacy

31. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Nursing Implications: Supporting Families - continued  Schizophrenia is a “family illness.”  Family members need to be involved.  Educate family about –Medication –Illness –Relapse prevention  Nurse assists family by –Identifying community agencies/groups for family members –Advocating for rights

32. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff 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

33. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Measures to Prevent Relapse - continued  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

34. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Measures to Prevent Relapse - continued  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

35. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Challenges to Adherence  Side effects  Level of symptomatology  Cognitive, motivational, financial, and cultural issues  Issues with caregivers  Insufficient medication teaching

36. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Increasing Adherence  Involve clients in treatment  Instruct client about reducing discomfort  Provide peer support  Provide reminders and positive feedback  Recognize accomplishments

37. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff 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?

38. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Personal Awareness - continued  What defines “normal” behavior?  What are my fears associated with mental illness?

39. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Personal Awareness - continued  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.

40. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Resources  http://www.nami.org http://www.nami.org The National Alliance on Mental Illness provides information, education, and support relating to mental health illnesses and disorders for clients, families, and professionals.  http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml 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. http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml  http://www.nlm.nih.gov/medlineplus/schizophrenia.html http://www.nlm.nih.gov/medlineplus/schizophrenia.html 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.

41. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental Health Nursing, Second Edition Carol R. Kneisl and Eileen Trigoboff Resources - continued  http://www.narsad.org/index.html http://www.narsad.org/index.html The National Alliance for Research on Schizophrenia and Depression (NARSAD) is a private, non-for-profit charity organization primarily organized to raise funds for research.  http://www.mayoclinic.com http://www.mayoclinic.com Search by topic on this Mayo Clinic link to find current information about mental illness