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Chapter 14

Chapter 14. Schizophrenia. Louis Wain cat. This cat, like many painted during that period, is shown with abstract patterns behind it. Psychologists have cited this increased abstraction as symptomatic of Wain's schizophrenia. Schizophrenia.

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Chapter 14

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  1. Chapter 14 Schizophrenia

  2. Louis Wain cat • This cat, like many painted during that period, is shown with abstract patterns behind it. Psychologists have cited this increased abstraction as symptomatic of Wain's schizophrenia

  3. Schizophrenia • Devastating brain disease that affects thinking, language, emotions, social behavior, and ability to perceive reality accurately • Often misunderstood and stigmatized by society • Many people function well with medication and social support • Others, more disabled may need higher level of support

  4. Prevalence and comorbidity • Lifetime prevalence is 1% worldwide with no differences related to race, social status, culture, gender, or environment • Early onset (18-25 yrs) usually male with more prominent negative symptoms • Onset (25-35 yrs) usually female, and have better outcomes • The younger the onset the more discouraging the diagnosis

  5. Theory • Neurochemical (catecholamines and serotonin), genetic, and neuroanatomical findings help explain the symptoms of schizophrenia • At present no one theory accounts for all phenomena found in schizophrenia disorders

  6. Schizophrenia facts Biologically based disease of brain Not one disorder but a group of disorders Psychotic symptoms are more pronounced and disruptive than are symptoms found in other disorders Basic differences are in degree of severity, withdrawal, alteration in affect, impairment of intellect and regression Depression is almost always present Necessitates identification and must be treated to lower the potential for suicide, substance abuse and relapse

  7. Symptoms • 3 groups of symptoms • No one symptom is found in all subtypes • Positive (hallucinations, delusions, bizarre behavior, & paranoia) -Respond to antipsychotic therapy • Negative (apathy, anhedonia, poor social functioning, and poverty of thought) -Do not respond to antipsychotic therapy • Cognitive (affect 40%-60%) difficulty with attention, memory, decision making, disorganized thinking and problem solving). Warrants careful assessment and interventions to increase the quality of life and functioning

  8. Course of disease • 4 Phases • Prodromal Phase: S&S that precede acute • Acute Phase: Periods of florid positive symptoms • Maintenance Phase: Acute symptoms decrease in severity, particularly positive symptoms • Stabilization Phase: Symptoms are in remission

  9. Application of nursing process • Assessment: 5 Subtypes • Paranoid, Catatonic, Disorganized, Undifferentiated, Residual • Diagnosis • Define by positive, negative or family focused • Outcomes Identification • Planning • Proceeds by identifying phase & assessing individual needs based on functional ability & involves identification of short term & intermediate indicators • Review and reassess data frequently • Implementation • Evaluation: Review and reassess the data frequently

  10. Antipsychotic medications • 2 Types -Traditional • Side Effects: tardive dyskinesia, EPS (acute dystonia, akathisia & pseudoparkinsonism), NMS & agranulocytosis -Atypical (less side effects than traditional) • Side effects: Weight gain, glucose impairment, elevated cholesterol, hypertension)

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