Transcript SCHIZOPHRENIA 2nd most frequent diagnosis of patients 14-64 y/o at CRH in 2008

SCHIZOPHRENIA
2nd most frequent diagnosis of
patients 14-64 y/o
at CRH in 2008
Target Audience
• Nursing Staff to include nurses and
technicians
In this module we will cover
•
•
•
•
What is schizophrenia
Symptoms of schizophrenia
Types of schizophrenia
Some of the more common treatments for
schizophrenia
Last update 6/25/09 ajj
CRH most frequent
diagnosis in 2008
• Under 14 y/o
– Attention Deficit
Disorder
– Oppositional Defiant
Disorder
– PTSD
– Bipolar
– Adjustment disorder
• 65 and over
– Persistent mental
disorder due to
conditions classified
elsewhere
– Alzheimer
– Schizoaffective
disorder
– Other and alcohol
dependence
– Bipolar, Manic episode
CRH most frequent
diagnosis in 2008
• 14-64 y/o
– Other & unspecified alcohol dependence
– Schizoaffective disorder
– Cocaine dependence
– Depressive disorder
– Combo of drug dependence excluding opioid
type drugs
What is schizophrenia?
• A chronic severe brain disorder; often they
hear voices, believe media are
broadcasting their thoughts to the world or
may believe someone is trying to harm
them.
• In men it usually develops in teen years
and early 20s; in women it usually
develops in 20s and 30s.
Diagnosis
• Currently there is no physical or lab test
that can absolutely diagnose
schizophrenia.
• A psychiatrist usually comes to the
diagnosis based on clinical symptoms.
Misdiagnosis
• This is a common problem since
schizophrenia shares a significant number
of symptoms with other disorders.
• Per the Nat’l Depression & Bipolar Support
Alliance there is an average of 10 years
from onset to correct diagnosis & tx.
Disorders that may appear like
Schizophrenia
•
•
•
•
•
Schizoid personality
Schizophreniform disorder
Schizotypal personality
Bipolar Disorder
Asperger’s syndrome
Symptoms of Schizophrenia
• Profound disruption in cognition and
emotion, affecting the most fundamental
human attributes:
– Language
– Thought
– Perception
– Affect
– Sense of self
Positive Symptoms
• Those that appear to reflect an excess or
distortion of normal functions.
Positive Symptoms
• Delusions. Those where the patient thinks
he is being followed or watched are
common; also the belief that people on
TV, radio are directing special messages
to him/her.
Positive Symptoms
• Hallucinations. Distortions or
exaggerations of perception in any of the
senses.
• Often they hear voices within their own
thoughts followed by visual hallucinations.
Positive Symptoms
• Disorganized thinking/speech.
• AKA loose associations; speech is
tangential, loosely associated or
incoherent enough to impair
communication.
Positive Symptom
• Grossly disorganized behavior.
• Difficulty in goal directed behavior (ADLs),
unpredictable agitation or silliness, social
disinhibition, or bizarre behavior.
• There is a purposelessness to behavior.
Positive Symptom
• Catatonic behavior.
• Marked decrease in reaction to immediate
environment, sometimes just unaware of
surroundings, rigid or bizarre postures,
aimless motor activity.
Other Positive Symptoms
•
•
•
•
•
Inappropriate response to stimuli
Unusual motor behavior (pacing, rocking)
Depersonalization
Derealization
Somatic preoccupations
Summary of Positive Symptoms
•
•
•
•
•
•
Delusions
Hallucinations
Disorganized thinking
Disorganized behavior
Catatonic behavior
Inappropriate responses
FYI: Positive Symptoms
• Positive symptoms are those that have a
positive reaction from some treatment.
• In other words, positive symptoms
respond to treatment.
Negative Symptoms
• Those that appear to reflect a diminution
or loss of normal functions.
• May be difficult to evaluate because they
are not as grossly abnormal as positive
symptoms.
Negative Symptoms
• Affective flattening.
• Reduction in the range and intensity of
emotional expression, including facial
expression, voice tone, eye contact and
body language.
Negative Symptom
• Alogia (poverty of speech)
• Lessening of speech fluency and
productivity, thought to reflect slowing or
blocked thoughts; often manifested as
short, empty replies to questions.
Negative Symptom
• Avolition
• The reduction, difficulty or inability to
initiate and persist in goal-directed
behavior. Often mistaken for apparent
disinterest.
Examples of Avolition
• No longer interested in going out with
friends
• No longer interested in activities that the
person used to show enthusiasm
• No longer interested in anything
• Sitting in the house for hours or days
doing nothing
Disorganized Symptoms
• This one is somewhat new and may not be
considered valid.
• It is thought disorder, confusion,
disorientation and memory problems.
Summary of Negative Symptoms
•
•
•
•
•
•
•
•
Lack of emotion
Low energy
Lack of interest in life
Affective flattening
Alogia
Inappropriate social skills
Inability to make friends
Social isolation
Cognitive Symptoms
• Difficulties in concentration and memory:
– Disorganized thinking
– Slow thinking
– Difficulty understanding
– Poor concentration
– Poor memory
– Difficulty expressing thoughts
– Difficulty integrating thoughts, feelings,
behaviors
FYI: Negative Symptoms
• Currently there is no treatment that has a
consistent impact on negative symptoms.
Types of Schizophrenia
•
•
•
•
•
•
Paranoid
Hebephrenic
Catatonic
Residual
Schizoaffective
Undifferentiated
Paranoid Schizophrenia
• Persons are very suspicious of others and
often have grand schemes of persecution
at the root of their behavior.
• During this phase they may have
hallucinations and frequent delusions.
Hebephrenic Schizophrenia
• AKA disorganized schizophrenia; characterized
by emotionless, incongruous, or silly behavior,
intellectual deterioration, frequently beginning
insidiously during adolescence.
• May be verbally incoherent and may have
moods and emotions that are not appropriate to
the situation.
• Hallucinations not usually present.
Catatonic Schizophrenia
• Person is extremely withdrawn, negative
and isolated.
• May have marked psychomotor
disturbances.
Residual Schizophrenia
• Lacks motivation and interest in day-today living.
• Person is not usually having delusions,
hallucinations or disorganized speech.
Schizoaffective Disorder
• There will be symptoms of schizophrenia
as well as mood disorder (depression,
bipolar, mixed mania).
Undifferentiated Schizophrenia
• Conditions meeting the general diagnostic
criteria for schizophrenia but not
conforming to any of the previous types.
• Exhibits more than one of the previous
types without a clear dominance of one.
Summary
• Before a diagnosis the psychiatrist must
make a thorough evaluation including a
physical/medical exam, a mental status
exam, appropriate labs, and a full history.
• History includes changes in thinking,
behavior, movement, mood, etc. as seen
by the family.
Medications
• In general it may take up to 6 months for
medications to show consistent effects.
• The newest medication is Invega.
• Meds include atypicals: Abilify, Geodon,
Clozapine, Risperidone, Seroquel,
Zyprexa.
– [Remember: a giraffe can really see a zebra]
• These medications may have such
intolerable side effects that the patient will
stop the drugs.
• One study showed the average time the
meds were taken regularly was 3 months.
Treatments
• Psychotherapy - an adjunct to meds and is very
useful to keep the patient on the meds.
• Group therapy
• Family therapy
• Community support groups
• Early detection and treatment has the best
results/response to treatment.
• Per patients, once you have schizophrenia
you have it for life. The best you can hope
for is control.
FYI: Cancer Study
• A study in France in 1993, with 3470
patients with schizophrenia, showed that
breast cancer was the second most
common cause of death.
• www.komen.org/schizophreniaassociated
withincreasedcancermortality. Cancer
2009.
• The next few slides are a review of
general psychiatric definitions, defense
mechanism and communication
techniques.
• They may or may not be related to the
current topic.
Psych Definitions
• Delusion
= fixed beliefs that usually
involve a misinterpretation of experience.
“Client believes someone is reading his
thoughts”
• Several types: grandiose, nihilistic,
persecutory, somatic
Psych Definitions
• Hallucinations = perceptual experiences
that occur in absence of actual sensory
stimuli; involves the 5 senses.
Psych Definitions
• Illusions
= person misperceives or
exaggerates stimuli that actually exist in
the external environment.
Defense Mechanism
• Affiliation =
Turning to others for help or support; sharing
problems with others without implying that
someone else is responsible.
Ex: An individual has a fight with spouse and
turns to their best friend for emotional support.
Defense Mechanism
• Devaluation =
Attributing exaggerated negative qualities to
self or others.
Ex: A boy has been rejected by his long time
girlfriend. He tells his friends that he realizes
that she is stupid and ugly.
Defense Mechanism
• Displacement =
Transferring a feeling about, or a response to,
one object onto another (usually less
threatening) substitute object
Ex: A child is mad at her mother for leaving
for the day, but says she is really mad at the
sitter for serving her food she does not like.
Communication Technique
• Confrontation =
Presenting the patient with a different reality
of the situation.
Ex: My best friend never calls. She hates me.
Nurse ‘I was in the room yesterday when she
called.’
Communication Technique
• Doubt =
Expressing or voicing doubt when a patient
relates a situation.
Ex: My best friend hates me. Nurse ‘From
what you have told me, that does not should
like her. When did she last call you?’
Resources
Schizophrenia Symptoms, by NARSAD,
The Mental Health Research Association.
Schizophrenia Treatment, by John
Grohol, PsychCentral, 08/07/08
Psychiatric Study Guide by Central
Regional Hospital
This powerpoint was kindly donated to
www.worldofteaching.com
http://www.worldofteaching.com
Is home to well over a thousand powerpoints
submitted by teachers. This a free site. Please visit
and I hope it will help in your teaching