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Chapter 16 Schizophrenia and Other Psychotic Disorders. 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. - PowerPoint PPT Presentation
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Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Contemporary Psychiatric-Mental Health Nursing
Chapter 16Schizophrenia and Other Psychotic Disorders
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
All rights reserved.
Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Features of Schizophrenia - continued
Progression varies from one client to another– Exacerbations and remissions– Chronic but stable– Progressive deterioration
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Features of Schizophrenia - continued
Positive symptoms – Excess or distortion of normal functioning– Aberrant response
Negative symptoms– Deficit in functioning
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Features of Schizophrenia - continued
Positive Symptoms of Schizophrenia – Hallucination– Delusions– Disordered speech and behavior
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Features of Schizophrenia - continued
Negative Symptoms of Schizophrenia– Flat affect and apathy– Alogia– Avolition– Anhedonia
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Subtypes of Schizophrenia
Paranoid type Disorganized type Catatonic type Undifferentiated type Residual Type
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Subtypes of Schizophrenia - continued
Paranoid Type– Delusions
Persecutory and grandiose Somatic or religious
– Hallucinations Delusions link with a hallucination
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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.
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Subtypes of Schizophrenia - continued
Catatonic type– Psychomotor retardation and stupor– Extreme psychomotor agitation– Waxy flexibility– Echolalia– Mutism – Echopraxia
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Other Psychotic Disorders
Schizophreniform disorder Schizoaffective disorder Delusional disorder Brief psychotic disorder
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Causes of Schizophrenia
Biopsychosocial theories
Interrelated factors
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Causes of Schizophrenia - continued
Biologic theories Psychological theories Family theories Humanistic-interactional theories
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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)
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Influences on the Course of Schizophrenia
Social Pressures – Lack of social support– Financial problems– Stigma
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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?
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Personal Awareness - continued
What defines “normal” behavior? What are my fears associated with mental illness?
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol 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.
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Resources 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.nlm.nih.gov/medlineplus/schizophrenia.htmlMedline 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.
Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458
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Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff
Resources - continued 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 Search by topic on this Mayo Clinic link to find current information about mental illness