Schizophrenia & Thought Disorders
Schizophrenia
Onset generally late adolescence to young adulthood
Approximately 1% or 2.2 million people are diagnosed with
schizophrenia Approximately 50% of schizophrenics have comorbid
substance abuse disorder
Etiology No one cause known Brain imaging being used Research
into: Genetic Predisposition Viral Theory
Biochemical/Neurostructural Changes Environmental Influences
Genetic: Risk 10-20% if one immediate family member; 40% if both
parents or an identical twin. Looking at chromosome 13 & 8
Viral: theory Biochemical: Dopamine
Positive Symptoms Hallucinations Delusions Suspiciousness**Most
easily recognized symptoms
Negative Symptoms
Decreased functioning Flattening of affect A-motivation
Anhedonia Anergia Alogia Emotional withdrawal Difficulty with
abstract thinking
Disorganized Symptoms Cognitive deficits Confusion
Disorganized/incoherent speech Repetitive rhythmic gestures
Attention deficitsSub Types of Schizophrenia
Paranoid Catatonic Disorganized Undifferentiated Residual
Assessment
Suicidality (25-50% attempt at least once; 5-9% succeed)
Positive, negative, disorganized symptoms Behavioral changes
including aggressiveness/violence Substance use/abuse Nicotine
(lowers blood levels of neuroleptics) Compliance Ability to care
for self Side effects of medication Metabolic Syndrome Pica
Psychogenic Polydipsia Homeless
Vocabulary (reviewed) Neologisms Echolalia Echopraxia Clang
Association Word Salad Depersonalization Derealization Thought
Insertion Magical Thinking Thought Broadcasting Psychogenic
Polydypsia
Interventions
Box 22.2 page 333 Interventions target symptoms and side effects
of medications Interventions may involve comorbid medical
conditions Interventions may also center around lifestyle
issues
Medications
Dopamine Stimulates heart Increases blood flow to kidneys,
spleen, liver Controls muscle movement and motor
coordinationTraditional antipsychotics were called
neuroleptics/dopamine receptor agonists because they reduced
dopamine transmissionThis decreased positive symptoms~antipsychotic
effectAtypical antipsychotics: positive and negative sx
First Generation Antipsychotics
Thorazine Mellaril Haldol Haldol Decanoate Prolixin Prolixin
Decanoate Trilafon
Atypical Antipsychotics
Clozaril* Risperdal Risperdal Consta Zyprexa* Seroquel Geodon
Abilify Invega Long acting injection FanaptBlack Box Warning
2003
Metabolic Syndrome
Blood Pressure (greater than 130/85) HDL < 40 men/50 women
Abdominal obesity Triglycerides =/> 150 Fasting blood sugar
=/> 110
Extrapyramidal Symptoms (EPS) Acute Dystonia Akathisia
Parkinsonism Oculogyric Crisis AIMS: Abnormal Involuntary Movement
Scale developed by NIMH Give anticholinergic: Cogentin Artane
Benadryl
Tardive Dyskinesia (TD) Involuntary rhythmic movements
Stereotypical movements Tongue protrusion Cheek puffing
Neuroleptic Malignant Syndrome (NMS)
Elevated temperature Altered consciousness/cognitive changes
Severe muscle rigidity Labile pulse & blood pressure
Diaphoresis, tremor, dystonia, seizures, arrhythmias Elevated CPK
Elevated WBC
Other Thought Disorders
Psychotic Disorder NOS Delusional Disorder Folie `a deux (shared
psychosis) Classified by type/content Culturally bound
Other Thought DisordersSchizoaffective Disorder
Depressed Bipolar Manic Depressed Mixed
