Discuss about schizophrenia, types, management and others

1. SCHIZOPHRENIA
2nd
most frequent diagnosis of patients
14-64 y/o
Pamela M. Veroy RN, MAN
Retrieved sources from: CRH (2008)

2. Last update 6/25/09 ajj
In this module we will cover
• What is schizophrenia
• Symptoms of schizophrenia
• Types of schizophrenia
• Some of the more common treatments for
schizophrenia

3. 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.

4. 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.

5. 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.

6. Disorders that may appear like
Schizophrenia
• Schizoid personality
• Schizophreniform disorder
• Schizotypal personality
• Bipolar Disorder
• Asperger’s syndrome

7. Symptoms of Schizophrenia
• Profound disruption in cognition and
emotion, affecting the most fundamental
human attributes:
– Language
– Thought
– Perception
– Affect
– Sense of self

8. Positive Symptoms
• Those that appear to reflect an excess or
distortion of normal functions.

9. 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.

10. 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.

11. Positive Symptoms
• Disorganized thinking/speech.
• AKA loose associations; speech is
tangential, loosely associated or
incoherent enough to impair
communication.

12. 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.

13. Positive Symptom
• Catatonic behavior.
• Marked decrease in reaction to immediate
environment, sometimes just unaware of
surroundings, rigid or bizarre postures,
aimless motor activity.

14. Other Positive Symptoms
• Inappropriate response
to stimuli
• Unusual motor behavior
(pacing, rocking)
• Depersonalization
• Derealization
• Somatic preoccupations

15. Summary of Positive Symptoms
• Delusions
• Hallucinations
• Disorganized thinking
• Disorganized behavior
• Catatonic behavior
• Inappropriate responses

16. FYI: Positive Symptoms
• Positive symptoms are those that have a
positive reaction from some treatment.
• In other words, positive symptoms
respond to treatment.

17. Negative Symptoms
• Those that appear to reflect a decline or
loss of normal functions.
• May be difficult to evaluate because they
are not as grossly abnormal as positive
symptoms.

18. Negative Symptoms
• Affective flattening.
• Reduction in the range and intensity of
emotional expression, including facial
expression, voice tone, eye contact and
body language.

19. 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.

20. Negative Symptom
• Avolition
• The reduction, difficulty or inability to
initiate and persist in goal-directed
behavior. Often mistaken for apparent
disinterest.

21. 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

22. Disorganized Symptoms
• This one is somewhat new and may not
be considered valid.
• It is thought disorder, confusion,
disorientation and memory problems.

23. 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

24. 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

25. FYI: Negative Symptoms
• Currently there is no treatment that has a
consistent impact on negative symptoms.

26. Types of Schizophrenia
• Paranoid
• Hebephrenic
• Catatonic
• Residual
• Schizoaffective
• Undifferentiated

27. 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.

28. 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.

29. Catatonic Schizophrenia
• Person is extremely withdrawn, negative
and isolated.
• May have marked psychomotor
disturbances.

30. Residual Schizophrenia
• Lacks motivation and interest in day-to-
day living.
• Person is not usually having delusions,
hallucinations or disorganized speech.

31. Schizoaffective Disorder
• There will be symptoms of schizophrenia
as well as mood disorder (depression,
bipolar, mixed mania).

32. 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.

33. 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.

34. 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]

35. • 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.

36. Treatments
• Psychotherapy - an adjunct to meds and is very
useful to keep the patient on the meds.
• Group therapy
• Family therapy
• Community support groups

37. • 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.

38. 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

39. Psych Definitions
• Hallucinations = perceptual experiences
that occur in absence of actual sensory
stimuli; involves the 5 senses.

40. Psych Definitions
• Illusions = person misperceives or
exaggerates stimuli that actually exist in
the external environment.

41. 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.

42. 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.

43. 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.

44. 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.’

45. 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?’

46. Thank you...