SCHIZOPHRENIA
AND OTHERS
PSYCHOSES
Definition of terms
• Ambivalence simultaneous opposite feelings (e.g. love and
hate); often expressed as approach-avoidance behavior
• Anergia absence of energy
• Anhedonia the inability to experience pleasure
• Apathy lack of feeling, concern, interest or emotion
• Autism preoccupation with the self with little concern for
external reality; a self-made private world of the schizophrenic
• Avolition lack of motivation
• Blocking interruption of thoughts due to psychological factors
Definition of terms
• Catatonia immobility due to psychological causes
• Clanging associations use of rhyming words
• Concrete thinking the use of literal meaning without the ability to consider
abstract meaning (e.g., “don’t cry over spilt milk” might be interpreted as
“because the milk is dirty.”)
• Compulsions ritualistic behaviors that a person feels compelled to perform
either in accord with a specific set of rules or in a routine manner.
• Delusions fixed false beliefs of importance to the individual that are resistant
to reason or fact.
• Double-bind conflicting demands by significant individuals in a patient’s life;
unable to meet both demands, the patient is doomed to fail.
Definition of terms
• Catatonia immobility due to psychological causes
• Clanging associations use of rhyming words
• Concrete thinking the use of literal meaning without the
ability to consider abstract meaning (e.g., “don’t cry over spilt
milk” might be interpreted as “because the milk is dirty.”)
• Compulsions ritualistic behaviors that a person feels compelled
to perform either in accord with a specific set of rules or in a
routine manner.
Definition of terms
• Delusions fixed false beliefs of importance to the individual that
are resistant to reason or fact.
• Double-bind conflicting demands by significant individuals in a
patient’s life; unable to meet both demands, the patient is
doomed to fail.
• Echolalia repetition of words heard
• Echopraxia repetitive, meaningless movement
• Hallucinations a false sensory perception unrelated to external
stimuli (e.g., seeing things that are not there)
Definition of terms
• Hebephrenic an outdated schizophrenic subtype characterized
by silliness, delusions, hallucinations and regression.
• Ideas of Reference the belief that some events have special
meaning (e.g., people laughing near the patient are perceived as
laughing at the patient.)
• Illusion misinterpretation of a real sensory stimulus.
• Loose association thinking characterized by speech in which
ideas shift from one subject to another that is unrelated.
• Mutism refusal to speak.
• Negativism motiveless resistance to all instruction.
Definition of terms
• Neologism A word or expression invented by the patient
• Obsessions recurrent, intrusive, and persistent ideas, thoughts,
images or impulses
• Paranoia extreme suspiciousness of others and their actions
• Premorbid the state before the onset of the disorder
• Psychosis the inability to recognize reality, complicated by a
severe thought disorder and the inability to relate to others.
• Religiosity preoccupation with religious ideas or content
Definition of terms
• Trichotillomania refers to an irresistible urge to pull out their hair; they feel
tension before pulling out the hair and relief or pleasure during and after
pulling
• Stereotypy persistent repetition of senseless acts or words
• Stilted language- use of words or phrases that are flowery, excessive and
pompous
• Verbigeration- stereotype repetition of words or phrases that may or may
not have meaning to the listener.
• Withdrawal behaviors designed to avoid interacting with others.
• Word salad randomized set of words without logical connection.
Schizophrenia
• Schizophrenia is a syndrome or disease process of the brain causing
distorted (indistinct, unclear, imprecise) and bizarre (odd, weird,
strange) thoughts, perceptions, emotions, movements, and behavior.
• Onset & clinical Course
It is usually diagnosed in late adolescence and early adulthood.
Prevalence is 1% of total population, or 3 million in U.S.; same prevalence
throughout world.
• 4 A’s of SCHIZOPHRENIA- coined by Eugene Bleuler
Affect- described as flat, blunted or inappropriate (indifference)
Autism- preoccupation with self and retreat into fantasy
Association- loosely joined unrelated topics
Ambivalence- having simultaneous opposing feelings
CRITERIA IN THE DIAGNOSIS OF SCHIZOPHRENIA
2 or more of the following for at least 1 month
- Hallucinations
- Delusions
- Disorganized speech
- Catatonia
- Negative symptoms
BIOLOGIC THEORY
Genetics: 1 parent (15%); 2 parents (35%)
Neuroanatomy: less CSF and brain tissue
Immunovirology: exposure to influenza during the 2nd trimester
of pregnancy
Neurochemistry: _________________________
Social Causation: Higher risk in lower class
Other Related Disorders:
- Brief Psychotic Disorder – psychosis less than 1 month
- Schizophreniform – psychosis for more than 1 month but less
than 6 months
- Shared Psychotic Disorder – 2 people sharing similar delusion
SIGNS AND SYMPTOMS OF SCHIZOPHRENIA
Positive Signs
- Hallucinations, Delusions, and other disturbances in thought and
perception
- Cause: ________________
Negative Signs
- Cause: ________________
- Asociality: lack of relationships
- Avolition: lack of motivation
- Anhedonia: lack of pleasure
- Alogia: lack of speech
- Abnormal affect
- Catatonia: purposive lack of movement; waxy flexibility, stupor
and mutism (absence of movements)
TREATMENT MODALITY (Schizophrenia)
1ST GENERATION 2nd GENERATION
TYPICAL/CONVENTIONAL ATYPICAL
↓Dopamine ↓Dopamine and Serotonin
Manages (+) Symptoms Manages (-) Symptoms
TREATMENT MODALITY (Schizophrenia)
3rd GENERATION LONG TERM INJECTION
Dopamine System Stabilizers DEPOT THERAPY
SIDE EFFECTS OF ANTIPSYCHOTICS
Constipation – increase OFI, fiber in the diet
Agranulocytosis – monitor _______, report any signs of infection
Tooth decay – sugarless hard candy or gum
Dry mouth – sugarless hard candy or gum
Orthostatic hypotension – change position gradually
Galactorrhea – use cotton underwear
Photosensitivity – avoid direct sunlight, use umbrella, SPF 25 lotion
Arrhythmias – immediately report abnormal heartbeat
Weight gain – lessen intake of sugary food and beverages
Sedation – avoid drinking and operating machineries
Extra Pyramidal Syndrome
Cause:
Dystonia (Acute)
- Early sign
- Involuntary muscle contractions
Akathisia: restlessness, agitation, inability to sit still
Pseudoparkinsonism – fine tremors, unstable gait
Nursing Action: Notify the physician
Medical Management: Decrease the dose/Shift to another
classification
Prevention: Early detection leads to early management
MISSED DOSE?
