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Schizophrenia and other Psychoticdisorder.pptx
- 4. INTRODUCTION ⚫The word schizophreniawas coined by Swiss Psychatrist Eugen Bleuler in 1908. ⚫It is derived from the Greekword skhizo (split) and phren (Mind).In ICD -10, Schizophrenia is classified under the code F2.
- 6. Definition ⚫Schizophrenia is apsychotic condition characterized by a disturbance in thinking, emotions, volitions, and faculties in the presence of clear consciousness, which usually leads to social withdrawal.
- 7. ⚫Schizophrenia is aserious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others.
- 8. Epidemiology ⚫Schizophrenia occurs equallyin males and females. ⚫The peak ages of onset are 20-28 years for males and 26-32 years for females. ⚫About 1% of general population has the risk of developing the schizophrenia in their life time.
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- 10. Genetics factors ⚫Passed onform one generation to another generation ⚫i.e. parents to their children ⚫Monozygotic twins have more chance of developing schizophrenia than dizygotic twins.
- 11. Chemicalfactors ⚫Imbalance of certainchemicals in the brain ⚫Increased dopamine level ⚫Imbalance of dopamine affects – sounds, smell, and sight and can lead to hallucinations and delusion.
- 12. Brainabnormality ⚫Abnormal brain structureand function.
- 14. Psychologicalfactors ⚫Family relationship alsoimportant ⚫Mother child relationship ⚫Dysfunctional family system
- 15. Environmentalfactors ⚫Viral infection ⚫Poor socialinteraction or highly stressful situation.
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- 17. psychological socio Theories Biological –cultural Theories Theories Genetic contribution Neurochemical and Neuroanatomic viral infection factors serotoninstructrual Dopamine Abnormalities Hypothesis hypothesis
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- 20. Genetic risk ofschizophrenia ⚫Identical twin affected – 50% ⚫Fraternal twin affected -15% ⚫Brother or sister affected -10% ⚫One parent affected -15% ⚫Both parents affected -35% ⚫Second degree relative affective -2-3% ⚫General population -1% (no affected relative
- 21. NeurochemicalandNeuroanatomicfactors ⚫An alteration inneurotransmitter systems ⚫Dopamine (DA) Hypothesis : It is belived that increase in dopamine levels. ⚫Serotonin hypothesis : excess serotonin
- 22. Structural abnormalities- neuroanatomicfactors ⚫Enlargedventricles ⚫Diminished glucose metabolism and oxygen in frontal cortical areas of the brain ⚫Abnormal brain function in the frontal and temporal areas of the brain.
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- 24. Psychological theories ⚫Stress –increased number of stressful life events ⚫Increased Expressed Emotions (EE) hostility, critical comments, emotional over involvement of “significant others” ⚫Family theories :-’’Schizophrenogenic mothers’’ lack of “real parents”, dependency on mother, anxious mother and parental marital
- 25. ⚫Information processing hypothesis Disturbances in attention , inability to maintain a set Inability to assimilate and • Psychoanalytical theories According to freud, there are regression to the pre-oral (and Oral )stage of psychosexual development with the use of defence mechanisms of denial, reaction formation and projection.
- 26. Socio – culturaltheories ⚫Social influences – poverty, abuse, family problems affect an individual’s mental functioning.
- 28. Clinicalfeatures Positive symptoms Negative symptoms Bleueler’s 4 A’s of Schizophrenia Firstrank and second rank symptoms Common signs & symptoms in schizophrenia
- 29. Positive and Negative symptoms PositiveNegative Delusions Affective flattening or blunting Hallucinations Avolition –apathy (lack of initiative) Excitement or agitation Attentiional impairment Hostility or aggressive behavior Anhedonia (inability to experience pleasure) Suspiciousness, ideas of reference Alogia ( lack of speech output) Possible suicidal tendencies Moodinesss Grandiosity Lack of motivation
- 30. Bleueler’s 4 A’sof Schizophrenia Bleueler’s 4A’s Affective disturbance Autistic thinking Ambivalence Associative looseness
- 31. Schneider’s First -ranksymptoms of Schizophrenia Audible thoughts Voices heard arguing Voices heard commenting on one’s actions Thought withdrawal Thought Insertion Thought broadcasting Delusional perception Somatic passivity
- 32. schizophrenia ⚫Thoughtand speech disorder Autistic thinking Loosening of association Thought blocking Neologism Poverty of speech Poverty of ideation Echolalia Verbigeration Delusions of various kinds:- delusion of persecution, delusion of grandeur, delusion of reference, delusion of control
- 33. Disorder of perception ⚫Auditoryhallucinations ⚫Visual hallucinations –Tactile ,gustatory and olfactory are far less common.
- 34. Disorders of Affect ⚫Apathy ⚫Emotionalblunting ⚫Emotional shallowness ⚫Anhedonia ⚫Inappropriate emotional response
- 35. Disorders of motorBehavior ⚫Increase or decrease in psychomotor activity ⚫Mannerisms ⚫Grimacing ⚫Stereotype ⚫Decreased self-care ⚫Poor grooming
- 36. Other features ⚫Decreased functioningin work, social relations and self-care, as compared to earlier life ⚫Loss of ego boundaries ⚫Loss of insight ⚫Poor judgment ⚫Suicide can occur depression, command hallucinations. ⚫
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- 39. Paranoid schizophrenia ⚫The word‘paranoid’means ‘ delusional’ ⚫It is most common form of schizophrenia. ⚫It has a good prognosis if treated early. ⚫It is characterized by the following features
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- 45. Hebephrenic schizophrenia Ithas early and insidious onset. Poor premorbid personality. It is the worst prognoses among all the subtypes. Features Marked thought disorder Incoherence (illogical) Severe loosening of associations and extreme social impairment Delusions and hallucinations are fragmentary and changeable.
- 46. ⚫Odd behavior –senseless giggling, mirror gazing, grimacing, mannerisms
- 47. Catatonic schizophrenia ⚫Catatonic (cata –disturbed ) schizophrenia is characterized by marked disturbance of motor behavior . ⚫Catatonic stupor ⚫Catatonic excitement ⚫Catatonia alternating between excitement and stupor
- 48. Clinical features ofexcited catatonia ⚫Increase in psychomotor activity ⚫Increase in speech production ⚫Loosening of associations ⚫Sometimes excitement becomes very severe and is accompanied by rigidity, hyperthermia and dehydration and can result in death. ⚫It is the known as acute lethal catatonia or pernicious catatonia.
- 50. Clinical features Retardedcatatonia ( catatonic Stupor) ⚫Mutism ⚫Rigidity ⚫Negativism ⚫Posturing ⚫Stupor ⚫Echolalia ⚫Echopraxia ⚫Waxy flexibility ⚫Ambitendancy ⚫Automatic obedience
- 51. Residualschizophrenia ⚫Symptoms include emotionalblunting , ⚫Eccentric behavior, illogical thinking, social withdrawal and loosening of associations.
- 52. Undifferentiatedschizophrenia ⚫This category isdiagnosed either when features of no subtype are fully present or features of more than one subtype are exhibited.
- 53. Simpleschizophrenia ⚫It is characterizedby an early and insidious onset, progressive course and presence of characteristics ⚫negative symptoms, ⚫vague hypochondriac features, ⚫wandering tendency, ⚫self- absorbed idleness and ⚫aimless activity
- 54. Diagnosis ⚫Mental status examination ⚫Psychiatrichistory ⚫CT scan and MRI show enlarged ventricals, enlargement of the sulci on the cerebral surface and atrophy of the cerebellum
- 55. Management ⚫Goals ⚫To reduce thesymptoms ⚫To decrease the chances of a relapse, or return of symptoms.
- 56. Medical management ⚫Medication ⚫An acuteepisode of schizophrenia typically responds to treatment with antipsychotic agents, which are the most effective in its treatment. ⚫Atypical antipsychotics control wider range of signs and symptoms than conventional agents do and cause few or no adverse motor affects.
- 57. Conventional antipsychotics ⚫Chloropramizine 300-1500mg/dayPO 50- 100mg/day IM ⚫Fluphenazine decanoate 25-50 mg IM every 1-3 weeks ⚫Haloperidol 5-100 mg/day PO—20mg/day IM ⚫Trifluoperazine 15-60 mg/day PO 1-5 Mg/day IM
- 58. Commonelyused atypical antipsychotic ⚫Clozapine25-450mg/day PO ⚫Risperidone 2-10mg/day PO ⚫Olanzapine 10-20mg/day PO ⚫Quetipine 150-760mg/day PO ⚫Ziprasidone 20-80mg/day PO ⚫Aripiprazole 10-15mg/day PO ⚫Paliperidone 1.5-12mg/day PO ⚫Amisulpride 400-800mg/day PO
- 59. ElectroconvulsiveTherapy (ECT) ⚫Indication for ⚫Catatonicstupor ⚫Uncontrolled catatonic excitement ⚫Severe side effects with drugs ⚫Usually 8-12 ECTs are needed.
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- 61. Psychosurgery ⚫Lobotomy used tosevere certain nerve pathways in the brain
- 62. Nursing Management ⚫Nursing assessment ⚫Historycollection –family members , other familiar member , old records ⚫Observe behavior pattern, posturing psychomotor, disturbance, appearance hygiene ⚫Identify the type of disturbance the patient is experiencing. ⚫Ask the patient about feelings while thought alterations are evident. ⚫Note the effect and emotional tone of the patient and whether they are appropriate in relation to the thought or present situation. ⚫Assess for theme and content of delusional thinking.
- 63. ⚫Assess speech patternsassociated with the delusional thinking. ⚫Assess speech patterns associated with the delusions. ⚫Assess for ability to perform self-care activity, i.e. sleep pattern and interaction with other patients
- 64. Nursing Diagnosis 1. Disturbedthought process, related to inability to trust, panic anxiety, possible hereditary or biochemical factors evidenced by delusional thinking, extreme suspiciousness of others. ⚫Objective :- The patient will ⚫Eliminate pattern of delusional thinking ⚫Demonstrate trust in others ⚫Demonstrates improved reality orientation
- 65. 2.Ineffective health maintencerelated to inability to trust, extreme Suspiciousness evidenced by poor diet intake, inadequate food and fluid intake, difficulty in falling asleep Objective :- The patient will Maintain adequate nutrition , hydration and elimination Maintain adequate sleep and rest Take medication as administerd
- 66. ⚫3.Self –care deficitrelated to withdrawal, regression, panic anxiety, cognitive impairment , inability to trust, evidenced by difficulty in carrying out tasks associated with hygiene, dressing, grooming, eating, sleeping and toileting. ⚫Objective :- The patient will ⚫Demonstrate increased interest in self-care. ⚫Complete daily activities with minimum assistance. ⚫Demonstrate adequate personal hygiene skills.
- 67. ⚫4. potential forviolence, self-directed or at others, related to command hallucinations evidenced by physical violence, destruction of objects in the environment or self-desructive behavior. ⚫ Objective :- The patient will ⚫Not injure others or destroy property or self ⚫Verbalize feelings of anger or frustration ⚫Express decreased feelings of agitation fear or anxiety.
- 68. ⚫5.Risk for self-inflictedor life-threatening injury related to command hallucinations evidenced by suicidal ideas, plans or attempts. Objective :- The patient will not harm self
- 69. ⚫6.Disturbed sensory- perception (auditory/visual)related to panic anxiety, possible hereditary or biochemical factors evidenced by inappropriate responses, distordered thought sequencing, poor concentration, disorientation, withdrawal behavior.
- 70. ⚫7. Impaired verbalcommunication related to panic anxiety ,disordered, unrealistic thinking, evidenced by loosening of associations, echolalia, verbalizations that reflect concrete thinking, and poor eye contact. ⚫Objective :- The patient will be abele to communicate appropriately and comprehensibly by the time of discharge.
- 71. ⚫8. ineffective familycoping related to highly ambivalent family relationships, impaired , family communication, evidenced by neglectful care of the patient , extreme denial or prolonged over- concern regarding his illness. ⚫Objective: Family will identify more adaptive coping strategies for dealing with patient’s illness and treatment regimen.
- 72. Homecare ⚫Never contradict tothe patient about hallucinatory voices and ideas. ⚫Being non –judgmental to the client. ⚫Frequently make him aware regarding reality to keep him in touch with reality. ⚫Provide assistance in maintaining personal hygiene of the client ⚫Try to keep the client associated with different conditions. ⚫Provide emotional support whenever required by the client. ⚫Assess the side effects. ⚫Be simple, direct and concise when speaking to the client. ⚫Protect the client from harming himself or herself or others. ⚫ Be sincere and honest when communicating with the client.
- 73. Rehabilitation ⚫Focus – strengtheningself-care and promoting and promoting and improving quality of through relapse prevention. ⚫Rehabilitation ⚫Half-way homes ⚫Long-term homes ⚫Day hospitals
- 74. Conclusion ⚫Schizophrenia it isa psychotic disorder marked by severely impaired thinking , emotions and behaviors. Schizophrenic patients are unable to filter sensory stimuli and may have enhanced perception of sounds, colors and other features of their environment.
- 75. References ⚫R. Sreevani, AGuide to Mental Health and 4th Psychiatric Nursing, edition, Jypee publisher, 2016. ⚫Ram Kumar Gupta, A Text Book of Mental Health and Psychiatric Nursing, 2011