Outline for Schizophrenia Spectrum Disorders

I.

Brief History: n 1908 by

the Swiss psychiatrist Eugen Bleuler. The word was derived from the Greek skhizo
(split) and
phren (mind)

More in men than women, late in teen then early 20s

The most devastating illness that psychiatrists treat,

enormous threat to health and happiness.

Up to 50%: attempt suicide, 13% succeed.

II. Incidence
the lifetime prevalence of schizophrenia is about 1 percent in the general population

IV. Predisposing Factors: cause and effect are not clear

Biological Influences: Correlation statistics: If your sibling has it then chances

are 10% greater.
Genetics: Higher in Irish in Ireland, then Irish in here. Because genetic pool is so
much longer

The Dopamine Hypothesis: these people have too much dopamine. Released at the nerve
terminals, increased receptor site activity too many receptors. Something structural and
biochemical. Lower dopamine helps lower condition. Amphetamine which increases dopamine
increase systems. Haldol, Thorazine lower brain levels of dopamine, by blocking it at the
dopamine receptor site. Autopsy: significant 2/3 of more dopamine in the brain.
Neurotransmitter: glutamate needs more, they tend not have it.

Physiologic Influences: mechanism is unclear,

Viral Infection: some viral infection, higher incidence of schizophrenia after
prenatal exposure to some influenza virus. Such as: Rubella, polio
cytomegalovirus toxoplasmosis: cat feces. Never to clean a litter box advised for
pregnant women. high incidence of viral infection:

Anatomical Abnormalities: large ventricle in brain. Less brain tissue,

Histological changes: cellular level, pyramidal cells in the area of the

hippocampus, maybe caused by in 2nd trimester of pregnancy and related
to influenza virus

Psychological Influences: early psychiatric illness, poor parent child relationship

has nothing do with it. Very much biochemical structural abnormalities

Environmental Influences: people from lower socioeconomically class experience

more symptoms. Higher incidence from lower economic status then higher
economic class.
Downward Drift Hypothesis Those with schizophrenia loses their job and moves
down to slower socioeconomic class loses job because of schizophrenia.

Stressful Life Events: no causes, but might contribute to severity of illness such as
socioeconomic class.
IV. Types of Schizophrenia Disorders: least severe to most severe

Schizotypal: blend and apathetic, magical thinking: believe in clairvoyant, magic,

superstitious. They have illusion: believe based on perception from illness.
Depersonalize themselves. When they get under stress, decompensate, sometimes
more right onto psychosis. Reduce contact with people.

Delusional: no bases in truth in thought process. False personal beliefs. Not

consistent with personal intelligence and their cultural background. Continue to
believe in spite of proof in
1. Erotomanic: you have to have 4 month, you believe some person in higher
status is in love with you, but that person keeps it secret. such as celebrity
stalkers
2. Grandiose: great exerted ideas with their own orders knowledge, power
and talent. sometimes they have great relation identity. Sometimes they
think they are religious leaders.
3. Jealous: Irrational and no case for it. Start searching for evidence. Might
attack as magic lover.
4. Persecutory: most common, believe that they are ether badly treated,
cheated, defrauded. Maybe violent.
5. Somatic: general medical condition and complaints.
6. Mixed: delusion

Brief Psychotic Disorder: last at least 1 day, but less than a month. Short term, full
return to their premorbid mental function. Usually confused and in an emotional
turmoil.
2

Schizophreniform: last at least a month, but last 6 month has to be with cationic
features. Progress is good if individual affect is not flat, no mood disorder, onset
of symptom is rapid, and functioning socially before diagnosis, and prognosis is
good.

Schizoaffective: al behaviors of schizophrenia with depression, mood depressive

disorder or bipolar.

Schizophrenia: disturbance in thought process, perception in affect. Disorganized

in thinking, problem with communication, impaired perception in reality, and
decreased functioning such as social, occupational. Problems with cognition,
impaired deception in reality, decrease perception in functioning and difficulties
with speech

Patterns of development of schizophrenia: pg 383.

Premorbid phase: beginning of social maladjustment, withdrawal, irritability,
Positive and n negative symptoms: full blown schizophrenia

Patterns of Development of Schizophrenia

Phase I

Phase II

Phase III

Phase IV

V. Clinical Presentation

Positive Symptoms: delusions, illusions, hallucinations, auditory is more common,

dangerous kind is: command. Echolalia: repeat words that you heard some say, imitate
movement, word salad: jumble the words randomly. Religiosity degree to which you are
religious, very extreme clang associations: choice of words that governed by sounds.

Negative Symptoms blend or flat, anhedonia: inability to feel pleasure. Apathy,

disinterest in environment, validation: cant initiate goal. Emotion ambience, : deteriorate
, social interactions, social isolation anergia: no energy, psychomotor usually. Waxi
flexibility: posturing: voluntary assumption of weir and bizarre
Pace and rock, regress.

VI. Clinical Complications

Suicide: always on guard against. Feel hopeless. Risk is greateer if they have mood
disorder. Co morbidities with medical probles

Chronic Fluid Imbalance: water intoxication. About 10% of these people have
intoxication. Psychogenic polydipsia. Exhibit repetitive, compulsive fluid seeking
behaviors. Tobacco makes it worse. Alcohol makes you get it faster. Cause: cardiac
failure, osteoporosis, brain damage.

VII. Treatment Modalities for Schizophrenia and Other Psychotic Disorders

Individual Psychotherapy: expensive, not available

Group Therapy

Behavior Therapy: using bizarre and disturbed behaviors

Social Skills Training:

Milieu Therapy: family therapy

PACT (Program of Assertive Community Treatment): team of approach that provides

comprehensive. Treatment.
1. First Generation Antipsychotics: typical or conventional .phenothiazine not used so
much. Thorazine, prolixin, Haldol. Dopamine 2 receptor antagonist: decrease the effects
of dopamine. Side effects: extrapyramidal, anticholinergic, neuroleptic malignant
syndrome: high temperature. Rare but can be fatal. Reaction to the drug, very high fever,
bp up and down, tachycardia, tachypnea. Muscle rigidity, must stop the drug. If suspected
do not give. Supportive care: cooling, blood thinner, prevent? elevated creatinine kinase?
only effective on positive symptoms
2. Second Generation Antipsychotics

Atypical 2nd generation: block d1, and d5 and d2. Exhibit antagonism for cholinergic,
histamine and adrenergic receptors. Abilfy, clozapine: sig risk of argunulocytosis.do
WBC before meds. Good pos and neg symptoms. Side effects: low extrapyramidal
symptoms, clozaril: extreme salivation have anticholinergic effects, altered glucose
metabolism ,wt. gain,

Nursing process: Cogentin for to prevent extrapyramidal symptoms, tremors and shuffling gait.
Response: hard for me believe, dont ask why questions. Listen, ask what they are hearing?
Aggressive: leave them alone and quiet place, call for help when aggressive, focus on family,
promote understanding
Test: 60 questions, couple true and false
Know the drugs about sleep. Look at obesity and nonsmoking medications. Chantix Wellbutrin.
Parkinsonian symptom: extrapyramidal sym . Prolactin elevation: Men and women discharge
from breast and breast tumor? Photosensitivity: must use sunblock.
Effective in pos symptoms Cogentin: to prevent extrapyramidal symptoms, schizo: read the notes
and care plans in all the chapters. Medical condition: straight forward, clear sign and symptoms
always consider medical condition first. Impulse control: know the triggers, identify and
intervene, stressful before, pleasurable during and after. Pull hair out in opposite side.
Kleptomaniac: cant afford the stuff they steal. S/s effect of suicide and nor epileptic syndrome,
water intoxication. Look at klonipine . no percentage and history
Starts with eating disorders, focus on sleep hygiene, and sleep meds, long acting, short acting.
Read from the book and notes. Obesity: BMI know the levels. BMI numbers for hospitalized.
Substance abuse: s/s of alcohol withdrawal, know the sign and sym. know the others ones too
and ones without treatment and withdrawal.
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